Chief Executive of Airedale NHS Foundation Trust; Bridget Fletcher discusses how this Yorkshire Hospital is delivering unique, new and bespoke video consultation services to support patients in their own home and preventing unnecessary admissions to ED and inpatient beds.
Overburdened A&E departments and hospital wards full to capacity are almost daily news items currently. It is likely that the individual human stories behind those news items involve very many people over the age of 65 living with one or more long term conditions. In fact statisticians tell us around 70% of our NHS resources in general are spent caring for patients living with long term conditions, much of which is re-active care rather than proactive.
It’s hard to understand why then we don’t make better use of some of the technologies that can enable those patients to manage their health in their home environment; monitoring their conditions over time to make sure they don’t get to crisis point; in most cases avoiding the situations that result in them calling 999, or that can support their early discharge from hospital.
This is not to suggest that technology is the single answer to all capacity problems. But it is one available option for helping to alleviate some of the problems facing healthcare providers today. The Health Secretary Jeremy Hunt recognised this when he visited Airedale NHS Foundation Trust in January. After his visit he tweeted ‘ I’ve just been to Airedale Hospital and seen some of the best use of technology anywhere in the NHS including digital patient records shared with GPs and great patient care’
Airedale have been developing and delivering telemedicine (secure video consultation between clinicians and patients) for over 7 years, initially providing services to the prison sector, but more recently to individual patients and to residential and nursing care homes. In 2011 they worked with partners in Yorkshire and the Humber (NHS Barnsley/South West Yorkshire NHS Foundation Trust and the University of Hull) to offer new and unique bespoke services to the rest of the NHS organisations in their region. Working under the name of the Yorkshire and the Humber Telehealth Hub, the partnership offered services that included telemedicine (Airedale NHS FT), telecoaching (NHS Barnsley) and telemonitoring (University of Hull). Earlier this year The Yorkshire and the Humber Telehealth Hub was used as the region’s ‘good practice’ example that achieved 3 Star Reference Site status with the European Innovation Partnership on Active and Healthy Ageing a European Commission programme aimed at identifying and spreading good practice.
Patients who used the services of The Telehealth Hub gave some very positive feedback on the quality of care given, describing telemonitoring and telemedicine services as ‘a life-saver’ or ‘a god-send’ and ‘reassuring’ or something which ‘takes the pressure off [nursing home staff] as we have access to a health professional who can advise us’. The healthcare staff involved also thought the services offered through The Telehealth Hub provided a more efficient, patient-focused approach to care.
The national think tank 2020health undertook an evaluation of the project alongside the University of Hull who evaluated the quantitative data. 2020health found The Hub enhanced the care of patients with long-term conditions. It also found it enabled local healthcare communities using it to think of telehealth services not merely as technology applications, but as enablers to developing services that can be tailored to the needs of patients.
The quantitative evaluation demonstrated that using telehealth services had contributed towards a reduction in hospital admissions and healthcare costs and were identified in each of the services offered through The Hub. In addition to the patient benefits associated with avoidance of hospital care, these results fed into substantial cost savings. In the first 11 months of operations, the telemedicine service based in Airedale avoided up to 124 hospital admissions, creating over £300k of gross savings. The telecoaching service (NHS Barnsley) was associated with a 22% reduction in monthly hospital admission costs. In Hull, the evaluation of benefits suggested that for every 100 heart failure patients receiving telemonitoring, 10 admissions were avoided each month. These clinical benefits represented financial savings of £118k.
More recent results from Airedale were launched at The King’s Fund Third Annual International Congress on Telehealth and Telecare, July 2013. These demonstrated telemedicine services provided to 14 homes in a 12 month period compared to the previous 12 months without telemedicine delivered a reduction in admissions of 45%, a reduction in length of stay of 30%, a reduction in bed days of 60% and a reduction in A&E attendances by 69%.
These figures aren’t just good news for the Secretary of State for Health – if we could persuade more clinical commissioning groups and provider trusts to deploy telemedicine technologies for their local population – it would be brilliant news for the people who wouldn’t have to sit waiting in A&E or spend night after night in a hospital bed too.
All excellent of course, but we do need to wonder why the whole systems demonstrator trial the DH plugged “biggest trial in the world” and the HACRIC “remote care PLC” report (from industry experts) cast significant doubt on the effectiveness or cost effectiveness of technology. If the public sector is going to hand over large chunks of public money to the sector we surely need robust evidence that it is better spent on telehealth and telecare than improving other aspects of care. And we need to keep spin and advertising from the profit-making sector away from any discussion of “evidence”