NHS England has sketched out the future of healthcare and it will be one using smartphones and wearable bio-sensors to monitor ourselves and alert clinicians. NHS National Medical Director Sir Bruce Keogh has written to around 250 organisations across health, social care, industry and third sector asking them to support the Technology Enabled Care Services (TECS) programme which will take the NHS into this new technological era.
The TECS programme, born out of the 3ML initiative (which didn’t quite go anywhere after all the song and dance, including from David Cameron), was reviewed last year resulting in the change of focus to “address the demand for support and practical tools to commission, procure, implement and evaluate technology enabled care services” according to Sir Bruce’s letter as reported on the NHS England website.
The TECS Stakeholder Forum‘s views and proposals now form the TECS Improvement Plan for 2014-17. This is a broader group following the failure of the 3ML Stakeholder Forum to achieve anything of substance.
According to NHS England, Sir Bruce explains: “To ensure continued progress, we have brought together a TECS Implementation Group consisting of experts and leaders from across these sectors whose remit is to support the strategic development and delivery of the proposals within the Improvement Plan. In addition, we have formed the TECS Executive Steering Group which meets regularly to provide clinical, technological and strategic leadership for the programme at a director level in NHS England.” Titanic and deck chairs?
The Scottish Health Secretary, Alex Neil, has announced the investment of an additional £10 million (about US $ 15 million) to support home health monitoring solutions across Scotland, the BBC has reported. This additional funding for the NHS Boards will enable people to use technology such as tablet computers and smartphones to monitor conditions such as diabetes, heart problems and lung problems at home, the report added.
In 2011, Nicola Sturgeon MSP, Cabinet Secretary for Health, Wellbeing and Cities Strategy in Scotland set out her strategic vision for achieving sustainable quality in the delivery of healthcare services across Scotland, in the face of the significant challenges of Scotland’s public health record, changing demography and the economic environment. The Scottish Government’s 2020 Vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting and, that Scotland will have a healthcare system where, amongst other goals, there will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.
Mr Neil’s announcement was made during a debate in the Scottish Parliament entitled ‘Update on Delivering the 2020 Vision in NHS Scotland’. Mr Neil claims past efforts in telecare and telemedicine have meant that £2.8 million has been “ploughed back” into Scottish frontline services and reduced emergency admissions to hospital by 70 per cent.
According to the pre-event information for Sensors in Medicine 2014 “sensor applications in medical diagnosis are growing at an astonishing rate. Twenty five years ago, these applications were limited to laboratory measurement of blood gases and electrolytes. Today biosensors are used in a variety of ways to monitor glucose in diabetes, detect and diagnose cancer and infectious diseases; new applications appear almost daily. Linking sensors to mobile phone technology has made wearable sensors a reality, allowing individuals to monitor not only chronic diseases, but also their lifestyle as a key input to preventative medicine.
“Sensors in Medicine 2014 will highlight the most innovative application of sensors in medicine, and promote the adoption of these new technologies by bridging academic, clinical and commercial worlds.”
The event takes place on 25th and 26th March 2014 at the Royal Geographic Society, 1 Kensington Gore, London SW7 2AR. The keynote address on day 1 is “New sensor technologies and mHealth”. Full information is available at the Sensors in Medicine website.
Additional upcoming event, 10 June 2014:
Sensors in Healthcare: As part of the Wales Festival of Innovation, the event will seek to showcase the expertise at Swansea University in the development of sensors for use in the medical sector and hear from Wales-based companies on their current innovations in this area. We will also encourage other Universities from the region to present posters. During the final networking session, a drinks reception will be held, with the opportunity to tour the Centre for NanoHealth facility. Whilst this event will just focus on Welsh innovations, we aim to encourage the attendance of participants (especially industrial) from the rest of the UK.
Responsive holograms that change colour in the presence of certain compounds are being developed into portable medical tests and devices, which could be used to monitor conditions such as diabetes, cardiac function, infections, electrolyte or hormone imbalance easily and inexpensively, according to the University of Cambridge. It is claimed that the technique can be used to test blood, breath, urine, saliva or tears for glucose, alcohol, drugs, bacteria or hormones. Clinical trials are said to be underway to test glucose and urinary tract infections (UTI) in diabetics at Addenbrooke’s Hospital.
It is estimated that the reusable sensors could cost as little as 10 pence to produce, making them affordable for use in developing countries. A prototype smartphone-based test suitable for both clinical and home testing of diabetes and clinically relevant conditions is under development.
If this is a commercial success this could form the basis of a multi-purpose portable tester suitable for telehealth use.
A research paper, Light-Directed Writing of Chemically Tunable Narrow-Band Holographic Sensors, has been published in Advanced Optical Materials.
