TECHNOLOGY ENABLED CARE Supporting Service Transformation Delivery Plan 2018/19

Transcription

1 TECHNOLOGY ENABLED CARE Supporting Service Transformation Delivery Plan 2018/19 April 2018

2 Introduction 1. The TEC Board agreed four Strategic Priorities in August 2017 for furthering the development and adoption at scale of Technology Enabled Care over the next three years. These built on the evidence and implementation to date and are informed by wider policy developments and emerging priorities. These four priorities are Preparing for the future identifying and testing new approaches that offer the potential to achieve change at scale Developing approaches once for Scotland developing approaches that have been shown to be effective, supporting scaling up across Scotland and addressing barriers that require national level action Building capabilities and supporting improvement championing, supporting, gathering and promoting the evidence of what works, to develop the culture and skills that recognise and use digital TEC including through developing business cases, supporting strategic planning and delivery. Transforming local systems supporting exemplars that are seeking to transform local health and social care systems using digital technology to shift local systems upstream to prevention and self-management 2. This Delivery Plan sets out the deliverables for each of these four strategic priorities. High level deliverables (which will evolve further on the basis of health and social care delivery /service transformation requirements) are set out for the period to 2021, with specific deliverables for 2018/19. Key work streams in 2018/19 that will enable the Programme to deliver are described, with the associated committed and planned budget allocation. 3. The TEC Programme will form a key component of the Digital Health & Care Strategy, published in April Currently the four TEC strategic priorities align well with, and support, the Digital Health & Care Strategy. There may however be a requirement to adjust the TEC priorities and this Delivery Plan as that overarching Strategy and associated implementation plan develops. Some of the activities outlined here may be taken forward as part of the broader approach to digital health and care, but the exact mechanism for that has still to be determined. The Digital Health & Care Strategy 4. Person-centred health and social care is at the heart of our strategic agenda in Scotland, but rising demand from services is placing systems under increasing pressure. Digital technology offers the potential to meet this rising demand for public services and growing expectations amongst people using services. Making better use of data and technology has the potential to improve the quality and

3 reduce the cost of services, as well as giving people more control over their own health and wellbeing. 5. The Digital Health & Care Strategy 1 focuses on how digital can support the strategic aim for Health and Care in Scotland in delivering high quality services, with a focus on prevention, early intervention, supported self-management, day surgery as the norm, and when hospital stays are required for people to be discharged as swiftly as it is safe to do so. The vision is as a citizen of Scotland: I have access to the digital information, tools and services I need to help maintain and improve my health and wellbeing. I expect my health and social care information to be captured electronically, integrated and shared securely to assist service staff and carers that need to see it and that digital technology and data will be used appropriately and innovatively to help plan and improve health and care services enable research and economic development and ultimately improve outcomes for everyone. 6. The Strategy builds on achievements to date and sets out future development and priorities. Its focus is two-fold (i).we wish to empower citizens to better manage their health & wellbeing, support independent living and gain access to services through digital means. We know this is leading to a shift in the balance of care by using the tools and technologies that we are already increasingly using for all other aspects of our lives. In order to achieve this at scale; (ii) We need to put in place the underpinning architectural and information governance building blocks for the effective flow of data across the whole care system that will enable the transformational ambitions of the Health & Social Care Delivery Plan, including public health and social care reform priorities. 7. Six key Domains are set out in the Strategy. Domain A: National Direction Domain B: Information Governance, Assurance and Cyber Security Domain C: Service Transformation Domain D: Workforce Capability Domain E: National Digital Platform Domain F: Transition Process 1 Scotland s Digital Health and Care Strategy: Enabling, Connecting and Empowering. April 2018

