Healthcare outside hospital walls

Implemented effectively as part of a whole system redesign of care, telehealth and telecare can alleviate pressure on long term NHS costs and improve people’s quality of life through better self-care in the home setting. Typically, it involves electronic sensors or equipment that monitors vital health signs remotely from home or while on the move. Readings are automatically transmitted to an appropriately trained person who can monitor the health vital signs and make decisions about potential interventions in real time, without the patient needing to attend a clinic.

Telecare is a service that enables people, especially older and more vulnerable individuals, to live independently and securely in their own home. It includes services that incorporate personal and environmental sensors in the home, and remotely, that enable people to remain safe and independent in their own home for longer. 24 hour monitoring ensures that should an event occur, the information is acted upon immediately and the most appropriate response put in train.

Why Telehealth?
Telehealth and telecare has the potential to make significant health improvements and quality of life impacts for people with a high dependency on the NHS, local GPs, social services and local hospitals. It provides a means to increase the availability of NHS clinical support by allowing local practitioners to be in permanent contact with those people less able to look after themselves.

Telehealth and telecare can help improve the reach of the services that the NHS provides and can help keep people out of hospital, avoiding the pressures this puts on them and their families. Individuals benefit too. Telehealth and telecare allows for more effective self care, improved quality of life for carers, less travel and disruption for routine check-ups, retained dignity, increased confidence to manage own health, and fewer stressful, unplanned hospital admissions.

There are numerous benefits for health and social care professionals. Through risk stratification, professionals can identify those people in their practice who have Long Term Conditions (LTCs) and could be better supported if telehealth were adopted. Professionals can be better informed of the status of these people and see less demand on services, with fewer A&E events and unscheduled inpatient episodes. Professionals may also see less impact on family members/carers of people with (LTCs) as they start to take more control of their own health.

More regular data means professionals can be better informed of a person’s health status which leads to early intervention and proactive care. What’s more, deploying telehealth-enabled services modernises the way by which large numbers of people with LTCs are treated improving their care, quality of life and the life of their carers, and makes more efficient and effective use of available clinical teams by reducing unnecessary home visits. The healthcare industry should also see significantly less A&E usage and unplanned admissions.

In May 2008, the Whole System Demonstrator (WSD) programme was launched, which has been one of the most complex and comprehensive studies the Department of Health has ever undertaken on the subject of telehealth, and has yielded a wide range of very rich data.

The WSD programme is the largest randomised control trial of telehealth and telecare in the world, involving 6191 patients and 238 GP practices across three sites, Newham, Kent and Cornwall. Three thousand and thirty people with one of three conditions (diabetes, heart failure and COPD) were included in the telehealth trial.

There are many different types of telehealth and telecare but each of the three sites made their own decisions on the equipment they would use in their health and social care economies.

According to the result findings, when used effectively, telehealth and telecare can reduce death rates by as much as 45 per cent. The programme also found a 20 per cent reduction in emergency admissions; 15 per cent reduction in A&E visits; 14 per cent reduction in elective admissions; 14 per cent reduction in bed days, and an eight per cent reduction in tariff costs.

The Department of Health (DH) believes that at least three million people with long term conditions and/or social care needs could benefit from the use of telehealth and telecare services. Following on from the WSD programme results, Paul Burstow, Minister for Care Services launched 3millionlives, a campaign to support the NHS, social care and professional partners to deliver telecare and telehealth to millions of people.

A key aim of the 3millionlives programme is for the Department for Health and industry to work together over the next five years to develop the market and remove barriers to delivery.

Care services Minister Paul Burstow said: “This paper shows that telehealth can help to reduce emergency hospital admissions by 20 per cent and mortality by 45 per cent for patients with long-term conditions. To realise these benefits we need service transformation – and telehealth can help deliver that change.

“We are working closely with industry, the NHS and social care organisations to make progress through the 3millionlives initiative to develop flexible funding models with a reduced price point, which will achieve the economies of scale needed to make telehealth a success.”

Real people benefit
Telehealth is helping individuals across the UK to gain better control of their long term conditions and improve their quality of life.

67-year-old Emelie, for example, suffers from E 
F a condition called Congestive Cardiac Failure (CCF), which is a heart condition where the heart loses the ability to pump blood efficiently. The result is that the body doesn’t get as much oxygen and nutrients as it needs, leading to problems like fatigue and shortness of breath.

Emelie was diagnosed with CCF in 1995. All though in the past few years her condition has improved somewhat, the concern for Emilie is that her blood pressure could go up very quickly without warning. “If I eat something with more salt than my body needs, my blood pressure goes up. All the symptoms flare up.”

Emelie, who lives alone, has been trialling the TeleHealth system in her home since July 2009. The system is aimed at giving her the tools she needs to help manage her own health at home with the supervision of health professionals. Using TeleHealth, Emelie is able to take her own blood pressure, weight, pulse and oxygen levels each day. The readings are taken with special equipment which is linked to a set-top box connected to her television. The results are automatically uploaded to a team of healthcare professionals who view them daily and can contact Emelie if anything is out of the ordinary.

Emelie, a retired nurse, is enjoying the part she now plays in managing her own health and she is more conscious of changes in her readings.

“I can see how my readings are related to my diet and how much physical activity I do. If they change, it makes you think
‘What have I done? What did I eat?’ and when you remember, you say to yourself ‘no wonder my readings have gone up!’ One day I took my BP after my exercise and the nursing team sent me through a message straight away to say it was extremely high and if I knew of a reason for the sudden change. Of course I realised right away that I should have waited before I did my readings after I exercised. But I definitely now know someone is looking out for me!”

Diabetes Management
Terry Munro, 65, suffers from insulin controlled Diabetes. Living alone with diabetes has always been a concern in case he ever fell into a diabetic coma with no one around.

Terry is now being assisted to live in his own home, thanks to the help of TeleHealth technology. With the TeleHealth system Terry can see for himself what his readings are and take necessary steps to avoid an emergency situation. Each day, Terry – who has been trialling the TeleHealth system in his home since December 2008 – takes his blood pressure, weight, and blood sugar levels. The readings are taken with special equipment which is linked to a set-top box connected to his television. The results, shown to Terry on his television, are then automatically uploaded to a team of healthcare professionals who view them daily. If any abnormalities are highlighted, immediate action can be taken.

“I have much greater peace of mind about my condition now. As soon as anything changes I know I’ll be contacted by someone in my care team to check up on me.” Terry is now more conscious of his lifestyle habits. He has increased confidence because help and advice is just a remote control button or phone call away.

Councils play their roles

Trafford Council has launched a Telecare Pledge Scheme, providing people over the age of 80 with a one year free trial of using the products in their home.

Executive councillor Michael Young said Trafford’s telecare scheme has proved extremely popular with local people who want to remain living at home..

“This pledge will provide more people with the opportunity to experience the huge benefits of Telecare equipment for themselves. This further investment is an important element of our continuing focus on providing personalised, quality care at a time and in a way local people need and deserve.”

Corporate director of communities and wellbeing, Deborah Brownlee, reinforced the importance of the Telecare pledge.

She said: “It is encouraging to see so many people already benefiting from Telecare equipment and services within their home. However it’s important to us that anyone over 80, or their families, who think this free year trial may be of interest to them take time to find out more.”

Further information