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The waiting game

No evidence telecare can cut costs, says DH-funded study

There is ‘no convincing evidence’ that telecare can reduce other healthcare or social care costs, according to the lead author of the latest analysis of the Government’s flagship pilot looking at the impact of using new technologies to improve care.

In another blow to the Department of Health’s plans to roll out telehealth and telecare to three million people by 2016, researchers from the DH-funded Whole Systems Demonstrator study said that telecare devices have no significant impact on the use of other NHS or social care services.

The latest in a series of papers to look at the DH pilot found no significant impact on duration of care, admissions to care homes, admissions to hospitals, length of hospital stay or GP contacts from using monitoring equipment and devices such as medication dispensers, falls detectors and bed occupancy sensors, compared with a control group receiving usual care over 12 months.

The results come after another paper from the DH pilot, published last week, found telehealth had failed to improve quality of life in patients with COPD, diabetes or heart failure, striking a blow to the Government’s ‘3millionlives’ campaign for much wider use of telehealth.

The GPC said the evidence also raised questions about the Government’s proposed new DES which will incentivise GPs to monitor groups of patients with long-term conditions using telehealth from April.

The authors of today’s paper - published in the journal Age and Ageing - said their data would have ‘implications for resource use and planning’ when rolling out telecare.

The randomised controlled trial is thought to be the largest of its kind and involved 2,600 people being looked after by carers or needing social care support in England, who were split up into a group monitored remotely using telecare via up to 27 different devices and a control group, given usual NHS care.

The researchers found the technology had no significant effect on rates of secondary care use or contact with GPs and practice nurses.

Of participants monitored using telecare, 46.8% were admitted to hospital within the 12 months of the trial, compared with 49.2% of controls. The differencebetween the groups was not statistically significant .

Similar proportions from the two groups were admitted to permanent residential and nursing care during the 12 months; 3.1 and 3.2%, respectively. GP contacts were 18% higher among the telecare group, compared with controls, but this was not significant when adjusted for prior differences in use.

Writing exclusively for Pulse on the study, lead author Adam Steventon, senior research analyst at the Nuffield Trust and project lead on the Whole Systems Demonstrator programme, said that telecare may have an effect over the longer term, but researchers were not able to measure this in their study.

He said: ‘Though our analyses were limited, we were able to test the claim that telecare reduces admissions to hospitals or care homes.’

‘Based on the findings of this particular trial alone, there is no convincing evidence to justify the public sector to invest in telecare from purely a cost saving perspective.’

He also said that the role of telecare may not be to reduce costs, but to reduce the anxiety of patients or carers. Read his full analysis of the implications of the study here.

But Dr Chaand Nagpaul, the GPC negotiator with responsibility for IT, said: ‘The Government needs to take note of their own study and put a halt on any blanket approach to expanding telehealth.’

‘At a time of austerity, the Government should not be promoting a policy based on ideology. Government should reconsider its commitment to roll this out as part of its “3millionlives” project and the last thing they should do is introduce elements of telehealth into the contract.

He added that CCGs should not feel pressured to introduce the technology: ‘Given that there’s insufficient evidence that telehealth reduces costs, CCGs should be under no obligation to use it and should decide on the best use of their resources based on evidence.’

A spokesperson for the Dh said: ‘We funded a three year randomised control trial involving more than 6,000 people, which clearly demonstrated that if implemented appropriately, telehealth can reduce emergency admissions by 20 per cent, A&E attendance by 15 per cent and mortality rates by 45 per cent.’

They added: ‘This trial has been used to help inform the 3millionlives initiative which aims to help improve lives through better integrated telehealth and telecare services in the next five years.’

What did the trial look at?

All intervention participants were given a Tunstall Lifeline Connect or Connect+ base unit together with a pendant alarm and up to 27 peripheral devices, including:

  • Functional monitoring, including the ‘Lifeline’ base units and pendants, bed and chair occupancy sensors, enuresis sensors, epilepsy sensors, fall detectors and medication dispensers.
  • Security monitoring, including bogus caller buttons, infrared movement sensors and property exit sensors.
  • Environmental monitoring, including gas, monoxide and smoke detectors, heat sensors, temperature extremes sensors and flood detectors.
  • Standalone devices not linked to a monitoring centre, such as big button phones, key safes for carers and memo minders.

Data from the peripheral devices were sent to a monitoring centre via a telephone line and alerts were monitored continuously.

Source: Age and Ageing, online 25 Feb

Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

The COPD Update session at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers, will cover the latest developments in telehealth.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.


Readers' comments (14)

  • Tom Caldwell

    no evidence of benefit, increase in workload and expense (because doing it does not save on consultations)......... I am certain the government will snap it up.

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  • I am a full term partner who also works in OOH to top up my pension to speed me towards the exit door.

    We often get calls in OOH tiggered by telehealth and I can honestly say IT IS A COMPLETE WASTE OF MONEY.

    What use is it to be told somebodies oxygen sats are 89% without the context of the clinical situation. You call the patients who tell you ' haven't felt so well in ages'

    If it is felt to be useful then buy them or their carers an oximeter ( in this case) and get them to check themselves and call for a doctor if not only is there level low but they feel unwell and have worsening symptoms from normal.

    We could save £milillions and millions by scrapping it.

    CCGs should use some muscle and scrap the schemes.

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  • The key issue remains poorly designed clinical models that do not utilise technology effectively. The WSD is an example of a technology driven project without a clinical model underlying it. As noted in one of the comments, isolated data without clinical context is useless. They should use the technology to put the data in context, and add a mechanism for acting on the information. Video conferencing would be a good start, and the ability to deliver clinical content in a relevant way would also help.
    Clinicians gather information then act on it. If the WSD had focused on emulating that model it may have shown greater benefit.

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  • Vinci Ho

    This looks like another nail in the coffin for Telehealth or Telemedicine.
    Sometimes one needs to take one step backwards and ask oneself , ' is advance in technology an absolute blessing for mankind??'
    You know , I know , these young people heavily dependent on Facebook , Twitters etc. these days are sacrificing their face to face verbal and social skills.
    Practising medicine especially family medicine is a 'people's science' not a technology . I hope some of these hot headed academics can understand .
    The government always go for these 'new' ideas rather than investing more into EXISTING system because simply they believe that will bring them more propaganda and hence votes. Please do not fall into that trap.........

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  • This isn't going to go away. Telehealth companies have got sales staff and advertising budgets - who needs evidence?

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  • The new type of telecare with sophisticated remote telemetry delivers less 'economic' benefits than expected compared to older versions of telecare which are pendant activated. Patients often know best and, as BORG/Heart rate/effort charts demonstrate, they often have a good sense of their body, its needs, and when to seek help. As stated in the article, what can we do for patients to enhance that pendant type telemetry method to minimise admissions and enable people to be cared for at home. What were the next steps after someone activated the pendant that resulted in admission - maybe they were very ill, or maybe the social care broke down, or maybe they were just having a mini crisis.

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  • We have to wake up - we are in the 21st century. We know we can't cope with demand now. Instead of winging about it clianican need to get involved in pathway developement. i have seen this work first hand and with the right servcie for the right patient its transforming.

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  • I agree: as part of the right service for the right patient it is an element of future healthcare provision. But not a fix for current demand problems. What will BT do with Ian Dalton now?

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  • Harry Longman

    The evidence says, it is not worth investing in telecare to save money. It's our money, our scarce resources, so we should not do it.
    Equally, it would be foolish to say that telecare can never work in any circumstances or with any new development. The technology will change, and it may well be worth continued small scale experiments at low cost.

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