Positive outcomes reported from controversial Yorkshire telehealth trial

Despite the refusal of some GPs in Yorkshire to support the deployment of telehealth technology in the area, a pilot study has revealed a measurable reduction in hospital admissions and improved patient outcomes.

Building Better Healthcare revealed last week that a rollout of Tunstall telehealth systems by NHS North Yorkshire and York as part of a £3.2m contract signed in 2009 had seen just 645 patients using the technology, out of an anticipated 2,000 devices.

The telemedicine technology and new way of working has brought about a significant and real culture change in the way clinicians and physicians believe medical consultations can be delivered

And, with the contract up for renewal next month, a number of GPs in the area, who will take over responsibility for commissioning NHS services in the spring, appear unwilling to back an extension. Practices in Hambleton, Richmondshire and Whitby have unanimously voted in favour of abandoning the project, with only one of the four main GP-led clinical commissioning groups in the county believed to still be supporting the deployment.

But results of the trial, which covered Yorkshire and the Humber region, have shown positive outcomes and provided some reassurance over plans to extend the project.

An evaluation by independent health think tank, 2020health, reports that outcomes from the patient point of view have have been ‘overwhelmingly positive’, with decreased hospital admissions, more care delivered at home, and greater patient satisfaction ratings. However, it adds that, in retrospect, the time frame for the pilot scheme was overly ambitious, as important obstacles prevented the services reaching as many patients as the hub had envisaged.

During the pilot, services were provided from three sites: NHS Airedale Foundation Trust, South West Yorkshire Partnership Foundation Trust (SWYPFT) and Hull and East Yorkshire NHS Trust/University of Hull. A different telehealth service was provided by each.

The telemedicine technology and new way of working has brought about a significant and real culture change in the way clinicians and physicians believe medical consultations can be delivered

Airedale piloted telemedicine services, that is delivering healthcare remotely through video conferencing technology. The Airedale ‘lessons learnt’ report notes that: “The telemedicine technology and new way of working has brought about a significant and real culture change in the way clinicians and physicians believe medical consultations can be delivered.”

SWYPFT aimed to encourage patients with chronic conditions to take greater control of their health and wellbeing, setting up a telephone-based health coaching service delivered by nurse care navigators. They support patients through self care and improve their condition management over the phone. The hub project initiation documents states that: “It is well documented that factors associated with health status are largely behavioural. Therefore, helping people understand how lifestyle choices impact on health and wellbeing is critical in promoting positive health.”

This ‘telecoaching’ service is almost unique in the NHS, enabling the intelligent dispatch of services to help people connect to the appropriate pathway of care. Results showed an increased number of people living independently, improved patient satisfaction, 20% fewer hospital admissions and a 30% reduction in length of stay. This led to an overall 32% cost reduction.

Our evaluation suggests that professionals need to evaluate and pursue opportunities to benefit from these technologies and to support a shift to care closer to home, while the Department of Health needs to rigorously assess why the uptake of telehealth has been so slow, even in cases without upfront capital costs such as the hub

The objective of the Hull element was to scale up and provide the existing Hull-based clinical triage capability to other tele-monitoring projects around the east of the region.

It noted that for every 100 patients being offered telemonitoring, 10 all-cause admissions were averted each month. Up to £2 000 can be saved per averted admission, returning a return on investment of 48%.

However, these pilot schemes did highlight obstacles which will need to be overcome. First, current uncertainties within the NHS mean that the future of funding is unknown for these sites. The new Department of Health (DH) Year of Care Tariff may help, but meanwhile this is slowing down their development.

Secondly, structural changes also meant that staff who were important supporters of the project were moved to different roles during the trial.

And, the report states, there is a need for a redefining of the GP/patient relationship if telehealth is truly going to flourish. The Yorkshire and the Humber Telehealth Hub found it was difficult to get GPs to sign up to telehealth as they expressed a feeling of apprehension towards the use of technology in health in general. GPs were also worried that they were being asked to take on more work. However, evidence suggests that telehealth in fact allows GPs to see more patients with a decreased workload.

Being able to scale up deployment at a time when there is indecision is a challenge, but this can be achieved where we can see clear benefits to all and not doing so would be a disservice to people and the NHS

These obstacles meant the pilot scheme didn’t achieve as much as it had set out to do in the allocated timeframe. Notably, not as many patients as hoped signed up to and it was therefore difficult to measure the true scale of potential saving costs. Hull noted, however, that as the scale of its scheme increased from 2010 to 2012 return on investment increased from 39% to 48%, which suggests there is a strong chance that telehealth could make more savings if rolled out at a national level.

These obstacles are not however, impossible to overcome. More support, financial and spoken, from the Department of Health, professionals and organisations is crucial, the report states.

It adds: “Our evaluation suggests that professionals need to evaluate and pursue opportunities to benefit from these technologies and to support a shift to care closer to home, while the Department of Health needs to rigorously assess why the uptake of telehealth has been so slow, even in cases without upfront capital costs such as the hub.”

Commenting on the report, Dr Shahid Ali, GP and clinical lead for the patients and intelligence directorate at the NHS Commissioning Board, said: “£70billion is spend on managing long-term conditions in the NHS on a yearly basis and this will continue to rise.

“There needs to be a new way to manage the rising demand and deliver high-quality care. Self-supported care using telehealth is a way of using technology to enable better, more efficient and high-quality care in the NHS to meet these challenges.”

Telehealth is without a doubt an innovative and high-quality service that is being commissioned by some now, but will be commissioned by all in the future and I would encourage commissioners and providers alike to read the report and act upon the lessons and key findings

Referring to the reluctance of some doctors to embrace a new way of working, he added: “Being able to scale up deployment at a time when there is indecision is a challenge, but this can be achieved where we can see clear benefits to all and not doing so would be a disservice to people and the NHS.

“Innovation needs to be at the heart off clinical commissioning group thinking as they commission high-quality services to address the needs of their respective populations. Telehealth is without a doubt an innovative and high-quality service that is being commissioned by some now, but will be commissioned by all in the future and I would encourage commissioners and providers alike to read the report and act upon the lessons and key findings.”

And Professor Stephen Singleton, interim chief executive of NHS North of England, said: “The answer is not just to do more of the same, but also to think and act differently. Embracing the possibilities that the adoption of technology can bring needs to be at the forefront of any service redesign. Technology is an enabler of change and has the ability to improve the patient experience at many points in the patient journey.”

Click here for the full report.