The coalition government and the Department of Health have put their weight behind telehealth as a means of improving health outcomes for 3m of the 15m people in England with long term conditions.
Telehealth has also been placed firmly on the quality, innovation, productivity and prevention agenda as an innovation, and it has been identified as an opportunity for investment in the UK life sciences industry.
WSD results give support
According to the early, headline findings at least, the results of the whole system demonstrator programme - the DH’s telehealth and telecare pilot in Cornwall, Kent and Newham - were impressive.
The WSD trial tested telehealth and telecare devices with 6,191 patients from 238 GP practices from May 2008 to September 2010, in what is thought to be the largest randomised control trial of the technologies in the world to date.
Although the results have yet to be published in full, those initial results showed a 15% reduction in A&E visits and a 20% reduction in emergency admissions, when the technology was used “correctly”. Elective admissions fell 14% and there was a 14% drop in bed days. Tariff costs were reduced by 8%.
Gap between national and local views
Announcing its 3millionlives campaign in January - a strategic partnership between the DH and the telehealth industry - it is clear that the department envisages taking a strategic and leadership role; but it will be up to local players and industry to create the market that makes the change happen.
Yet it appears there is still a gap between the policy statements and the reality on the ground. At a round table organised by Appello, GPs and clinical commissioning group leaders supported telehealth in principle.
However, they expressed doubt about the breadth of the evidence base and in particular whether it gave them enough information on which to select the patients who might benefit most from telehealth. In other words, they said “yes” to 3m lives but asked: “which three million?”
This was not their only concern. GPs and practice managers had doubts about the strength of the business case, including whether the funding mechanisms exist to allow any cash savings to accrue to them rather than to other parts of the health service. Commissioners do not yet know what a “good service” looks like and how they might best commission one.
To that end we have co-founded the Telehealth Forum, which brings together organisations including the NHS Alliance, the National Association of Patient Participation, the British Lung Foundation, members of the Royal College of GPs and Royal College of Nursing, and Appello.
Its purpose is to develop information and educational materials that are shaped from the bottom up by patients and their carers, in collaboration with the doctors and nurses responsible for their overall care and, in due course, for commissioning services for people living with long term conditions.
Taking in the patient perspective
From a patient’s perspective telehealth can provide a number of clear advantages. It keeps patients informed about their condition, provides comfort, added security and reassurance for many very vulnerable patients who are otherwise feeling isolated and alone.
In terms of logistics, it can also substantially reduce the amount of time patients spend travelling to and from healthcare providers. During cold winters this is a distinct positive for the patient, particularly in avoiding infections in waiting rooms.
Not all these advantages would necessarily be viewed as clinical benefits by commissioners but for patients they are very real.
Telehealth can clearly complement but is not a replacement for face-to-face healthcare services. It can assist the health professional and the patient to develop a trusting, caring and effective relationship. But it is another tool in the professional’s bag to be used where and when appropriate for both parties.
When to use telehealth has to remain a clinical judgement, not one dictated by cost. The challenge for emerging clinical commissioning groups will be to judge the value of this new tool and to invest resources accordingly.
The British Lung Foundation is encouraging commissioners to listen to their patients, to make sure that the patient experience of telehealth is effectively fed into the commissioning process. Their thoughts and experiences should play a vitally important part in any cost/benefit commissioning exercise.
Nevertheless, we fully support the notion that millions of lives can be enhanced through the implementation of modern, flexible and reliable telehealth; and 2012, it seems, is the year to start that process.
About Apello: Launched in August 2010, Appello provides nurse-led, home-based, personal monitoring, advice and support for a monthly pay-as-you-use charge.
Appello comprises CarelineUK, the largest telecare and telehealth monitoring provider in the UK, health record provider CentriHealth, control centre infrastructure provider Volt Delta and telehealth home hub and remote monitoring supplier Numera Health.
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