With the right approach to handling governance, quality and safety issues, telehealth can help the NHS address the growth in future care needs, says Andrew Corbett-Nolan.
Commissioners and providers have transformed the NHS over the past few years, shifting the care model from acute in-patient treatment to one where more patients are being cared for with shorter hospital stays and fewer available beds. However, being able to meet the known challenges of the years ahead means more needs to be done.
Care needs are themselves changing. The number of people living with long-term conditions is rising, and the future trends dwarf efforts to contain the costs of care if we stick to the current ways of working.
Today, 75 per cent of NHS resources in England are devoted to supporting the lives of the 15.4 million people who live with at least one chronic condition. Since 1996, the number of people diagnosed with diabetes in the UK has increased from 1.4 million to 2.6 million. Predictions suggest that by 2025, nearly 20 per cent of the national wealth will need to be spent on healthcare, unless the existing care model is drastically altered.
As such, sticking with the status quo and hoping the health service survives with a bigger budget is not realistic. There’s only one option: that is to change and modernise the NHS, to make it more efficient, more effective and above all, more focused on prevention and health, not just treating sickness.
Telehealth has the potential to transform the health service, supporting patients who live with potentially significant health conditions but for the majority of time are able to manage these and enjoy independent, fulfilling lives at home. It can reduce the risk of patients’ health gradually deteriorating and developing acute care needs and, because the patient is intimately involved in monitoring their vital signs, it fosters a better understanding of their condition and builds empowerment and confidence.
However, delivering these benefits at scale demands the correct approach to devising and implementing telehealth programmes.
Our report, Better care for people with long-term conditions: the quality and good governance of telehealth services found a number of healthcare leaders chose to treat telehealth as a cost containment tactic, thereby missing a sizable proportion of its value as a means of significantly realigning working principles, and transforming the expectations of patients.
Critically, many healthcare managers and clinicians had very out of date views about what modern telehealth can deliver and as such aren’t focussing on this proven means of delivering better patient outcomes.
Understanding telehealth
This presents a real risk that the introduction of telehealth may be slowed by the common myths and preconceptions surrounding the nature of the service. Some healthcare professionals mistake it for an emergency service, while others see it leading to greater isolation from reduced human involvement.
These misunderstandings need to be recognised and resolved to ensure commissioners fully realise the potential of telehealth and this significant opportunity isn’t lost.
Telehealth plays a pivotal role in supporting older people and those with long term needs to live independently, by effectively managing their health and well being. Early adopters of the service and trusts mainstreaming telehealth have demonstrated how it delivers clear benefits to the patient and local healthcare economy alike.
The increasingly widespread use of telehealth solutions is also transforming the ability to manage chronic disease and long-term conditions in the community, shifting the balance away from the current reliance on hospitals and long-term institutional care.
However, the ground for telehealth needs to be laid carefully, as it is critical to “size” the issue correctly in the minds of commissioner and provider managers, as well as clinicians, in order to identify and address preconceptions and misunderstandings.
Good governance matters
To date, PCT commissioners have typically been responsible for the implementation of telehealth services. As health reforms progress, the responsibility should broaden to include both the new clinical commissioning groups as well as providers of care, who will increasingly become responsible for the whole pathway of patient care and be incentivised to take the care of patients with long term conditions from the hospital.
In order to effectively govern telehealth, strategic planners and service development managers in both commissioning and provider organisations need to look across the range of strategic agreements they have in place, and combine these with telehealth services. These include committing to patient engagement, identifying needs in the local joint strategic needs assessment, building partnerships between health and social care and documenting local savings and investment plans.
As with any successful programme, the earlier that all those involved are engaged, the more successful and rapid the change will be. Clinicians are no less likely than others to harbour common misconceptions about telehealth, and a comprehensive and thorough education programme needs to be put in place so that clinicians understand the programme, what it intends to achieve and how this will impact on new ways of working.
Managing the risks and rewards
It is also important to understand the incentives that will drive the implementation of telehealth. Telehealth can provide cost savings to a local healthcare economy by reducing the number of hospital admissions. However, to introduce telehealth across a whole healthcare economy, the provider’s services will also need incentivising through risk and benefits sharing.
Reducing the payment-by-results income of a provider through reduced admissions will not incentivise a commitment to service change. By introducing telehealth appropriately, commissioners can align services with the local QIPP programmes, formal risk and benefits sharing systems and arrangements to encourage providers to take overall responsibility for whole care pathways.
For telehealth services, commissioners should secure a range of assurances from the provider of the telehealth services. For example, it is critical to understand who is managing the decision-making clinician and who will refer patients to the telehealth service, agreeing their care plans and having the authority to vary care from these plans.
Looking to the future
As a means of delivering patient-centred, effective, efficient and economical packages of care to those requiring the largest slice of NHS resources, telehealth needs to be on the agenda of all NHS organisations, whether they are commissioning or providing services. Boards need to make it their business to understand the potential of telehealth.
In order to successfully implement telehealth, boards need to understand how the ageing population is likely to affect their services and the lives of their services users over the coming decade, devoting time to understanding these changes and the route for collecting, analysing and reviewing the most basic health and care data.
On appreciating the potential benefits locally, healthcare leaders will need to understand how to implement change and recast the care pathway, changing the care value chain, realigning ways of working and revolutionising the expectations of patients. In doing so, those responsible for healthcare organisations will need to be well versed in the safety and quality issues that have to be addressed.
The “value for money” argument for telehealth services is well rehearsed, but as the demand for care increases in times of financial constraint, telehealth has proven to be more than just a cost-effective solution: it is also clinically effective and patients like it. It benefits both service users and clinicians, reducing unplanned hospital admissions, putting less strain on resources, while maintaining patients’ health through closer management of their conditions.
Put simply, telehealth delivers empowerment to the majority of those using the NHS, and can raise the bar on what it’s possible to deliver in terms of improved quality of life and independence for people living with a long-term condition.
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