4 Technology Enabled Care, including the TEC Programme and approach to date, has an important contribution to make to all these Domains but in particular to Domain C Service Transformation. This has a focus on spread and adoption at scale, service redesign and service change. Technology enabled care 8. Technology enabled care is a cornerstone for connecting and empowering citizens, and key to ambitions for transforming the delivery of care. It makes a critical contribution to better health and wellbeing in the community by adopting tools and approaches to enable people to improve and manage their own health, remain independent and safe, and by improving access to, and the efficiency and effectiveness of, information, advice, care and treatment Technology enabled care in Scottish Government provided. This is widely Strategies: Examples recognised. The Health and Social Care Delivery Plan Social Care Reform agenda 9. The key role for technology enabled care is reflected in a Primary Care Innovation Fund Joint Housing Delivery Plan growing number of national AILIP Scotland s National Dementia Strategy strategies that recognise the Mental Health Strategy contribution to be made by The Modern Outpatient digital solutions and include 2030 Nursing Vision specific actions that include technology enabled care. Achieving Excellence in Pharmaceutical Care: A Strategy for Scotland 10. The contribution of technology enabled care was considered by an external, independent panel of UK and international experts asked to advise the Scottish Government on how digital technology can support Scotland s aim for high quality health and social care services with a focus on prevention, early intervention and supported self-management. Their report 2 identified a number of successes that have been achieved in specific areas, including using technology enabled care in prevention and early intervention. The report cites Scotland is already an international leader in technology enabled care. The Panel concluded that While the TEC Programme has demonstrated the contribution of technology to improvements in health and care services, there is now a need to integrate these opportunities in a more effective and sustained way. In order to do this, digital technology now needs to transform the way in which health, housing and social care services are provided, empowering people to self-manage and live more independently thereby reducing demand on services (including pressures on the 2 Digital Health and Care in Scotland: Report of the External Expert Panel April 2017

5 workforce) and improving outcomes and quality of life. In particular, evidencebased and scalable approaches are needed to be adopted at a national level, so that local health and care systems can focus on using digital technology for upstream prevention, self-management and greater independent living. External Expert Panel Report 11. The Health and Sport Committee s report Technology and innovation in health and social care 3 applauded initiatives such as developments in telehealth/telecare, video-conferencing and virtual clinics. The report did, however, note that the spread of such approaches should be accelerated, which chimes with the External Panel s recommendation that evidence-based technology enabled care be more broadly implemented at scale across Scotland. It noted that many submissions were supportive of the TEC Programme with some specific examples cited. It also set out a number of recommendations including the opportunity for person-centred approaches, the need for a national Once for Scotland approach, a requirement to support scale up and adoption of evidence-based technologies and to address cultural barriers to encourage widespread acceptance and uptake of technology and innovation. The TEC Programme is already making a contribution to these aims and this current Delivery Plan develops this further. 12. We are now at the point where the challenge is no longer about proving the value and potential of technology enabled care: rather it is achieving widespread adoption so that technology enabled care is integral to business as usual and redesigned services and care pathways. The TEC Programme 13. The national and centrally managed programme enables learning to be gathered from local, UK and international experience at the same time as cross Scotland issues are being addressed on a Once for Scotland basis. This includes Testing new approaches and identifying new opportunities for scale up Supporting scale up and accelerated adoption of technology enabled care Supporting local improvement and change Identifying common issues and barriers to change, and finding solutions Gathering and sharing learning, such as the development of common service models, gathering evidence of impact and effectiveness, and the development of toolkits Facilitating knowledge exchange and collaborations with European and international regions and countries. 14. The importance of this national programme in coordinating and driving change, as well as the challenges it faces, has been emphasised in a recent study of the TEC 3 Health and Sports Committee Technology and innovation in health and care. 1 st February 2018

