Why telehealth will transform care of Kent’s patients

Locally, we have already seen what a dramatic effect telecare and telehealth can have on the daily life and wellbeing of people with long-term health problems after it was introduced by the primary care trusts in Kent and Kent County Council seven years ago.

Take, for instance, Haris Patel, 54, from Folkestone whose health conditions include problems caused by hardening of the arteries.

He said: “Before I had telehealth, I used to spend 10 months of each year in hospital. Since I got it, I have been in for two weeks in the last three years, and that was planned. Telehealth gives me peace of mind.”

Now the Department of Health is so impressed with the results of the Whole System Demonstrator Programme, which tested the technology in Kent, Cornwall and Newham, that it is championing its use nationwide.

The project found there was a 45 per cent reduction in deaths among patients taking part, a 15 per cent drop in attendance at A&E, and 20 per cent fewer emergency admissions to hospital.

Care services minister Paul Burstow said: “People were absolutely clear that high-tech healthcare has improved their lives for the better.

“I want to see more people across the country benefit. That is why we are working with industry, the NHS and councils to change the lives of three million people across England over the next five years.”

So what is this technology? Telecare, introduced in Kent in 2004, offers remote monitoring of people’s safety. Available to vulnerable people, who meet specific criteria, it consists of sensors that can be worn (such as a falls monitor on the belt) or placed in the home (such as a flood alarm if someone might not remember to turn off the taps).

Sensors are connected to a 24-hour monitoring centre which contacts the person and raises the alarm if there is a problem.

Telehealth, which enables remote monitoring of people’s health, is even more innovative.

Available in Kent since 2005, it offers suitable patients with conditions such as diabetes, lung disease and heart disease, the chance to measure their pulse, blood pressure, blood glucose, blood oxygen level, peak flow (lung capacity), temperature and weight, all at home.

Their community matron from Kent Community Health NHS Trust, or specialist nurse, monitors their readings from day to day, picking up subtle changes in their health before they develop into something more serious.

This helps people stay well – as does the power it gives them over their lives. People get to ‘know their numbers’ and understand the impact their day- to-day life has on their health, so they can spot when things are deteriorating and take action.

It has been such a success that the technology is no longer just a pilot – it is being rolled out across Kent and Medway and will be available as part of the care package for those who are eligible.

This is a wonderful example of what the NHS and social care can achieve by working closely together to improve the quality of life for local people.

(Original article: http://www.yourcanterbury.co.uk/blogs/why_telehealth_will_transform_care_of_kent_s_patients_1_1176973)

Is it time to change the name ‘Lone Worker’?

BS8484 was deliberately produced early on in the development of the Lone Worker Protection market with the intention of imposing controls on false alarm rates from an early stage.

While this has been shown to be a real benefit, with a very low rate of false alarms and therefore a high level of police support, it can expose other problems which were not foreseen with little market experience.  One of these is the name ‘Lone Worker’.

While the name did not get a mention in Health & Safety legislation it is there that we find its roots. The HSE were using the term at an early stage and it served its purpose well by highlighting the vulnerability of a specific employment group which signalled the birth of the Lone Worker market.

The Police were clearly going to be a most significant element in the market, as the primary response service, and they liked the name for two reasons:

Restricting it to employees only gave a degree of built-in control against false alarms because;

1. There was a mechanism to control bad practice and therefore reduce false alarms
2. Services would only be purchased and used in response to a specific threat identified through a formal risk assessment process
3. There would be training – both on using the device/service and on the avoidance and management of potentially dangerous situations
4. The term Lone Worker effectively excludes ‘consumers’ who are by definition beyond organisational control and who would probably purchase such devices and services for more general and unspecified risk to elderly relatives and young children or teenagers.  The fear was that without the discipline of the corporate environment, including training and control over their use, many more false alarms would be created.

However, while the term has been instrumental in mobilising the market it also confuses many who are not familiar with it.  It does not immediately conjure up an image of many of those vulnerable people to whom it in fact applies.  To the initiated it implies someone whose job is essentially solitary and risky because there are no other people around them; perhaps a distant figure toiling in the field vulnerable to accident or sudden illness.  Not many organisations have such people so why should they be interested?

