Long term conditions like diabetes place a large burden on healthcare systems. A study in Yorkshire examined experiences providing care for long term conditions. It found that telehealth interventions can reduce hospital admissions, bed days, and costs while improving patients' quality of life. The Whole System Demonstrator Programme trial of telehealth and telecare in various UK regions showed a 45% reduction in mortality rates and 20% fewer emergency admissions among other benefits. Telehealth represents an opportunity to deliver more specialized care while reducing strain on hospitals and caregivers.

1. Healthcare Policy in the Area of Long Term
Conditions: Experiences of Yorkshire
Rachel Binks
Nurse Consultant, Critical and Acute Care
Airedale NHS Foundation Trust

2. Our Context
Long term conditions Long term conditions -
consume - much more common
as we age
50% GP appts
By 2034 –
64% OP appts 5% population >85yrs
70% IP bed days x2.5 increase
70% NHS spend (compared with 2009)

3. Our Context
Diabetes
Complex
Common
Costly
Controllable, but
poorly managed
(process and
outcomes)

4. The big picture …
“…DH position: further efficiency savings in
the NHS will continue after 2015, with the
total savings rising from £20bn to a
possible £50bn by 2019-20…
…A startling admission of the long term
impact on public services of the global
financial crisis and ensuing (double dip)
recession…
…The translation is an NHS that has
barely managed 1% productivity per
annum let alone 5% each year for EIGHT
YEARS…”
John Appelby
Kings Fund

6. Important relationships

8. NHS Outcomes
Framework
• The NHS Outcomes Framework reflects
the vision set out in the White Paper and
contains a number of indicators selected
to provide a balanced coverage of NHS
activity.
• Its purpose is threefold:

9. Purpose
1. to provide a national level overview of how well
the NHS is performing;
2. to provide an accountability mechanism
between the Secretary of State for Health and
the NHS Commissioning Board for the effective
spend of some £95bn of public money; and
3. to act as a catalyst for driving up quality
throughout the NHS by encouraging a change
in culture and behaviour

10. A complex
Structure
but
many
outcomes
that we can
influence with
telemedicine

11. Long Term
Conditions
Reducing time in
hospital
Emergency
admissions that
should not need
admission
Helping people
recover

12. Domain 2
• Enhancing
quality of life
for people
with LTCs

13. Domain 3
• Helping
people to
recover
from
episodes
of ill health
or
following
injury

14. “It is clear that the NHS, as currently
configured for long term condition care, is
not sustainable in the face of the projected
increase in comorbidity and level of need”
Long Term Conditions Compendium of Information
(3rd Edition, 2012)

15. Long Term Conditions
Compendium of Information
• The Department of Health has published
the third edition of the ‘Long Term
Conditions Compendium of Information’.
• It is aimed at commissioners as well as
health and social care professionals, to
provide the evidence for improving care
and outcomes for people with long term
conditions (LTCs).

16. Whole System
Demonstrator Programme
• This document contains the latest
statistical data on long term conditions,
links to the LTC QIPP (quality, innovation,
productivity and prevention) workstream
and provides data from the ongoing
evaluation of the Whole System
Demonstrator Programme on telehealth
and telecare, which supports the delivery
of 3 Million Lives.

17. LTCs a priority
• It also showcases examples of innovative
projects across the country where
organisations and communities are
pushing the boundaries to deliver
improvements in LTC care.
• The information and evidence captured in
this third edition of the compendium
continues to reinforce why a focus on
LTCs should be a priority.

18. The Whole System
Demonstrator Programme
• One of the most complex and comprehensive
studies the Department has ever undertaken, and
has yielded a wide range of very rich data.
• Launched in May 2008. It is the largest randomised
control trial of telehealth and telecare in the world,
involving 6191 patients and 238 GP practices
across three sites, Newham, Kent and Cornwall.
• Three thousand and thirty people with one of three
conditions (diabetes, heart failure and COPD) were
included in the telehealth trial.

19. The Whole System
Demonstrator Programme
• For the telecare element of the trial people were
selected using the Fair Access to Care Services
criteria.
• The proposition being analysed was “Does the use
of technology as a remote intervention make a
difference?”
• As each site used different equipment and had
differing populations there is confidence that the
results are transferable to other locations.

20. Findings
• 45% reduction in mortality rates
• 20% reduction in emergency admissions
• 15% reduction in A&E visits
• 14% reduction in elective admissions
• 14% reduction in bed days
• 8% reduction in tariff costs

21. Benefits for the
Individual
• More effective self care
• Improves quality of life for carers
• Less travel and disruption for routine
check-ups
• Retention of dignity
• Increased confidence to manage own
health
• Fewer stressful, unplanned hospital
admissions

22. Benefits for Healthcare
Professionals
• Through risk stratification, professionals can
identify those people in their practice who have
LTCs and could be better supported if telehealth
were adopted
• Professionals can be better informed of the
status of these people and see less demand on
services, with fewer A&E events and
unscheduled inpatient episodes
• Professionals see less impact on family
members/carers of people with Long Term
Conditions (LTCs) as they start to take more
control of their own health

23. Benefits for Healthcare
Professionals
• More regular data means professionals can be better
informed of a person’s health status which leads to early
intervention and proactive care
• Deploying telehealth-enabled services modernises the
way by which large numbers of people with LTCs are
treated improving their care, quality of life and the life of
their carers
• It makes more efficient and effective use of available
clinical teams by reducing unnecessary home visits
• It involves people far more in the management of their
own healthcare
• It significantly reduces the incidence of A&E usage and
unplanned admissions thus reducing the disturbance on
elective planning

24. Next steps
• The headline findings, with the detail now
supported in the paper, provided the impetus for
3millionlives and the drive for industry to work
with health, social care and housing
stakeholders to develop workable business
models to enable telehealth to be delivered at
scale and at the right price, and pricing structure,
for the public purse.

25. Next steps
• A further four reports are planned, which will
analyse other elements of the telehealth trial,
including a separate paper on costs and how
telehealth affected quality of life.
• The telecare findings are due to be published at
some point in the future. The full BMJ article is
available online. *published by the BMJ.
Research team lead by the Nuffield Trust. 3ML
Press Release

26. Implementing
telehealth
telecare
telecoaching
telemonitoring
teleconsultation
BMJ 14th July 2012 345; 7, 16, 20

27. We must have
New ways of
delivering
early
specialist
opinions and
care

28. so less in here…

29. The bigger picture …
scale of financial
challenge
growing demand
unmet need
+ traditional
hospital dominated
medical model
=
designed
inappropriate by default
utilisation
stretched capacity

30. a system designed by
default
some people seem to
do quite well without
waiting for healthcare
support……

32. Much more of this
numerous potential use
cases:
• long term conditions
• outpatients
• nursing homes
• employee health & well
being
• early supported discharge
• admission avoidance
• dementia – carer support
• social care
• purely social calling
• specialist networks

33. Thank you for listening
Any Questions?