The January 2014 newletter from the Telecare Learning and Improvement Network was published two days ago and has the usual rich collection of news and links to news and articles. This month there is a lot on dementia. Always a good read to catch up with any news you may have missed and for pointers to some events.
Sensemaking and Telehealth: Examinig the Adoption and Normalisation of Remote Monitoring for Community Nursing is the title of a seminar to be held at the Universirty of Leeds next month discussing the role of telehealth in community nursing.
The presenter is Dr Jo Nicholson from the Rehabilitation and Assistive Research Group at the University of Sheffield. The seminar is on the 20th of February at noon and venue and other details are available at the University of Leeds Faculty of Education, Social Science and Law website here.
The video-link/ videoconferencing system used by Airedale NHS Foundation Trust to provide remote medical assistance is being rolled out to additoinal care home sites. The service is staffed by a specialist nurse at Airedale General Hospital who uses the system, known as the Telehealth Hub, to assess patients and support staff at the homes.
According to the Keighley News the service was installed in a Bradford nursing home with the first use on New Year’s Eve. Staff at Ashville Care Home are quoted as saying that the service allows their residents to receive medical care without having to call a GP out or take them into hospital. A hopital visit would mean having to get extra cover as a member of staff needs to go as well.
Meanwhile the Telegraph & Argus reports the roll out to care homes in Calderdale and Huddersfield. According to the report, Airedale is working to install the system in 200 care and nursing homes this winter under the Immedicare joint venture.
We have previously reported (Airedale NHS Foundation Trust and Involve-Visual form JV to market telehealth solution, TANN England Aug 28, 2013) and wondered about where the profits of commercialisation of this NHS service will end up. What is the cost to the Airedale NHS Trust and how much of the benefit is returning to the public purse?
Bupa, the UK based private health insurance and hospitals company and the International Telecommunications Union (ITU) announced on Tuesday that they are to collaborate on a four-year international m-Health initiative called “Be Healthy, Be Mobile”.
The programme, led by ITU and WHO, will target non-communicable diseases such as diabetes, cancer, cardiovascular and respiratory diseases in low and middle income countries.
In its first phase, the initiative is focusing on deploying mobile health interventions in areas such as diabetes, smoking cessation, hypertension, wellness and training of health workers. More than 25 countries have already expressed interest in participating. A smoking cessation programme via mobile phones is currently underway in Costa Rica.
Posted in mHealth
Tagged Bupa, mhealth
We reported in June 2011 that Liverpool Community Health NHS Trust (LCH) was launching a telehealth pilot to monitor 50 heart failure patients from a central monitoring station (see Telehealth Pilot in Liverpool). LCH has recently announced that they aim to roll out the service across Liverpool to at least 1,000 patients in the next 2 years.
The original trial was reported to have been funded under the North Merseyside QUIPP programme (Quality, Innovation, Productivity and Prevention) and was a partnership between the North Merseyside Health Informatics Service and LCH. These organisations were also two of eight partners that won funding from the Technology Strategy Board last year for a project called “More independent” (or “Mi”) to build a “smart house”. That project was completed earlier this year. The expansion of the telehealth pilot is now being branded as Mi.
This still doesn’t seem to be quite a mainstreaming of telehealth as the LCH website has no reference to telehealth as it does for, say, Community Equipment Service.
Narayana Hrudayalaya is a hospital in Bangalore, India, founded by a heart surgeon who trained in the NHS in 1980’s and is one of the largest cardiac hospitals in the world, performaing thousands of operations every year. Its primary target is to perform large numbers of heart operations leading to higher efficiencies and increased expertise, but it is also the biggest telemedicine centre in India, according to Mukti Jain Campion, who reports from India in Surgical Cuts, one of a series of programmes on BBC Radio 4 this week. The telemedicine facility allows doctors around India to send , for example, ECGs, over the internet for free diagnosis within 24 hours. Another example covered describes how anaesthetists at the hospital were trained in liver transplant procedures with doctors in US monitoring the patients in India during the operations using telemedicine facilities linked to the world’s leading liver transplant hospital.
The programme can be accessed for the next seven days here.
The failure of a telecare fire alarm may have contributed to the death of a 51-year old wheelchair user in a fire at her home last month according to The Inverness Courier and the Scottish Express. Barbara Anderson died in the fire which broke out in her home in Inverness at around 7.45 in the morning on the 6th of August this year. The telecare fire alarm installed at her home is said to have not raised an alarm at the monitoring centre leading to a delay in summoning the fire service.
Due to the critical nature of such alarms in homes of vulnerable adults, the NHS is said to be checking nearly 4000 such alarms currently in use.
