As an ageing patient, reluctant to go near hospitals for fear of contracting MRSA, I have been increasingly irritated that definitive results of the "whole systems demonstrator" (WSD) of telehealth and telecare have been so slow to appear. Preliminary findings were published and launched with a fanfare by the King's Fund last year.
Then came silence, until January, when the government realised that telemedicine could mean vast savings for the NHS. Telehealth meant that fewer hospital beds would be needed since long-term patients would in future be treated at home, with a home monitor and direct line to the district nurse/GP/hospital. So, it launched the 3 million lives initiative.
Embarrassingly, the medical profession – GPs and hospital doctors alike – responded by sitting on their hands while they waited for the results of the WSD. They had smelled a rat.
The final report was being held because rigorous academic study would show that the preliminary findings were too optimistic. They were hoping that the final report would show that they would not have to bother about changing their time-honoured ways of handling patients, to make use of these pesky new technologies, like superfast broadband. And they could give the government a bloody nose – as payback for the health bill and the cuts in pensions – by boycotting the 3 million lives initiative.
The academics in the Nuffield Trust have finally published in the BMJ a report on the WSD. Or, to be more precise, it is a report on half the WSD. The original WSD covered 6,000 patients in Cornwall, West Ham and Kent with a variety of long-term conditions. What has now been published covers 3,000 patients and is limited to patients suffering from three long-term conditions: chronic obstructive pulmonary disease, diabetes, or heart failure. The remote treatment of patients with these three diseases is now called telehealth.
The other 3,000 patients in the trial, being monitored remotely for other complaints, are defined as being treated with telecare. We have to wait until the end of this year for the WSD report on them. Hence, we will not get an overall picture of the success or failure of the WSD.
I can see why it has been quicker to provide a telehealth report. There are only three conditions handled and the main measures have been whether fewer people have died, and whether trips to hospital have been reduced. Telecare is more diffused, and much of the current treatments are provided by the social care department of local government, not NHS. It is tricky for academics to get their heads round such a messy scene.
The headline findings of telehealth were mixed. The good news was that mortality of telehealth patients over the year of the trial was 46% less than the control group. Hospital admissions were 18% lower. To me, these figures should be enough to justify an immediate rollout. I fancy the idea of increasing my chances of staying alive. But it won't happen – because the third big finding of the report was that telehealth would not save money.
And money is what matters to the NHS. It has to save £2bn. If telehealth does not save money, it is a no-no, not only with the DH but also with the commissioning groups. And at a time when hospital trusts are approaching bankruptcy, they will not relish losing more inpatients because telehealth keeps them out of hospital.
This particular trumpet gives a particularly uncertain sound, so I can't see any clinician or administrator preparing for the telehealth/telecare battle. We will have to wait another long year for the justification of further bigger and better rollouts of these initiatives. Meanwhile, I and my contemporaries soldier on into our 80s, forever fearful of unnecessary trips to hospital. Guardian Professional.
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