NHS England has sketched out the future of healthcare and it will be one using smartphones and wearable bio-sensors to monitor ourselves and alert clinicians. [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/09/NHS-England.jpg” thumb_width=”150″ /]NHS National Medical Director Sir Bruce Keogh has written to around 250 organisations across health, social care, industry and third sector asking them to support the Technology Enabled Care Services (TECS) programme which he says will take the NHS into this new technological era.
The TECS programme, born out of the Three Million Lives (3ML) initiative (which didn’t quite go anywhere after all the song and dance, including from Prime Minister David Cameron), was reviewed last year resulting in the change of focus to “address the demand for support and practical tools to commission, procure, implement and evaluate technology enabled care services” according to Sir Bruce’s letter as reported on the NHS England website.
The TECS Stakeholder Forum‘s views and proposals now form the TECS Improvement Plan for 2014-17. This is a broader group following the failure of the 3ML Stakeholder Forum, which consisted mainly big industry organisations, to achieve anything of substance.
According to the NHS England website posting, Sir Bruce explains: “To ensure continued progress, we have brought together a TECS Implementation Group consisting of experts and leaders from across these sectors whose remit is to support the strategic development and delivery of the proposals within the Improvement Plan. In addition, we have formed the TECS Executive Steering Group which meets regularly to provide clinical, technological and strategic leadership for the programme at a director level in NHS England.”
This all sounds like a lot of bureaucracy and a drawn out attempt to rescue what remains of the 3ML programme. I started thinking of the Titanic and deck chairs.
A new report analysing the telehealth development in the UK and proposing improvements has been [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/03/Tackilng-telehealth-report.png” thumb_width=”150″ /]produced by Inside Commissioning. The report Tackling Telehealth – how CCGs can commission successful telehealth services is written by a panel of authors led by Dr Ruth Chambers who co-chairs NHS England’s Task and Finish group for commissioning skills and capability for the delivery of Technology Enabled Care Services (TECS).
The UK has been experimenting with telehealth as much as any country in the world and has notably carried out the largest clinical trial of telehealth anywhere, the Whole System Demonstrator (WSD). WSD produced some valuable results with regard to telehealth benefits, including reduced mortality, and was instrumental in the launching of the key government telehealth programme, 3 Million Lives (3ML) in 2011.
Last year the GP magazine had carried out a major survey of telehealth implementation in the UK by making information requests from all 176 Clinical Commissioning Groups (or CCGs, a new administrative unit introduced by the current government) under the Freedom of Information Act (a common technique to gather official data). A comprehensive analysis of the returned data (108 out of the 176 had responded) forms a major part of the Tackling Telehealth report.
The research results reported are mixed. Some of the results make painful reading. The 3ML target of 100,000 telehealth users in seven pioneering “pathfinder” areas by end of last year was dismally missed with the actual figure being below 3,000. In one pioneer area the local council had withdrawn a telehealth tender due to lack of a supplier able to meet the requirements. Another 3ML pioneer area had decided to decommission its telehealth services. Meanwhile other CCG areas have reported more than 1,000 telehealth users each and one had budgeted £1M for services this financial year.
The report looks at what needs to change for telehealth to be successful and follows this up with a case study.
This is a very well written and professionally presented report. I do have one reservation though. The case study deals with the selection of a supplier for telehealth products in Nottinghamshire and quite blatantly that selected supplier is noted as a co-producer of the report. I think this does bring the independence of the report into question and somewhat spoils the authority which it may otherwise have had.
The report is free to download so long as you register on the Inside Commissioning website here.
Australia was delivering personal healthcare at a distance (by radio and plane) long before ‘telehealth’ and, indeed ‘telecare’ were coined. One therefore wonders in what way a consortium of Australian companies were inspired by England’s 3millionlives (3ML) in developing their own version: One in Four Lives. Perhaps they thought they could do better.
10 months after the One in Four Lives launch in May 2013, they have produced a white paper (PDF download) which is, in effect, a manifesto calling for government support. It has some well-respected authors who accurately opine that the real challenge is not technological but is in “…creating sustainable, profitable business models that can meet the needs of governments, services operators, clinical practice and patients.”
The telehealth-world politics of this consortium might make an interesting study. We can only scratch the surface and wonder… According to the UK’s Telecare Services Association, its chief executive Trevor Single attended the original kick-off meeting in Australia. Who is not ‘in’ is quite interesting. Tunstall, the instigator of 3ML in England and which has a strong presence in Australia, is notable by its absence. Also missing are significant providers such as Silver Cross and OzCare, and the leading Australian universities and institutions in telehealth research. The dominant partner appears to be BT which, as our UK readers will be aware, led by its Clinical Director, Global Market Development at BT Global Services, Angela Single, has ambitions to dominate the telehealth world.
Related media items:
The Australian, May 2013: BT leads big push to roll out national telehealth services
ARN, March 2014: Telehealth could save “unsustainable” federal health budget, according to a white paper
A new group of industry stakeholders is asking the Australian Federal Government to adopt telehealth as a means to cut the growing national health budget. A whitepaper from the group was presented in Canberra on Wednesday to MP Steve Irons, chair of the House of Representatives Standing Committee on Health by George Margelis (who has previously contributed here at TTA) representing MPT Innnovation Group.
