Telecare: what’s happened to the whole system demonstrators?
The patient from hell asks when the lessons from the WSD will be shared and what the delay means for the future of telecare
I am in despair about the future of telecare. You will remember that a trial, called the whole system demonstrator, covering 6000 long-term patients in Kent, Newham and Cornwall, has been chuntering along for about three years. In June last year, a Kings Fund conference announced relatively upbeat preliminary findings for the WSD. The full report was supposed to be imminent. But autumn and winter came and went, and still the report did not appear. We were told that it was just going through the necessary “peer review” process.
At the beginning of March, the Kings Fund held a two-day international congress on telehealth and telecare. Ah, thought I, naively, this is when the WSD report will finally be launched in all its glory, and will give a massive boost to the swift roll-out of telecare across the country.
I was wrong. The report was not released, because more peer review has still to be done, apparently. Indeed, it will not be released all at once, but dribbled out through the rest of the year. Last year, I deplored the dead hand of academia on research into telecare. Nine months later I repeat my concern. When I first became aware of telecare 15 years ago, I felt good, because it would be mature enough to help me in my old age. Now, I am in my old age, and telecare is clearly going to be of no help to me or the mass of my contemporaries.
Instead of giving clear directions for the next steps in telecare, most of the speakers devoted their presentations to saying how difficult – in fact near impossible – their task had been to conduct a “randomised controlled trial” into a subject as complex as telehealth, and make meaningful conclusions. There were too many variables: the different medical conditions being treated; the different age ranges of the patients; the effect of ethnicity; the state of the social care data on some of the patients; the accelerating speed of change in the telecare devices; the lack of interoperability; the different skills levels of the nurses and carers; the cooperation – or otherwise – of the GPs.
OK, I agree it is complex, perhaps too complex for the current methodologies for doing medical trials of this sort. However, I had hoped to hear where the big breakthroughs would come, and also where the dead ends were located. I had hoped to learn what the criteria were for success, and where the pitfalls lay. I wanted good solid statistics about reduced inpatient time and better quality of life. I got none of that.
There were positive speakers, but they weren’t from the leaders of the WSD project. One of them was the minister, Paul Burstow, supported by a henchman from the DH. Rather bizarrely, last December, Burstow announced the 3millionlives initiative. This was a governmental go-ahead for fast implementation of telecare, based on the good news from the interim statistics of the WSD. For example, telecare in the WSD areas resulted in a fall of 20% of emergency admissions. And it resulted in a 15% drop in visits to A&E. And most spectacularly, telecare resulted in a drop of 45% mortality between those long-term patients who are receiving telecare and those who aren’t. The result, according to Burstow, could be a saving of £1.2bn.
None of the other speakers at the congress confirmed or denied these amazing figures. When they mentioned figures, they were very iffy about whether they were positive or negative. So, who is right, the minister, or the naysaying academics? We should be told.
For me, the most convincing speaker at the conference was Haris Patel, not a policy wonk or a peer reviewer, but a long term hypertension sufferer from Folkestone. He used to spend eight to ten months in hospital every year. However, since having a blood pressure monitor at home linked to his district nurse, he has been an inpatient for only five weeks. What made the difference was that his carers could react to changes to his blood pressure in minutes, and change his medication quickly. Telecare had changed his life. With witnesses like him, who needs peer reviews?
Patel, the only patient who spoke, was vouchsafed a six-minute slot. I get the feeling that if 15 or 20 long-term patients were seeded among the audience, and some of them allowed to speak, then they would have made hay with the academic naysayers on the platform. And telecare would have a future.
http://www.guardian.co.uk/healthcare-network/