While this remains a possible use the most likely situations are those where there is a threat because they are not alone; that there are one or more others present who could represent a threat to them.   The term ‘Lone’ therefore has come to mean someone who is not actually alone but is ‘Lone’ in the sense of having no co-workers to come to their immediate aid if required.

Also, as various organisations have discovered the flexibility of such services and how they could be applied to all sorts of people and situations, so the term Lone Worker has become further muddled.

For example several police forces that have responsibility for the protection of high risk domestic violence victims use Lone Worker services to allow them to call for help if they need to.  By no stretch of the imagination can such people be described as Lone Workers yet Lone Worker services have, in such circumstances, saved lives, saved serious injury and put violent offenders behind bars.   While they are not Lone
Workers these are certainly ‘vulnerable people’ and perhaps this would be a more accurate description?

They are also clearly at risk and maybe this would be an even better description – ‘People at Risk’?  It has the clear advantage of relating to risk which would perhaps focus people on that key word as an essential precursor to buying.

Words with imprecise meanings create false images in people’s minds.   It is quite possible that the images conjured up by the term ‘Lone Worker’ in the minds of those hearing it for the first time, without the benefit of a full explanation, are something of
a turn-off.

It is also quite possible, even probable, that this lack of precision has contributed to confusion and consequent slow development in the market.

If this is so it will, more importantly, have failed to reduce vulnerability for some ‘People at Risk’.

(source: http://www.bs8484.com/v2/2011/12/is-it-time-to-change-the-name-%E2%80%98lone-worker%E2%80%99/)

Council cuts could leave 750 vulnerable people in Lincolnshire without cash for care

COST-CUTTING proposals could leave more than 750 vulnerable people without cash for their care and Telecare.

Lincolnshire County Council is planning to make people with "moderate needs" ineligible for care funding in a bid to save £4.6 million a year.

Officials say 3,096 people are classed as moderate, which is where they cannot care for themselves properly without help or specialist equipment.

Of these 1,509 will have to be reassessed, with predictions suggesting half of these people will lose their cash.

The other half are expected to be upgraded from moderate to substantial – the second highest level behind critical.

People who are only given special equipment will not be affected by the changes.

A council consultation found 88 per cent of people who responded were against the move.

Labour group leader Councillor Robert Parker said the proposed action was "scandalous", bearing in mind the majority who responded to the consultation were not in favour of it.

The Lincoln West member said he remained unconvinced that the Big Society – family, friends, neighbours and voluntary groups – could provide a replacement service to cope with the people's needs.

Mr Parker said: "You can't get it any clearer. The council goes out to consultation to reduce the support for people with moderate needs, 88 per cent say it shouldn't be withdrawn and the council is taking no notice.

"Consultation in Lincolnshire is becoming meaningless as the council takes no notice of it."

The council's adults scrutiny committee will discuss the idea next Wednesday, with the Conservative executive making a decision on Tuesday, October 4.

It is the latest example of the authority cutting back its adult social care responsibilities, following decisions to close council-owned care homes and consult on reducing in-house council services.

The authority says it will attempt to limit the impact on those who no longer qualify for financial support.

Councillor Graham Marsh, the council's executive member for adult social care, said a growing elderly population meant a decreasing budget faced increasing pressures.

Up to £39 million has to be saved by adult social care by 2015.

Mr Marsh said: "We need to limit the number of people who receive funding, rather than spreading the money too thinly and seeing no one receive the quality level of service they need.

"The proposed change to our eligibility criteria will see Lincolnshire join almost 80 per cent of authorities nationwide in funding people with substantial needs and above – in fact some only fund those with critical needs.

"This will ensure our services are in place for the future to support and improve the lives of about 13,000 people."

But opposition leader Councillor Marianne Overton said there could be greater cost for the authority by making this short-term saving.

