Been there. Done that. Waiting for the zealots’ t-shirt.

For the past few years the Telecare Services Association’s conference has flirted with telehealth – its core ‘home’ audience being social services telecare providers. But during the past year the seduction has been complete and throughout today the speakers’ focus on telehealth’s nuptial preparations has been positively upbeat – complete with ‘topical’ reference to Dylan’s The Times They Are A-Changin‘ (1964).

With all the attention on telehealth, telecare has been largely relegated to the workshops and exhibition hall where, I’m happy to say she seems to be getting along quite nicely, thank you.

As if telehealth were already wearing her bridal veil, none of today’s speakers defined what they meant by the term and with each new speaker it will take time for the audience to work out that they are not talking about the same thing as the previous one. Furthermore, if the term ‘telecare’ in the final day session entitled What can the UK teach the USA about Telecare delivery and what opportunities does this offer to the UK market? by Jonathan D Linkous, Chief Executive of the American Telemedicine Association does not also turn out to be a variation of ‘telehealth’ I’ll wear my conference bag home on my head!

So what was revealed today?

Nothing of the Whole System Demonstrator (WSD) randomised control trial results, of course, but we knew that would be the case, anyway, didn’t we? I suppose so because no one took Conference Chair Roy Lilley’s challenge to ask for their money back. Professor Stanton Newman’s re-titled session turned out to be WSD Trial – Evaluation of Telehealth and Telecare: Who accepts and rejects the equipment and why which was an interesting complement to the Telecare Aware Soapbox item on the topic. However, it is really just a byway in the WSD countryside.

Between Professor Newman, Paul Burstow, the Minister for Care Services and Stephen Johnson, Head of Long Term Conditions at the Department of Health (DH) we were variously told that the WSD results were:

• in the last stages of the peer review process
• that they are only a couple of weeks away from publication
• that DH was considering how to follow up publication to get the best bang for the buck (I paraphrase)
• that DH is working on a LTC-based ‘year of care’ tariff which, one assumes, will include an element for telehealth

Hey ho! Telecare in England had its chance to become the belle of the ball with the Preventative Technology Grant back in 2006-08 and councils frittered that chance away like nervous adolescents. Let’s hope the NHS can do better when its turn comes! (Hmm…have I just mixed metaphors? Sorry!)

A couple of snippets from Professor Newman’s presentation (you can wait for the full results, can’t you?): 5831 participants to the WDS were recruited [out of 27,000 invitations, we learned from later speaker Gwyn Weatherburn] but only a very small percentage of people who had the equipment installed asked for it to be removed. People who were less likely to ask for it to be removed were female, younger and from minority ethnic backgrounds.

Roy Lilley, who, at some point had been branded a zealot neatly turned that around and had the majority of the audience proclaiming that they too were telehealth zealots! We are now waiting for the t-shirt.

Dave Tyas, telehealth co-ordinator from the Cornwall WSD brought the issues to life with the example of patient ‘Eddie’. Main points I picked up from his presentation were:

• Most people DO get on with the technology regardless of age
• Resistance initially came from the GPs who had workload concerns, but referrals are now increasing
• A service needs to set up in a way that can scale across conditions and numbers
• Patient satisfaction with delivery/installation is critical
• Lack of information is the main barrier for patients
• What patients DO is more important than what they SAY

Stephen Johnson followed Paul Burstow’s speech. Three points from Stephen for me were:

• If we cannot be clear about telehealth amongst ourselves (the zealots!) how can we expect the public to be clear?
• After the WSD results are published it will be hard for people to argue for more pilot projects. (Hooray!)
• Unlike MRI scanners we do not have the luxury of having 30 years to get it mainstreamed.

To the last point I’d add that neither do current potential users.

Gwyn Weatherburn’s presentation was a round-up of the wide-ranging interest of the Royal Society of Medicine in the topic. It was more interesting than I’ve probably made it sound.

The afternoon was drawn to a close by Adam Darkins, a British ex-brain surgeon who is Chief Consultant, Care Coordination Services for the Department of Veterans Affairs (VA) in the US. As he oversees one of the largest telahealth projects in the world (he has picked up the American way of pronouncing it despite not losing his English accent) his credentials are second-to-none. His presentation was also the most visually interesting with old photos drawing analogies with current technological concerns. Two significant points I noted were:

• Using home telehealth does not unlock money from hospital-based healthcare
• Developing counties do not have to disinvest from old healthcare systems before investing in the new ones that are emerging. So, if they can invest, they could leapfrog the developed counties.

