Telehealth: fact or (science) fiction?

7 Dec 11
M Rutter & J Stringer

The government is keen on promoting the benefits of telehealth and telecare in the NHS. But it's less enthusiastic about coughing up the funds that could make it all happen

We welcome the Department of Health’s promise to 'rapidly accelerate the use of assistive technologies in the NHS, aiming to improve at least three million lives over the next five years.' This was made in its report Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS.

It comes on the back of positive results from the Whole System Demonstrator programme, which showed that telehealth and telecare can genuinely reduce hospital admissions, emergency attendances, hospital bed days and mortality.

But the Department proposes working with industry 'to identify ways of reprofiling [capital] costs so that they can be met from downstream revenue savings.' It’s naive to think that industry will meet the start up costs of telehealth. Even if it did, that places all of the risk on industry and of course risk always comes with a premium.

The danger here is that telehealth is seen as something that can be implemented through outsourcing rather than using the kit as part of a suite of tools to tackle long-term costs and ultimately remove cost from the health economy.

Central government isn’t footing the bill for telehealth, so how will the fundamental costs of engaging clinicians, project management, service redesign and pathway redesign be met? All of that requires significant resource from the NHS side.

We’ve calculated that providing assistive technologies to three million people over five years will cost £0.5 billion, assuming of course you exclude the low-cost text messaging solutions only appropriate for those further down the pyramid of need.  Where, in these difficult times, will the money come from?

The frustration is that never before has an opportunity to change the way that care is delivered been scrutinised so thoroughly and demonstrated such a significant return on investment; a 20% reduction in non-elective admissions. Will anything change without the upfront investment?

Incentive schemes will be needed to fund a local enhanced service or pay the difference in the quality and outcomes framework. We’ve mooted the idea of creating a tariff and were pleased to see that the Department will be developing a tariff for telehealth and telecare as an incentive. It will also introduce a 'shared savings formula' – something forward thinking commissioners and providers are doing already.

The construction of a commercial deal that allows telehealth providers to benefit from downstream revenue savings is very problematic, what constitutes a saving when telehealth is about the avoidance of admissions and other health events? How do you take into account the regression to the mean (i.e. what the normal profile of patient activity looks like)? Basing the deal on deployment of units is far simpler but places the risk of savings being delivered on to the NHS organisation.

The Department has acknowledged the benefits of assistive technologies and that service redesign and incentives are needed to drive adoption and diffusion.  This is progress, but buyer beware; the kit represents only a fraction of the challenge.

Matthew Rutter is senior manager and Joe Stringer is a partner at Health Advisory Services, Ernst & Young

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