Clinical Commissioning Groups (CCGs) are to partake in the largest deployment of telehealth services in the country to date, giving some 1,500 patients the opportunity to use touchscreen technology to respond to questions about their own health at home.
The scheme – which is being commissioned by Surrey County Council involving six CCGs, at a cost of £2.7m – will initially give patients with chronic obstructive pulmonary disease (COPD) and heart failure the opportunity to feed information about themselves to a specialist nurse who will remotely access the information.
Initial feelings towards the move is that it will reduce the amount of face-face consultations with nurses and doctors, which will bring a saving, but critics of telehealth worry that it will cost more money than it is likely to save.
Is Telehealth the silver-bullet the NHS needs?
Telehealth, since its dawn, has been held by many as the silver-bullet initiative that will at once improve the NHS services we receive as well as providing a saving to the public purse – particularly relevant as the health system takes on the Nicholson challenge of slashing the amount of spending in the NHS by £20bn.
Health minister Jeremy Hunt, speaking at an Age UK conference earlier this year said that the rollout of telehealth services will benefit 100,000 people. Advocates note that it will help people, who otherwise find it difficult to travel in to surgeries or hospitals, to carry on with their day-to-day lives.
The Department of Health, back in 2006, announced the establishment of three pilots known as a the Whole Systems Demonstrator (WSD). In 2011 it revealed the headline findings which showed telehealth reducing hospital readmissions, helping identify lapses in a patient’s condition, and, crucially, showing that patients were 45per cent less likely to die within 12 months of treatment than other patients.
Do the costs attached to Telehealth make it impossible to roll out widely?
Somewhat, in its current form. Telehealth is currently seen as new technologies which are expensive to purchase, maintain and replace. Organisations such as Dr Thom, an online GP, make telehealth much cheaper than face to face methods of care by using existing technologies such as Skype and email supported by CQC approved algorithms to approve prescription only drugs.
Even though new technology telehealth can create 20 per cent falls in admissions and reduction in mortality, the costs attached to telehealth are average out at just over £90k per additonal year of ‘quality’ life added to that person. To put this into some context, the usual threshold set by the National Institue for Clinical Excellence is £20,000-£30,000 per year gained of ‘quality’ life.
Researchers from the London School of Economics analysed the outcomes of 965 patients, 534 of who were monitored with telehealth equipment and 431 who had received usual care. The results found that the quality of life for patients who were beneficiaries of telehealth was only marginally better than usual – and certainly not enough to justify the costs attached.
The future for telehealth
Most, I think I can safely assume, are convinced of the benefits of telehealth as a means of making life easier for particular people, namely the elderly and those with long term conditions. Though there is some evidence conflict, the research does lean towards showing some health benefits, too.
Claire Medd, Clinical Director EMEA, Intel-GE Care Innovations (U.K.) Ltd, in her article on the changing delivery of care, noted that the story of David Ward, a patient at NHS Wakefield who said that “telehealth gave him so much confidence that he didn’t have to worry about his health like he used to”, and that “he enjoyed a ‘new lease of life’.”
The problem, as ever, is attached to costs (the Nicholson Challenge, though interestingly David Nicholson is vocally in favour of telehealth). Advocates themselves admit that more needs to be done on the efficiencies of telehealth, but they also argue that costs will lower over time and hardware costs will be lower now than they were when the WSD project initiated.
Those who advocate on behalf of telehealth have a lot of firefighting to do, particularly when costs look so high on paper, but I don’t think anyone is in any doubt that there is a future for telehealth.