The independent councillor said: "Moderate care sounds OK, but it means a person cannot carry out three essential personal care tasks.

"For example, they cannot get out of bed, go to the toilet and make their breakfast. People in that situation will receive no support from the council, even though they have no other income. They say they will provide alternatives, but Telecare is expensive.

"These are not people who are perfectly fine and want a little bit of help on Sundays."

A Lincoln woman, who uses council services, also told the authority: "Without this support I would struggle to move to be more independent and would become more lonely and depressed as I could not afford to pay for services out of my benefits.

"This would make me more isolated."

The council received 630 responses to its consultation.

Forty-six per cent suggested the criteria should be lowered to include all four care levels.

Petition calls for changes to working alone rules in Saskatchewan

The killing of a convenience store employee in Saskatchewan in June has spurred the provincial labour federation to support a petition to change regulations for retail employees working alone.

Many delegates attending the Saskatchewan Federation of Labour's (SFL) annual Occupational Health and Safety Conference from September 11 to 13 strongly supported and signed a petition calling for the introduction of "Jimmy's Law" into the provincial legislature, says Larry Hubich, president of the SFL. The proposed law is named after Jimmy Wiebe, who was murdered at a gas station convenience store on June 20 in Yorkton.

It would require employers to schedule two employees to work together between the hours of 10 or 11 pm and 6 am or provide protective barriers between lone workers and the public.

The incident that prompted the petition occurred in the early morning hours of June 20. At about 4:50 am, members of the Yorkton RCMP received a report of a man who had been found deceased in the Shell Canada convenience store by a customer, says Corporal Rob King, a spokesman for the Saskatchewan RCMP division. Four days after, King says, the Yorkton RCMP detachment charged Kyle Furness, 20, with first-degree murder in connection with the homicide of the 50-year-old worker, an employee of the store for more than 10 years.

Jimmy's Law is modeled after similar working alone regulations in British Columbia which were introduced in 2008, but have not yet come into effect because of the complexity of the issue, says Megan Johnston, a spokeswoman for WorkSafeBC. That year, however, BC introduced a separate pay-then-pump requirement following the death of a young gas station attendant.

"Grant's Law" - named after Grant De Patie, who was dragged to his death in March of 2005 while trying to prevent the theft of gas from a station in Maple Ridge, BC - requires mandatory pre-payment of fuel at all gas stations in BC, Johnston says.
Wayne Hoskins, president of the Western Convenience Stores Association (WCSA) in Surrey, BC, says it's important to note the distinction between mandatory pre-payment of gas and the requirement for multiple workers or barriers. "While Grant's Law was well-intended, it refers to outside, or ex-store, and not in-store coverage," Hoskins explains.

"There are some things you can do everything in the world to try and prevent or protect from happening, but they're going to happen anyway," he says. "Having an additional employee is not necessarily going to save the unfortunate tragedy from happening. It may stop that person from going to that store. If you build a better mousetrap, the mice figure out how to get around it."

In British Columbia, the working alone regulations - known as the Late Night Retail Safety Procedures and Requirements - consist of an engineering control (barrier) or administrative control (extra staff), Johnston says. Hoskins says that a third option has also been proposed: additional training, testing and certification. This option, a combination of both engineering and administrative controls, will be presented to WorkSafeBC's board of directors in October. Meanwhile, the SFL will discuss Jimmy's Law at its executive meeting on September 19 and 20 and decide on the next course of action, Hubich says.

Ontario also considering pre-payment option

Ontario is another jurisdiction considering a mandatory pre-paid policy for gas stations following a recent gas-and-dash incident. On May 19 at about 4:55 pm, gas attendant Hashem Rad, 62, was struck by a vehicle that took off with unpaid gas at a Petro-Canada station in Mississauga, Ontario (COHSN June 13, 2011). Rad was taken to hospital, where he succumbed to his injuries the following day.

Whatever the outcome with British Columbia's third option, Hoskins warns against an "emotional knee-jerk reaction" whenever there is a fatal incident at a retail outlet. "When there's random acts of violence, everybody is an expert on what the solution might be before they look into it," he contends.

