My name's Pauline Jervis, I'm one of the Assistant Senior Manager's and I work for Surrey County
Council , um, Adult Social Care.
My role, really, is around joint commissioning with Health and Social Care.
I guess, um, its part of a wider initiative really, we are, um, funding Surrey wide telehealth
programme.
It's funded through what we call our better care fund which is sort of joint health and
social care funding.
We are working with all of our clinical commissioning groups and also all of our providers including
Surrey and Borders on development of a wide scale telehealth programme and I guess the
drivers behind it are the things you would expect really, ever increasing demand particularly
with an ageing population and their associated risk of long term conditions and complex needs.
Against a backdrop of strained resources, our provider services are all working to maximum
capacity and we needed to find a way, really, of managing people in a sustainable way, being
able to provide them with high quality care, um but working within a limited budget.
Telehealth seemed to offer an opportunity to do that.
Well, I guess, um, the approach that Surrey has taken was that this was never really about
a project or testing something.
It was about that we had made the decision on wide-scale implementation.
We were particularly targeting people in the traditional model, with long term conditions
such as heart failure and respiratory disease but we also wanted to allow some scope for
testing more innovative approaches and we were working with all the providers, Surrey
and Borders partnership approached us with what they saw as sort of a hot spot, if you
like, where there are increasing numbers of people with severe and enduring depression.
These people are high users of healthcare and community services but also emergency
services and, um, there was some research done that they wanted to talk to sort of us
about that whether we could try something in Surrey and it was about delivering a behavioural
activation programme through a none face to face mechanism using telecare to support that
to enable people to really better manage their condition and also allow people to sort of
take care of themselves with the hope that going forwards there will be less need
for intensive support and that they will learn some techniques to better manage their care.
There were lots of challenges.
Um, I think the key challenge is, really, is a very different way of working.
I think challenges were about starting with a blank sheet of paper we had to develop,
although we had a Surrey wide model, because there are six Clinical Commissioning Groups
and a number of providers and a number of acute hospitals we needed to have a sort of
strategy if you like that had an overarching, um, direction of travel but could be locally
adapted to suit the pathways and the needs of each of the individual organisations within
Surrey.
So, what we did was we set up, um, individual groups through each of the Clinical Commissioning
Groups led by the local clinicians, GP's, hospital consultants but also working with
our providers very locally to develop local models of care, local pathways, um and we've
done exactly the same with Surrey and Borders, one of the local CCG's or Clinical Commissioning
Groups, North West Surrey, acting as the sponsor.
The clinical leads for that commissioning group are also the clinical leads for the
project in Surrey and Borders so we have a really robust infrastructure to take the work
forward.
Critical success factors; I think there are a number of them really.
I think one of the key things is when you are looking to procure a provider; you need
more than somebody that's just going to give you the equipment and give you a readymade
protocol or pathway.
Um, in Medvivo, which is our provider of telehealth services, we um, have a project manager or
a programme manager, she actually works locally, spends a lot of time with the individual Clinical
Commissioning Groups with the clinicians with the provider services and I think that makes
a real difference.
It is the link between the company that provide it and the actual people on the ground that
are going to be using it that are going to be developing the pathway.
So I think that is one of the critical success factors.
I think one of the other critical success factors is about having really good strong
clinical leadership.
Um, it's not just about equipment; equipment is a fairly small part of it, it's about the
attitudes, the cultural changes, it's about clinical buy-in, it's about provider buy-in,
it's about supporting different ways of working and that sort of thing and I think the other
thing is to not underestimate the time it takes.
There is the practical things like writing the local pathways and protocols but more
importantly I think it's around cultural change.
It takes a long time, um, for people to see it not as an initiative or a way or working,
sorry, not something that is bolted on to their way of working but that it really needs
to be embedded in part of day to day care, part of a matrix of care, to support people
with complex needs and that you see it as a tool or part of your everyday working.