Two halves and a bit

The morning’s plenary sessions were quite intense and, although they finished at 11:00 felt like half a day. They introduced more undefined uses of the word ‘telehealth’. The second half comprised the break-out sessions and/or digging more deeply into the exhibition area. I got caught up in the latter. The final bit was a short plenary session. (Notes below.)

First off there was Dr Dawn Harper, GP, author and co-presenter of the UK’s first primetime ‘telehealth’ television programme where people called in (it’s not airing at present) via Skype to discuss and share with the viewing masses things that they were too embarrassed to discuss with their doctors. Unlikely, but true. And, Dr Harper thought, the reason why they did (apart from getting 5 minutes of fame), was that they were often frustrated with the care, or lack of it, that they were getting from the NHS. As I understood it, the programme would sometimes pay for treatments not available on the NHS. Her session raised issues about the consultation and communication styles of doctors and nurses in the 21st century and about access to them.

Dr Harper was followed by Peter Carter, Chief Executive of the Royal College of Nursing. He took the audience by surprise by not trumpeting the importance of nurses, as you might expect. Instead he demonstrated that, thanks to his travels around the country meeting nurses ‘in the field’ he has become a passionate advocate of monitoring patients at home via telehealth services. He showed a video about a Second World War veteran who asks to be supported to live at home. It moved many in the audience to tears. Now it’s your turn: My Right to Choose

Dr Carter said that the UK has sleepwalked into a situation where we are not geared up to serving people with LTCs properly and that the (anecdotal) evidence for the benefit of telehealth monitoring is clear. He said – and I heavily paraphrase from here on – that it’s not a panacea, but it can make huge inroads into helping the NHS out of the mess it is in and it would be better if the Department of Health would get off its non-directive fence and do a bit of top-down direction for once. There was enthusiastic applause.

The final speaker of the morning, Dr George Crooks, Medical Director NHS24 in Scotland talked on Integrating Services across Scotland. The good news is that NHS24 is working on a strategy for next year for Scotland that will bring together all aspects of public-facing telehealth (in its very broadest sense) from information-giving by phone, internet and TV to home health monitoring AND it will include telecare provision. NHS24, with its special relationship to the Scottish Government, will become the largest provider of these services. (Interesting procurement and tendering issues there!)

[Unbelievably, for someone representing such a high profile organisation, at least one of Dr Crooks’ presentation slides comprised a picture copied off the internet, making one wonder how many other people’s copyright he was infringing. The offending picture still had the Shutterstock watermark designed to discourage copyright theft! It’s about the cost of a cup of coffee to buy the right to use the unwatermarked image.]

Snippets from the exhibition

There were a number of companies introducing new technologies and services this year and needing to update their websites with the information. When they do there will be links on Telecare Aware. Just to whet your appetite, there are:

• a telecare game from SupraUK called Save Doris
• a new UK-wide telecare installation service from SupraUK
• new additions to Tynetec’s range
• a new service from Telehealth Solutions
• new device monitoring software from Burnside, called Monicare
• an additional feature to CareConnectMe’s service
• eye-popping case studies of the use of Just Checking equipment with people with learning disabilities

I missed all the break-out sessions and I’m sorry because some look as though they drill down into some interesting stuff. The organiser’s info on them can be found listed here and I’d be pleased to publish notes from people who ran or who attended sessions. Email me.

Final plenary session

First there was a canter through the UK Government’s Technology Strategy Board’s (TSB) Delivering Assisted Living Lifestyles at Scale (DALLAS) programme by David Bott. People not in the selected participating sites are encouraged to ‘join in’. [Sorry I did not write down the link for the latter and cannot find it on the site.]

Finally there was ‘The Big Issue’ debate on whether the future of integrated services (undefined) should be national, regional or local or a mixture.

The lead participants, Alyson Bell; Nicholas Robinson; Mike Biddle and Moira McKenzie did not get the chance to shine, mostly because the discussion was conducted under time pressure owing to the need to prepare the hall for the conference dinner afterwards. The result was predictable and lacklustre.

This report is provided by the organiser of the day at St Pancras Hospital, London, 22nd June. Report and copies of the presentations are in PDF format.
Report (brief overview)
Telehealth – The Gloucestershire Experience (Aspinall; Strain)
Tele-healthcare In Wolverhampton (Beards; Smart)
The Wandsworth Experience (Jackson; Campbell; O’Donnell; Kong)