"I don't know how sitting down and having a discussion about how we make sure workplaces are safe and that people who are in these vulnerable workplaces like conveniences stores and gas stations where there is a chance of them being assaulted and murdered... is a knee-jerk reaction," Hubich counters.

Writing A Lone Worker Policy

Increasing numbers of people are working on their own, at least some of the time, from shop assistants to warehouse staff to night workers and those who are occasionally based at home.

This shift away from traditional nine to five, office-based working has meant fresh challenges for employers, who need to manage the risks associated with lone working.

The first step if you have solo workers in your organization, is to carry out a proper risk assessment. Decide what needs to be done to ensure the safety of those who work alone – your current policies and procedures may not be sufficient.

You need to be sure that the person working unsupervised has the experience and good health to cope unaided, especially if they are handling potentially dangerous equipment. Has enough training been offered? Is it too stressful for them? Equally, you will need to think about how they will communicate and get help in an emergency. If the worker’s first language is not English, this can be even more important.

For example, what would be done if there were a break-in while only one night security guard was on duty? You may want to consider emergency alarms and the like. Equally, consider whether the person is trained in First Aid – or needs to be.
Regular contact and visits for those working alone can be vital. At the same time, consider how the quality of their work will be evaluated.

Some groups, such as expectant moms, the very young, older workers, those with disabilities, or trainees, may face particular challenges, and, in fact, it may not be safe for them to work without supervision.

Finally, if the lone worker deals with members of the public, there may be special considerations concerning who they see, and what emergency procedures are in place.

You may well need to have in place a lone worker policy, which sets out all these things in stone and makes procedures clear. Communicate this clearly to anyone who works alone, and display the document prominently.

Apart from anything else, lone working can be a lonely business. Make sure the employee knows they are looked after, and that you have given due consideration to their safety and welfare.

GPS Tracking Devices Attached to Toucans Help Scientists Gather Data on Seed Dispersal

In Panama, scientists form the Smithsonian Institute are using GPS tracking devices to gather data on how Toucans disperse seeds.

Toucans love nutmeg seeds. When Toucans eat, they gulp the nutmeg seeds whole. The outer pulp is processed in the bird’s crop, and the hard inner seed is then regurgitated.

There were were two main things scientists had to do to set up the experiment. First, the scientists had to figure out how long and how many seeds the Toucans would eat in a day. So the scientists gathered fresh seeds from a nutmeg tree and fed them to captive toucans at the Rotterdam Zoo.

During the GPS tracking experiment, five zoo toucans fed 100 nutmeg seeds took an average of 25.5 minutes to process and regurgitate the seeds.

Next the scientists captured six wild toucans that were feeding from a large nutmeg tree in the rainforest. The scientists attached lightweight backpacks containing GPS tracking devices to the wild birds. The GPS tracking devices recorded the birds’ exact location every 15 minutes and used accelerometers to measure the Toucans’ daily activity level.

The GPS-enabled backpacks are designed to fall off the Toucans after 10 days.

When matched with the seed-regurgitation time of the zoo toucans, the GPS tracking data indicated the wild toucans were probably dropping nutmeg seeds a distance of 472 feet, on average, from the mother tree. Each seed had a 56 percent probability of being dropped at least 328 feet from its mother tree and an 18 percent chance of being dropped some 656 feet from the tree. In addition, the accelerometer revealed that the toucans’ peak activity and movement was in the morning followed by a lull at midday, a secondary activity peak in the afternoon, and complete inactivity at night. This is a normal pattern of tropical birds.

“Time of feeding had a strong influence on seed dispersal,” the scientists write. “Seeds ingested in morning (breakfast) and afternoon (dinner) were more likely to achieve significant dispersal than seeds ingested mid-day (lunch).” This observation explains why tropical nutmegs are “early morning specialists” with fruits that typically ripen at early and mid-morning so they are quickly removed by birds.

