Will Yorkshire CCGs pull the plug on the NYY telehealth project? (UK)

It seems but yesterday that Telecare Aware readers were flagging up that the £3.2 million procurement by NHS North Yorkshire and York PCT (NYY) of Tunstall telehealth monitoring equipment (including ‘free’ implementation consultancy services but plus ongoing costs of £1.7m per year) looked too hasty, too large and too soon.

But no, it is over two years since NYY PCT responds to Telecare Aware item: The £3+ million telehealth spend that has achieved…what? was published.

So it gives editor Steve no pleasure at all to point you to the following article that appeared in the Yorkshire Post today: Telehealth revolution in tatters after snub by doctors. In short, the failure of the project to take off is causing the local Clinical Commissioning Groups (CCGs) that take over responsibility for it in April to question its future. The journalist dissects the issues so I shall leave it to him or her to do that for you.

However, if the CCGs do pull the plug on the project it will be interesting to see what happens with the taxpayers’ unused telehealth equipment that Tunstall has been paid for but not yet had to deliver. Does the contract entitle them to pocket the difference? Or perhaps one of the CCGs could take delivery of the remaining equipment and make it available to other Telehealth Pathfinder sites. One final question lingers… Where is Ernst & Young (Tunstall’s implementation consultancy subcontractors) [TA Jan 2012] and its reputed £1m fee in all this?*

* “For over two years now Ernst & Young have played a major part in deploying telehealth at scale in a number of NHS regions.” E&Y press release.

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Comments

  1. Cathy

    Okay making a gross assumption here: 100,000 to benefit in 2013, across 7 sites is around 14,000 per site. In this item we hear that 1,200 have benefited during the lifetime of the project with around 650 enjoying that benefit at anyone time [i](although the numbers quoted by different people do not quite add up so the article possibly has been comparing apples and oranges?)[/i]. So to meet Government targets in 3ML this area has to increase the number of those benefiting 12 fold within 11 months.

    GPs are of mixed view as to its value; and we see time and time again that the public do not understand it and are either outraged at being cared for by a robot or at best dismissive. With GPs taking the commissioning decisions from April it will become increasingly important to win the hearts and minds part of the debate

    In the article we have a politician saying it won’t happen without external funding … yet this area has had unused telehealth equipment (67% of its stock) for several years – so perhaps finance is the red herring here again?

    The reason telehealth is so slow to be adopted is that people do not know what it is, do not understand how it can benefit them and their family – these, rather than the health boards or CCGs, are the customers. In marketing terms there is NO DEMAND from the customer; we all know the joke about a shopkeeper being asked for an item and saying “we don’t stock it there is no demand for it”

    Simon Arnold, please remove your head from cloud cuckoo land – these numbers just do not stack up and every time you make statements, like that in this article it damages your credibility just a wee bit more. The one-trick pony is not going anywhere and flogging it will not make it go there any quicker. However compelling you think the case for large scale teleheath deployment that boat is leaving port with the creation of the CCGs.

    Time for a rethink to win those customers over to encourage them to generate demand so that their GP has to take notice and escalate it to his/her CCG. Time for GPs to be exposed to many alternative telehealth possibilities and informed so they can recognise the demand that is generated and time for politicians to stop bleating about money and look at how people are informed to support them make choices about their lives.

    [i]Look at the marketing opportunity we have right now – would you want to have to venture out to your GP surgery with COPD or CHF in this weather? Is it beneficial for GPs to have to be out making house calls in this weather? What if that emergency ambulance you call breaks down in the snow and although it turns out you didn’t need it seven other people who did need it don’t get it? These are the sort of questions that make sense to people[/i]

  2. UNATTR

    The worst part about this is that everybody knew that this type of result was coming from NYY.

    Over a year ago they had deployed around 440. 200 in the following 12+ months is dismal based on what they knew they then needed to do. So their ability to ramp up operations was simply not there. Why?

    Could it be because the money was non-recurring and therefore once you have set up your team, bought way too much equipment and paid the consultants (no expertise in telehealth whatsoever but thought that they could implement tried and tested project implementation methods from other walks of life)? Then there is nothing left for the rainy day.

    Well it poured down. And still is. 3 years to at least have it embedded somewhere is ample time. The trouble is volume. Never should have agreed to purchase that volume, or any figure over 100. As soon as you stick numbers in then, if you don’t achieve that volume, you are vilified. Ernst and Young should have put that in their report.

    Equally if NYY chose to only follow 60/70/80% of the Ernst and Young proposed new pathways then they only have themselves to blame.

    I think now is time for NYY to put out a statement. In the eyes of 80% of the GPs it has failed anyway so at least try and salvage something.

  3. UNATTR

    Ernst and Young did put it in their press release – you could have paid me 10000th of their fee to come up with ‘its not just about kit’. Love it.

