Changing the Way Care is Delivered with Telehealth

Given the increasing prevalence of chronic diseases among an aging population, a prolonged recession and worrying financial black hole (last year, more than 30 English hospital trusts recorded a combined deficit of more than £300million), the NHS is at a crucial crossroads.

Against this backdrop, the Government launched the “3millionlives” campaign, which leads with the central belief that at least three million people with long term conditions or social care needs could benefit from using telehealth or telecare.

With the introduction of Care Commissioning Groups (CCGs), there is an opportunity for telehealth to support and add value to patient care, as the responsibility for planning and designing health services in England becomes more localised. Indeed David Nicholson, Chief Executive of NHS England has already vocalised plans to vigorously promote the use of telehealth across England from April 2013.

This intention has been met with widespread support among a growing base of advocates including Michelle Mitchell, Charity Director General at Age UK, who has publically supported the role telehealth can play in helping the ageing population respond to changes to their long term conditions or assist them in controlling their symptoms: “For older people, [telehealth] can mean staying in their own home and retaining confidence to carry on with their day-to-day lives. Whilst telehealth is by no means a replacement for face-to-face appointments and direct care, it could give many people a real chance of taking control of their health and improving wellbeing.”

As a reflection of how serious the industry is about telehealth, the Department of Health commissioned the largest controlled study of its kind, called the Whole System Demonstrator (“WSD”), to assess the effect of home-based telehealth interventions among 179 general practices in three areas in England, involving 3,230 people with diabetes, chronic obstructive pulmonary disease or heart failure.

The first WSD research paper reinforced the Government’s appetite for telehealth. The report, on the effects of telehealth on secondary care and mortality, concludes  that telehealth-enabled care delivery can help reduce the length of patient stays in hospitals. The study also shows a reduction in hospital readmissions as medical staff can more regularly monitor their patient’s health, identify lapses in their condition and intervene before their symptoms escalate. Crucially, it was noted that patients who received telehealth-enabled care were45% less likely to die within 12 months of treatment compared to patients in the control group.

The second WSD report noted that telehealth did not impact quality of life or psychological outcomes for patients with chronic obstructive pulmonary disease, diabetes, or heart failure over 12 months.  This is in fact a good outcome as patients in the intervention group did not report a sense of feeling isolated and overlooked, a common concern for health professionals and patients considering remote care. Instead, the study showed that using telehealth to treat long-term conditions neither enhanced nor diminished a patient’s sense of quality of life.

The third WSD report revealed that the pilot cost of £92,000 per quality adjusted life year was almost three times the upper limit for cost effectiveness set by NICE. This suggests that there is much that can still be done in improving efficiency; however, it also appears these calculations neither consider the potential impact of the differences in mortality between the control and intervention groups, nor the lowering costs of technology over time.  Today the hardware costs are much lower than they were at the WSD project’s initiation in 2008 and current funding options from vendors can now include rental schemes rather than up-front capital investment.

Overall, the key benefits in outcomes from the WSD cannot be ignored. On a personal level telehealth can also have a profound impact. David Hayward, a partner at one of the General Practices in North Yorkshire involved in trialling telehealth noted that the equipment is “very easy to use” and “the patients get on with it and love it….they find it extremely reassuring.” The daily act of inputting vital signs reassures patients that their health is being monitored on a regular basis without needing to leave the comfort and sanctuary of their own home.

The technology’s successful deployment still rests, in part, on communicating these benefits to the public. Change can be daunting, especially for those who have fought for regular, in-person access to particular healthcare specialists and are uncertain about what the impact would be on them.  Such fears may be addressed through sharing the stories of others, such as David Ward’s experience, where a patient at NHS Wakefield District found that telehealth gave him so much confidence that he didn’t have to worry about his health like he used to. While using telehealth he enjoyed a ‘new lease of life’.

As the first WSD paper demonstrated, telehealth has the potential to make significant improvements. However, this is only achieved when combined with a change in care. Jennifer Dixon, Director of Nuffield Trust is right to assert that it’s not enough to just plant telehealth in usual NHS care. “You have to make it unusual NHS care; you have to do something different to get the full benefit of telehealth.”  Heeding this advice, telehealth could fundamentally change the NHS for the better.