The Department of Health has launched a campaign to use telehealth to improve the lives of 3m people over the next five years.
The launch came as the DH simultaneously published a review of innovation in the NHS and the ‘early headline findings’ from its Whole Systems Demonstrator programme.
The WSD randomised controlled trial was launched in May 2008 to assess the benefits and impacts of telehealth and telecare technology on the NHS and social care services.
It is probably the largest trial of its kind in the world, involving more than 6,000 patients and 230 GP practices across sites in Newham, Kent and Cornwall.
The programme was initially due to run for a minimum of two years. Now, three and a half years since its launch, the DH has released the ‘early headline findings’ of the telehealth element.
The results, which take up one paragraph in a report totalling four pages, say the correct use of telehealth can deliver; a 15% reduction in A&E visits, a 20% reduction in emergency admissions, a 14% reduction in elective admissions, a 14% reduction in bed days and an 8% reduction in tariff costs.
The report says the results show “at least three million people with long term conditions and/or social care needs could benefit from using telehealth and telecare.”
To achieve this, the DH is launching its ‘three million lives’ campaign in partnership with industry, the NHS, social care and professional partners.
The DH said in a separate statement it would deploy remote medical devices - such as home-based equipment that can send details of the vital statistics of at-risk patients to doctors – to 3m people over the next five years.
However, the WSD results report maintains the campaign is not a national target or a government guarantee.
“Instead, it is more about the department providing national leadership, strategic direction and advice to NHS and social care organisations, with support from industry [which] would be responsible for creating the market and working with local organisations to deliver the change.”
It says a detailed workplan for the campaign is in the early stages of development and further information will be available “in due course.”
Meanwhile, a review of innovation in the NHS says the early indications from the WSD programme need to be exploited through the spread and use of telehealth.
It says the need for capital investment in telehealth is “prohibitive”. To get around this problem, it says the DH will work with industry to identify ways of re-profiling costs, so they can be met from downstream revenue savings.
Despite the limited release of the WSD results and the financial problems raised by the innovation review, Prime Minister David Cameron used telehealth as an example of the government's commitment to create a vibrant life sciences industry in the UK.
"We've trialled it, it's been a huge success, and now we're on a drive to roll this out nationwide," he said in a widely anticipated speech yesterday afternoon.
"Dignity, convenience and independence for millions of people. And this is not just a good healthcare story. It's going to put us miles ahead of other countries commercially, too."
The full results from the WSD programme are being evaluated by six major academic institutions – City University London, University of Oxford, University of Manchester, the Nuffield Trust, Imperial College London and the London School of Economics.
This evaluation will be published in various papers, once again, “in due course”. The same commitment is made for the telecare segment of the WSD programme.
In addition: “More detailed analysis of the data will results in further papers being published over the coming months and years.”
© 2011 EHealth Media.
A vast literature about telehealthRichard Sarson 162 weeks ago
Some of the commenters seem to think that telehealth is something that has suddenly sprung out of the woodwork. If you hunt for them, there have been write-ups of a myriad pilots over the last 15 years, in the UK, and more importantly in cold countries like Norway and Canada, where several feet of snow for half the year makes telehealth a must-have. Some of these write-ups have been academic - too academic for me.
The WSD Demonstrator programme is massive, and is to be followed, I understand, by a larger project called Dallas, covering 50,000 patients. So, nobody can grumble about lack of "rigour".
re: tele health or call centretony.f 163 weeks ago
Just wondering if this really is tele-health or simpy call centre related work, having seen a few attempts at tele-health from private companies not many are actually delivering what i would as a clinician call tele-health ie. patient on screen with clinician on screen... Happy to be proved wrong on this one..
Babies and bathwater...nota bene 163 weeks ago
There may be valid concerns about how good DH/NHS is at spending wisely on technologies but it's ridiculous that we are not taking full advantage of the connectivity which so many homes have these days.
As per recent headlines, many of us lead lifestyles which increase significantly the likelihood of our suffering from cancers. Many more have conditions such as stress which benefit from non-medical interventions. Tele-something (no time to get hooked on the nomenclature here) might have an educational role to play, particularly where a condition is emerging or has emerged and requires lifestyle changes to address it - giving up smoking, controlling our diet, etc - or action or medication to keep it under control - diabetes, Parkinson's, COPD, coronary heart disease, etc.
There is much work to do to find out what does and does not work (in health outcome terms) in this field, but we need to get started. In the same way that for many people multiple texts per day have overtaken the once a week telephone call, a higher frequency of patient interaction (even if only with a machine) may have something seriously beneficial to offer in maintaining health and quality of life.
Contributors to this debate should not dismiss other contributors' assertions based on their personal experiences in favour of rigorous research. If we must have research/analysis, please can we focus initially on the potential harm which might be done (as one contributor suggested) by telehealth, identify measures to address, and then get on with some meaningful trials at scale? And not bog this down in an elongated benefits-and-drawbacks discussion before we start improving and saving lives?
