How can you effectively meet the needs of your patients and tackle health deprivation, without overstretching the resources of existing health and social care services?
This was the challenge facing Wirral Health Commissioning Consortium (WHCC) – a division within a federation clinical commissioning group (CCG) – consisting of 27 practices. Wirral has a population of more than 310,000 and a relatively high percentage of older people, with the number of over 85s set to increase from 7,900 to 17,600 by 2033. This is combined with pockets of high deprivation and significant health inequalities across the borough. WHCC wanted to undertake a complete system overhaul that could eradicate variations in health outcomes and improve mortality rates, whilst reducing dependence on secondary care services.
Tackling health inequalities
Health deprivation is a serious problem in Wirral, with a 15-year variation in mortality rates across the borders. There are approximately 13,000 patients with heart disease and a further 7,000 with COPD living in Wirral. These diseases require regular clinical intervention and are often associated with unnecessary hospital admissions and significant budgetary pressures on the local health and social care economy.
In order to reduce the burden of long-term conditions on both primary and secondary care services in Wirral, WHCC decided to implement telehealth in partnership with Tunstall Healthcare as part of a whole system change, putting patients’ needs at the forefront of decision-making. Using telehealth, to enable patients to manage their conditions in their own home reduces the need for repeat GP appointments and regular hospital admissions. The technology, which can work as part of a centralised or integrated service, provides additional support and reassurance for patients and their families/carers, whilst reducing mortality rates and emergency A&E visits through early intervention.
But systematic change requires more than just the technology. For us, telehealth is part of a wider service delivery that needs clinical advocates and strong systems in place to manage the information that comes from the telehealth devices. Simply relying on the technology as a lifeline is not enough; GPs and nurses need to realise that telehealth does not supply all the answers, but is a crucial element that requires acceptance and understanding from both the patients and the providers.
COPD patient pathways
COPD accounts for a high number of hospital admissions in Wirral. Last year alone, WHCC recorded 386 emergency COPD-related admissions at a cost of £660,861. As part of our system overhaul, we established a project dedicated to supporting patients with COPD to improve the quality of care and access to specialist services for patients.
We devised a patient pathway that ensured all clinicians were heavily involved in the referral stage for telehealth. Patients were selected based on well-defined eligibility criteria and, taking their individual needs into consideration, a management plan was agreed as part of a partnership between GPs and specialist clinicians. The patients’ vital sign readings were sent to the monitoring centre on a regular basis, where they were monitored by specialist COPD clinicians and checked for abnormalities and trends if outside pre-determined levels.
We recently received an accolade at the North West Respiratory Awards 2012 for the community work we carry out using the telehealth service to support patients with COPD in the management of their own conditions. As a result of the project, community staff have been able to encourage patients to self-manage their conditions, whilst specialist COPD nurses have been commissioned to deliver dedicated sessions at GP practices, helping patients with a history of repeated hospital admissions.
One particular patient living alone with a confirmed diagnosis of COPD was given telehealth as part of a complete care package and, consequently, clinicians discovered other co-morbidities affecting her condition such as repeated drops in BP. As a result of telehealth, the patient avoided unnecessary hospital admissions and felt positive and reassured by the additional support from the telehealth system.
Evaluation is a vital part of recognising measurable success to determine whether the investment is worthwhile. The BMJ recently published a peer-reviewed study looking at the effects of telehealth on the use of secondary care. The results, which clearly validate findings from the Whole System Demonstrator (WSD), demonstrate that telehealth could reduce mortality rates and the need for emergency hospital admissions.
Before embarking on any new project, you should ensure you have a robust system in place to calculate QIPP (quality, innovation, productivity and prevention) savings and compile qualitative data from service users and providers, or run the risk of wasting time and effort. We are in the process of conducting a 12-month evaluation with patients and staff to gauge how they feel about the financial investment and we have already discovered early benefits from telehealth.
For us, it is vital that we utilise the knowledge of our patients to identify service development needs and gaps in service provision. We have to make changes in order to support the direction of community care and the growing elderly community at home, and it is important to engage with clinicians and nurses to build on the support from GP practices across Wirral.
Is it a bright future?
NHS Wirral has also supported a £1.6m joint venture with the local authority to implement a telecare service to support independent living for local residents, including those with long-term care needs. This has brought an additional form of support for patients who otherwise may be, or feel, at risk in their own home.
We believe telehealth will be one of the key elements in achieving our aim to eradicate our significant health inequalities and without it we could face rising costs and a potential decrease in quality over time. Telehealth delivers empowerment and can raise the bar on the possibilities to deliver improved quality of life and independence for people living with long-term conditions.
* Dr Naylor is chairman of Wirral Health Commissioning Consortium, Merseyside. The consortium is to join with Wirral NHS Alliance and Wirral GP Commissioning Consortium to form one CCG.