Do we need a telehealth tsar?: Telehealth pilots show promising results but technology will not deliver benefits if care pathways are poorly designed
Among the numerous challenges facing the NHS in England, caring for more than 15 million patients with chronic conditions is arguably the biggest and accounts for 70% of its budget. Telehealth can offer better long-term care at lower cost, but despite its attractions and ministerial backing, implementation remains patchy.
"I think the problem is that what we have often done is apply technology to poorly thought out care pathways," says Simon Jones, NHS Direct's director of patient choice in England. He argues that NHS managers need to examine the points where interventions are delivered on a care pathway and whether these could be delivered effectively using telehealth.
3millionlives, the Department of Health's (DH) five-year programme to develop telehealth and remove barriers to take up, has no government funding and relies on industry to create funding mechanisms, Jones points out.
"Straight away you have a conflict: technology companies who make their money by selling telehealth and a healthcare delivery process that has to be clinically driven," he says.
Jones also acknowledges that telehealth is suffering from a lack of national leadership. "We have got a cancer tsar, a children's tsar – we have got an everything else tsar – but does the heart tsar know about telehealth?"
In November, health secretary Jeremy Hunt announced seven telehealth "pathfinders" over the coming year as part of 3millionlives. Tenders are being put together by the NHS Commissioning Board, with technology companies supplying equipment and services at no upfront cost.
However, Jones says, there has been little detail about the pathfinders, some of which are whole system demonstrator sites, part of the largest randomised control trial of telehealth and telecare in the world.
"If there is no money, it is up to the industry supplier to be creative and what they then have to do is come up with models where they supply equipment and recoup their costs," he says. "A very tricky thing for any industry to do."
NHS Direct's experience of telehealth started in 2008 when it was commissioned by NHS South East Essex to assess the benefits of telehealth by managing 80 patients with chronic obstructive pulmonary disease (COPD). An evaluation of the pilot, which ran until March this year, showed that 94% of patients said the equipment was easy to use; 83% felt it had helped them; and 84% wanted to continue with the service. In addition, the average number of 999 calls made each month by the patients using the telehealth service was down by 72% and the number of visits made by those patients to their GP had reduced by 56%.
Large scale, fully managed telehealth pilots managed by NHS Direct for 300 COPD patients in Leeds and Hull, backed with innovation funding from NHS East of England, yielded similarly positive results. Both pilots began in November 2012 and although the Leeds service ended this October when funding ran out, Hull has been recommissioned by the new clinical commissioning group.
Jones says the services were run with Bosch Healthcare because its technology includes an anxiety management programme: "One of the reasons we worked with Bosch was because we also knew that if you have COPD or heart failure you have a very high chance of having depression."
NHS Direct's Own Health project, which combined telecoaching and telehealth monitoring, was used by about 12,000 people in Birmingham who had been diagnosed with COPD or heart failure, or were at risk of developing long-term conditions.
"Every patient had a management plan and a care manager. Some of them, if their symptoms were a little bit worse, also had the technology devices in their home, so we also monitored their vital signs," Jones says. However, despite good outcomes, Own Health fell foul of the change in the commissioning landscape.
Another telecoaching project run by NHS Direct in Nottingham will be re-tendered in March 2013. Jones explains that it started about two years ago when NHS commissioners in Nottingham expressed their frustration about commissioning locally-delivered "lifestyle" sessions based around exercise, weight loss and giving up smoking for people with long-term conditions, with no monitoring of attendance and outcomes.
NHS Direct offered to carry out an assessment and to build a programme to book people into sessions and monitor progress. It now looks after 7,000 people and Jones says compliance rates have risen from 40% to 77%.
DH figures show that about 24,000 people with diabetes die prematurely each year because their condition has not been managed effectively, so could telehealth make a difference? Jones says diabetes can be effectively monitored remotely, but because the savings from diabetes are long-term, compared to those for reducing hospitals admissions for COPD, the financial incentive is less.
And there's another issue: "There is a tension between GPs wanting to manage diabetes and the more specialist role of secondary care clinicians, and what this has led to is these bitty pathways.
