Can telecare ease GPs' workload?

After years of optimistic rhetoric, evidence of telecare's benefits to patients is emerging. Stephen Robinson reports.

Telecare uses technology in the home to monitor patients (Photograph: Central Lancashire NHS)

The DoH wants to reduce the burden of long-term conditions on primary care by bringing telecare to the masses.

And for good reason: care for the 15 million people with long-term conditions in England accounts for £7 of every £10 spent on health and social care.

Telecare offers an alternative to standard care. It uses technology in the home to monitor patients and link them and their data to care staff.

For years it has been heralded as the next generation of healthcare, promising to reduce workload pressure on GPs and free up hospital beds. Now evidence for the benefits of telecare is beginning to mount up.

In 2007, a pilot involving 250 patients in Kent reduced hospital admissions, A&E visits and GP consultations. Organisers estimated it saved £1,878 per patient in just six months.

A Scottish telecare trial in 2009 saved £11 million and 80,000 hospital bed days.

Revolutionary service
Stephen Johnson, the DoH's deputy director for long-term conditions, extolled the benefits of telecare at a recent King's Fund event in London.

He believes the 'revolutionary' service could transform care of long-term conditions.

'We could see reduced levels of emergency admissions; better clinical outcomes; greater independence; less strain on carers; fewer cases of missed exacerbations; a more satisfied workforce and better use of scarce resources leading to significant savings,' he said.

At present, only individual councils have spearheaded telecare systems. 'To get real benefits you've got to think big,' said Mr Johnson. 'Lets stop wondering what or if it can work and move on to how to make it work.'

But integrating hi-tech telecare into established practice may prove difficult.

Cost is one barrier. In another pilot, Essex County Council spent £38,000 installing telecare equipment and £15,000 on care support for just 240 patients.

The council claims the trial saved £3.82 on traditional care for every £1 spent on telecare. But experts at the conference worried that procuring such funds may be too big a hurdle when local authority and health budgets face huge cuts.

David Miles, assistive technology and telecare lead at Nottingham City Council, said: 'Will it save money? I think it's more about budget shifting than returned savings.'

Consequences
Professor Stanton Newman of the school of community and health services at City University in London, thinks there will be other unintended consequences from intensely monitoring patients' health.

'Close scrutiny leads to better health outcomes,' he said, 'but the device may increase visits to GP practices.'

Surveillance may detect a further problem or disease and increase, rather than reduce, referrals, reducing the perceived cost effectiveness of any scheme, he points out.

Instead, Professor Stanton argues the source of real savings may arise from the preventive benefits of keeping an eye on patients' health, such as more consistent glucose monitoring in diabetes.

Other barriers make a nationwide scheme more difficult. Retraining community carers alone would be a huge exercise. Introducing new technology into practices and encouraging use among health staff on pilots has already proved challenging.

When care services are asked to invest millions of pounds up front, such doubts are enough to sink the plans. There is an alternative, though.

The DoH believes a private telecare market will soon emerge, as health technology companies are pursuing this avenue.

Dr Justin Whatling, chief clinical officer for BT Health, said: 'Is it possible to offer telecare for £10 per month? If we can provide it for that, we may get people paying out of their own pocket.'

A combination of patient-bought equipment and NHS-funded care support may prove to be the most sustainable compromise.

Telecare promises much but the DoH will find it hugely challenging to launch a nationwide scheme.

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