Community Alarm Analogue to Digital Transition and Service Review Update
North Lanarkshire Council · 16 May 2023
Back to Adult Care and Social Work Committee — 16 May 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref DF/MF/KW Date 16/05/23 Community Alarm Analogue to Digital Transition and Service Review Update From Diane Fraser, Chief Officer (Adult Social Work Services) E-mail fraserd@northlan.gov.uk Telephone 01698 332001 Executive Summary This report informs Committee of the current position in relation to the Community Alarm Service, particularly describing the drivers for undertaking a review of the service and anticipated outcomes; and the Service’s transition from an Analogue to Digital infrastructure. Recommendations It is recommended that the Adult Care and Social Work Committee: (1) Acknowledge the contents of this Community Alarm Service Report. (2) Acknowledge the work being undertaken to ensure a seamless transition from analogue to digital and the work to date. (3) Acknowledge the progress to date and work ongoing regarding the Community Alarm Service review including the review of co-dependent services, particularly Home Support Out of Hours provision, Social Work Emergency Services and Registered Social Landlords. (4) Acknowledge the position with current and future charging for the service. (5) Acknowledge that recommendations will come back to the committee for endorsement from the review. The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities Ambition statement (13) Improve preventative approaches including self-management and giving people information and choice over supports and services
Page 2
1. Background 1.1 The Community Alarm Service supports people in North Lanarkshire live safely in their own home by providing a range of responses depending on the individual circumstances of calls made through the button and box in each person’s home. The responses include: • Providing reassurance • Contacting a friend or family member to visit • Arranging a home support worker to attend • Contacting GP or Emergency Services 1.2 The service operates 24 hours per day, 7 days a week, 365 days per year. When the individual activates the alarm, a signal is sent via the telephone line to the alarm receiving centre in North Lanarkshire which is staffed 24 hours a day, 365 days a year. A Response Advisor (call handler) speaks directly to the person to find out what kind of assistance is required. 1.3 The service provides 7,500 people in North Lanarkshire with the confidence that they can call for help at any time of the day or night, every day of the year and is an essential service when people experience particular difficulties such as a fall or sudden illness. 1.4 The majority of people live in their own home however the service also provides cover to all tenants living within NLC Sheltered Housing Complexes during out of hours and variously to registered social landlords. 1.5 The Community Alarm Service currently provides a telecare service to around 6,500 service users using dispersed analogue community alarms and to around 1,000 users within sheltered accommodation. 1.6 The service receives on average 1,000 alarm activations per day. Approximately 20% of these daily activations result in a Home Support Worker responding to support the person in their own home, to support with either personal care or in the event of a fall. Most alarm calls are for reassurance, essential to maintaining people in their own homes. 1.7 In addition to the basic button and box which people generally associate with Community Alarms, there are over 1,000 pieces of assistive technology programmed through to the alarm receiving centre. This ranges from door contacts to hard wired smoke detectors for individuals with cognitive impairment. 1.8 In 2020, as part of the centralisation of Care at Home, the service was relocated to the Dalziel Building to sit alongside the centralised Home Support Service, strengthening links and connections. Because of the responsive nature of the support offered through Community Alarms, as well as providing core service it also provides resource to support the Home Support Service, particularly out of hours, as well as significant support to the Social Work Emergency Service. The reach and stretch of the service requires a review of the operating model. 1.9 By 2025 all analogue telephone services in the UK will be switched off and replaced by digital systems using internet protocol (IP) technology. Telecommunication suppliers are well on the way to making this switch to IP networks. Scotland’s telecare service providers including health and social care partnerships, housing associations and many other organisations who use analogue connectivity to deliver their services, need to upgrade.
