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At a time when the health service is under pressure to improve quality with fewer resources, new technologies are being carefully scrutinised.
Telecare – continuous, automatic and remote monitoring to manage the risks associated with independent living, for example, pendant alarms and sensors to detect movement – and telehealth – remote exchange of physiological data between a patient at home and medical or nursing staff – have been promoted as part of a wider strategy of service redesign intended to improve productivity without compromising quality. But how effective are they?
One of the biggest sources of information on the impact of telehealth and telecare is provided by the Department of Health's Whole System Demonstrator (WSD) pilot programme, a £31 million trial involving more than 6,000 users of telehealth services comparing findings between those using services and a control group. Early insights from this work will be reported at a major International Congress on Telehealth and Telecare that The King's Fund is hosting on 1-3 March.
he results of the WSD trial will provide the most convincing evidence yet developed on the extent of the benefits, and return on investment, of such new ways of working. However, even if this evidence is overwhelmingly positive, will it be enough to convince local authorities and/or the new GP commissioners of the need to invest in it?
Although there were a number of 'early adopters', wider uptake has been slow. Some of the barriers may relate to lack of evidence or technical issues – but the biggest barrier may be the need for professionals and organisations to change their established methods of practice. Technologies are but tools. They may help enable certain aspects of care management to be delivered cost-effectively, but the prerequisite for their success or failure is the willingness of various stakeholders to embrace new ways of working.
For telehealth and telecare to become mainstream, a step-change in thinking is required. First, the emerging knowledge and evidence must provide a convincing narrative on the business case for change, outlining the benefits that it could bring and providing some of the practical steps to effective implementation of technology-assisted integrated care. Patients, carers and their families also need to feel empowered to understand, recognise, trust and ultimately demand new approaches to care that integrate services around their own needs.
For the present, the financial squeeze has placed the immediate future of telehealth and telecare on a knife edge and many local authorities and PCTs (but not all) seem to be turning away from it as they do not see how it can provide a quick enough return on their investment. This, of course, represents a paradox since it will be through schemes such as telehealth and telecare that the necessary strategic objective of developing cost-effective care support strategies within the home environment has the most potential.