This presentation was given at ms space North 2013, an MS Society event for people living with MS.

1. Cathy Dorrian
Service Development Manager
National MH Programme
Scottish Centre for Telehealth &
Telecare, NHS 24

2. Overview of Presentation
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Background – SCTT & NHS 24
National Delivery Plan 2012-15
Business Plan 2012-15
Telehealth & Telecare in Scotland –
multichannel approaches & examples
• Questions?

3. Background - SCTT & NHS 24
• SCT funded by SGHD - operational 2007
hosted by NHS Grampian
• Reviewed in 2009 and merged with NHS 24 in
2010
• Telecare (JIT) joined SCT in 2010 – now SCTT
• National Delivery Plan launched for 2012-15
• SCTT Business Plan 2012-15

7. The NHS in Scotland is facing growing
demand for its services and NHS boards
need to consider new models of care such
as telehealth to help manage current and
future demand. Targeted appropriately,
telehealth offers the potential to help NHS
boards deliver a range of clinical services
more efficiently and effectively. NHS boards
should consider the use of telehealth when
introducing or redesigning clinical services.

8. internet
phone
TV
mobile
telecare
video
SMS
Face
2
Face

9. Definitions…..
“Telehealth”
is the provision of health services at a distance using a range of digital and
mobile technologies. This includes the capture and relay of physiological
measurements from the home/community for clinical review and early
intervention, often in support of self management; and
“teleconsultations” where technology such as email, telephone, telemetry,
video conferencing, digital imaging, web and digital television are used to
support consultations between professional to professional, clinicians and
patients, or between groups of clinicians.

10. Definitions…..
“Telecare”
is the provision of care services at a distance using a range of
analogue, digital and mobile technologies. These range from
simple personal alarms, devices and sensors in the home,
through to more complex technologies such as those which
monitor daily activity patterns, home care activity, enable
‘safer walking’ in the community for people with cognitive
impairments/physical frailties, detect falls and epilepsy
seizures, facilitate medication prompting, and provide
enhanced environmental safety.

11. Definitions…..
• “Telehealthcare” is used as an overarching
term to describe both telehealth and telecare
together.

12. Teleneurology
• “ The use of modern communication
technology to enable neurology to be
practised when the doctor and patient are
not present in the same place, and
possibly time” (Patterson 2005)

14. • First piloted in Aberdeen 2005/6
• Study confirmed the feasibility of seeing patients
using videoconferencing technology
• Demonstrated safety, effectiveness & acceptability
to staff and patients
• Since then: sustainable services to Orkney,
Shetland, Banff, Wick, Ft. William, Portree,
Stornoway, Benbecula and Dumfries & Galloway –
• New service to Oban from SGH in development

15. Teleneurology Services
Shetland
August 2013
Orkney
Wick
W. Isles
Benbecula
Skye
Inverness
Glasgow
Aberdeen

17. Standard Statement 2 – Access to Neurological
Health Services – Quality Dimensions
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Safe – feasibility established
Effective – evidence based
Patient Centred – acceptable, high patient satisfaction rates
Timely – reduces waiting times for patients and avoids
Consultant travel
• Efficient – reduces costs & the NHS Carbon footprint in rural
areas
• Equitable – delivering care regardless of patient geography
and mobility issues

18. Carer in Inverness
“ I don’t think we would have been able to
see the Doctor (Neurologist) if we didn’t
have this appointment……it would have just
been too difficult for us to travel”

19. Prior neurology service
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Bi-monthly neurologist visit to WIH, Stornoway
– 6 visits / year
– 18 clinics a year
Inpatients
– Care at WIH
– Emergency transfers to INS, Glasgow
Issues with the service:
– Waiting times for outpatients
– Waiting times for investigations
– Wait for further review / results / rx
– Retirement in 2009
– Need for change

20. New Conversational Service
• July 31st 2009
• Tandberg 880MXP @ Neurology, Glasgow
• Neurologist
• Tandberg 95Edge system @ WIH,
Stornoway / Benbecula
• Patient + Nurse
• No fresh installation costs

21. Service outcome
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Waiting times reduced – average 6 weeks
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23/41 discharged
Further Follow Up
• 1 MS clinic
• 1 standard clinic review at Glasgow
• 10 teleneurology fu – all accepted

22. Question
Disagree
No opinion
either way
Agree
Patient feedback
Response %
0
1
38
Disagree 0%
Agree
98%
NOE
2%
I felt shy & nervous about speaking
23
6
10
Disagree 59%
Agree
26%
NOE
15%
I could hear everything that the Neurologist said
1
0
38
Disagree 2%
Agree
98%
NOE
0%
I was worried that others might be watching or listening
35
4
0
I felt the Neurologist understood my problems
0
0
39
Disagree
0%
Agree
100%
NOE
0%
I felt the Neurologists explanation of my symptoms was
satisfactory
0
3
36
Disagree
Agree
NOE
0%
92%
8%
I felt the OP appointment with the Neurologist was
useful
0
1
38
Disagree
Agree
NOE
0%
98%
2%
I had confidence in the way that the Neurologist
addressed my problems
0
1
38
Disagree
Agree
NOE
0%
98%
2%
I found the neurology appointment via tele-link
acceptable & would agree to be seen by this method
again if necessary
1
4
34
Disagree
Agree
NOE
2%
88%
10%
I was able to say all that I wanted
Disagree
Agree
NOE
90%
0%
10%

23. Conclusions
• A conversational clinic works
• Patients
– High degree of satisfaction
• Service
– Targets and objectives can be achieved
• Environment
– 83,120 minutes of gas-cooking
– Cumulative benefit

25. Telecare & physical disability
• Using telecare effectively in the support of
people with severe physical disabilities and
long-term chronic conditions
• Telecare is not an alternative to direct care by
carers, although it can reduce the need for
check visits, ‘supervision’, or visits to clinics.