Page 3
1.10 North Lanarkshire Health and Social Care Partnership (NL H&SCP) and North Lanarkshire Council (NLC) have invested significantly in early intervention and supported self-management for over a decade, with support for change and investment across all sectors which focus on wellbeing. The Community Alarm Service is a key part of supporting self-management with technological advancements creating the opportunity to move from being a crisis response service to being more proactive and preventative. 1.11 The above circumstances summaries the importance of the Community Alarms Service, the changes to the digital infrastructure and need to review the operating model for the service. A review of the Community Alarms Service will develop options for the future service model that capitalise on new ways of working using digital technology, to establish community alarm and telecare services that are person- centred, and outcome focused, and support the achievement of the priorities and ambitions of the North Lanarkshire Health and Social Care Strategic Commissioning Plan 2023-26 2. Report Community Alarm Service Review 2.1 In line with the Digital Health and Care Strategy, a joint initiative between the Scottish Government and COSLA published in October 2021, we aim to improve the health and wellbeing in our communities. We must examine the current community alarm service and identify areas for development or changes required to the service to facilitate a more positive outcome for our citizens. Digital transformation must encompass the full range of health, social care and wellbeing services commissioned and provided by Health Boards, by Integration Authorities and by Local Authorities and their third and independent sector partners. Importantly, it extends as well to informal care, self-care, prevention, and public health. 2.2 This community alarm review will ensure that we are providing a person-centred and outcome focused approach to our community alarm and telecare service delivery that puts the citizen at the centre to ensure that new ways of working and technology will meet the long-term needs of the people of North Lanarkshire (Independent Review of Adult Social Care Scotland). 2.3 The review will consider the current service delivery model and involve communities, service users, families, carers, staff, and other key stakeholders to have their say in development options for the future service model that will deliver the best outcomes for users. 2.4 Focus groups will be a key aspect of this review to allow the views and wishes of our communities and services who have input to our Community Alarm Service to have their voices heard. These focus groups will ensure that we are building towards a person centre service that will meet the ongoing and future needs of the people who require to use the service and those who may require to use the service in the future. In addition, surveys will be sent to key stakeholders including for example GP services across North Lanarkshire for their feedback on the existing service and future needs.
Page 4
2.5 Focus Groups will include but will not be limited to: • Community Alarm Service • Home Support • Social Work Services (Social Work/Integrated Rehab Team/Integrated Day Service /Locality Support Service/Mental Health) • Health Care (Acute/District Nurses/GP’s/Falls Team/Pharmacy) • 3rd Sector (VANL/Getting Better Together Shotts) • Carers (Carers Together/MacMillan) • Housing Services including Registered Social Landlords 2.6 A range of data sources across a variety of systems in use in North Lanarkshire will provide essential information regarding the current community alarm usage and will allow us to detail how and who we support in our communities. This data will also help us determine how we currently use the resources within the Community Alarm Service. 2.7 Using one of our third sector partners we will interview around one hundred individuals living in North Lanarkshire who have had a Community Alarm Service recently, currently use the service or a carer of a family member of someone using the service. 2.8 We will analyse and interpret the range of feedback that has been gathered by the service from the public, from families and wider stakeholders contacting the service. 2.9 We also have Care Inspectorate Inspection Reports of the service and will use the information provided to enhance our learning of the service overall. The review will consider the recommendation to review the registration of the service. 2.10 The move from an Analogue ARC to a Digital ARC will require additional ongoing resources within the Community Alarm Service team to implement and manage the new operational environment. There will be various Device Management Platforms (DMP) that will need to be utilised to monitor, configure and setup new alarms onto the new Digital ARC, and this additional requirement needs to be included in the resource review of the service. 2.11 The service has not been included in any of the recent service reviews of the linked services it supports. It is therefore important that all areas of support the Community Alarm Service provides are included to ensure that proper management and governance structures are in place to support the transition to a new digital platform. Analogue to Digital 2.12 Telephone lines in the UK are being upgraded to digital technology. The process of migrating to digital telephone lines has already started. The rollout is scheduled to be completed by 2025, when analogue telephone services in the UK will be switched off and replaced by digital systems using internet protocol (IP) technology. 2.13 Telecommunication suppliers are well on their journey to making this switch to ‘IP networks’. Any systems relying on analogue lines, such as telecare, will be affected by this change. Individuals who have been provided with Analogue telecare equipment from North Lanarkshire Council must have their equipment updated to Digital ready devices to continue to receive a safe and reliable service. 2.14 North Lanarkshire is being supported in this transition by the Digital Office for Scottish Local Government. Across Scotland, most current solutions use analogue dial-up protocols to carry status and alarm signalling between the alarms devices in users’ homes and the Alarm Receiving Centres (ARC) - North Lanarkshire’s ARC is based in
Page 5