6 Programme. 4 A key finding from this evaluation is that, even where technologies have established an evidence base, the pace of implementation can be slow a common feature in other programmes and evaluations. In relation to technology enabled care, implementation is challenging because of the rapidly evolving nature of the technologies, the importance of context and the need for multi-stakeholder buy-in. Workshops undertaken with stakeholders as part of the study found strong support for the contribution of the TEC Programme to supporting implementation. The study also concluded that the Programme is already employing many implementation strategies that are consistent with international best practice. 15. The Programme has a wide scope that has developed as new opportunities and barriers have been identified. Whilst the Programme s primary focus has been on service improvement and transformation, it has also funded certain product and infrastructure developments. The TEC Programme continues to provide funding for the health and social care portal proof of concept work, and led the earlier work on a Digital Platform. The TEC Division within the Scottish Government also provides some funding to the Digital Health & Care Institute (DHI) to support innovation to address specific key challenges for health and social care, ensuring a supply of next generation TEC options. 16. The TEC Programme has benefited to date from very effective cross sector leadership at Board level and collaboration with other national organisations, in particular NHS 24 and SCTT, NHS NSS, NHS NES, DHI, Local Government Digital Office, and national organisations including Scottish Fire and Rescue, Alzheimer Scotland, Scottish Federation of Housing Associations, to support development and implementation activities with joint programmes of work. Local health and social care partnerships and other national and local organisations (e.g. third sector, independent care and housing) have also continued to contribute to development work and support implementation and improvements. This work will inform the implementation plan for the Digital Health and Care Strategy and contribute to the new delivery arrangements required going forward. Evolving our approach 17. The four Strategic Priorities for technology enabled care will see investment in approaches that have been shown to be effective focusing on a smaller number of programmes /initiatives, a number of which have been referred to in the recent External Panel and Health and Sports Committee Reports. There are important shifts in emphasis and focus. Investing higher levels of funding to achieve integrated, whole system digital health and social care that builds on the full range of technology enabled care, such as Home & Mobile Health Monitoring, video-conferencing, telecare, and online tools linked into core ehealth systems 4 Just Economics TEC Programme Data Synthesis and Evaluations Options Study. March 2018

7 Investing only in digital technologies Investing in evidenced based approaches to support scale up and adoption across Scotland, building on success to date Using technology enabled care as a driver of transformational change in local systems, shifting away from digitisation of current services. Facilitating the transition of successful programmes and approaches to delivery partners shifting to business as usual Seeking out and supporting innovation and inward investment opportunities. Ensuring closer alignment and collaboration with other national change and improvement programmes Giving greater focus to the need for culture change and skills development within the health and social care workforce, and on supporting change management and addressing barriers to change Promotion and dissemination of outcomes, outputs and lessons learned to national and international stakeholders Adopting evidenced based implementation framework to bridge gap between science and practice and support mainstreaming of technologies Outcomes and Deliverables 18. For each of the four Strategic Priorities, we have identified (a) The outcome that we are aiming to achieve over the next three years (b) High level deliverables, relating to each outcome (c) Specific deliverables for 2018/19 (d) Committed and planned budget allocation for the constituent work streams.(see Annex A) 19. The following sections set out the outcomes, high level deliverables and the specific deliverables for 2018/19. The associated budget allocation is also provided. Strategic Priority 1: Preparing for the Future Supporting Domains C, D and E: Digital Health and Care Strategy Identifying and testing new approaches that offer the potential to achieve change at scale Outcome and high level deliverables 20. The purpose is to continue to identify approaches using technology enabled care that have the potential to offer significant change and improvement at scale. The focus will be on identifying approaches to support service change, rather than on the new technology itself (where the lead lies elsewhere e.g. the Digital Health & Care Institute, CivTech, Censis etc.). This might be about testing new to you technology, applying technology in a different way or at a different time in a pathway, or testing out a model that other partnerships have found successful.

8 21. There are also opportunities to test the potential of next generation technologies. Collaboration with the Digital Health & Care Institute (DHI) and other Innovation bodies is crucial to ensuring that pipeline tools and approaches are connected to our requirement for implementation and scale up. This also provides opportunities to lever inward investment through UK, EU and international funding opportunities and business developments building on success to date. 22. Our work will continue to support small tests of change, but will extend to developing models of service delivery and approaches that support ambitions in the Digital Health & Care Strategy to accelerate the pace of change and shift systems towards prevention and supported self-management. An important shift in approach from 2018 is to make clearer the strategy that will guide investment and identify a flow of scale up opportunities that are relevant, useful and effective. 23. Using TEC Programme funding to leverage additional international and other investment has been very effective and has helped generate new thinking to shape approaches. This will remain a key part of our approach in our forward programme. The TEC International Engagement Team and associated International Engagement Action Plan 5 will continue to facilitate opportunities for collaboration, position Scotland s interest in shaping funding calls and facilitate networking and knowledge exchange between international partners. This will be particularly important going forward after the UK exits the European Union in March The outcome to focus this strategic priority from is Preparing for the Future Partners have access to a pipeline of service improvements and innovations in technology enabled care that are effective, can be adopted at scale and support the delivery of key national priorities, while maintaining Scotland as an international leader. 25. Associated high level deliverables ( ) for this outcome are A clear pipeline of innovative solutions, products and approaches and an associated implementation model are in place for translation into mainstream at scale services and pathways across health and social care Further health and social care challenge competitions and feasibility studies where digital innovation can deliver improvements that are effective and can be adopted at scale have been undertaken 5 International Engagement Action Plan Technology Enabled Care and Digital Healthcare Innovation

