Thank you Chris [Ham, King’s Fund].
Hopefully, most of you here today are reasonably fit and well.
You’ve all managed to make it here to the King’s Fund, so by definition you’re all fairly independent.
But for many people in England, the story’s more complicated than that. For people with Long Term Conditions, life can be an endless succession of doctor’s appointments, nurses visits and time spent in hospital.
For them, being independent - doing what they want and going where they please, when they please - can often be a luxury they can no longer enjoy.
That was the case for Joe Barr. By the age of 60, so hardly old - a little younger than you Chris, if you don’t mind me saying - he had developed a number of long term conditions, including COPD, diabetes, kidney disease and obesity.
His whole life was built around his conditions. He probably felt like he spent more time in NHS waiting rooms than he did with his wife and their two dogs!
Of course, Joe’s story is far from unique. There are around 15 million people in England who have long term conditions. And as our population ages, that figure is only going to increase.
But, Joe’s story didn’t stop when he became ill. For luckily for him, he lives in Cornwall and was part of a pilot project to test the benefits of telehealth technology. A project that, in his words, provides “a brilliant service” that means, “I can take responsibility for my illnesses.”
Now you wouldn’t be here if you didn’t already know about the Whole System Demonstrator, so I won’t explain what it is. But I do want to shout from the rooftops what it’s done.
What it’s done for people like Joe and for thousands like him across Cornwall, Kent and Newham.
Quite simply, it gave Joe his life back.
By understanding his own particular needs and then integrating specific technologies into his care plan, he now has his independence and, to a significant degree, his health.
He knows that his condition is being monitored and that if anything is heading in the wrong direction it can be jumped on immediately.
He can have friends and family round when he wants…
He can go where he wants…
He can do what he wants…
…and that’s because he no longer has to stay in all day waiting for the doctor to call;
…because he no longer has to spend hours in hospital waiting rooms,
…and because his vital signs are monitored constantly, anything that could be serious is picked up before has a chance to become so.
Just now I said something important. Telehealth worked for Joe because it first understood his needs and then looked at how technology could support those needs.
It started with the patient, with the person. Not with the technology.
But all too often, this is the reverse of what happens. Someone in a PCT sees a nifty piece of kit, buys a load in and then wonders why it ends up gathering dust in a cupboard somewhere.
Good telehealth or telecare is not about technology, it’s about people. Empowering people to live their lives as independently as they can. Technology can play an important role in that. But it will only ever fulfil its potential if it is integrated into a properly designed patient care plan. If it supports what a particular individual actually needs.
It’s the same with whole system of health and social care. Up until now, each part has organised itself around its own needs.
Hospitals around what a hospital needs. GP practices around what GPs need. Social care providers around what they need.
And we’ve ended up with a confused, disjointed, fragmented mess.
What we need more than anything in the years ahead is to take the approach that Joe’s team took with him. They started with Joe’s needs and built the system around him.
If I get sick and need help, it doesn’t really matter to me who provides it. Whether it’s the NHS, a local authority or someone else. I just want good, seamless care.
But it matters very much if my health care is not integrated in to my social care. If GP is not linked in to my social care. If the hospital that treats me doesn’t involve me, my GP or my social care provider in drawing up a discharge plan.
Fully integrating care means starting with the person in the middle and working out. It means making care more effective. It means managing conditions better and preventing small problems from developing into major incidents.
And if this is the way that we approach telehealth and telecare, the potential benefits - for people using it, for healthcare professionals and for the NHS as a whole - are enormous.
The headline findings from the Whole System Demonstrator are staggering.
• A 20% fall in emergency admissions
• 15% fewer visits to A&E
• 14% fewer elective admissions
• 14% fewer bed days
• And an 8% reduction in tariff costs
And while this is primarily about improving lives rather than saving them, there was a 45 percent - yes, 45 percent - difference in the mortality rate between those using telehealth and those in the control group.
Quite unexpected and truly extraordinary.
And all of this has a significant cost implication for the NHS. Already, 7 out of 10 in-patient beds are occupied by people with long term conditions. Around 70p in every NHS pound is spent looking after them.
By keeping people out of hospital, by reducing the time they’re there when they have to be and by being far more targeted and efficient with the use of NHS resources, we estimate the widespread use of telecare and telehealth could save the NHS up to £1.2 billion over five years.
But this is not just a case of me saying we will do it, clicking my fingers and then it all happens. What this government more than any other before it understands is the limits of its own power.
Once, a government might have set a target. Say, for 50% of people with long term conditions to have telehealth or telecare support by 2015.
That would certainly get people moving. We might even hit the target. But it would probably miss the point.
PCTs would buy in loads of stuff and much of it might even be put into people’s homes. But would it reap the rewards we know it can? I doubt that.
We need local providers and local commissioners to look at the needs of their communities and make decisions based on the clinical and social needs of their patients. If technology can help, then we need to remove all barriers to it playing its part.
But the way to do that isn’t to impose it from above, but to make it easy to do and leave it to the best judgement of people on the ground to see through.
At the moment, there are several issues to deal with, several barriers in the way.
Initially, there was a lack of evidence that it can work on a large scale. The Whole System Demonstrator has taken care of that. The evidence is compelling and we haven’t even started to delve into the detail yet.
