Telehealth transforms lives, saves money and is backed up by evidence. So what’s stopping us, asks Jim Easton?
The BMJ has now published its first paper on the Whole Systems Demonstrator (WSD) programme, Effect of Telehealth on Use of Secondary Care and Mortality: findings from the Whole System Demonstrator cluster randomised trial.
The paper has reiterated the headline findings, namely that telehealth services can substantially reduce mortality (by 45 per cent), reduce the need for emergency admissions to hospital (by 20 per cent), lower the number of bed days spent in hospital (by 14 per cent) and reduce the time spent in accident and emergency (by 15 per cent).
In addition, the Department of Health estimates that savings from the widespread use of telecare and telehealth could save the NHS up to £1.2bn over five years (although the financial benefits in the study are inhibited by early implementation costs).
But for me, this is really about transforming service delivery for people with long-term conditions so that many more people are able to benefit from it.
It’s true that telehealth has had its fair share of good and bad publicity recently. In some camps, it is claimed that telehealth is not wanted by clinicians because of the lack of robust evidence and where an investment has been made, it is stuck on shelves. In some ways it’s a typical story of innovation in healthcare.
Linda Prosser, the commissioning director at NHS Gloucestershire, has been one of the innovators. She is implementing a telehealth service as a key component of chronic obstructive pulmonary disease and heart failure care pathways. Her message for fellow health commissioners is: “This is a great example of how austerity can be a virtue. Being focused on cost-effectiveness led us to work creatively and innovatively to really improve the quality of services.
“We are enabling people to look after themselves and live more independently. We are also seeing other benefits, including reductions in unplanned consultations and hospital admissions.”
There is no avoiding the challenges ahead. The UK economy, in common with healthcare systems in all developed countries, can’t sustain the current models of care in the medium term. Seventy per cent of the NHS budget is spent on long-term conditions (£80bn) and it will rise by 257 per cent in the next nine years. Change that drives quality and efficiency together is essential.
As we grow older, we want a life with fewer hospital visits and not be tied to clinics of bricks and mortar. People are growing up with technology and it’s going to be commonplace for many of us.
When the headline findings were released in December 2011, there were two options – sit and wait, or do something about it. We believed there was a moral imperative to get the headlines from WSD out there. WSD really allows us to say that if you use telehealth or telecare, this is what happens and gives us a proper evaluated evidence base.
That is why we launched 3millionlives (www.3million lives.co.uk) in collaboration with industry, the NHS and local government. It aims to transform care for people living with long-term conditions using telecare and telehealth where appropriate, and is born of the WSD programme, which makes the case for adoption at scale.
While we know it works, it’s important to get the contract right. The WSD costs were high due to the nature of the trail – the lesson we have learned is about responding and finding ways of changing models of delivery so that we get use up and costs down – then it becomes cost effective.
To this end, the use of revenue-based models and risk and rewards contracts are becoming more widespread.
The Department of Health’s role incorporates leadership, governance and programme management from the centre. It provides the policy context and will look to maximise the benefits of national levers and incentives such as tariff and CQUIN.
The department is not looking at the disease-specific care pathways, but the overarching design of care and how telehealth and telecare fits in.
The rest of the world is gearing up to do something and so it’s really important that the UK is leading. But at the end of the day, it will only work if patients accept it.
David Ward, 69, from Wakefield had a heart bypass 12 years ago. Through a telehealth solution he is able to self-monitor his vital signs, along with key data such as blood glucose and weight, and the information is sent to his care team for analysis. He says: “The confidence I have in this system means I don’t worry about my health like I used to. I’ve started to walk small distances again. I’d go as far as saying it’s given me a new lease of life.”
Telehealth has so many possibilities and we owe it to people like David not to wait, but to act now.