9 The market has been sufficiently stimulated into providing suitable next generation technologies, particularly for the shift to digital telecare and in the integration of telecare and telehealth Further UK and international funding collaborations have been established, bringing inward investment in support of further improvements and innovations in technology enabled care. Specific deliverables 2018/ Much of the initial groundwork required within this strategic priority will be taken forward as part of the broader approach to supporting innovation within the Digital Health & Care Strategy. An immediate priority will be to review our approach to identifying, testing and then growing opportunities around digital health, including technology enabled care and emerging tech such as the Internet of Things (IoT). This review will identify key gaps in services and approaches, where technology enabled care offers potential solutions alongside wider service redesign. The review will gather stakeholder views national and local from across sectors and interests to inform its conclusions. We plan to complete this review by October The review will then shape the development of future investment under this strategic priority. 27. Within the TEC Programme, we will build on the successful use of tests of change and have a further phase of tests of change and or scale up feasibility studies during 18/19. These will offer opportunities for local partners to access small scale funding that will support local change programmes. Calls for submissions will also target specific topics or issues, which have already been identified as key areas of opportunity and change where technology enabled care has an important role to play. 28. The TEC Programme focuses on service change and improvement rather than developing the new technology itself. The Programme has however provided funding for the Digital Health & Care Institute (DHI) to support the development of new products in technology enabled care. Further funding for DHI is included in the 2018/19 budget, and an early task will be to agree a clear specification and programme with DHI that supports the wider Digital Health & Care Strategy. 29. The TEC programme with the Scottish Centre for Telehealth and Telecare (SCTT) has been very successful to date in securing inward investment from international and other sources. This has offered Scotland access to international expertise and opinion, as well as enabling us to develop important new approaches, such as Living it Up. The Programme will continue to monitor inward investment opportunities as part of the division wide activity in this area. It is expected that at least two major proposals for inward investment will be completed in the year.

10 30. Deliverables are set out for 2018/19 below relating to specific activity under the TEC Programme and wider activities of Scottish Government s wider technology enabled care activities. Deliverables in 2018/19 (budget circa 2,250,000 6 ) A structured programme of tests of change and feasibility studies has been undertaken that supports the increased use of technology enabled care in both local and national change programmes o 12 tests of change or feasibility studies undertaken by March 2019 o Review and analysis of tests of change and scale up opportunities to date to identify themes, opportunities & barriers by June 2018 o Further tests of change underway by September Horizon scanning undertaken of new UK, EU and international funding opportunities that support scale up, by July 2018, with an ongoing horizon scanning process in place. An enquiry to assess the potential application of TEC focusing on children and young people is undertaken by June 2018 with a plan for developing a programme agreed by September A review has been completed in collaboration with DHI that identifies gaps in approaches, services (and products) and informs priorities for future investment priorities o Initial review completed by October 2018 o Recognised innovation pipeline and process of continuous review in place by March Market stimulation of appropriate next generation solutions (including the integration of state systems with consumer market / citizen self-monitoring & self-management solutions) to better leverage and expand scaled-up services using an enhanced national infrastructure commenced by September The business case for the next five years of the DHI has been agreed in collaboration with the Scottish Funding Council and the Enterprise Agencies by March At least 2 major proposals for inward investment from UK, EU and international funding programmes have been submitted by March Part of this funding is contributing to supporting digital health and care innovation opportunities and will be reviewed with regard to progress with levering inward investment

