Telehealth and telecare: Key points and background

• Telecare and telehealth are both types of assistive technology that enable health and social care services to be provided remotely to people in their own home; however, they are quite distinct in their definitions and uses. Telecare is characterised by continuous, automatic and remote monitoring to manage the risks associated with independent living. Examples include sensors that can detect movement, falls, and bed occupancy. Telehealth is the remote exchange of data between an individual and a health care professional, and aims to assist in the diagnosis and management of health care conditions. Examples include monitoring blood pressure and blood glucose levels for clinical review by a health professional using phone lines or wireless technology.
• Both telecare and telehealth have the potential to support a number of key policy objectives, for example around delivering care closer to home, preventing unnecessary hospital admissions, providing choice for people with long-term conditions and supporting independent living.
• The technology driving these developments has improved vastly with the introduction of broadband and secure web-based services for exchanging data between patients and clinicians. Many studies have also shown the potential benefits of telecare/telehealth to users but there remains a lack of robust evidence, particularly related to cost-effectiveness. Telecare/telehealth has not yet been implemented on a large scale.
• In April 2006, the previous government injected £80 million across social care authorities in the form of a Preventive Technology Grant to help initiate telecare innovations seeking to maintain the well-being and independence of older people. Over £30 million was additionally allocated to establish a Whole System Demonstrators Programme seeking to demonstrate how telecare/telehealth innovations can help in the management of people with long-term conditions. This has involved a large randomised control trial involving more than 6,000 patients and the results are due in November 2011.
• In July 2008, the Whole System Demonstrators Action Network (WSDAN) was launched. WSDAN, a project funded by the Department of Health and led by The King’s Fund, has developed an evidence database on the impact of telehealth and telecare in the management of people with long-term conditions. In addition, it has worked with 12 member sites to examine the progress and challenges of telecare and telehealth adoption.
• Today, about 1.7 million people in England benefit from telecare services, and the number is growing. In contrast, there are only about 5,000 users of telehealth services, many of whom are enrolled in the Whole System Demonstrator Pilot Programme.
• For telecare and telehealth to become mainstream, commissioners need robust evidence on its cost-effectiveness, as well as shared learning on targeting relevant populations and service design.

Interest and investment in telecare and telehealth has grown steadily over the past five years. The technology is now being tested in a large randomised control trial in England, while Wales and Scotland both have strategies in place to support wider adoption. However, it is yet to become mainstream.

The interest has been sparked by the potential the technology has for helping the NHS and social care services to meet a number of policy ambitions: moving care closer to home, supporting older people to live independently in their own homes, making efficient use of resources spent on long-term conditions, and avoiding emergency hospital admissions. Internationally, the promise of technology has also been recognised, though health systems worldwide have often been unwilling to fund its development due to a lack of robust evidence on its cost-effectiveness.

Although telecare and telehealth are both forms of assistive technology designed to enable health and social care to be delivered ‘remotely’ within the home environment, the two are quite distinct:

• Telecare is the remote or enhanced delivery of health and social care services to people in their own home by means of telecommunications and computer-based systems. Telecare is characterised by continuous, automatic and remote monitoring of real time emergencies and lifestyle changes over time in order to manage the risks associated with independent living.
• Telehealth is the remote exchange of data between a patient at home and medical staff at hospital to assist in diagnosis and monitoring. Among other things it comprises home units to measure and monitor temperature, blood pressure and other vital signs for clinical review at a remote location (for example, a hospital site) using phone lines or wireless technology. Examples of telehealth devices include: blood pressure monitoring; blood glucose monitoring; and medication reminder systems.

In 2004, an Audit Commission report said that telecare and telehealth could support independent living for older people by:

• reducing hospital stays by supporting earlier discharge
• virtual visiting – for example, by monitoring the safety of older people with dementia who live alone
• the use of reminder systems – for example, reminding older people to take their medication
• the use of home security and social alarm systems – for example, smoke and heat detectors, alarm systems and crime surveillance, as well as monitors that pick up any unexpected changes to an older person’s routine. 

