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The waiting game

Telehealth pathfinder schemes struggle to recruit patients

Exclusive: Seven pathfinder areas spearheading the Department of Health’s drive to extend telehealth across the country have so far recruited just a fraction of the patients they are supposed to help by the end of this year, a Pulse investigation reveals.

In the pilot areas which were able to provide figures, just over 8,000 users have been signed up to date, despite health secretary Jeremy Hunt last year pledging that 100,000 patients would be helped by the end of 2013.

The poor take-up comes as CCG leaders taking control of the schemes told Pulse the technology was a ‘solution looking for a problem’, with patchy evidence emerging from studies looking at the Government’s Whole Systems Demonstrator (WSD) pilot. Research published last week found the scheme cost £92,000 per quality adjusted life year, almost three times the upper limit for cost effectiveness set by NICE.

Last November Mr Hunt announced that seven pathfinder regions would be taking the lead in rolling out telehealth to patients this year – the first stage in the plan to reach three million users with such technologies by 2017.

But across the five pathfinder areas that were able to provide details of their schemes, progress has been limited.

Two of them – NHS Kent and Medway, and NHS Cornwall and Isles of Scilly – participated in the WSD pilot and so have well established telehealth services. But they reported that they currently only have 500 and 900 active users of telehealth respectively.

In Worcestershire, some 6,000 patients are currently supported by a mixture of telehealth and telecare. But NHS North Yorkshire and York, which is part of a joint pathfinder with Humber PCT cluster, still has only 650 patients using telehealth, despite previous efforts to boost uptake in an earlier pilot launched in 2010. In Bassetlaw CCG, which is part of a joint pathfinder with NHS South Yorkshire, just 21 patients have signed up. NHS South Yorkshire and Humber PCT cluster were not able to provide separate figures for their part of each pathfinder, while the remaining two pathfinder areas, NHS Merseyside and Camden CCG, were also unable to provide figures.

Dr Tamsyn Anderson, clinical lead for long term conditions and urgent care at Kernow CCG and a GP in Newquay, Cornwall, told Pulse that while the new technology was mainly viewed positively by patients, many clinicians still considered it ‘a solution looking for a problem’.

She said: ‘The biggest difficulty is that the evidence doesn’t really provide sufficient confidence to allow our clinicians to take this forward.’

However she said some lower-level technology developments, such as smartphone applications, could prove more appropriate for patients to self-manage: ‘Certainly from my experience I’ve felt that we need to look at things so that we establish a pathway that works well and then it will be a lot easier to use the technology in appropriate places - whereas here it sort of feels like the technology is there and we’ve said, “which patients will fit it?” ’

Practices are to begin preparing to rollout telehealth to a wider group of patients through a new remote care monitoring DES in the 2013 GP contract, details of which were released earlier on Monday.

But Dr Sam Everington, chair of NHS Tower Hamlets CCG, said he believed the Government’s approach to telehealth was too rigid.

‘You don’t necessarily need a lot of this live-time monitoring,’ he said, adding that ‘it’s too crude to base things on biological measures – and it obviates self-management.’

Rather than providing regular blood pressure levels, or peak flow or spirometry measurements, he said, patients should simply email their GP if their levels went outside predefined limits.

He said: ‘None of us can afford new initiatives at the moment. If it’s going to cost something, the fundamental question is “What am I going to stop doing?” This is a redesign – that’s why there are lots of questions [about telehealth] as the research I’ve seen questions its value for money.’

A spokesperson for the 3millionlives campaign said CCGs were ‘working hard’ to ensure that telehealth was rolled out.

She said: ‘The sites will be road-testing the new 3millionlives way of commissioning, ensuring that appropriate, outcome-based service provision is put in place that appropriately meets the needs of people within the responsibility of the relevant CCGs.’

‘The inclusion of technology within that service design will vary from site to site, but what will remain the same are the much improved levels of cost-effectiveness in the provision of technology.

‘Using the headline findings from the WSD as the basis for measuring outcomes, this will provide current, real-world evidence that the inclusion of technology in service provision is not only effective, but also cost-effective.’


Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

Learn more about telehealth at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers.

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 (1)

  • Do they have a bull-shit monitor? Recruit and attach one to a health minister or two.

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