Members of the One in Four Lives group include the Australian Information Industry Association (AIIC), BT Australasia, Anywhere Healthcare, Philips, MPT Innovation Group and the University of Western Sydney (according to Pulse IT) and is chaired by Lisa Altman, Health Practice Director at BT Australasia (part of BT Global Services). The name One in Four Lives reflects that 25% of Australians have chronic health conditions.
Australia has widespread use of telehealth as the many news items we have reported bear out. However majority of these are video link type schemes and the new group is advocating greater use of more sophisticated telehealth schemes using home-based connected sensors and dedicated monitoring clinicians.
If, like me, you thought One in Four Lives sounded familiar, that is probably because the words “Three Million Lives” may have flashed through your mind. Three Million Lives, or 3ML, is a programme that was launched by the UK Goverment in 2011 to get that many people using telehealth. Just to complete the comparison, BT also happens to be the lead company in 3ML.
See also Australian Aging Agenda
3millionlives goes sideways, again…
NHS England formally scrapped the planned seven ‘pathfinder sites’ projected to enroll 100,000 residents, in favor of a more limited scheme to gain adoption of telehealth in areas where ‘energy already exists’ in a new plan, ‘Integrated Care for 3millionlives’ to be delivered by March 2014. Health Secretary Jeremy Hunt in November 2012 set the 100,000 goal for 3ml; NHS England took over the program in April from the DH The totals tell the tale. An independent review by GP 8 Nov gave the total patient count as of September as just 2,368 patients in 20 active pathfinder CCGs (clinical commissioning groups). A spokesperson for NHS England quoted in GP stated that the goal of 3 million patients is still valid for 2017; Rachel Cashman, head of collaboration for excellence at NHS England, indicated at a conference that the plan would cover telehealth, telecare, telemedicine and telecoaching . If this were Silicon Valley, the word used would be the done-to-death ‘pivot.’ NHS England abandons health secretary’s pledge on telehealth (GP), 3millionlives delivery plan by April (eHealthInsider)
As the world turns in Lancashire…
…it seems like a change in party control from Conservative to Labour has derailed the One Connect deal to provide telecare to county residents and possibly the career of the Conservative leader. The current Lancashire County councillors have charged that the deal, signed by the previous lead Councillor, would overcharge the county by £1.4million. One Connect is a 60/40 percent joint partnership between BT and the LCC. Muddying the waters is a personal dispute between the Conservative head and the Liberal Democratic leader. Tories turn on party leader (Lancashire Evening Post)
The July Telecare LIN newsletter has been published and is available for download here. This month Mike has two short items on the Kings Fund congress earlier in the month and the transfer of 3ML from DH to NHS England plus the usual monthly round up of news with the top item being O2’s pull out from telecare and telehealth.
When editor Donna passed an item from iHealthBeat to me, her comment was “Just as the DOD and VA are fighting over systems, maybe VA can make a few pounds selling VistA to the NHS!” Well, it’s much more interesting than that!
The iHealthBeat item is about a £285,000 ($430,000) exchange programme – of “leaders, staff and ideas” – to see what people from NHS England and the Veterans Health Administration (VA) could learn from each other about digital records and technologies. (This follows the scandalously expensive collapse in 2011 of the NHS’s attempt to develop its own national electronic record system.) Digging around some more, we discover from an item by eHealthInsider that the exchange programme began as part of the 3millionlives (3ML) initiative to compare notes on telehealth monitoring. With 3ML now being incorporated into NHS England, we find that the extended remit of the exchange programme has relegated telehealth to what many seem regard as its proper place in the scheme of things – the sidelines.
In February we reported and commented on the clumsy tender by Worcestershire County Council for ‘Supply of a Solution for Assistive Technology for Worcestershire’ as part of its 3millionlives (3ML) Pathfinder site status. The tender process should have completed and been awarded some weeks ago and yet we cannot find any reference on the internet to the outcome. Does any reader have a link to an announcement we have missed? All we have seen referencing Worcestershire lately is a gushing – but apparently unrelated to the tender – press release by Tunstall on 25th June in praise of its long-standing partner organisation Worcestershire Telecare a service supplier that is independent of the council.
Despite the echos of star (reward) charts for children as recommended by Supernanny, the issuing of stars by the European Commission to cities in recognition of developing ways of helping older people is probably a Good Thing. It provides a mechanism for recognition of good practice and a means of promoting healthy competition. It also means that, in order to rate the cities, someone somewhere has to have a vision of what is ultimately possible. There are six categories of innovation in the EU’s ratings: medication adherence, fall prevention, frailty and malnutrition, integrated care, independent living and age-friendly environments. Good examples have been noted from Andalusia, Scotland, the Basque region and Portugal. There are details in the press release. Moreover, it is not just about recognising good practice it is about sharing it via a Digital Market Place for Innovative Ideas. Perhaps the rating process holds some ideas for NHS England as it wonders how to promote telehealth. Hat tip to Bob Pyke.