The Audit Commission also pointed out that: ‘Increasingly, telehealth not only overcomes the inconvenience of distance, but also provides people with greater choice and control over the time and the place for monitoring their condition, increasing convenience and making their conditions more manageable. It reduces pressures on clinics and acute hospitals and could make a significant contribution to the management of a number of chronic conditions, including COPD (chronic obstructive pulmonary disease), heart failure, hypertension, asthma and diabetes.’

In July 2005, the Department of Health published Building Telecare in England where it emphasised how ‘telecare offers the promise of enabling thousands of older people to live independently, in control and with dignity for longer’. This built on an announcement by the previous government in July 2004 that it would invest £80 million, over two years from April 2006, through the Preventive Technology Grant – later extended to a third year. The purpose of the grant was to initiate change in the design and delivery of health, social care and housing services and prevention strategies to enhance and maintain the well-being and independence of individuals – particularly older people. 

Whole System Demonstrators

In 2006, prompted by the White Paper Our Health, Our Care, Our Say, the Department of Health moved to set up the £30 million Whole System Demonstrators (WSD) Programme to test out how telecare and telehealth could contribute to improving the management of people with long-term conditions.

By May 2007, three WSD pilot sites had been selected (Newham, Kent and Cornwall) to be involved in a large randomised control trial with 6000 individuals. An intervention group is being established to receive telecare or telehealth interventions for the management of one of three long-term conditions (diabetes, heart failure and COPD) to compare with a control group receiving routine care. It is a complex evaluation with a multidisciplinary team, led by Professor Stan Newman at University College London.

The aim of the evaluation of the WSD pilots is to provide a better understanding of the level of benefit associated with telehealth and telecare in an integrated health and social care environment, as well as to ‘fast track’ future change by addressing key implementation barriers. By the end, the WSD pilots should enable people to understand whether and how telecare/telehealth can be more clinically and cost-effective than standard care; and whether it improves the quality of life and independence of individuals and their carers.

Between 2008 and 2011, The King’s Fund and the Department of Health’s Care Networks were funded to run the Whole System Demonstrator Action Network (WSDAN). WSDAN combined research, educational and experiential learning opportunities to examine the progress and impact of telecare and telehealth in supporting the management of long-term conditions including developing a database on the evidence .

WSDAN’s work estimates that about 1.7 million people in England are using some form of telecare. Although these are primarily pendant alarms, it is thought some 300,000 of these installations are sensor-based systems using personal and environmental monitors. It is generally considered that the UK is now the world leader in the adoption of this new technology. However, only about 5000 people currently benefit from home-based telehealth remote monitoring – mainly for heart failure, diabetes and COPD.

The evidence base for telehealth and telecare is under-developed and has contributed to the slow uptake of new technologies. WSDAN has assessed the issues related to sustaining innovation in telehealth and telecare to show that whilst there is continuing momentum and political aspiration to embed new technologies into the mainstream, significant barriers need to be addressed before this achieved. WSDAN has also reported on the experience of its 12 member sites to provide further knowledge and insight into the progress that has been made in the adoption of new technologies

Delivering Assisted Living Lifestyles at Scale

In 2011, the DALLAS project (Delivering Assisted Living Lifestyles at Scale) was launched with a £23m budget, DALLAS seeks to establish up to 5 communities across the UK to show how assisted living technologies and services can be used to promote well-being and provide top quality health and care, enabling people to live independently. It seeks to do so ‘at scale’ with more than 10,000 people to be provided with support in each community. The Telecare Learning and Improvement Network (LIN) supports this work by providing a national network to aid the application of telecare and telehealth to aid the delivery of housing, health, social care, and support services for older and vulnerable people.

Whole System Demonstrator programme findings 

In December 2011, the Department of Health published headline findings from the Whole System Demonstrator programme.

These initial results are very positive, showing reductions in A&E visits, emergency admissions, elective admissions, bed days and mortality rates.