Health Matters | Paul Corrigan's blog

I sometimes feel that there is a conspiracy within the NHS against the implementation of step change. Those who do not want to change the way in which they work are always seeking evidence against the new. They show that the ways in which they do things are the best ways and that there is no evidence for new-fangled ways of working being any good at all. All these new ideas not only don’t save money – but are unsafe as well.

So much is so obvious. People in favour of the status quo organise against change.

Where the conspiracy sometimes seems to come in is that those in favour of change usually organise their pilots in such a way as to demonstrate the very point that the conservatives need. It doesn’t save money or relieve distress.

Over the last few years much of the work on telecare and telehealth has been of this kind. It always looks as if telecare should be able to diminish costs and improve outcomes, yet time and time again the pilots show the opposite to be the case.

Pilots have been either too small or more often carried out using an untargeted approach which has failed to segment the population to really reach those that could get the most out of the distanced approach.

Earlier this month the DH published the long-awaited (or at least long-awaited for the nerds amongst us who look forward to such things) findings of the Whole Demonstrator Programme on telehealth and telemedicine. This has been a long time coming and in fact December’s publication is not the final report but the Headline Findings from the final report.

They are unusually resounding,

“They show that if delivered properly telehealth can substantially reduce mortality, reduce the need for admissions to hospital, lower the number of bed days spent in hospital and reduce the time spent in A and E” (Whole System Demonstrator Programme page 1)

Given that the NHS desperately needs:

• Reductions in mortality
• Reductions in admissions to hospital
• Reductions in bed days spent in hospital and
• Reductions in the time spent in A and E

this is really good news.

The next sentence in the report is the crucial discriminator,

“The key is to integrate these technologies into the care and services that are delivered”

New kit, however brilliant, does nothing on its own. The key is to develop a new patient pathway that integrates it into great patient care.

The early headline findings come from the largest randomised trial of telehealth and telecare in the world with 6191 patients from 238 GP practices.

They show that if used correctly telehealth can deliver a 15% reduction in A and E visits, a 20% reduction in emergency admissions, a 14% reduction in elective admissions, a 14% reduction in bed days and a 8% reduction in tariff costs.

This great news for a cash-strapped NHS.

But even better news for a population with a growing number of very old people was that there was also a 45% reduction in mortality rates.

(Declaring an interest here. I am a 63 year old expecting at least another 30 sprightly years and looking forward to telehealth in my later years with gusto!)

For the future the DH is going to provide national leadership in partnership with the industry. What we will need is a clear analysis of the conditions under which this will work and the conditions under which it cannot.

It would be useful if the DH and industry came to a simple procurement agreement which greatly diminished the costs for the local NHS and provide the kit where those conditions would work best of all.