The challenges for commissioners and providers of telecare and telehealth have never been so great, but there are also some exciting fresh opportunities to be considered.
While undertaking extensive structural changes to implement GP consortia and reposition community health care services, the NHS will need to redirect £15-20 billion of internal efficiency savings to frontline services through QIPP (Quality, Innovation, Productivity and Prevention) and other initiatives. Although some additional funding may have been earmarked for social care, local authorities have to find up to 28 per cent front-loaded savings over the next three to four years.
Many of the NHS changes are still to be ratified in a Health Bill due in early 2011, but health organisations are already following a timetable for the removal of strategic health authorities (SHAs) in 2012 and primary care trusts (PCTs) in 2013. They will be replaced with an NHS Commissioning Board and an unknown number of GP consortia, and possibly GP provider organisations. From April 2011, NHS community services will move to newly formed community foundation trusts, and social enterprises, or be part of acute hospital trusts or mental health trusts.
Local authorities will take on the public health function from 2013, and over the next year there will be a strong push towards more integrated health and social care services as well as personal budgets for users and patients. In order to find significant savings, social care authorities are looking at eligibility criteria, charging, and current service provider contracts, as well as streamlining back-office functions. In addition, some authorities are looking at outsourcing social work activities and the majority of their provider services where they have not already done so.
The local authority funding settlement and the NHS Operating Framework due in December 2010 will provide the financial setting for the 2011/12 financial year.
What will be the impact on telecare and telehealth?
Along with the challenges that change always brings, there will also be some opportunities. The most successful organisations will innovate and avoid retrenchment. That means decommissioning some ineffective and costly services, and looking for better, cheaper, proven alternatives.
First, we take a look at some of the challenges for telecare and telehealth and how they could be managed:
Telecare and telehealth champions may no longer be available or in the 'right place' to influence service adoption and mainstreaming – it is important to have robust commissioning and provision arrangements in place for 2011/12, based on national and local priorities and available resources, that can survive the loss of champions and early adopters.
Telecare charges will be levied for the first time or increased – charges should be transparent and in accordance with legal requirements (eg, re-ablement and intermediate care, charging for services, etc). Charges and service costs need to be transparent for personal budgets and efficiency initiatives. Organisations that are effective and efficient will be able to demonstrate that services provide good value for money, and demonstrate positive outcomes.
Changes to 'Fair Access' criteria – services will need to be clear about who benefits most from telecare. Which care pathways are the most important? How can care and support plans be enhanced by telecare, and at what cost? In addition, telecare can be used in re-ablement and prevention programmes as well as providing valuable assessment information through lifestyle monitoring.
Curtailment of specific telecare and telehealth projects – financial pressures may see the curtailment or abandonment of specific projects, yet internal and independent evaluation may be able to demonstrate 'better for less' with win-win situations for users, patients, carers, staff and overstretched budgets. Is the local evidence in place to embed telecare and telehealth into care pathways at scale?
Now, what about some of the opportunities for telecare and telehealth?
'Better for less' is a more appropriate maxim going forward than 'more for less', since it encourages people to think differently about how services are commissioned and provided, rather than trying to spread traditional services (more of the same) more thinly.
Examples of new opportunities include:
GP consortia – pathfinder programmes across the NHS regions will commence in April 2011. GPs will need to look at how they commission services for whole populations as well as individual patients in their local surgeries. Improving the outcomes for hundreds or thousands of patients across a locality may seem a daunting task unless innovative approaches such as risk stratification, disease management and telehealth are considered. Rather than buying equipment, consortia and GP provider groups could look for solution providers to improve quality of life for people with chronic obstructive pulmonary disease [COPD] and reduce hospital admissions.
Discharge from acute hospitals – with a potential 30-day re-admission penalty from April 2011, acute hospitals will need to work with intermediate care, re-ablement and telecare/telehealth programmes to ensure that re-admissions are kept to a minimum. Local authorities and community services could play a key role.
Personal budgets – social care authorities will need to bring telecare into their personal budget plans as the take-up is increased. Telecare can enhance current and new support plans while providing user and carer reassurance. Personal budgets for people with long-term conditions may have considerable potential in the future, with telehealth an important option.
Self-care, prevention and re-ablement programmes – whether it is reducing risk for someone discharged from hospital after a fall, or helping to manage COPD exacerbations, telecare and telehealth have an important role to play in reducing anxiety as well as costly hospital admissions.
Efficiency and innovation programmes – while awaiting the outcomes from the Whole System Demonstrator (WSD) programme, many local authorities and PCTs are including telecare and telehealth in their efficiency and QIPP programmes.
There is now a strong following wind for the use of technology to support a wide range of health, housing and social care services, and the evidence, new products and structured implementations are increasing daily in the UK and across the world.
The UK is a world leader in telecare. There are now 200,000 telehealth users in the United States, and a recent announcement of a telehealth programme covering 100,000 people in one region of China suggests that we are moving out of the early adoption period for remote monitoring. Although the organisational landscape will change significantly in the UK over the next three years, and there are still some important challenges to overcome, it is now looking as though the opportunities for using technology to support more effective and efficient local services are reaching a tipping point.