  4. Mark

    Cathy is right, most people wouldn’t know telehealth if it bit them on the bottom, and until that situation is addressed (and for telecare too, as it is only marginally more understood) then the targets set for 3ML have little chance of being hit and more importantly sustained.

    Deployments like this, which obviously had primary benefit for the equipment supplier and their partner consultants, only create more bad publicity which sets telehealth back all the time. Is it any wonder that GP’s have a low opinion of telehealth when stories like this appear. I’m sure there are many people up and down the country debating the telehealth question with their CCG’s who will be dismayed at this!

    Part of the money spent would have been better used stating the case in favour, and creating awareness and demand amongst the public.

  5. Cathy

    [quote name=”Mark”]Part of the money spent would have been better used stating the case in favour, and creating awareness and demand amongst the public.[/quote]
    If I recall correctly it was stated or suggested that the money used was a pot of funds available at the end of the financial year which would otherwise have been clawed back?

    This has been a flaw in public sector funding for as long as I can remember being aware of public sector budgets – if a department’s budget is agreed and the money management leaves surplus when everything expected is done the surplus should not be clawed back … there is no motivation for the budget holder and we see money being wasted just to spend it.

    As Mark suggests the money could have been more wisely spent but that wouldn’t have met the clawback avoidance criteria and would have been difficult to get through a procurement framework perhaps?

  6. Having had first hand experience of the benefits of telehealth/care of many patients I am saddened that so-called health professionals dismisss it benfits so casually. What are they afraid of? patients being in more control of their health conditions?
    Before the CCGs dismiss the use of both telecare and telehealth- please speak to patients who have used it. I know it will not suit everyone and requires robust governance arrangements but those that it works for gives patients great benefits in giving them more confidence through the self-management of their conditions which result in more patients being independent in ther own home for longer,less admissions to hospitals and overall better quality. All I can say don’t be afraid of it and don’t dismiss it before you try. If pioneers had done this we would still have smallpox epidemicis!!!!!!!

  7. Mary R

    A relative of mine with an elderly sick relative prone to occasional falls in the NYY area was scared to go out, needed others to do her shopping – till I told her about the Tunstall equipment and what it could do. She went down to Town Hall and enquired but had to keep asking doggedly before she got the equipment that got her release and peace of mind. Where was the local communications campaign, where were the good news stories ??? I am in technology so came at it from the other end, saying – see if you can get one of these (I’d printed out from the Tunstall website) from the Council and if not then they could have bought one, they were lucky.

    I also work with the NHS and I can hear in my head community staff saying ‘do you want me to look after patients or promote technology’ – the answer is that someone should have been championing the devices from outwith the nursing fraternity – they bought them, and things do not roll-out magically with effort put in as explanation and progress reports to all types of audience.

    Sadly my relative has now died, but at least their last few months were calmer for all the family than they might have been! Do not dismiss the technology — tell people about what went right and learn from what went wrong – please.

  8. Cathy

    Napier and Mary R – these are exactly the sort of testimonials that other members of the public need to see and hear. Thank you for adding them to this discussion.

    Napier if you are in England and will be subject to a new CCG from April it would be really helpful, if you have not already done so, to make the same representation direct to that body if you can.

    Mary R it sounds as if you are talking more specifically about telecare – which still needs the public to have knowledge of it. I have three comments though from my experience working within social care relating to telecare – please do not take these personally because I am not in your area:

    1. there have been champions trying to embed telecare for several years and the lack of join up across health and social care has been
    a barrier.
    2. The very fact that you researched Tunstall – nothing wrong with Tunstall equipment but it is a brand and there are many others – may give you an indication of why they have been successful at selling large quantities of equipment but which, as in the NYY case cited in the paper is not being used. When one brand so dominates a market it stifles innovation and generates complacency.
    3. Because there is a wide range of brands and because everyone is an individual it is not as simple as pulling telecare (or telehealth) off a shelf and solving the problem. The assessment of the right piece of equipment for that person needs thought and needs to consider risk. The Public
    Sector is generally risk averse so a person being independently at home is exactly that – as soon as that person wishes to be independent and go out into their community the risk goes up. As a consequence of being risk averse and streamlining how much time is available for assessment (resulting in a checklist completion rather than assessment) it has been easier for the public sector to provide basic community alarm equipment and call it job done!

    Sadly whilstever telecare/telehealth are not seen as ‘looking after a service user/patient’ and no one takes responsibility for it being their job it will not progress. There should be no choice between providing care or promoting technology it should all be part of the same task and you are right that that does not happen by magic.

    As to where are the good news stories? I guess usually buried underneath the “oh no they are saving money by cutting X” stories that dominate our media.

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