11 Strategic Priority 2: Developing approaches Once for Scotland Supporting Domain C, D, E and F: Digital Health and Care Strategy Developing approaches that have been shown to be effective, supporting scaling up across Scotland and addressing barriers that require national level action Outcome and high level deliverables 31. A key requirement, identified across national strategies and highlighted in the External Expert Panel draft report and Health and Sports Committee Inquiry referred to above, is identifying approaches that can be scaled up on a Once for Scotland basis. Building on the original Telecare Development Programme scale up, there has been important progress facilitated by TEC funding to support national coverage and transition to business as usual for ALISS and Living it Up (LiU), national scale up of ccbt (computerised cognitive behavioural therapy) and scale up of self-management of hypertension in three NHS Board and associated Health & Social Care Partnerships to date. However, the significant priority in the forward programme is to accelerate this process and this will be the core focus of the Programme with the highest level of funding. We want to build on and learn from these successes and extend them, focusing initially on national scale up of hypertension and diabetes technology enabled care solutions (as recommended by the Expert Panel), whilst continuing to identify other opportunities through the Preparing for the Future work streams. 32. A main focus of the Once for Scotland approach is that digital technology will support Scotland s commitment for high quality health and social care services that have a focus on prevention, early intervention and supported self-management. 33. Integration of health and social care requires parallel action in achieving integration between telehealth (HMHM) and telecare technologies, and integration into core IT systems. The ambition within the overall Digital Health & Care Strategy to create a single national platform emphasises the importance of joined-up care. 34. Building on earlier work around remote consultations, the opportunity to support service transformation and pathway redesign across health and social care will be facilitated by a national approach and model (e.g. Attend Anywhere) with a particular focus initially on scheduled care. 35. Preparing for technology changes, such as the analogue to digital telephony switch, to ensure that technology enabled services are fit for purpose has been a key focus of the TEC programme. This switch to digital technology is essential work required over a number of years. The Programme s support will minimise any risk for vulnerable people in the transition, but will also seek to maximise opportunities for integration of health and care technologies and data to support improved outcomes for people.

12 36. An important role for the TEC Programme has been to identify barriers to adoption and scale up of technology enabled care, and to find solutions through standardisation and common approaches, so that the focus can be on applying approaches to local contexts and avoiding reinventing the wheel. We anticipate that there will also be a continuing role in national procurement to support some of this scale up, most obviously of licences. 37. The outcome to focus this strategic priority from is Once for Scotland Improved Outcomes for citizens, service improvements and economies of scale have been achieved by developing common approaches and standardisation, national pathways and efficient commissioning and procurement arrangements. 38. Associated high level deliverables ( ) for this outcome are ccbt and digitally enabled hypertension services have moved into sustainable business as usual Technology enabled pathways for diabetes and at least one other long term condition are being embedded Citizens can routinely access appointments remotely, and TEC has contributed to a significant reduction in outpatient appointments An integrated service delivery model for remote monitoring and response for health and care needs has been developed Digital telecare has been proven and a national replacement programme for analogue telecare is well underway A recognised at scale implementation model is in place, and barriers to local service transformation and scale up that require action at national level have been identified and addressed on a continuing basis. Specific deliverables 2018/ In order to work towards these aims, our initial focus for developing technology enabled pathways in 2018/19 will be on those specific areas where the evidence is strongest, such as in the treatment of mild to moderate depression (ccbt), the diagnosis and management of hypertension, and the management of diabetes. (a) ccbt has already achieved national coverage. During 2018/19 the primary focus will be on achieving a sustainable business and funding model. We will

