The future of telehealth and telecare in England is on a knife edge

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.

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#328 Geezer

I think what old folk need is not a gadget led NHS but more home help.

#332 disappointed
AT lead
local authority

I totally agree with Nick, having spent much time in the last ten years trying to gain initial investment in technology to enable individuals to remain in the community and as independant as possible which would have both benefits for the individual and the local authority it seems that most want local evidence that it works before embracing it, kind of difficult.
Also one must assume that from Geezers' comment he/she doesn't actually understand what is on offer in technology terms and that they have had no chance to discuss the situation with older people otherwise the statement would not have been made.

#335 Bernard Stacey
Consultant Physician

Patients generally look nervous when one tries to transfer their care to a Virtual Clinic (telephone and postal contact), never mind introducing more advanced technology. Whilst it doubtless works for some groups it is absolutely not the answer to substantial sections of those with chronic disease - many of the elderly do not feel confident in the use of these gadgets, however simple they may appear to their designers and proponents, all of whom come from a more techo-savvy generation.
Furthermore, it breaches one of the central tenets of clinical medicine - that there is no substitute for seeing and examining the patient.
Fine for certain groups and pursue it for them. But don't make the mistake of thinking it is a panacea for healthcare. To a large extent, Geezer has it right.

#336 david roberts
assistant director

Whilst new technology might offer real benefits, we do need some solid research to point to where scarce cash can be invested to benefit users and even help the budget. I am fed up with the criticism of professional staff as luddites for being bothered about knowledge before spening public cash on something that might not work when it could be used on plently of things that do. See this weeks BMJ for an article that provides a more measured appraisal of the cost benefits of telehealthcare.

#348 Simon
Management Consultant

I agree with David. It is often said that technology is not a panacea to the world's problems. Email was meant to reduce the workload on some of us, but aren't we slaves to it? The faster you reply to someone, the faster they reply to you and so on. And does the email actually speed up the activity or change that you are really trying to complete in most cases? It is all about context - using and applying the technology in the right way. Focused investment in teleheath and telemedicine will work, but it is not a mass alternative to treatment or physical physician - nods all round I suspect? Trials such as the WSD, if looked at with the right perspective can provide the contextual evidence and 'care settings' where the technology in the right hands, in the right care setting, with the right patients and their supporters can really make a difference to the patient - since we're putting the patient first and at the middle of their care and perhaps secondly to the coffers of the health providers. A careful, systematic and methodical review of this WSD report in the context of the individual care provider and its patients is an absolute necessity in this day for any provider looking to take advantage of this kind of technology on behalf of its patients.

#349 Gillian Seward
Chairman, Older People's Group
Bristol LINk

I can see great potential in its use. Besides the considerable savings it can achieve, it can also bring reassurance to both the patient and his/her relatives. I[t is very reassuring to know that if one collapses, there is no need to rely on the non-existent milkman!] Daily monitoring of one's vital statistics should reassure both the patient and his relatives.
However, I do think there is the danger of its use causing greater isolation, particularly to those living alone. This will lead to depression and worsening of the condition(s) that make it necessary.
I believe patients need to be selected very carefully; the equipment needs to be introduced gradually, with ample explanations; and there should be a careful monitoring of the mental condition - something (as far as I know) telemedicine is unable to do.
Even with these precautions, I think there will still be people for whom telemedicine will be unsuitable.

#350 Sharon

As someone who has used Telehealth to support the management of patients with Long Term Conditions for the last 5 years I understand the concerns many people have about the adoption of Technology into a health Care System. I have a couple of comments to make however. The Technology is however a very powerful tool that can be used to not only enhance the patient's health stautus but also empower and promote self care for patients with a long term condition. Patients have a limited amount care provided from face to face contact with health professionals, the rest of the time is self care. Thus the technology provides an opportunity to develop more contact since it does not replace the clinical contact, merely increases it. The technology is not for everyone however I agree and it is important that an assessment is made by the clinician to establish suitability for the patients. It is designed to improve care for patients not generate anxiety. Finally I would like to finish by saying that it does not matter what type technology is used, rather it is more about what is done with the information genrated that has the most significant impact on a patient and their health status. It would be a great shame if it was not adopted wholeheartedly by the health care system.

#358 David
Telecare lead

It seems that everyone involved in providing support to those in need agree that telecare and telehealth is neither suitable for everyone nor able to replace face to face care. Telecare and telehealth were never intended to replace clinical care or personal care, merely to support it. To gain the maximum benefit from telecare clinicians should adopt telecare as a tool they can use to the benefit of their clients in much the same way as new procedures are adopted to improve the level of care provided. There have been many cost / benefit analyses which prove the case for telecare. I am afraid that as most telecare providers will tell you that clinicians seem to be the group most reluctant to to give telecare more than a cursory glance let alone get involved in proving the case to their own satisfaction. If nothing else, use of telecare can be a great support to unofficial carers reducing health related issues developing in the carer. Illness of the unofficial carer has implications for all concerned and use of telecare could help avoid this. The telecare industry has been advised that increased awareness by the patient of their condition can reduce such things as re-admissions and self management of a condition is surely to be encouraged. The earlier comment that the data from the WSD trials needs to be fully evaluated before spending money on something that may not work ignores the wealth of data already proving the case does work when applied appropriately. Perhaps what is needed is for the 'face to face' service providers to get on board so any trials can be tailored to their satisfaction and meet their requirements.

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