Ideally, the scientists observed, nutmeg trees could increase their seed dispersal distances by producing fruit with gut-processing times of around 60 minutes.

Source: The original article, “The effect of feeding time on dispersal of Virola seeds by toucans determined from GPS tracking and accelerometers,” was recently published in the journal Acta Oecologica (http://www.sciencedirect.com/science/article/pii/S1146609X1100107X).

Patient safety: what's to be learned from road safety?

The idea that healthcare has a lot to learn from industries that are inherently risky but nonetheless manage good safety records – like aviation – has proven enormously persuasive. Aviation provides many examples of how to improve things that are currently not done as well as they could be, including effective teamwork and standardisation of routines.

But there are important differences between healthcare and air travel. Aviation incidents, when they occur, are dramatic, headline-grabbing events. And when a plane crashes, the crew has as much chance of going down as the passengers, so the stakes are as high for them as those they serve. By contrast, when errors occur in healthcare, they tend to harm one patient at a time, and clinicians are not affected by the outcome in the same way as patients.

Further differences lie in the scale and nature of the systems, and the constraints on what can and can’t be done. In aviation, the number of different types of personnel and types of procedure is limited: flights are scheduled and airlines can control exactly how many people are on a flight. Both crew and passengers can be compelled to comply with safety instructions, and those thought likely to pose a security risk or cause trouble can be stopped from boarding.

Hospitals are vastly more complex. Delivering good healthcare may require crossing multiple organisational, professional and institutional boundaries. Healthcare organisations conduct many thousands of different procedures, involving multiple staff, and are subject to problems of uncontrollable surge. But they often lack the ability to turn people away either because of capacity problems or because individuals pose a risk in some way.

Many of the factors that disrupt good care may be outside the control of individuals or teams, and they are dealing with autonomous patients, who may either decline or be unable to cooperate with what others feel would be in the best interests of safety. And hospital facilities, sometimes built in centuries past, are often poorly designed for the tasks they now undertake.

So, though there is much to be learned from aviation, it will never provide the full answer for healthcare, and some of its ‘solutions’ may require more adaptation to make them work in healthcare than is often recognised. In fact, looking at examples where achieving safety has been much more challenging, such as road safety, may in fact provide important lessons for patient safety.

As in healthcare, road safety accidents are only rarely headline-grabbers. Road use has the same deceptive familiarity as healthcare, and everyone has had a prang or two.

Road transportation suffers from many problems endured by healthcare: unsuitable physical infrastructure, poorly coordinated design, complexity introduced by individual autonomy and preferences, unpredictable surges, behaviour that is not always consistent with what is known to be safety-promoting, and a wide range of expertise and experience among road users, among many other things. But though it is not fully there yet, road transportation has succeeded in becoming much safer.

Both casualties and deaths on the road have shown steep declines since the 1960s (see the Office for National Statistics website), even though road traffic has substantially increased. Nearly 8,000 people were killed on the roads in the UK 1966, compared with just over 2,200 in 2009. The key is that improvements have been brought about by a range of strategies, targeting different levels and facets of the problem.

Structural and regulatory changes have gone hand in hand with large scale behavioural and cultural adjustments, and improvements to technology and infrastructure. For example, legal interventions have targeted unsafe behaviours such as speeding and drink driving; car design has massively improved; and standards of driving have improved through more rigorous training and licensing regimes.

Some interventions have removed choice and autonomy (such as removing the right to travel without a seatbelt, or to drive a banger that’s deemed not to be road worthy), but over time the resistance to them has diminished. That many people continue to be killed every year shows how difficult it can be to achieve institutional, cultural and behavioural change across the board, especially once the fabled low-hanging fruit has been picked.

Clearly, I am not trying to argue that road safety is a perfect model for patient safety. But neither is aviation. We need to be smart about how we learn from other areas, recognise that we need to select and combine many different instruments, figure out the optimal balance of ‘hard’ and ‘soft’ interventions, and keep working at the wicked problems.

Mary is Professor of Medical Sociology at the University of Leicester and a member of The Health Foundation's Improvement Science Network.