the Dalziel Building in Motherwell. Digital IP telephone lines are not designed to support these analogue protocols meaning that there is a risk that telecare alarm signalling will not operate reliably. This may result in a higher number of failed calls and redials being seen by the Community Alarm responders on the ARC system. 2.15 Current telecare equipment is connected to an individual’s home phone telephone line. The new digital solutions being installed connect to a home’s Broadband Router and from there connect to the IP telephone network. These require mains power to operate, but if there is a mains failure in the house the digital connection (and therefore the Community Alarm) would not work. Backup connection for community alarms is provided via the mobile telephone network using a SIM card in the digital alarm. The currently installed analogue alarms do not have a SIM and therefor have no resilience in the event of a power outage. 2.16 This transition to digital will require reviewing all the alarm devices that are in place within homes in the community and sheltered house residencies and replace these current analogue devices with digital ready alarm devices. There will also be a requirement for digitally enabled peripherals such as falls detectors, door contacts etc, to be thoroughly tested to ensure that they are compatible with any new digital alarm receiving centre and alarm device. The ability to connect existing interconnected fire/smoke detectors via the digital alarm is currently not available. Some manufacturers are working on solutions and have indicated there may soon be an ability to connect with some specific mainstream supplier products. 2.17 We have already changed over 1900 analogue alarms, with a further 600 scheduled to be exchanged by June 2023 to meet the planned change over dates advised by the Telephony providers. 2.18 There will be a requirement for the implementation of a digital ARC in North Lanarkshire to replace our current Analogue ARC to safely allow for calls to be transmitted through the digital network. The requirement of a new digital ARC to support this transition has allowed North Lanarkshire to work with the Digital Office for Local Government to create a tender for a national shared digital ARC. This will allow the Partnership to adopt a new Digital Solution that will meet future requirements and can be customised to our specific operational requirements. This work has included 13 other local authorities to ensure that a robust and secure solution can be found. The tender for this solution was published in March 2023, with a planned award date of June 2023. 2.19 North Lanarkshire currently runs PNC 8.1 an analogue ARC provided by Tunstall Healthcare (UK) Ltd. The current contract runs until the 31st of March 2023 and is being extended for 1 year. 2.20 North Lanarkshire Council have committed to be part of a Nationally Procured Digital Alarm Receiving Centre, led by the Digital Office. This procurement is now live, and the anticipated award date is the end of June 2023. North Lanarkshire will be one of the first adopters. 2.21 Funding was secured from Technology Enabled Care (TEC) Scotland to the sum of £15k to support us to carry out a telecare service review in anticipation of Analogue to Digital transition.
Page 6
Community Alarm Charging 2.22 From 14 September 2020 a charge of £3.40 per week (49p per day) was introduced, with the rate remaining the same since that time. Any calls made to the response centre are also billed as normal telephone calls by the person’s telephone company. 2.23 At the time of introducing the charge everyone with a Community Alarm was offered a full financial assessment. Anyone receiving a service since or considering a service is offered a financial assessment to check their income is fully maximised. In these uncertain times and recognising the cost-of-living pressures, the importance of this offer is recognised. Anyone whose circumstances change or who is concerned about the affordability is also encouraged to discuss this with the service with further assistance offered. 2.23 The weekly charge of £3.40 was introduced at the North Lanarkshire Council budget setting meeting on 24th February 2020 which was consistent with the average charge in Scotland as per 2019/20 Audit Scotland Local Government Overview report. North Lanarkshire was one of the last local authority areas in Scotland to introduce a charge. The total projected annual value of the approved charge was £1.410m. 2.24 It was recognised that the agreed charge would support the Council and the Integration Joint Board to continue to deliver this service to a high standard through having the appropriate staffing and financial resources to meet the needs of those who use the service. 2.25 It should also be noted that the transition from Analogue to Digital alarms will attract further operating costs as each alarm will have as a minimum one roaming SIM card, and perhaps two if there is no home broadband connection that can be used as a primary connection to the ARC. Current costs for these roaming SIM cards are £4.00 per month per unit, the cost of which could increase annually in line with inflation. The Digital Office have indicated that they will engage with Telecom suppliers to try and negotiate a Social Tariff, however this has not progressed as yet. Based on a current installed estate of 7,500 alarm units this will bring an operating cost of between £360,000 and £450,000 per annum (based on £4.00 per month current charge or an anticipated £5.00 per month) to support the new digital alarms. 2.23 Due to the Covid-19 outbreak introduction of the charge for community alarm was delayed until September 2020. This delay ensured that the communication to recipients and support with enquiries and financial assessment was effectively resourced. 2.24 It was agreed that a 4 weekly invoice would be issued to people receiving the community alarm service. As the charge has progressed the service has supported people and their families in setting up direct debit payments for the community alarm charge. As a result of the system supporting billing, unfortunately when paying the charge via a direct debit an invoice continues to be issued every 4 weeks as the system is unable to identify and remove those service users from the billing system. 2.25 The volume of invoices now being issued is excessive, with around 83,000 invoices being issued over the course of the last financial year. To improve the experience for people in receipt of a community alarm, or for family members paying it on their behalf, and to minimise the oncome lost through the administration of the billing process, improvements to the billing system, alternatives, and a wider range of options for payment are being explored.
