Whole System Demonstratorprogramme

Stephen JohnsonDeputy Director – Head of Long Term Conditions

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Technologies for what purpose?

• The second half of the 20th century saw major improvements in communicable disease treatments and surgical advances

• The first half of the 21st century will see increases in non-communicable diseases and improvements in care of people with long term conditions

• Technology is readily used and accepted in the treatment of many acute interventions – CT, MRI, x-rays, etc

• But can technology be used to improve the care of people with long term conditions?

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………….Yes, at least that is the claim, but where is the evidence?

Back in 2006 it was recognised the evidence base was not as robust as we would have liked

So we secured funding and set out to fill that gap

WSD was born (3 sites, 6000 people, 238 GP practices, making it the largest RCT of TH/TC in the world)

2007 to 2008 sites were selected

2008 – 2009 patients recruited (easy this RCT thing isn’t it!!)

2009 to 2010 patient data collected

Jan 2011, data to evaluation team

Now? – well now the data is being evaluated and peer reviewed prior to publication

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What will WSD tell us?

THEME Question NO. PARTICIPANTS REQUIRED

1Nuffield

Does the introduction of telehealth or telecare result in reduction in service utilisation and costs of care?

5721 participants

Combined Model

2UCL

What is the effect on carer burden, self-care behaviours and quality of life? What predicts whether people will use the service as planned? What is the clinical impact?

3445 participants

470 informal carers

3LSE

What is the cost−effectiveness of the introduction of telecare & telehealth?

3445 participants

470 informal carers

Professional interviews

4Man’rOxford

What are the service users, informal carers and health and social care professionals’ experiences of telehealth and telecare?

234 interviews so far.

Participants & informal carers.

Health & social care professionals.

5Imperial

What organisational factors facilitate or impede the sustainable adoption and integration of telehealth/telecare?

48 key WSD managers and commissioners in health & social services. Staff from 3 WSDAN sites and 3 non WSD related sites

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What have we learnt?

• Technology is only part of the story, you must re-design services to maximize the benefit of the technology

• That includes looking again at skill mix and facilities

• Clinical engagement is essential, but takes time

• Patients are suspicious, and building trust takes time

• Patient data was not as good as we thought, disease registers were out of date of inaccurate

• Some population groups were very difficult to reach

• Good project/programme management is essential

• What you do on a small scale does not necessarily scale

But…………………………..

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If you get it right, and focus on the whole system

Work across traditional organisational boundaries

Re-design care pathways

Educate patients and the public

Build clinical advocacy

Share Information

Develop interoperablesystems

Re-train staff

The rewards are significant…………………..

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BUT

the key to success is service change not just introduce the “kit” and hope for the best!

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Remember why we are doing this

The number of people with long term conditions is growing (15.4m now, but up to 18m within 20years) and they account for 70% of spend

People with LTCs live with their condition every minute of every day, not just the 3 to 6 hours they are with a professional

8760 hours in a year, that leaves a lot of time

Telehealth and telecare should help more people to lead a better quality of life, be more independent and spend fewer days in hospital

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What next?

This will need significant leadership at all levels as well as raising awareness of what can be achieved and how to use the technology properly

But to lead needs a directionBut to lead needs a direction - align incentives, re-train staff, develop interoperability, embed common standards and reduce high unit costs

Government has already committed to support an industry led Code of Practice and invest in DALLAS

Yet more could be achieved by encouraging “patient pull” (showing that there is an alternative to using traditional buildings), using the media to give sustained information and ensuring NHS is supported to change

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Stephen JohnsonDeputy Director

Head of Long Term Conditions

0113 254 7362

stephen.johnson@dh.gsi.gov.uk