Back in May we wondered if it might not be time for the 3ML initiative to be “moved to a new home” But this week’s low-key 3ML announcement (undated) that it has moved (from where it used to couch surf, with the Telecare Services Association) to a new home within NHS England’s Medical Directorate* leaves one wondering whether the also desired “reinvigorated and regenerated” will come about.
The move seems to confirm the widely held suspicion that, despite assurances about 3ML including telecare, it is really about telehealth. This is reinforced in the language of the announcement which is quick to reference clinicians. But how will NHS England get the ‘real’ NHS to adopt telehealth in practice? By being “a true partnership and synergy within NHS England” of course! [Glad to see, by the way, that it will be “delivered going forward”, not delivered backwards!]
We wonder too whether NHS England will continue to accept funding from 3ML’s private company partners. If it does not, it will not be the 3ML partnership originally envisioned and if it does, it could become a political embarrassment.
Has 3ML just been hit from the sandpit of the bunker into the long grass of the rough?
* “The English NHS is controlled by the UK government through the Department of Health (DH), which takes political responsibility for the service. Resource allocation and oversight was delegated to NHS England, an arms-length body, by the Health and Social Care Act 2012.” Wikipedia.
In 2012 an estimated 100,000+ new users were connected to telecare and telehealth systems according to a 3millionlives (3ML) press release today. The figure, 3.3% of the five-year 3ML target, is based on a Telecare Services Association (TSA) survey of 80 organisations. The increase does not take into account the number of new telecare connections one might have expected without the 3ML initiative or the net change owing to ‘user churn’. But at least someone is trying to assess what is happening, which is good. Press release (PDF)
MedCityNews reports a speech yesterday by the UK’s Secretary of State for Health at the Health Datapalooza IV conference in Washington DC. If the hype in the headline is enough to make you suspicious, the rest will leave you wondering if Jeremy Hunt is not floating free of reality: Six health data advances from England that will be “bigger than the Internet”.
Angela Single, of BT, has been re-elected as chair, and Ileana Welte, of Bosch UK, elected vice-chair of the 3millionlives (3ML) industry working group. Press release (PDF)
Just when the UK’s 3millionlives (3ML) project seems to have hit the doldrums, BT has taken its model ‘down under’ to Australia. According to The Australian (part pay-walled) “BT is spearheading a multi-million-dollar push by more than 20 key private and public sector players in the healthcare industry to roll out telehealth services in Australia, mirroring a British e-health initiative to provide services to three million people within five years…BT is convening a meeting later this month of key players across the sector, including those in private, community and aged care, to sign off on bankrolling the initiative, expected to run for up to two years, to develop a framework to fast-track the rollout of telehealth services.”
It will be interesting to see if a private 3ML-type initiative without the dead hand of Ministerial blessing will fare better than the original. Of course, the connecting link between the Australian and UK initiatives is Angela Single, Chair of the UK’s 3ML Working Group who is Clinical Director of BT’s Global Telehealth and Telecare Managed Service Pratice [sic]. Will BT, with the benefit of the UK experience, be able to make a fresh start In Australia? More, is this development a sign that the UK’s 3ML investors are restless? Might it not be time for 3ML to be reinvigorated and regenerated Dr Who-like and moved to a new home?
The Australian item: BT leads big push to roll out national telehealth services.
…Meanwhile, also in Australia, a seemingly unrelated story: Telehealth projects get $20m funding boost ITNews.
At the end of this month NHS North Yorkshire and York (NYY) – a Primary Care Trust (PCT) – and the Yorkshire and the Humber Strategic Health Authority (YHSHA) that oversees it, will be no more. They will be replaced by four Care Commissioning Groups (CCGs).
NYY and YHSHA together spent £3.2million capital money on Tunstall telehealth equipment in 2010, with the PCT paying ongoing support fees and depreciation costs. The procurement was intended to provide 2,000 devices for a project to deliver telehealth to people in the area. It was a pre-cursor of the 3millionlives (3ML) campaign but the local GPs had to be persuaded to participate without the benefit of knowing the Whole System Demonstrator (WSD) results.
The NYY project has had the aspect of a slow motion car crash for everyone apart from (more…)
The Good Governance Institute (GGI) has been working with Birmingham City Council (BCC) to develop a quality assurance programme for Birmingham’s telecare service. In October 2011 Birmingham contracted with Tunstall to increase its user numbers to 25,000 (now 27,000 according to the latest press release) in three years. Independent quality assurance was part of the commitment then. [TTA Oct 2011] The GGI has now published a report Birmingham Telecare Service: Establishing an independent quality assurance process which “documents in full the first stage of this work, and the framework for the ongoing programme.” Although dated October 2012 it has only just been cleared for release. This may be of use to the 3ML Pathfinder sites as well as telecare services. The GGI also has some user interviews on video, here. Download the report here (PDF)