"Out there is a whole plethora of technology, but you have to start with the care pathway." Guardian Professional.
Among the numerous challenges facing the NHS in England, caring for more than 15 million patients with chronic conditions is arguably the biggest and accounts for 70% of its budget. Telehealth can offer better long-term care at lower cost, but despite its attractions and ministerial backing, implementation remains patchy.
"I think the problem is that what we have often done is apply technology to poorly thought out care pathways," says Simon Jones, NHS Direct's director of patient choice in England. He argues that NHS managers need to examine the points where interventions are delivered on a care pathway and whether these could be delivered effectively using telehealth.
3millionlives, the Department of Health's (DH) five-year programme to develop telehealth and remove barriers to take up, has no government funding and relies on industry to create funding mechanisms, Jones points out.
"Straight away you have a conflict: technology companies who make their money by selling telehealth and a healthcare delivery process that has to be clinically driven," he says.
Jones also acknowledges that telehealth is suffering from a lack of national leadership. "We have got a cancer tsar, a children's tsar – we have got an everything else tsar – but does the heart tsar know about telehealth?"
In November, health secretary Jeremy Hunt announced seven telehealth "pathfinders" over the coming year as part of 3millionlives. Tenders are being put together by the NHS Commissioning Board, with technology companies supplying equipment and services at no upfront cost.
However, Jones says, there has been little detail about the pathfinders, some of which are whole system demonstrator sites, part of the largest randomised control trial of telehealth and telecare in the world.
"If there is no money, it is up to the industry supplier to be creative and what they then have to do is come up with models where they supply equipment and recoup their costs," he says. "A very tricky thing for any industry to do."
NHS Direct's experience of telehealth started in 2008 when it was commissioned by NHS South East Essex to assess the benefits of telehealth by managing 80 patients with chronic obstructive pulmonary disease (COPD). An evaluation of the pilot, which ran until March this year, showed that 94% of patients said the equipment was easy to use; 83% felt it had helped them; and 84% wanted to continue with the service. In addition, the average number of 999 calls made each month by the patients using the telehealth service was down by 72% and the number of visits made by those patients to their GP had reduced by 56%.
Large scale, fully managed telehealth pilots managed by NHS Direct for 300 COPD patients in Leeds and Hull, backed with innovation funding from NHS East of England, yielded similarly positive results. Both pilots began in November 2012 and although the Leeds service ended this October when funding ran out, Hull has been recommissioned by the new clinical commissioning group.
Jones says the services were run with Bosch Healthcare because its technology includes an anxiety management programme: "One of the reasons we worked with Bosch was because we also knew that if you have COPD or heart failure you have a very high chance of having depression."
NHS Direct's Own Health project, which combined telecoaching and telehealth monitoring, was used by about 12,000 people in Birmingham who had been diagnosed with COPD or heart failure, or were at risk of developing long-term conditions.
"Every patient had a management plan and a care manager. Some of them, if their symptoms were a little bit worse, also had the technology devices in their home, so we also monitored their vital signs," Jones says. However, despite good outcomes, Own Health fell foul of the change in the commissioning landscape.
Another telecoaching project run by NHS Direct in Nottingham will be re-tendered in March 2013. Jones explains that it started about two years ago when NHS commissioners in Nottingham expressed their frustration about commissioning locally-delivered "lifestyle" sessions based around exercise, weight loss and giving up smoking for people with long-term conditions, with no monitoring of attendance and outcomes.
NHS Direct offered to carry out an assessment and to build a programme to book people into sessions and monitor progress. It now looks after 7,000 people and Jones says compliance rates have risen from 40% to 77%.
DH figures show that about 24,000 people with diabetes die prematurely each year because their condition has not been managed effectively, so could telehealth make a difference? Jones says diabetes can be effectively monitored remotely, but because the savings from diabetes are long-term, compared to those for reducing hospitals admissions for COPD, the financial incentive is less.
And there's another issue: "There is a tension between GPs wanting to manage diabetes and the more specialist role of secondary care clinicians, and what this has led to is these bitty pathways.
"Out there is a whole plethora of technology, but you have to start with the care pathway." Guardian Professional.
No comments:
Post a Comment