primary provider
telehealth
and cut down on burgeoning accident and emergency admission costs. There has been a very real commitment from both the coalition and its Labour predecessor to expanding remote care. These administrations have overseen a concerted effort to stimulate the uptake of remote care, with over £160m of public funding spent in the UK from 2006 to 2011. That has been backed up by more than 25 official government reports over the last ten years. The whole process has been given extra impetus by David Nicholson’s £20bn challenge. So, has all this investment and research garnered encouraging results? Early indications from government
T
research show that, if used correctly, telehealth can deliver a 15% reduction in A&E visits, a 20% reduction in emergency admissions, a 14% reduction in elective admissions, the same reduction in bed days and an eight per cent reduction in tariff costs. The coalition also claims it demonstrates a 45% reduction in mortality rates. These figures were devised from the Whole System Demonstrator Programme, which ran from May 2008 to September 2010. The study monitored 6,191 patients and 238 GP practices for a minimum of a year across Cornwall, Kent and Newham, assessing how using telehealth could benefit the NHS. It aimed to provide ‘a clear evidence base to support important investment decisions’ and ‘show how the technology supports people to live independently, take control and be responsible for their own health and care’. The programme assessed how effective the use of telehealth and telecare were in treating chronic diseases; specifically diabetes, heart failure and COPD. The Government’s latest and most
ambitious initiative, the 3 Million Lives, established in 2011, aims to bring telehealth and telecare to an estimated three million people who could most benefit. Remote care does seem to be an excellent solution to the country’s ageing population, increasing numbers of people with chronic conditions and ever-tightening health and social services budgets. There are, however, questions about how ready the telehealth industry, on which these changes are reliant, is to deliver a major shift towards remote care. There are some problems, not least
because the industry is in its infancy. Because of this, the companies involved, although
New public-private partnerships emerging in Europe are designed to jointly deliver healthcare infrastructure and services
elehealth has been backed by successive governments as a means to move healthcare into the community
representing a massive market, are all competing with a very similar market share. While competition is, of course, healthy and represents good value for consumers, a market-leading product creates a certain amount of homogeneity and eases a transition towards mainstreaming. The level of interoperability between different remote care devices causes difficulties as clinicians and institutions get used to the idiosyncrasies of a particular system. This lack of a clear market leader also makes it difficult for the industry to identify a successful business model that could stand up to the strain of large-scale expansion. Yet more complications are caused by the continuous advances in technology, which can be an obstacle to purchasing decisions, as those signing-off on large investments in new systems are reticent for fear of seeing a better product hit the market a week later. A possible foil for these problems could
be the new public-private partnerships emerging in Europe, which are designed to jointly deliver healthcare infrastructure and services. These alliances share risk between purchasers and suppliers, and use payment mechanisms between parties that incentivise best practice. This could provide greater certainty of income for remote care suppliers while alleviating certain risks for the public sector that have caused hesitance around investment in the industry. If these problems can be improved upon,
there is certainly potential for a service that could revolutionise the way that care in the community is delivered. Beyond government sound bites and statistics, there are encouraging results that can be built upon. The Institution of Engineering and Technology is making a concerted effort to unite those working in the field to share knowledge and expertise, hopefully overcoming some of the problems caused by what can seem like a disparate industry. It is advancing the idea of ‘connected health’ in order to establish new telehealth applications and possibilities in both the developed and developing world. If the remote care revolution is to develop in a sustained way, shifting healthcare out of hospitals and into homes, it will require an even greater commitment from Westminster. With a concerted, mutually beneficial, partnership between government and industry, a gold standard can be created that will allow a national rollout and a long- lasting improvement in the way the nation accesses healthcare. ¾
february 2013 19
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