Telehealth is inevitableNeelam Dugar 163 weeks ago
I think telehealth is inevitable as much as todays mobile phone is.
Most radiologists review oncall CTs at home on their laptop around NHS today.
What is crucial is access to full clinical information for a patient to support patient care.
This is where Global interoperability standards XCA & XDS play a big role. The informatics community in NHS must ensure we do not repeat the mistakes made by NPFIT.
Accentuate the negative, eeliminate the positiveRichard Sarson 163 weeks ago
Some of the above niggling comments reflect the usual luddism of the medical establishment, faced with any major technological change to their 19th C working practices. Just like their objections to the SCR, until OOH doctors, pharmacists, the muscular dystrophy society, Asthma UK and others weighed in with evidence that the SCR enhanced patient safety.
As an elderly patient, I want to avoid as far as possible MRSA by visiting hospital as little as possible, or catching the snuffles in a GP's surgery.
Besides, video appointments (on occasions where hands-on examination is not necessary) would save me time and the doctors time, and the NHS a load of money.
For me to extend my life, please, please, DoH, roll out telehealth as fast as possible. (I fear that Jan Hoeksma is right; there isn't any money to do it.) You've dragged your feet long enough already - 15 years by my reckoning. Don't listen to the usual bunch of naysayers. Find the money.
Wide of the markJacquesOuze 163 weeks ago
No, you're way off with this. Most of the comments are neither nit picking nor luddite. For my part, they reflect a concern that politicians are exhorting the NHS to spend money on unproven systems as part of wider attempts to stimulate the economy.
In spite of various claims, there is no hard evidence that telemedicine either leads to better clinical outcomes or saves money. So one likely outcome is that the widespread adoption of telemedicine will be just another drain on NHS budgets without demonstrable benefit. The only winners will be software vendors with products to shift.
What raises this from being a minor irritation to a major issue is that various parts of NHS R&D and bodies like NICE were put there to prevent companies getting their products into circulation before their benefit could be assessed, thereby saving taxpayers money. It appears that the government may be colluding with business to subvert these safeguards.
If the benefits are really there, publish the research.
Telehealth saves moneyMoonray Healthcare 163 weeks ago
An integrated, service led telehealth solution actually saves PCT's money by reducing hospital admissions through improved patient monitoting and care. CFO's of PCT's should be looking at the results of the WSD trials and realising that telehealth solutions will help them achieve their cost reduction targets while at the same time giving patients with long term conditions a personalised monitoring service that they have been crying out for for years.
Some Telehealth saves moneyNick Tordoff 163 weeks ago
You miss the point that several of us are making. The report hedges its findings very carefully
"early indications show that IF USED CORRECTLY telehealth can deliver ...( various valuable benefits)"
but what does "used correctly" mean. Without this information we could all be rushing a head with implementations that are not correct and will be wasting our money.
I am not luddite or anti-telehealth. Quite the opposite. I just want to make sure I use the small amount of available cash wisely. I just want them to publish the results of the trials
Time saver or time waster?P Millares Martin 163 weeks ago
If patients were better served by a computer analysing their symptoms, most doctors would have been redundant long time ago.
It is fine to improve data sharing so you get a better assesment of the clinical picture in front of you, but forcing telephone and televideo consultations not necessarily saves time, you still need to do a consultation, where examination is not always possible, where relationship get colder, and not necessarily as fructitious.
And the big question is who is manning it? There are things that can get sorted with telephone and if you want to push it televideo, but there is still the need of someone to do the consultation, and the need of training to achieve a reasonable standard of care, as they can not be a replacement for all face to face consultations, and no examination
Benefits of TelehealthMoonray Healthcare 163 weeks ago
Telehealth in this context is not about remote GP consultations, it's about managing patients with chronic health conditions such as COPD, CHF and Diabetes. It is this group of patients that make up a large percentage of healthcare costs and if managed better via telehealth solutions would result in cost reduction for the NHS, and more importantly provide a better quality of life for patients.
Evidence?Paul Cundy 163 weeks ago
I represented the BMA at a launch event earlier in the year. The policy people admitted that they were "having to crunch the numbers again" in order to track down the anticipated benefit. Then a presenter from one of the showcase pilots got up and admitted there had been no long term benefit, indeed that after a while the patients got a bit lonely staring at their boxes and "opted to have personal visits from staff again".
So I would add my voice to those asking to see the data published so others can independantly analyse it.
From the GPs perspective there are two issues; the information tsunami that will result. Despite the intermediary "monitoring" services they will inevitably be threshold driven and will result in numerous allegedly wayward readings being referred to us. These will all then need to be assesed. Who, when, how and what do we stop doing to resource this?
Secondly is the concept of time as an intervention. Beleive it or not I have children brought to my emergency appointments who have developed a cough or a temperature or a headache during the school run, symptoms reported at say 08:45, ring the surgery, book appointment, seen by me at 9:20. The problem is that at this stage of the illness its impossible to asses. Wait 4 or 12 or 24 or even 72 hours and see how things progress using time as a tool is an extremely valuable process. These proposed systems make reporting so rapid it has the potential to distort everything.