NHS Highland and Highland Council have been operating telecare services since 2007 when the then Community Alarm Service (pendant alarms) was upgraded to handle a wider range of sensors.
As reported on our main TTA site (3millionlives “axed”; long live 3millionlives) HSJ reported that the main 3ML group set up by the Government is being fundamentally restructured to reduce industry technology players and add a range of other stakeholders. A new governance process is also being introduced.
Launched in December 2011 by David Cameron as a campaign to provide telehealth devices to 3 million people in five years, there was a lot of promotion when Paul Burstow was the Care Services minister. The 3ML Industry Leadership Group led by Angela Single from BT was set up with a £10k ticket price for membership which restricted the group to the big players in the market such as BT and Tunstall. Nearly two years into a five year programme the Government is now trying to steer the programme to focus on patient outcomes by widening the membership and renaming the group as “Integrated Care for 3millionlives Stakeholder Forum”.
No announcement has yet been posted on the 3ML website 3millionlives.co.uk.
Interesting piece in The Guardian on the difficulties of persuading GPs to use telehealth. Richard Vize’s article describes the relationship between the GPs and the Department of Health as poisonous and the cause is that the GPs see the Government continuously meddling with the GP contracts – see our previous item Telehealth likely to be uneconomical, little evidence of patient benefit . Not surprising really that GPs, and their trade body the BMA, would be nervous of a Government department which appears to be constantly looking at ways of reducing thier income.
Richard’s article agrees with ours that the LSE figures for per patient telehealth costs are not realistic in the long term and one shouldn’t compare it with the NICE ceiling of £30k per ‘quality adjusted life year’ to conclude telehealth is uneconomical. Read the whole article here.
PR Newswire published a press release yesterday on commercialisation of the Telehealth Hub described in a presentation by Dr Richard Pope at the Kings Fund Third Annual International Congress on Telehealth and Telecare on the 2nd of July 2013. In that presentation Richard Pope, Director of Innovation and Research at Airedale NHS Trust, gave details of the Telehealth Hub at Airedale and the effect it appears to have had on hospital admissions, length of hospital stays and use of A&E.
Airedale NHS Trust and Involve-Visual Ltd, previously known as Martin Dawes Solutions Ltd, the technology “partner” have formed a joint venture, Immedicare, to market the system being used at Airedale. As the system was developed using public funds and a large number of partners, how much of the resulting profits, if any, would return to them, I wonder.
The Telehealth Hub at Airedale Hospital is a video link system which allows patients with long-term conditions to have face-to-face consultations from their residential and nursing homes. It started in September 2011 with money from Regional Innovation Funds and is a partnership between Airedale NHS Foundation Trust, NHS Barnsley, Hull and East Yorkshire NHS Trust, NHS Yrkshire and Humber, University of Hull and the Health Innovation and Education Cluster (see here for more details). In spring this year Airedale NHS Foundation Trust announced that the 1000th patient had been connected to the system.
The findings presented at the Kings Fund congress in July was from 17 nursing and residential care homes and compared the 12-month period before the introduction of the Telehealth Hub with the 12-month period after it was used and showed, in the case of care homes, that there was a 45% drop in hospital admissions, 30% reduction in the length of stay and 69% drop in the use of A&E. Given that this is from a single study care should be taken in coming to any conclusions, but Richard Pope notes that this could amount to a saving of roughly between £300k and £1M a year. A formal study with a control group is being planned.
The General Practitioners Committee (GPC) of the British Medical Association believes that the use of telehealth for remotely monitoring patients, as proposed by the UK Government, is unlikely to be cost-effective for GP practices and that there is little evidence of patient benefit.
‘Remote care monitoring for patients’ is a Directed Enhanced Service (DES) from the NHS for 2013/14 and as GP reported at the time, the GPC criticised the Government at the end of last year that this DES is “politically motivated interference in GP contracts”. A DES is a medical service over and above the normal GP services and the GP practices can choose whether or not to provide a DES. GPC’s negotiator Dr Chaand Nagpaul quoted £80k per patient per year cost for telehealth from the WSD data to dismiss telehealth last year. But it is not obvious that the WSD figure is appropriate in this case.
The NHS DES Directions for 2013 includes a service (called a remote care monitoring plan, ) for patients with long term conditions, the purpose of which is to “establish a system to enable patients to manage and monitor their own treatment and condition other than by attendance at the contractor’s practice premises for a face to face consultation with a health care professional”. That is Department of Health speak for telehealth. This service is due to be implemented in 2014/15 and the Department of Health expects this to reduce unnecessary patient visits to GPs. The problem though, according to the GPC, is that the Government will pay only 21p/patient in the current preparatory year and GPC suggests this may not cover the costs for some practices.