Thanks to Government Computing we have two reports from the Health Service Journal 2012 Telehealth Conference 30-31st October:
Our headline quote is taken from the former, which flags up current thinking from speakers from the Department of Health and academia. The second focuses on the variability of wireless broadband coverage in the UK and has a memorable quote from Hazel Price, assistive technology project manager at Kent County Council, “In Kent we have more dead spots than a collection of cemeteries.”
There seems a string of publications from a range of sources all saying about the failings of the WSD and its benefits. The project entailed both TELECARE (the forgotten half) and Telehealth and it is Telehealth that these reports all relate to I wish this would be highlighted.
Let’s not forget that the WSD telehealth trials took people with a confirmed diagnosis of 1 or more of 3 different chronic conditions, and provided them with a standard set of pretty basic monitoring equipment and response protocols for dealing with exacerbations. Evaluation should be easy thanks to a Payments by Results tariff for costing hospital admissions etc.
By comparison, the telecare trials are far more challenging:
1. Service users could present with a wide range of issues and risks to their independence ranging from those with a single moderate risk (such as a fall at night) through to those with complex problems related, perhaps, to cognitive impairment.
2. They might also have very different support mechanisms, family values and long term care preferences
3. The equipment that they might be offered could be limited by the 20 or so items in the catalogue of their supplier, or it could be enhanced by items from an order-of-magnitude larger inventory of related products that might support the delivery model of their choice
4. Assessors may not have been trained in the same way
5. Those that design the telecare service may not be aware of the options
6. Response protocols may be different.
7. There are no international comparisons that can be made on outcomes and benefits.
It’s hardly surprising that the evaluators have struggled to get their heads around the above confounders. Fortunately, those of us who are at the sharp end know (because it’s blindingly obvious) that when the right people are properly assessed, and get the right (and not too much) equipment as part of the right telecare service then not only does it lead to better outcomes, more choice, and greater satisfaction for carers and cared for, but it also saves significant amounts of money for the NHS, for local authorities, and for the service users themselves.
It could be that the evaluation has found that when the wrong people get the wrong equipment as part of the wrong service, it’s a total waste of money and leads to poorer outcomes – also something that bleedin’ obvious! So could it be when the evaluators are working out the potential savings (and they must be enormous) that they are having to factor in an “appropriateness” element to allow for poor quality delivery?
I totally agree with Jo’s comments here.
The approach to the awareness / training and delivery of Telecare and other technologies defines its success. Putting equipment out there for the sake of it and ‘silo-ing’ Telecare into packages such as falls / dementia etc does not put the person or patient at the heart of things.
The provision of technology needs to complement existing care and support packages and be checked and tested on a regular basis to ensure it is still meeting the needs of the person. Putting packages of technology out there in order to satisfy targets and meet extrapolated figures to evidence cost diversions / cost avoidance will not work.
The telecare WSD was always going to be difficult to evaluate for all the reasons outlined in previous comments. However, the most difficult for the evaluators was surely the lack of previous robust studies and randomised control trials. Indeed, many people said that it would be impossible to even construct such a trial because of the need to apply person-centred principles to assessment and service provision. Add to this the small number of academics trained in social care economics as opposed to Health Economics, then it is apparent that the researchers had to work from first principles.
Despite the fact that the results are running some 12 months behind those of the telehealth trial, I am confident that they will show particular benefits for carers and for preventing many vulnerable people declining into long term care.
My guess is that lessons have already been learned and best practice identified. Services are already been reconfigured both to give individuals more control, and to integrate telecare into a broader proposition that includes aids and adaptations and other services that support the same ambition of increased independence for the target groups.
Hopefully, these activities, along with the WSD results, will strengthen the 3 Million Lives proposition, and will help to push forward the UK’s lead in all digital healthcare matters.