The widespread deployment of assistive technologies has proved disappointingly elusive in the UK due to a shortage of public investment, suspicion among healthcare professionals, and because traditional systems were, in the past, seen as too complicated and inflexible.
There is real potential in the UK for expanding the use of assistive technologies, such as telehealth, to avoid unnecessary trips to GPs and hospitals
Simply putting new technology onto old processes, where neither information flows, nor are the discrete departments or teams linked up, is unlikely to deliver neither the financial benefits expected, nor the better patient outcomes hoped for.
Experience has shown that simply laying a telehealth service alongside the normal hospital and GP-based services on its own is unlikely to be successful. It is critical to engage both these stakeholders such that GPs, who are accountable for their patients, feel involved but not overloaded and hospitals see home healthcare as an extension of their care into the community, rather than a competitor to their in-hospital services.
But, with the right approach, and a good evidence base, the Government can still realise its vision of supporting more than three million patients with long-term conditions to live independently in the community for longer, according to industry experts.
Speaking to BBH this week, Alan Davies, director of home healthcare for the UK and Ireland at Philips, said: “There is real potential in the UK for expanding the use of assistive technologies, such as telehealth, to avoid unnecessary trips to GPs and hospitals. I do not think it should stop people using specialist care centres when they need to, but it can help to prevent unnecessary trips and ease the pressure on services.
“If together we redesign the right care processes, get on board the right staff, and get the right technology, we can provide much more immediate care for people who need this support.”
He said the Government’s efforts to date to drive innovation through the adoption of telehealth has, on the whole, been rather cautious and slow.
“I was working in the sector six or seven years ago when we were just introducing telehealth, and we made mistakes at that time” he explained.
Overall, there were a number of things we did not get right in the early days and I think that, as an industry, we have learned that we need to be more specific, focusing less on the technology and much more around the change in the way we provide healthcare, and the people who will most benefit
“We assumed the nurses manning the back end of the system could cope with the sheer volume of information that was coming through. But, in reality, they became nurses so they could treat people and help them, not so they could watch a screen all day, and that was a problem.
“The implementation was also sold to GPs on the basis that their time was valuable and that we didn’t want to bother them with things that could be dealt with in another way. When you think about it now, that was guaranteed to make GPs very suspicious. Suddenly they didn’t own a process for their patients and, unsurprisingly, it didn’t take off in the way we hoped it would without their support.”
In addition, technology providers were not being specific about the types of patient who would benefit the most.
“If we want to demonstrate a clear return, then we need to be focusing on the sickest of the long-term condition patients first,” said Davies. “Once these people are activated then we can look to move further down the acuity pyramid.”
“Overall, there were a number of things we did not get right in the early days and I think that, as an industry, we have learned that we need to be more specific, focusing less on the technology and much more around the change in the way we provide healthcare, and the people who will most benefit.”
Home Healthcare can improve and enhance service delivery in a numbers of ways:
- By making care more accessible – avoiding trips to the GP surgery or hospital
- By making care more specific – more data should equal more personalised interventions
- By making care more immediate – patients receiving care when they need it
As ever the technology does not replace physical intervention, it complements it and helps extend the capabilities of an integrated team of healthcare professionals working with the patient themselves.
We are having positive conversations with clinical commissioning groups, some of which positively support providers in their areas working with industry, but the Government could potentially do more to encourage this kind of partnership behaviour
Home Healthcare can also promote improved health and wellbeing by making patients more aware of the underlying science and cause/effect of their condition or situation; helping them take direct responsibility for self management; and by giving them more confidence that healthy lifestyle programmes actually work.
BBH revealed a fortnight ago that the Government had quietly shelved its 3millionlives campaign, which aimed to get patients emailing their vital signs to their local GP surgeries.
While nurses largely welcomed the plan, it was reported that GPs were complaining they were bogged down with data. Many elderly patients also did not get along with the technology provided.
Now it is expected the Government will soon announce a watered-down version where ‘technology enabled care services’ are available, but with no ambitious targets attached.
“We need to be careful to learn from the lessons of the past, but also to recognise and absorb the best from the areas that have deployed programmes to the benefits of patients today, such as in Torbay and Liverpool, for example,” said Davies.
“In the early days of telehealth we used to provide a one-size-fits-all solution. Now we offer a portfolio of solutions that can be used for step-up or step-down care, recognising that patients at particular times need more intensive specialist care and at other times could potentially self manage with the proper education and a few reminders. Moving forward, technology should be able to be adapted in this way to suit each individual and their needs at the time.”
Meanwhile patient matching and applicability has become more advanced as the science of risk stratification has become better established to better target those patients who (a) need the technology assistance; (b) have a clear business case for having it commissioned them and; (c) have the likely characteristics of someone who will comply with and benefit from using it as part of a Home Healthcare programme.
The market is also moving towards mobile devices, so that people can request and/or receive support outside of their homes as they live their daily lives.
“Digital mobile healthcare is the new frontier,” said Davies.
We feel the challenge now is to empower the patient to better self manage while involving the community, primary and secondary care services linked through a self-care hub
“We are working with a number of trusts to introduce assistive technologies to support health and wellbeing services. We are also having positive conversations with clinical commissioning groups, some of which positively support providers in their areas working with industry, but the Government could potentially do more to encourage this kind of partnership behaviour.”
The collection and concentration of data from vital signs monitoring, and broader within the health and social care system, also needs to be enhanced. Davies said: “There is lots of pressure on the NHS. We are all living longer and, as a consequence, we also develop multi-morbid conditions and the money simply can’t keep up, so we need to find ways of making the money go further if we are staying true to the fundamental ethos of free healthcare for UK citizens through the NHS.
“We feel the challenge now is to empower the patient to better self manage while involving the community, primary and secondary care services linked through a self-care hub. We see ourselves playing a flexible role, but we talk of a service partnership deliberately where we invest people, technology and funds to not only start up, but in partnership maintain, an effective home healthcare service into the community.
“Philips sees wearables becoming common and the need to link up home-based technologies with hospital-based ones and patient records will be crucial, thus our planned introduction of an open API cloud-based Digital Health Platform with the aim of connecting up disparate information sources for not only re-active patient care management across the end-to-end process, but also pro-active service tailoring and individual treatment design in future.”