The challenge of the numbers of people with long term conditions is increasing and any innovations to help this group self-manage as well as provide earlier prevention and intervention strategies should be welcomed.

As well as the outcomes from the WSD Programme, we are seeing the Northern Ireland Programme launched, considerable progress in Scotland and the Technology Strategy Board’s DALLAS Programme commencing in Mid-2012. We are also seeing increasing numbers of lower priced telehealth solutions, mobile and smartphone apps available to consumers.

We currently have around 1.7m people in England with telecare/telehealth of which an estimated 6000 have home remote health monitoring as used in the WSD Trial. Further patients are involved in telephone-based disease management support as well as increasing examples of the use of telemedicine (video consultations etc).

I agree that we need to know the best circumstances in which to use some of the telehealth services. This could mean for instance specific daily vital signs measurements and symptom recording for people with certain severities of heart failure or COPD, for instance. The involvement of GPs and data sharing are vital and this could be a challenge during NHS reforms – 230 GP practices were involved in the WSD trial. The detailed trial results will help with these points and should provide greater clarity for commissioners.

We can also expect to hear more about the ‘Three Million Lives’ in the new year. It will need some innovative thinking around the business model and risk sharing with industry.

There is one point you made that could be clarified ‘during the early stage of the WSD pilot only one in ten of those who were asked actually signed up’. The WSD Programme was a randomised controlled trial with very specific eligibility criteria. This meant that potential participants could not be sold the benefits of trying the service as this could prejudice the outcome of the trial. During the recruitment phase of the trial, people would not know whether they were in the group receiving the service or in the control group. In addition, because of trial ethics and protocols, it could take several weeks to put them into their group. This meant that around 27,000 people were approached leading to around 9000 home visits and around 6000 total participants. Prof Stan Newman, the lead investigator for the trial has already done presentations with WSD trial statistics on people refusing or leaving the trial.

To date, very few hospitals have been involved in home remote monitoring as it has been essentially a primary care initiative – as in the headline findings, there could be a reduction in hospital inpatient visits and therefore fewer tariff payments for COPD, heart failure etc. This could change where hospital trusts in some cases now have community health teams who could provide primary care services into the home.

There are also opportunities for new business and reimbursement models including the possibility of a telehealth tariff or outcome-based reward. North Yorks and Gloucestershire have explored some of these issues in their telehealth programmes.

Regards
Mike Clark (Twitter @clarkmike)

Well-written article, pleasure to read.

Your NHS experience perfectly illustrates the point: “If it ain’t broke, don’t fix it.”

I totally agree about evolution as an effective agent of change, rather than the hubris of ‘redisorganisation’ (good term).

Hope politicians see sense, too.

Elisabeth