By Dick Vinegar, Guardian Professional
This time last year, telehealth was riding high. On the back of the initial favourable report of the «»Whole Systems Demonstrator»» in Kent, Cornwall and West Ham, which tracked the progress of about 3,000 patients monitored by telehealth, the Department of Health launched its 3millionlives initiative.
It imagined that telehealth would be the silver bullet, which would reduce hospital admissions drastically, allow patients with long-term conditions to be monitored and treated in the comfort of their own homes, and, along the way, save the NHS from bankruptcy. Health secretary, Jeremy Hunt, claimed that 100,000 patients across seven pathfinder areas would benefit from telehealth in 2013.
However, in 2013, it all turned pear-shaped. Subsequent peer-reviewed reports from the Whole Systems Demonstrator (WSD), carried out by academics, found that neither did telehealth save any money, nor did it improve the quality of life for the participants. These reports delighted most GPs, who had seen telehealth as a threat to their age-old way of handling patients.
The BMA’s GPC IT lead declared that «»for the average patient who lives half a mile from their practice, and who has conditions that are not terribly urgent and is mobile, telehealth is of no value whatsoever.»» He has also described telehealth as a fad, which will soon fade from memory.
The current number of patients using telehealth across the country is only around 5,000, a far cry from Jeremy Hunt’s prediction of 100,000 in 2013.
One might expect after this slow progress and this level of rubbishing from the medical establishment, that the telehealth-pushers would crawl away into a corner and die. And the counties which took part in the WSD would shut up their telehealth shops. But no, Cornwall and Kent have retained their telehealth infrastructures, and continue to offer telehealth to their COPD, heart failure and diabetes patients.
Cornwall now has 1,150 telehealth patients, where they had only 800 during the WSD trial. I ask myself why the local hospital trust, the local council and the local CCG all continue to devote scarce resources to a technology, which has been deemed by their intellectual and medical betters to be dead in the water?
A cynic would say that the main reason is that many of the people involved in the WSD have staked their careers on telehealth, and are loath to give up. There may be an element of that in the higher echelons, but I find something different among the people at the sharp end, who are mostly community matrons and nurses. They have a fire in their belly, and a conviction that what they are doing is the most important thing in the NHS, which I marvel at. They choose the right patients for telehealth. They deal with the alarms 24/7. They learn from their initial mistakes. They decide when they need to visit a patient at home. They seem to be winning the battle to keep their patients out of hospital.
They show that the writers of the WSD were involved in a futile paper exercise, where stats were more important than patients whose lives were transformed by their visits to hospital being reduced from 30 to zero in three years.
The WSD was, I understand, a randomised controlled «»double blind»» evidence based trial. This is the normal procedure for a drugs trial, but quite wrong for a technology trial. For starters, the trial took place in 2008-2010, and the reports trickled out in 2012-2013, a long time after the event. The thing about technology is that it evolves and gets cheaper quickly. To make judgements in 2013 about a technology installed in 2008 is ridiculous.
And it takes time and practice for humans to get used to a new technology and a system which hangs on it. In 2008, telehealth system designers and nursing staff were struggling to learn the ropes. And, most critically, patients also had to learn what it is all about, and use the monitoring gadgets successfully. To make judgements at that stage of the game is rather like saying that Gareth Malone’s choirs were hopeless after their first rehearsal. Indeed they were, but, they soon got better. The same is true of telehealth.
So, basically the WSD trial period was at a time of maximum chaos. And vast sums of money were spent to record that transitory moment of chaos. I commend therefore the guts of the authorities in Kent and Cornwall to put two fingers up at the findings of the academics, and follow their own instinct that telehealth is both patient-friendly and cost effective. And I applaud the frontline nurses, who save the lives of their telehealth patients.
This article was published by Guardian Professional. (C) Guardian News & Media Ltd