Page 7
2.26 It is important that we move to as position of issuing less invoices and issuing them to reflect the payments arrangements that suit people. Consideration is being given to introducing the options of paying annually or quarterly for community alarms which may be attractive to some recipients and would reduce the cost associated with issuing invoices. 2.26 Income generated within the current financial year 2022/23 at Period 12 is £822k, with a forecasted outturn of £981k for the full year. Income generation while substantial falls short of the initial estimated income generation of £1.410m which was an over estimation evident as a result of cleansing of the information supporting the assumptions in the calculation. 2.27 Non-payment of around £280k of charges has accrued. Given the age profile and vulnerability of the people supported via the community alarm, the service would like to be able to contact all service users more quickly to support with alternative payment methods and to offer financial reassessment. 2.28 The income generated from the charge for community alarms is important to the continued development of the service and increased operating costs associated with digital advancement. It is however important to note that the Council had not pursued the recovery of debt and as noted in previous Committee Reports, given the vulnerability of people using the service individual community alarms will not be cut off due to non-payment. 2.27 The review of the current service will include a review of the staffing resources needed to support the charging process. 3. Measures of success 3.1 The review will consider the current service delivery model and involve communities, service users, families, carers, staff, and other key stakeholders to have their say in development options for the future service model that will deliver the best outcomes for people. The review will also ensure that the service is digitally ready to continue to provide a safe and reliable service. 4. Supporting documentation None Diane Fraser Chief Officer (Adult Social Work Services)
Page 8
5. Impacts 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? An EQIA and Fairer Scotland Impact Assessment will be undertaken as part of the review process. If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality- and-fairer-scotland-duty-impact-assessments Yes ☐ No ☒ 5.2 Financial impact Does the report contain any financial impacts? Yes ☒ No ☐ If Yes, have all relevant financial impacts have been discussed and agreed with Finance? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? The future financial impact will be explored fully as part of the review process. 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☒ No ☐ If Yes, have all relevant HR impacts have been discussed and agreed with People Resources? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? HR Business partners have been fully engaged in the design and development of the review process and will be key partners in undertaking analysis of the information gathered. 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☒ No ☐ Legal impacts will be fully explored as part of the review process. If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data?
Page 9
Yes ☒ No ☐ A data protection impact assessment will be undertaken as part of the review process If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☐ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐ 5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Where the impact identifies a requirement for significant technology change, has an assessment been carried out (or is scheduled to be carried out) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? 5.9 Risk impact Is there a risk impact? Yes ☒ No ☐ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? The risk register will be updated in line with the findings and outcome of the review of the service. 5.10 Armed Forces Covenant Duty Does the report require to take due regard of the Armed Forces Covenant Duty (i.e. does it relate to healthcare, housing, or education services for in-Service or ex- Service personnel, or their families, or widow(er)s)? Yes ☐ No ☒ If Yes, please provide a brief summary of the provision which has been made to ensure there has been appropriate consideration of the particular needs of the Armed Forces community to make sure that they do not face disadvantage compared to other citizens in the provision of public services.