26. Examples of Telecare equipment – safety at home

27. Further information about Telecare….
•
Telecare National Development Programme in Scotland,
please contact the Joint Improvement Team via their website:
http://www.jitscotland.org.uk/action-areas/telecare-in-scotland/
• Joint Improvement Team Area 3ER, St Andrew’s House,
Regent Road, Edinburgh EH1 3DG
T - 0131 244 3535
e - jit@scotland.gsi.gov.uk
W- www.jitscotland.org.uk

28. NHS Scotland – Digital TV Platform
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Working to widen public access to NHS Scotland on new
channels on digital TV
NHS Scotland services on Freesat & Sky:
Go to Channel 539 (Community Channel)
Press RED
NHS Scotland services on Virgin: Interactive Channel
Also available to download as an app on android and iphones by texting postcode or 'NHS24' to 61061

30. NHS Scotland - Digital TV Platform
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Service Delivery Benefits:
Helping people to self serve
Efficiency savings
Fewer GP ‘no-shows’
Delivering services on popular devices
Using trusted technologies to deliver health services for older people - TV
Bridging the digital divide
For more information about the service or how to be involved:
Head of Health Information Services, NHS 24

31. NHS Inform – Team and Channels
• Delivered by Health Information Services team:
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Strategists
Content Managers
Technical Development and Design
User Engagement and Partnership
Health Information Advisors
• Delivering services via the following channels:
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Website
Digital TV Channel
Mobile site
Telephone line

33. Physiotherapy Led Web-Based Rehabilitation for People with Multiple Sclerosis
Date: 2/26/2013
piloted in NHS Ayrshire & Arran
Dr Lorna Paul Reader in Rehabilitation Nursing & Health Care School University of
Glasgow
• SCTT Learning Network webcast – open access
http://www.video3uk.com/default.aspx
http://www.video3uk.com/sctt

34. Tony McLaren: National Coordinator
Breathing Space and NHS Living Life

36. What is NHS Living Life?
Living Life is a free telephone service provided by
NHS 24 for anyone aged 16 and over who is feeling low,
depressed or anxious.
The service can:
• help you develop additional coping skills
• support you with helpful workbooks and resources
• provide telephone support sessions at times that suit you
• refer you on to other services where appropriate
If you would like to know more about Living Life ask
your GP for a referral or alternatively call us directly
on 0800 328 9655.
You can also find further information at:
www.nhs24.com/UsefulResources/LivingLife

37. Opening Hours:
Living Life is open from Monday to Friday 1pm -9pm
What to expect in the community?
You will be:
• asked to complete a short questionnaire to see if the
service is best suited to your needs
• Offered a series of telephone support sessions
which occur weekly or fortnightly over 4-12 weeks.

38. Scottish Government MH Strategy 2012 - 2015
• Commitment 6
– Effective use of new technologies
• Commitment 13
– Faster access to Psychological therapies
• Commitment 14
– Equality of access to services

39. Wait time – Referral to IA (Days)
Oct ‘12
Nov ‘12
Dec ‘12
Jan ‘13
Feb ‘13
Mar ‘13
Apr ‘13
20
20
25
10
10
12
8

40. Feedback: What did you find useful?
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Reading materials
Telephone sessions, being able to talk
Access form my house and in the evening
Other materials recommended
Everything explained clearly
Focus was on looking forward; changing my mindset and thinking
was a very positive experience
Coach always phoned me and was always on time
Prompt arrival of workbooks and materials
Coach/Therapist was a good listener and a very helpful &
understanding person to talk to
Help with recognising my problems and identifying the emotions
involved in situations
Chance to break down my distress into manageable chunks and
to work through these
1 by 1Therapist helped me accept my situation and build on my
self-esteem
Therapist was very understanding, supportive, patient and easy
to talk to.
Never felt rushed….

41. Feedback
“ Without the help offered by
Living Life I would have been
unable to identify and deal
with issues that needed to be
dealt with. Living Life has
aided my recovery."
"I was able to work on tools
and mind-set to help me deal
with the life stresses that
came my way.“
"I feel much happier. I am now
a much stronger and more
confident person."

42. "It gave me confidence to get
out of the door although I felt
happy that I didn't have to
visit any surgery.
Confidentiality was very
important to me and the
weekly talks were great. I was
able to see progress."
“The first time was really helpful, I
was at a very low point and he
(advisor) got where I was coming
from and each point I made, he
reacted to what I said and it was as
if he had suffered depression himself
or had been dealing with or worked
with depressed people for a very
long time, he had a deep
understanding……”

43. Mission Statement
Breathing Space is a free, confidential
phone and web based service for
people in Scotland experiencing low
mood, depression or anxiety.
We are here in times of difficulty to
provide a safe and supportive space
by listening, offering advice and
information.
It is our belief and hope that by
empowering people they will have
the resources to recover.
Breathing Space is a COSCA (Counselling
and Psychotherapy in Scotland)
recognised counselling skills organisation.

44. Call Volume
• Circa 7000 answered calls
per month
• Total calls – 650,000 since
February ‘04
• Open between 6pm and
2am Mon – Thurs. From
6pm Fri to 6am Mon
• Calls average 20 mins
• 90% average call answer
Inverness Caledonian FC
support Breathing Space

45. •
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Depression
Relationship difficulties
Alcohol and drugs
Gender Identity/Sexuality
Self-harm
Abuse
Bereavement
Unemployment/Debt
Prison Issues
Anxiety/Stress
Trauma
Mental Health Problems
Rurality
Isolation & Loneliness
Spiritual/Existentialist
Scene from previous TV Advert

46. Any questions?

47. Thank you!
cathy.dorrian@nhs.net