An audience of senior clinicians, commissioners and directors at the International Congress on Telehealth and Telecare in London, were resounding in their commitment to work with the home monitoring industry to help the NHS become more sustainable.
Delegates attended a packed workshop, to hear real examples of how home monitoring schemes are being developed and rolled out across the UK. Key challenges were highlighted and debated, including education of frontline staff and how to create structures and service models which support telehealth.
Malcolm Hart, Head of Philips Home Monitoring UK, was able to show evidence of how Philips Healthcare solutions have helped to deliver improved outcomes at a lower cost. “There seems to be a green light now,” he said, “for progression of telehealth and telecare services. The results of the Whole System Demonstrator study have drawn attention to significant opportunities for improvement in mortality and lower costs in the health care system, with the Department of Health itself estimating that these technologies could save £1.2 billion per year.”
Hart expressed his commitment to making real headway towards the government’s target of improving 3 million lives by 2017. “If you think about the fact that 15 million people have a long term condition, 3 million seems to be quite achievable,” he said. “But if you think there are only about 5000 people in the UK on some sort of home monitoring system at the moment, then 3 million seems quite a long way off.”
“We all need to collaborate and co-ordinate care between hospital and home,” he added. “Currently, data is fragmented and there is a loss of intelligence. We need partnerships between secondary care, primary care, third sector and technologies - we won’t get there alone.”
Piers McCleery, Director of Planning and Strategy at the Royal Brompton and Harefield NHS Foundation Trust in London, was able to explain to the audience in some detail how his hospital is using tele-monitoring to prevent acute admissions for heart failure patients.
“I can see how we can make the first steps towards 3 million lives,” he said. “Tele-monitoring works extremely well for the high risk substrata of the heart failure population and we are working with other hospitals in NW London to try and roll out this technology. In North West London District General Hospitals (DGH), there were about 1800 emergency admissions last year with a primary diagnosis of heart failure. Something like three quarters of those were re-admissions of people who had already been admitted in the previous three to four months. Tele-monitoring is a fantastic tool to for keeping an eye on them after discharge when they’re most at risk of being readmitted.
McCleery also identified an opportunity for pre-operative monitoring of diabetic patients. “They can be fully optimised before coming in for a coronary artery bypass graft, so we don’t get cancelled operations, which costs £5000-£6000 a go.”
Acccording to McCleery, the structure for introducing tele-monitoring in cardiac patients already exists. He described how the cardiologist in secondary care links up with specialist tertiary providers and also liaises with GPs. Community nurses, he claimed, would be able to visit patients during the first week of a Motiva system being installed.
“There is already a vertical network which tele-monitoring fits seamlessly into,” said McCleery, “and the nurse can give initial face to face conformation to validate what the Motiva system is telling them.” He added that the North West London Health Innovation and Education Cluster (HIEC) had also developed an online course to train health practitioners in interacting over the telephone.
Huw Jones, a former Director of Commissioning for Hull Primary Care Trust, and now owner of HD Insight, questioned the robustness of this structure and asked whether there was enough expertise to implement the systems within different levels of the NHS. He described how people, including his own father, were now purchasing telehealth devices online and claimed that frontline staff needed to be educated on how to advise people on their options.
“Clinical teams don’t know enough about these services and they don’t know about the wider options available. I don’t think there is enough expertise to be able to run 500 different telehealth and telecare systems in England. We need to work in partnership with others. It’s just as much about industry being able to respond to the statement about 3million lives as it is about the NHS and other health structure being able to respond to the challenge.”
Jones called for a new type of transaction between manufacturers and the NHS. “We need to change the currency of what the deal is based on,” he said. “Commissioners should say they’re not just buying kit anymore and instead procure a service which achieves a reduction in the 28 days readmission rate.”
Each of the speakers described how important it was to move quickly in order to maximize potential. “We need to deliver a clear economic model to commissioners,” said Piers McCleery, “and I would advocate starting with highest-risk groups. With heart failure patients that could save £500-£750 per emergency admission. If you scale that up to 50,000 people across the country you get £25million. It may only be only a small part of a £100billion NHS budget but it’s your first building block.”
According to Huw Jones, the focus should move to patient choice and interoperability. “We could have a system which could pick up and integrate all the telehealth data into our own electronic health records. There could be a number of potential frameworks for patients to choose from within a wider geographical area. Those 3million lives are a group of people who may use the open market to buy their own monitoring systems.”
Malcolm Hart summed up by emphasising the willingness of Philips Healthcare to help tackle the 3 million lives target. “The solutions are out there but we need a structure to support them and to drive re-enablement,” he said. “With 15 and a half million people living with long-term conditions, I’d like to think there could be some sort of supported solution for at least 3 million of them.”