The pressure on the finite resources of the NHS continues to increase exponentially. An ageing population and the increasing cost of medical technologies and drugs mean that NHS clinicians and managers are constantly having to find ways in which to make a little go a long way.
Patients who suffer long-term conditions make up 31% of the population, but approximately 69% of all primary and acute care budgets in England are spent on them. 5% of patients who have one or more long-term conditions account for 49% of all inpatient bed days. Managing the long-term health care needs of patients with long-term conditions in the context of an NHS facing efficiency targets will be particularly challenging. One method that is being considered and trialled is the introduction of telehealth programmes across the UK – a process that began in 2006 following a Department of Health paper that proposed telehealth within a whole system redesign of health and social care for people with long-term needs.
Telehealth is only the latest step change promised by the NHS to improve patient care, and the latest development in an on-going revolution that has transformed healthcare delivery. Before training as a lawyer, I practised as a nurse and manager within the NHS for nearly 20 years. The challenge then – as now - was always to deliver a service as efficiently and cost effectively as possible. When I first began, my ward was an acute orthopaedic ward where the elderly patients would come in to have a hip or knee replacement. They would spend weeks in bed before being carefully rehabilitated, and the discharge planning at that time merely involved calling their family to establish a good time for the patient to go home. Years later when I left the NHS, things were very different. Patients undergoing the same procedures were discharged just a few days after a period of focused therapy/rehab. The discharge planning process started before the patient’s admission!
What is Telehealth and what does it offer?
Telehealth involves the remote exchange of data between a patient (in their own home) and healthcare professional (not in the patient’s home) as part of the patient’s diagnosis and healthcare management, and the benefits have primarily been in preventing unplanned hospitals admissions and facilitating early discharge. This level of reliance on technology makes me feel anxious. The NHS and other Government Departments have a poor track record of managing the introduction of new technology. Unfortunately when I was in the clinical arena, various IT systems designed to save us valuable time crashed, performed poorly and were eventually shelved.
There are obviously several areas of concern that need addressing:
- Will the technology be sufficiently robust and reliable? If the management of patient's conditions is dependent on the technology then it will need to seamlessly fit and talk to current NHS systems.
- What will the back-up systems and plans be? How much thought and time will be spent on planning for a system failure?
- Has there been sufficient research to demonstrate its usefulness and will it really deliver?
- Can you ever replace a face-to-face clinical encounter and if so what will the limits be? It will need to be in place and functioning before person to person care is withdrawn.
- Radical changes are already being introduced into the NHS. Is this really a suitable time to introduce this project?
- More detailed research and peer review is required. It should be recognised that the technology will inevitably evolve at a rapid pace and the research needs to keep and maintain the same pace or it will be quickly irrelevant and out-of-date.
- Will the proposal really mean a fall in admissions? Will the monitoring of patient’s vital signs merely result in more admissions as clinicians admit patients so as to ensure their safety and well-being?
The NHS has arguably reached or will soon reach the limits with what can be achieved by reducing length of stay and bed occupancy. There would be many of my colleagues from both the legal and medical professions arguing that things have gone too far already and that patients are discharged far too quickly. As specialist clinical negligence lawyers, our shelves are full of cases involving patients discharged too early with sometimes poor aftercare. Is it really fair to expect clinicians to make important judgements on electronic data and numbers without robust and direct patient assessments? As a lawyer, I am used to seeing negligence based on human error; the potential for errors based on this technology could be huge. The introduction of telehealth may represent another step-change in healthcare: it may also open up a new area of negligence within the clinical environment.