The Whole System Demonstrator programme

The Whole System Demonstrator (WSD) programme has been one of the most complex and comprehensive studies the Department has ever undertaken, and has yielded a wide range of very rich data.

The WSD programme was 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. For the telecare element of the trial people were selected using the Fair Access to Care Services criteria.

There are many different types of telehealth and telecare but each of the three sites made their own decisions on the equipment they would use in their health and social care economies. That in itself was not a problem for the study, as 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.

The WSD Headline Findings for Telehealth

  • 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

There are many definitions of telehealth and telecare, but for simplicity these definitions incorporate those from the whole system demonstrator programme.

What is telehealth?

Telehealth – often referred to as remote patient monitoring – refers to services that use various point-of-care technologies to monitor a patient’s physiological status and health conditions. When combined with personalised health education within a chronic disease management programme, it can significantly improve an individual’s health and quality of life. Typically, it involves electronic sensors or equipment that monitors vital health signs remotely from home or while on the move. Readings are automatically transmitted to an appropriately trained person who can monitor the health vital signs and make decisions about potential interventions in real time, without the patient needing to attend a clinic.

What is telecare?

Telecare is a service that enables people, especially older and more vulnerable individuals, to live independently and securely in their own home. It includes services that incorporate personal and environmental sensors in the home, and remotely, that enable people to remain safe and independent in their own home for longer. 24 hour monitoring ensures that should an event occur, the information is acted upon immediately and the most appropriate response put in train.

Why telehealth and telecare?

  • Potential to make significant health improvements and quality of life impacts for people with a high dependency on the NHS, local GPs, social services and local hospitals.
  • Provides a means to increase the availability of NHS clinical support by allowing local practitioners to be in permanent contact with those people less able to look after themselves.
  • Can help improve the reach of the services that the NHS provides, looking after those who are often ‘invisible’ from the main acute services.
  • Helps keep people out of hospital and avoids all the pressures this can put on them and their families.

Benefits for Individuals

  • 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

Benefits for Health and Social Care 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
  • 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

BMJ Whole System Demonstrator Paper

Summary of Paper One – Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial*

The paper provides a detailed review of the impact the WSD telehealth trial had on secondary healthcare and mortality. A final total of 179 general practices took part in the trial (from a starting point of 239 potential practices) from across Kent, Cornwall and Newham. A total of 3154 patients were analysed as part of this trial. These individuals were split into two groups, 1584 in the control group (usual care, without telehealth) and 1570 in the intervention group (telehealth). To be a participant in this trial patients had to be over 18, and have a clinical diagnosis of chronic obstructive pulmonary disease (COPD), heart failure or diabetes (or a combination of more than one of these long term conditions). The primary aim of the telehealth trial was to assess the proportion of patients who had an inpatient hospital admission within the trial period (12 months). The trial resulted in a proportion of 11% fewer admissions for the patients using telehealth than for the individuals within the control group. Additional end points were identified and the results showed that when using telehealth correctly, patients and healthcare professionals would benefit. These results included:

  • 45% reduction in mortality rates
  • 14% reduction in the number of patient bed days
  • 20% reduction in emergency admissions
  • 14% reduction in elective admissions
  • 15% reduction in emergency department visits
  • 8% reduction in tariff costs

As reflected in the headline findings, the results show a direct impact on mortality rates − a 45% reduction − which from the patient’s perspective must be one of the most important reasons to use telehealth. The paper also provides an overview of the figures that resulted in a 20% reduction in emergency admissions − impacting on both the quality of life for individual patients and their families, and on the use of health resources. The length of stay for patients who had to be admitted to hospital during the trial was also found to be lower for patients using telehealth, than those without (a 14% reduction in bed days) Not surprisingly, the costs savings were not shown to be overally significant, as the trial was started in 2009 and based on low scale payment models. Despite this, there was an overall reduction of £188 per head.

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. 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. Press releases relating to the report from 3millionlives and the BMJ are attached below. The full BMJ article is available online. *published by the BMJ. Research team lead by the Nuffield Trust.  3ML Press Release

 

CCG potential savings featured at NHS Innovations Expo

At the recent NHS Innovations Expo, 3millionlives had an exhibition stand, and was part of the Dementia Village. The idea was to make the village ideal for individual people who may be living with dementia. There was a house, a garden area, a village green complete with bandstand, a GP practice and an array of village shops.

The house was furnished through the hard work of Eldercare who set up the house and Wigan and Leigh Hospice, who generously lent the room sets to make the house so authentic. Within the house was a selection of telecare and telehealth equipment that could meet the needs of a person living with dementia, as well as other health and social care issues. After a call out to TSA members, 3millionlives was able to select a range of technologies that linked into a single monitoring centre which was set up in an adjacent area. We were then able to demonstrate to visitors to the house what happened if a person needed assistance. We are grateful to all the organisations who responded to the request for unbranded technologies, and in particular to Ascom, Care Innovations, Eldercare, Invicta Telecare, Peaks and Plains Housing Trust, Tunstall, Tynetec and Verklizan who kindly donated unbranded equipment and/or staffing assistance.

In addition to the house and monitoring centre in the Dementia Village, 3millionlives had an exhibition stand in the main arena. This held information about the partnership, but the main feature was a glass wall that outlined the potential cost savings CCG’s could achieve based on one of the key findings from the Whole System Demonstrators (WSD’s). The paper Effect of telehealth on use of secondary care and mortality, concluded that a 20% reduction in emergency admissions was achieved during the trial when telehealth was used appropriately. Health analysts from the Department of Health took this finding and, using the emergency admission figures for each GP practice from the previous year, calculated the potential savings this could produce for each CCG.

Examples of some of the figures generated by CCG outlining the 20% reduction in emergency admissions are outlined below:

NHS Birmingham CrossCity CCG   £2,364,600
NHS Cambridgeshire and Peterborough CCG £2,081,520
NHS Somerset CCG £1,612,800
NHS Cumbria CCG £1,467,900
NHS Leeds West CCG £1,141,140
NHS Redbridge CCG £536,340

These figures did not include costs for alterations, or additions to services, but were generated to stimulate discussions. Most of the clinicians that came onto the stand were interested in finding out how telehealth and telecare could provide solutions for increased demands on their services, and how to modernise more traditional based services. The discussions were not about bolt-ons, but were about how to include these services in both primary and secondary service redesign.

The full breakdown of these CCG potential savings is available, along with the map outlining CCG areas and summary savings.