13 also evaluate the approach to date to identify what has worked, and why, so that learning can inform further expansion as well as approaches in relation to hypertension and diabetes. (b) Progress in those areas that have adopted remote monitoring for hypertension has been very good, with very positive feedback. There will be major drive in 2018/19 to secure adoption in other areas, with an expectation that a further 10,000 people will be using remote monitoring for hypertension by March (c) During 2018/19, we will expand the use of MyDiabetesMyWay to support selfmanagement and wellbeing, and undertake a communications and marketing campaign to support use of a new MyDiabetesMyWay app. 40. Expansion of the Attend Anywhere platform to provide video consulting capability across Scotland will be taken forward. This will include supporting the re-design and local implementation of modern outpatient services through use of video consulting, with an expectation that 25 new service start-ups will be achieved by March In addition, work will continue on preparing the way for a national switchover to digital telecare, exploiting the opportunities this brings. There is a substantial programme in place to coordinate and drive forward preparations for switch over from analogue to digital telephony services (A2D). Its focus in 2018/19 will be on understanding the current and planned connectivity landscape, and supporting the switchover of initial waves of telecare users. We expect that by March 2019, six partnerships will be live with 1,000 digital telecare users and a further 1,000 digital telecare users will be in clustered models. 42. We will take forward our work with the housing sector, with a particular focus on using the sector s reach with people who are not in receipt of formal care services but may be in the future. The initial programme has increased awareness of the potential of technology enabled care and there are some housing providers showcasing the potential contribution that housing can make. There is however more work to be done, including ensuring that housing providers with sheltered housing and community alarms systems are aware of the implications and the opportunities around the switch from analogue to digital telephony. 43. During 2018/19, we will establish a regular review process for making sure that barriers that require national action are identified and assessed. We expect that this will involve both horizon scanning to identify emerging issues (such as for example the growth in the internet of things and related issues around cyber security) and a process for identifying common barriers to implementation and delivery at local level.

14 Deliverables in 2018/19 (budget circa 3,775,000) Supported self-management An additional 10,000 people are using remote monitoring for hypertension by March Two Diabetes management pathways scoped and up to 20% increase in people using My Diabetes My Way /self-management by March Prevention and early intervention 6 organisations go live with a digital alarm receiving centre, supporting 1,000 people by March Hub and cluster model for digital telecare established for 1,000 people by March A Charter is in place by December 2018 that sets out the housing sector s role in technology enabled care and is supported by practice guides and case examples. Early Intervention Mental Health Sustainable, mainstream funding secured for the continued running and development of ccbt by March Remote access Attend Anywhere embedded further into existing services, with a further 25 services targeted for implementation by March Out of hours remote monitoring model in care homes has been tested and reviewed by November Enablers Through Scotland Excel, a new procurement framework for telecare and telehealth released. Review into call monitoring and response services commissioned by September National procurement for remote monitoring solution by October An action plan to address barriers to local service transformation and scale up that require action at national level is in place by November 2018 Funding is also identified of up to 1 million to support the development of the health and care portal and digital platform which forms part of the wider Digital Health & Care Strategy implementation plan. This is an essential enabler for scale up going forward.

15 Strategic Priority 3: Building capabilities & supporting improvement Supporting Domain C and D: Digital Health and Care Strategy Championing, supporting, gathering and promoting the evidence of what works, to develop the culture and skills that recognise and use digital technology enabled care including through developing business cases, supporting strategic planning and delivery. Outcome and high level deliverables 44. We have made important progress in achieving our ambitions in the adoption and scale up of technology enabled care, and gained widespread acknowledgement of the potential that it offers as part of change programmes. The recent study on evaluation options has however highlighted the key importance of, and barriers to, implementation: this includes the need for local leadership and support from those involved in service delivery. 45. The lead role for workforce development and organisational development rests elsewhere (primarily with NES and SSSC): the TEC Programme s role is in supporting that work, providing the content, including the evidence base, around technology enabled care. Our focus will be on ensuring that is relevant, readily available and useful. The TEC work going forward will support and contribute to the wider delivery arrangements for Digital Health & Care Strategy, as well as the development of a digital maturity framework for health and care services. 46. A key focus will be to look at what people need and value, and then to reshape and supplement what we make available. This will include the creation of a central, easily accessible repository of national and international information, case examples, tools and evidence to be hosted by a new website for digital health and care. The audience for this will be those using services and unpaid carers, as well as service providers and commissioners. 47. The draft evaluation by Just Economics referred to above recommends that we adopt the RRRP (Rapid, Relevant, Research Process) approach to evaluation and provide more guidance and advice to those undertaking evaluations. A microsite is proposed to host guidance documents and tools and sit as part of the wider resources to support implementation of the Digital Health & Care Strategy. 48. Technology enabled care is an enabler, not a thing. Its potential to drive change is widely recognised, reflected in the extent to which it is referenced in national strategies and change programmes. We will focus time and effort in collaborating with key partners and supporting national change programmes to use this transformational potential.

