Andrew Donald, chief executive of NHS Birmingham East and North, has been working with NHS Direct and Pfizer Health Solutions under the umbrella of Birmingham OwnHealth to roll out Honeywell HomMed technology to patients in the community who suffer from long-term conditions.
Established in 2006, the organisation has so far helped 15,000 people, with close monitoring and early prevention resulting in fewer trips to hospital, greater self esteem and a feeling of empowerment among patients.
The NHS has a chaotic system of care and people use the services in any way they see fit, usually on an unplanned and often expensive basis
But, according to Donald, unless other trusts follow suit, and GP commissioners buy into the idea, the full benefits will not be realised and the opportunity to contribute towards the £20billion worth of savings will be lost.
He said: “The NHS has a chaotic system of care and people use the services in any way they see fit, usually on an unplanned and often expensive basis. The problem we have is that care is based on ‘diagnose and treat’ rather than a ‘predict and prevent’ approach.
“The principle has always been helping people to look after themselves better, but the only way this will work is if the member feels they can take control of their condition. At the moment a vast majority of the public feel like they do not have control of their own health. We have created a paternalistic system which has created ‘learned helplessness’. We’ve got to help the public take back responsibility for their own health by providing a programme that will make a difference.”
OwnHealth has a 95% approval rating from patients and has been found to improve clinical metrics, such as blood pressure; a result that has been evaluated by Birmingham University as being as good as face-to-face care.
We have created a paternalistic system which has created ‘learned helplessness’. We’ve got to help the public take back responsibility for their own health by providing a programme that will make a difference
Donald said: “People with chronic conditions do not get cured, but they can be helped to live longer and healthier. What we are currently seeing is people living longer, but with more illnesses and a poorer quality of life.
“This telehealth scheme creates a different environment that allows behaviour change to occur. Implementing technology that makes people monitor their own condition reduces costs and makes our organisation more efficient. Nurses on the ground are also more productive because they can make better choices about who needs to be visited because the technology is monitoring patients remotely.”
But despite these advantages, he said adoption of telehealth, telecare and telemedicine technologies was not yet widespread; something which is threatening the success of those schemes already up and running.
Donald said: “It is important that people view this as a whole. This is about life, not about health. We need to make sure that the development of these types of services goes alongside social care developments. However, unless you do it at scale, you will not achieve the financial savings you need.
Implementing technology that makes people monitor their own condition reduces costs and makes our organisation more efficient. Nurses on the ground are also more productive because they can make better choices about who needs to be visited
“Our programme was designed alongside a set of metrics which have been monitored from day one and have allowed the trust to judge success or failure over time. This programme costs around £4m a year and helps around 10,000 people, but it needs to grow as an option for all people in east and north Birmingham with a chronic condition; this could be up to 100,000 people. To do this the hospital system will need to contract alongside the expansion.”
A lot of staff were concerned that it would take their work away, but, frankly, there is more work than we know what to do with
A key barrier is a lack of understanding and support from staff. Donald said: “A lot of staff were concerned that it would take their work away, but, frankly, there is more work than we know what to do with.
“The Government’s NHS White Paper talked about putting patients in charge of their own care, and patients having a different relationship with clinicians. The danger is that, because of the scale of savings the Government is calling for, we will try to save the money on the wrong things. Instead of prevention, we will continue to focus on management and lose all the gains that we have made.”
This focus on healing the sick, rather than preventing ill health in the first place, is an indication of the current NHS mindset, which the introduction of telecare technologies will help to eradicate.
Donald said: “We have got to spend a bit of time convincing GPs. Some get it, but lots don’t. If we continue down the current cost route of hospitalisation and so on, then we will reach a situation where the NHS can’t afford to pay for all that people want. You then get into the debate of co-payment. We can avoid this if we consider prevention and use technology. This is in the right space in terms of what the NHS White Paper is after, but it could get lost in the transition if we do not pay attention to it.
If we continue down the current cost route of hospitalisation and so on, then we will reach a situation where the NHS can’t afford to pay for all that people want
“OwnHealth is an unearthed jewel, but no one knows how to promulgate it. Frankly, if we don’t help people to help themselves and change the nature of the pathway of care, then the NHS of the future may not be available to everybody who needs it.”
This is a view echoed by Gill Stewart, director of operations at NHS Direct, who told HES that the OwnHealth model should be rolled out for the sake of patients and NHS commissioners:
“OwnHealth is about looking after people in their own homes and better enabling them to look after themselves,” she said. “As a result, they typically do not have to go to A&E or see their GPs as frequently.
“The NHS has to look for new ways to care for people as it does not have infinite resources. This is what the future of the NHS looks like.”
if we don’t help people to help themselves and change the nature of the pathway of care, then the NHS of the future may not be available to everybody who needs it
Statistical data from Birmingham OwnHealth shows that, before joining the scheme, a group of 74 patients had, in total, 175 hospital admissions and spent 1,353 days in hospital at a cost of £348,000. Since joining, the group has collectively amassed 24 admissions and 291 days in hospital at a cost of £72,000.
One of those patients to benefit is 70-year-old John Robinson. He said: “Now I have more good days than bad.”
Before joining the scheme, it was necessary on two occasions to remove 10 litres of fluid from around his abdomen, which had built up due to heart failure. The procedures were painful, particularly on one occasion when a surgeon accidentally damaged Robinson’s bowel. Now, thanks to the constant monitoring of his condition using Honeywell HomMed monitors, these painful operations are no longer needed as his community matron, Sharon Dempsey, can intervene to change his medication before the fluid build-up becomes critical.
If everyone with my condition used the technology, it would free up the NHS greatly as more elderly people would be able to stay at home
Dempsey said: “We can pick up on trends, which for John was very useful, as we can tell if he is retaining fluid and make an early intervention. Previously, he was sleeping downstairs, immobile and needing physiotherapy. He is now back upstairs and goes out shopping on a Friday with his wife.”
Former HGV driver, Robert Price, 69, is also an avid supporter of the technology. He suffers from Chronic Obstructive Pulmonary Disease (COPD) and Type 2 diabetes and has been using the monitor for two years.
I think this is the best thing that the NHS has ever come out with as I’m not taking up a hospital bed and not having to wait in the doctor’s surgery
He said: “When I go to hospital all the readings are out because of the exertion it takes me to get there, yet this machine takes all the same readings at home. Now I can sit down with the nurse and discuss the results. I think this is the best thing that the NHS has ever come out with as I’m not taking up a hospital bed and not having to wait in the doctor’s surgery.
“The monitor takes daily readings of my heart rate, my weight, blood pressure and oxygen levels. I also have 10 questions that I need to answer. If I answer ‘yes’ to any of these I get a call to see what the matter is. They ask me is if I feel alright and, if I’m not, my community matron gets in touch.
“If everyone with my condition used the technology, it would free up the NHS greatly as more elderly people would be able to stay at home.”