But people need to know about it. To understand what it can do. To know how best to utilise it.
There are also technical issues to get over, such as a general lack of interoperability and confusion over incentives.
And of course, this stuff doesn’t come for free. Whatever the long term savings, there are some substantial initial costs.
That’s why the Department of Health is working with industry and with the medical professions to remove those barriers.
• To raise awareness of what is available and how to make the most of it,
• To move towards standards for interoperability,
• And to look at innovative ways that providers and commissioners can pay for telehealth and telecare, such as through ongoing contracts.
Few people buy an iPhone for cash up-front, they pay for it through a monthly contract. So why couldn’t a community nursing provider pay for a remote blood pressure monitor in a similar way?
We’re already seeing exactly this in places like Gloucestershire, where the PCT is working with Tunstall, one of the largest telecare and telehealth companies.
Tunstall cover the up-front costs such as clinical engagement, pathway re-design and training. They then supply NHS Gloucestershire on a per patient, per month basis. Any costs savings the PCT makes through things like reduced hospital admissions can then be re-invested back in to front line NHS services.
• NHS Gloucestershire avoids the need for large up-front costs,
• The supplier builds a relationship with a customer it would otherwise not have had,
• And the patient gets their life back.
A win-win-win situation.
With the right incentives and the right business model, the benefits for everyone can be huge.
And in time, costs of the equipment will fall. Costs in the UK are significantly higher than in the US. No wonder when we have about 6,000 users and they have almost ten times that number just within the Veterans Association.
But we’re looking at a potential customer base of 3 million. Just think of what a market of that size can do in terms of innovation and economies of scale.
We need to change the way we do things. Working in partnership with industry, with the NHS, social care, the voluntary sector and, importantly, with patients and with carers to get this right - from the bottom up.
And to show just how committed we are to this, we’ve signed a Concordat with industry trade associations signalling our clear commitment to work together and to spread the benefits at scale and at pace.
Now, there are issues that come from a potential market of that size. Principally, the problem of broadband capacity.
It’s true that many of those who stand to benefit from telehealth and telecare will live in rural areas. Areas that are not particularly well served in terms of broadband access.
That’s why, where the numbers don’t stack up for businesses to invest in broadband infrastructure by themselves, we are willing to step in to tip the balance.
That’s why we earmarked over half a billion pounds in the Spending Review to support broadband rollout in rural areas. And why we’re running 4 pilot schemes in places like Cumbria and North Yorkshire, to see how we can most effectively bring the benefits of broadband to the countryside.
There is also the issue of people within the NHS and social care not having the skills and understanding of the potential benefits of the technology.
That’s why we’ve asked the NHS Institute to develop a support programme to make sure that patients and staff are properly engaged and helped to make the most of these technologies locally.
This will include developing a series of ‘how to’ guides and advocacy campaigns to build patient support and to win over sceptical clinicians and managers…
… making sure that everyone realises that this is about improving outcomes - improving lives - not about wasting money on expensive and unnecessary kit.
As Joe said, “in the beginning [my consultant] would not look at the reports and pass them back to me. Now when I go he asks me where my last six month’s readings are!”
Winning this argument locally will be the key to unlocking the benefits that the Whole System Demonstrator has shown are possible.
If local clinicians in NHS Trusts, in voluntary or independent sector providers are convinced that this is money worth spending…
and if local commissioners are convinced that this is an approach worth supporting…
… then the pursuit of better outcomes for patients and greater value from stretched budgets will drive progress far faster and far more effectively than any imposed target ever could.
Cornwall, for example, is so convinced of its value that they want to bring the benefits to 30,000 people over the next 5 years.
This is what has happened in the pilot areas, and it is what is increasingly happening beyond them too.
Like in Croydon, where three GP practices are using telehealth technology to monitor patients remotely. If they feel unwell, they can talk to a nurse or their doctor on the phone, with all the relevant clinical information readily available.
• This saves valuable time if there’s something wrong,
• it avoids wasting everybody’s time if there isn’t,
• it’s far more convenient for the patient and the clinician,
• and the results already show that the costs of the programme have been covered and savings are being made.
Our modernisation of the NHS and of social care is all about enabling people to take the initiative, putting people in control of their own care and treatment…
putting local doctors, nurses and other health professionals in charge of how their money is spent…
and making sure that whatever we do, it is always focussed on improving outcomes.
The proper use of telehealth and telecare has the potential to be a triple whammy - to hit all three objectives in one.
• Helping to give patients like Joe their lives back.
• Putting health professionals in charge of the technology rather than the other way around.
• Improving the quality of people’s lives, keeping them out of hospital and keeping them far more healthy.
All of this will play a big part in the Information Strategy that we’ll publish soon. The way that a patients records can be accessed, added to and shared electronically will be one of the key benefits of telecare and telehealth.
Giving people control of their own information, building that information around the individual rather than having numerous separate records dotted around all over the place, will offer real clinical benefits.
It’s been said that, whatever the concerns about security and privacy, nobody ever died because someone had seen their data. On the contrary, many have died because they hadn’t.
Technology, no matter how amazing it might be, is just a tool. But in the right hands and used in the right way, this is a set of tools that can make a very big difference indeed.