Event Report: Telehealth and Telecare

“It’s killing patients, at the worst, and, at best, it’s costing us a lot of money for no added benefit.” Professor James Ferguson, clinical lead at the Scottish Centre for Telehealth and Telecare (SCTT), was candid in his assessment of the effects of relying on accustomed methods of delivering care. “By not adopting new ways of delivering care we are ensuring that large numbers of our population are dying,” said Ferguson, underlining the link between overloaded hospitals and increased mortality.

A consultant surgeon in emergency medicine at NHS Grampian, the Aberdeen doctor helped devise the scene in Casino Royale when a poisoned James Bond saves himself via remote medical help. As far as Ferguson is concerned, though, the enemy in this instance is SLOTH – secret league opposed to telehealth and care. It was a constant refrain – the resistance of clinicians to do things differently – over the course of Holyrood’s two-day conference on telehealth and telecare last month.

“We need to get the doctors involved in this agenda and that starts with the undergraduate discipline – medical students of today who will be the doctors of tomorrow,” said Professor George Crooks, SCTT director and medical director for NHS24. Crooks relayed a recent unsuccessful attempt to persuade deans of medical schools to incorporate technology-enabled care into the
undergraduate curricula. “They basically said, ‘what do you want us to take out to put that in?’ which was missing the point completely… It’s part of day-to-day service delivery – it’s not an add-on.”

The fact there was a negligible increase in the number of people aged over 65 provided with telecare between 2011 and 2014 led Dr Margaret Whoriskey, Joint Improvement Team (JIT) director, to suggest a “plateau” had been reached in terms of additional users. It is against this backdrop that the Scottish Government has pledged £30m through to 2018 as part of the technology-enabled care (TEC) programme. A report on Scotland’s state of readiness for mainstreaming technology-enabled care is to be published by JIT within the next few weeks.

“It’s really complex,” said Dr Janet Hanley, NHS team leader for the Edinburgh Health Services Research Unit. As well as seeking to change professional and patient behaviour, technical issues persist, for instance, around consultation via video link. “We can speak to people on Everest [but the] middle of West Lothian, middle of East Lothian is more tricky,” she said. “We don’t have good broadband and health centres don’t have good broadband either.”

That said, Telescot, the largest programme of like for like randomised control trials of telemonitoring worldwide, has underlined the effectiveness of technology, for example, in allowing patients to manage blood pressure. A small number of GP practices in Lothian are set to pilot a new way of working that will see individuals with high blood pressure expected to check it themselves at home. “If you go to the surgery, the nurse or the doctor may take your blood but they will look online at your record that you’ve produced for your blood pressure – this is a step change,” said Hanley.

However, there was a clear sense that take-up of technology within health and social care depends much more on people rather than products. “If we simply invest the £30m TEC programme on fancy shiny bits of technology, we will have failed,” said Shona Robison, Cabinet Secretary for Health and Wellbeing. Staff training and public awareness must be addressed, while Robison acknowledged a need to “significantly up our game” when it comes to involving citizens, citing the Scottish Government’s digital participation strategy as well as the launch of a health literacy action plan.

Crooks raised the prospect of a more radical means of ensuring progress in alluding to the “biggest sledgehammer” on hand – one that government turned to in order to integrate health and social care – legislation. The “more conventional” way, he said, is to attract the attention of those making decisions. “That requires politicians to have the courage of their convictions and to determine policy, supported by civil servants, that makes it unambiguous that the system is going to move in a certain direction. It has to make policy that is sensible and is evidence-based, and I think what we’re hearing is that the evidence base is now irrefutable.”

Robison underlined the opportunity with the first Scotland-only GP contracts from 2017, negotiations on which are under way. “Contract negotiations are never easy when you get into the nitty gritty,” she said. “But, at the moment, what we’re talking about are principles and directions of travel and I think the use of technology is an important one. Now, how that ends up being built into a different way of doing things, we have to work on the detail of that. But the sense I get is that everybody is up for a bit of a different way. We’ve got the opportunity from now to 2017 to get that right.”