16 49. The outcome to focus this strategic priority from is Building Capabilities and Supporting Improvements Awareness, knowledge, and skills about technology enabled care amongst those commissioning and delivering health, care and support helps drive improvement and transformation in health, housing & social care services 50. Associated high level deliverables for this outcome are Technology enabled care forms an integral part of all relevant national change programmes and of workforce development in health and social care, with technology enabled care expertise provided that adds value. A central, easily accessible repository of knowledge and information resources about becoming ready and able to co-design and co-deliver local technology enabled service improvement and transformation is available. Capabilities are built by sharing experience gained and lessons learned between Scottish and international stakeholders. Technology enabled care data and evidence of what works is routinely collected and analysed as part of service planning, improvement and delivery. Specific deliverables 2018/ An early priority will be to agree specific inputs with other national change programmes, where technology enabled care has been identified as a component part. Our focus will be on agreeing the specific contribution alongside the added value that is anticipated as a result of that input. We anticipate that this process will also inform other work streams in the TEC Programme, such as the information, evidence, tools and resources that can usefully be provided. 52. There is already a significant body of information and evidence along with tools and other resources available about technology enabled care. It is however not all in the same place, or always readily accessible. There is a need for a review to identify gaps, shortcomings and updating requirements based on a clear understanding of what partners and stakeholders need and value. This mapping and review will be undertaken in the early part of 2018, so that it can inform the development of a Communications and Engagement Action Plan that includes both our national and international work. 53. We will continue to hold events prepare briefings and develop resources as the Communications and Engagement Plan is developed. These will include both our national and our international activities.

17 54. We are already aware that national and local partners are seeking improved data and information to inform planning, commissioning and service development. We will further develop approaches to data including tools such as our data visualisation project with Strathclyde University and disseminate tools to support local analysis for planning and service delivery such as the minimum data sets developed in partnership with NHS NSS. 55. The study on evaluation options for technology enabled care undertaken in 2017/18 has provided valuable recommendations on areas for improvement. During 2018/19 we will take forward these recommendations, particularly in relation to developing a revised measurement framework for the Programme so that work stream related evaluations use common definitions and collect certain core data, enhancing our ability to identify themes across the Programme. Deliverables in 2018/19 (budget circa 475,000) Specific inputs to other national change programmes, where technology enabled care have been identified as a component part, have been agreed by October A TEC Communications and Engagement Action Plan has been developed by December The Digital Health & Care week and national conference and at least six learning events have been held during 2018/19. European and international engagement is progressed with at least six study visits, 10 webinars, and four joint events undertaken during 2018/19. Two on line learning modules have been developed and made available to health and social care staff. National on line learning network for ongoing support, learning and knowledge exchange is in place. TEC data collection tools are in place by March 2019 to support local strategic and operational planning for health and social care. A revised measurement framework for the TEC Programme that responds to the recommendations in the 2017/18 review of evaluation approaches and includes project evaluations, benchmarking and regular data collection, is in place by August Successful delivery of the EU Third Health Programme funded project, SCIROCCO, by November 2018, which will include Scotland s participation in twinning and coaching activities with other European regions to share experience