Simple idea = complex problem.
My point about mythsNick Tordoff 163 weeks ago
Most implementations of telehealth are nurse led. Triggers on thresholds are sent to community or specialist nursing teams. This means there is little inappropriate impact on GPs and a substantial reduction in unnecessary visits by Nurses.
I am not a medic but the analogy between a childhood cold being left for 24 hours and a sudden change in vital signs for a heart failure patient seems a little stretched.
Where we agree is that we need to see the data. We need to understand what a good implementation is so that we don't drive up unnecessary interventions. Perhaps more importantly, we need to understand which implementations were deemed as not good in order to acheive the remarkable results in this paper.
Where are the scientific papers?TrishaGreenhalgh 163 weeks ago
I've bene waiting for the results of the WSD trial for many months. How appropriate to hear them from David Cameron.
As every undergraduate knows, there are a number of questions to be asked about a randomised controlled trial with an economic component - for example:
[a] What was the sampling frame (i.e. who exactly are we talking about when we say tele-health "works" for them)?;
[b] What proportion of people invited to participate agreed to do so, what proportion declined and why? Why was recruitment significantly slower than anticipated?
[c] What exactly was the intervention (e.g. how much extra input from professionals did the intervention group get compared to controls)?
[d] What were the predefined primary endpoints?;
[e] What was the cost, in terms of money and staffing levels, of providing the intervention and was this fully taken into account in any cost calculations? (e.g. what was the incremental cost effectiveness ratio of preventing an A&E attendance?)
[f] Given that results are being discussed by politicians in terms of "lives", was mortality a predefined endpoint in the trial and if so, was there a statistically significant difference in mortality between intervention and control groups?
And so on. Can someone please publish some DATA so we can have the scientific debate we need before yet another expensive technological solution gets pushed into policy "at scale"?
Assertions vs supported reasoningKeepItSimple 163 weeks ago
Trisha makes the vital point here. We're talking about big money and people's lives. I know we're not used to it, but can contributors please stop making assertions based on their own particular experience and thoughts and instead join the request for properly researched evidence? I have opinions but they remain pretty useless and certainly unsupportable by evidence so they are suitable only as a debating point around the water cooler.
PS - I don't exempt the DH on this - where's the evidence to support the organisational change underway?
Important questionsNick Tordoff 163 weeks ago
I case anybody dismisses these questions as *just* academic it is worth noting that the trial covered three very different disease areas COPD, diabetes and heart failure. Previous studies have shown very different outcomes for telehealth interventions in these different areas.
As an exagerated example, the results could derive from massively improved mortality in two of these areas and telehealth being actively haremfull in the third. Even if the differences between the impact of telehealth on the deseases is is much more minor it is likely have a significant impact on the its cost effectiveness of different approaches to roll out.
Lastly without the detailed findings we don't know to what extent these findings can be generalised to other long term conditions.
Please get on and publish the results!
Follow the moneyJon Hoeksma 163 weeks ago
Recent conversations with suppliers involved in the area of telehealth suggest that the government's ambition of 3m people to get telehealthy services within the next five years may be a pipe dream as there is no money to back up the aspiration.
Suppliers say that DH policy wonks have come back with responses like: 'we haven't got any money to pay for this, we hoped you might'. Without investment or freeing up existing NHS funding, by say changing NHS tariffs, the only way this is likely to happen is if it becomes a consumer service that people pay for directly. As things stand why would you.
So the policy ambition is laudable but its going to fall flat very quickly without resources to make it happen.
Jumping the gunJacquesOuze 163 weeks ago
I'm uncertain as to how laudable the policy ambition is. As Prof Greenhalgh points out, the research has not been published yet, so we don't know what constitutes the 'correct use of telehealth' still less the full pros and cons and business impacts.
Pre-emptive policy announcements of this kind, particularly those that involve an effusive PM make me highly suspicious. I suspect otherw will feel the same and reserve judgement accordingly.
challenges exist - part of reason for 3MLIntellect Healthcare 163 weeks ago
your concern for this falling flat is valid - but it is one of the reasons we have launched the 3 Million lives Campaign. One of the core workstrands for the 3ML campaign is to remove the barriers that exist today to scale telehealth - including changing tariffs which DH are already working on.
We have a list of other barriers to remove, incentives to provide, guidance for commissioners and education for carers, and looking at commercial and service models to use.
We're still in early days and are working on setting up the programme to deliver this with the wider industry, DH and health community. We would welcome everyone's views once we've had the chance to spell out the details and get more data and analysis from the WSD.
It is about time we move from small scale pilots to main-streaming this service to patients. We have got very good support from industry (not just Intellect members) and wider health and care community so far to take this froward. Something's got to change in the NHS and we hope this will be one of the new changes.