There is a more efficient and cost-effective way to treat long-term conditions that also benefits the patient
A target of delivering between £15bn and £20bn in efficiency savings over the next four years has been set by the new operating framework for the NHS.
The announcement of the Whole System Demonstrator (WSD) results in early December 2011 highlighted that telehealth provides a unique opportunity to make significant financial savings when implemented for patients suffering with long-term conditions.
The report provides robust evidence in support of changing the way healthcare is delivered and accessed and, in particular, the way that the NHS manages the growing problem of long-term conditions. The government's recent drive to boost private sector funding of infrastructure projects is also a timely catalyst to help deliver telehealth systems in the UK.
Patients who suffer from long-term conditions make up 31% of the population, but approximately 69% of all primary and acute care budgets in England are spent on them. They account for more than half of GP appointments and nearly two-thirds of all outpatient appointments. The 5% of patients who have one or more long-term conditions account for 49% of all inpatient bed days.
One particular long-term condition, chronic obstructive pulmonary disease, is the second most common cause of emergency admissions, the largest cause of hospital readmission and is one of the most costly diseases in terms of hospital care.
So, looking at different ways of delivering care to patients who suffer from these long-term conditions is a key priority for an NHS facing challenging efficiency targets. The delivery of those targets will require the NHS to challenge the current methods of service delivery and the boundaries that are often placed on the provision of acute, community and social care.
Telehealth and telecare have been shown to provide opportunities for delivering care more efficiently. There is national and international evidence that demonstrates the delivery of both cost savings and improved care to patients with long-term conditions. The benefits have primarily been in preventing unplanned hospital admissions and facilitating early discharge.
It also provides a mechanism through which selected patients with long-term conditions can remotely monitor a range of daily vital signs such as blood pressure, oxygen saturation, pulse rate, temperature and weight. This also provides trend data for clinical teams.
Additionally, it has been demonstrated that the act of taking their own readings can provide patients with a greater understanding of their own condition thereby promoting improved self-management and they often highlight a renewed independence from a normal daily life.
Recent Department of Health research highlighted that over 90% of people with long-term conditions say they want to be more active self-carers and over 75% would be confident in being a self-carer if they had support and assistance.
The WSD projects figures show a 20% reduction in emergency admissions and a 14% reduction in elective admissions. Telehealth also leads to significant reductions in the number of A&E visits, increased levels of patient satisfaction and a 45% reduction in mortality.
Even greater benefits can be realised when the NHS works collaboratively with colleagues in adult social care to develop integrated telehealth care pathways.
This kind of integrated approach can deliver reductions in the amount of domiciliary care needed, as well as a 17% reduction in the number of people needing residential or nursing care over a 12-month period. Equally, in groups of frail elderly people who were provided with telecare, there is a reduction in the number of hospital admissions following falls.
While the evidence for telehealth is clear, to date, telehealth procurements have usually been on a small scale. They have not been fully implemented and have not led to substantive changes in the way services are delivered or in the patient experience of those services.
The NHSis currently missing the opportunity for significant financial benefits and improved patient care and urgently needs to look at implementing telehealth on a larger scale.
Ivan McConnell is a telehealthcare expert at PA Consulting Guardian Professional.
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