18 and learning in successful technology enabled care implementation that will inform local system and service transformation. Strategic Priority 4: Transforming local systems Supporting Domains A, C, D and F: Digital Health and Care Strategy Supporting exemplars that are seeking to transform local health and social care systems using digital technology to shift local systems upstream to prevention and selfmanagement Outcome and high level deliverables 56. This Strategic Priority parallels thinking in the Digital Health & Care Strategy, and the TEC programme activities will complement and support this wider approach. There are also important connections and associated opportunities with other national priorities, particularly community empowerment and digital inclusion: collaboration with other programmes will bring opportunities of skills exchange, increasing capacity and the prospect of greater impact. Keeping the TEC programme s focus ambitious, but realistic and achievable, will be important. 57. Certain features are central to the TEC programme s purpose in embarking on system level change. Service re-design incorporates technology as integral Re-design embraces and delivers significantly greater opportunities for selfmanagement Demonstrably greater support for carers has been delivered so that they can continue their role for longer and with a better quality of life There is a multi-sector focus and success in mobilising and using the assets of the housing, independent and third sectors as well as health and social care Demonstrable improvement in key national indicators is delivered. The focus here will be site specific, but is most likely to include reduced admissions to hospital, lower care home stays, reduced level of care at home, reduced dependence on medication, fewer falls, fewer visits to GP, greater selfreported improvements in quality of life, and workforce related indicators.

19 58. The outcome to focus this strategic priority from is Transforming Local Systems The contribution that technology enabled care can make to transforming local systems, particularly upstream towards prevention and supported selfmanagement, is clear and pathfinder local partnerships are actively engaged and delivering 59. Associated high level deliverables for this outcome are Exemplars illustrating the role and contribution of technology enabled care services and supports are available for general use. Local partnerships have access to clearly articulated local digital transformation guidance by 2019 and advice developed from local exemplars ongoing. Specific deliverables 2018/ The scale and focus of these pathfinders requires further discussion: they could focus on a particular geography (a local community/locality, GP Cluster or GP practice), a particular population (such as people with a long-term condition), or a particular care pathway (such as respiratory), or some combination. It will not however be on a single service, which would reduce the potential for transformational change. 61. Work is already underway in Ayrshire & Arran, where an initial phase has focused on development of a shared transformational vision for the respiratory pathway. This is placing a self-managing service user in the driving seat of their own care, able to access and work with a range of services that enable them to live as full a life as possible at home. An initial phase has focussed on creating the conditions for transformational change, developing an explicit theory of change supported by an organisational development approach. This work will continue during 2018/19 to implement the pathway and explore wider transferability to other pathways and geographical areas. 62. For the remaining programme, an initial period of discussion, such as in workshops and innovation labs, will be undertaken both to generate interest in participation and to shape the call for submissions. This will take place during the first half of 18/19 in close collaboration with other national programmes to achieve synergy. A call for submissions with clear guidance will aim to identify between three and five pathfinders by December 2018 in support of implementation of the Digital Health & Care Strategy. The remainder of 2018/19 will be focused on supporting the set-up of these pathfinders.

20 63. During 2018/19, a formative evaluation will also be commissioned around these pathfinders. This type of evaluation ensures that the learning from the early stages can inform the project s design and performance, as well as making sure that learning can be made available more widely. Deliverables in 2018/19 (budget circa 800,000) Between three and five pathfinders identified by December 2018 in support of implementation of the Digital Health & Care Strategy Formative evaluation commissioned around pathfinders by March 2019 Conclusion 64. The TEC Delivery Plan sets out high level and specific deliverables in the context of the TEC strategic priorities and the Digital Health & Care Strategy objectives. The associated budget is set out in Annex 1. The Delivery Plan builds on the work to date (since April 2015) with a well-established programme and collaborations with delivery partners in place. The scope and pace of work will further evolve in the context of the Digital Health & Care Strategy but the TEC contribution is being clearly set out to support the wider implementation plan. 65. The deliverables and associated measures will be kept under review to ensure a balance between reasonable ambition and ability to deliver. As has been the case to date, the learning from implementation will inform next steps and regular updates will be provided to the Board along with a revised measurement framework. 66. The overall work and approach of TEC to date is well positioned to support the new Digital Health and Care Strategy. In particular the focus on National Direction (Domain A) will ensure that TEC is integrated as a key contributor to the national approach being taken forward building on the strong collaboration with national partners. Specific contributions across the Strategy Domains are referenced in this delivery plan and will be further developed over the next year. Additionally TEC will inform some key aspects of Domain F the Transition Process. Dr Margaret Whoriskey Director TEC Programme