Bainbridge warns of need for telecare

23 Jun 2008

Health and social care services have five years to develop the telehealth and telecare services they will need to cope with an ageing population, Dr Mike Bainbridge, NHS Connecting for Health’s clinical architect, has warned.

Speaking at a fringe session at this year’s NHS Confederation conference, Dr Bainbridge said that ageing combined with an increasing burden of chronic disease threatened to make current models of healthcare unsustainable within a few decades.

He said costs would start to rise in 2010 and that by 2050 “delivery using current models could cost four times what it does now – or 40% of GDP.” All developed countries were facing similar issues, he added, “but only in Britain are we seeing joined up thinking about how to handle them.”

Dr Bainbridge said that where most countries were still focusing on their acute and nursing home sectors, Britain was looking at getting care out into communities and homes and running whole system demonstrator trials of telehealth and telecare systems.

The whole system demonstrator project is underway, in Kent, Cornwall and Newham, but Dr Bainbridge said the need to get such systems in place was urgent. “We have to do this over the next five years if we are not to see the NHS go over the falls – the equivalent of Niagara Falls – with or without a barrel,” he said.

Bainbridge also argued that healthcare IT systems would increasingly need to deliver information to patients, as well as to clinicians, administrators and regulators.

Like many other speakers at the conference, he seemed fascinated by the possibilities opened up by Microsoft and Google developing platforms for patients to hold and share their own healthcare information.

“There are issues with citizen-entered data,” he acknowledged, admitting that professionals would need evidence about who it related to, to the quality of the devices that had gathered it, and its trustworthiness - as well as help to cope with the volume of material generated.

However, he said the NHS would not be able to resist the trend. “The data is going to start flowing over the next few years, so we are going to have to deal with it,” he argued.

Similarly, he said one of the key reasons for running the whole systems demonstrators for telehealth and telecare was to test how data generated by new monitoring devices could be directed into records and to monitoring and alarm services; and to examine how these should be managed and regulated.

Dr Bainbridge hinted that Lord Darzi’s Next Stage Review of the NHS would support the shift to community, home and personal care.

This was supported by other speakers at the conference, who said improving primary care would be one of the first “world class commissioning” challenges for PCTs, and that there would be no let-up on the GP-led health centre agenda, despite opposition from doctors.

However, like many other speakers Dr Bainbridge was unable to give details of the review or the Swindells Informatics Review, which he said would be published “any day now.”

Lyn Whitfield

Reader's Comments

There are issues with citizen-entered data ....

23 Jun 08 14:03

Might these issues perhaps be similar to those around CRS data?

Namely:

1. Evidence about who it related to (and the status of the person sntering it) 2. The quality of the devices that had gathered it 3. Its trustworthiness 4. The volume of material generated.

What about the infrastructure?

maryhawking@tigers.demon.co.uk

23 Jun 08 20:36

Telemonitoring devices are interesting - but yu will still need the infrastructure to receive messages, evaluate them and the action required and the systems to provide that support. I doubt whether total reliance on telecare is safe without the infrastructure - which no-one is prepared to discuss.

Lifting and the laundry

24 Jun 08 14:54

Two issues

1. The robustness of the technology

2. Web 2.0 isn't going to do the lifting and the laundry

Patient monitoring and treatment devices even in optimum circumstances (e.g. high dependency units) are delicate easily dislodged, decalibrated or otherwise perturbed and emit a stream of false alarms. How these will perform in a home setting is pretty obvious.

I have recently had the duty to assist my frail mother in the care of a terminally ill stepfather.

My experience both as a doctor and a part time carer is that helpful bodies on the ground are needed - not technology! Home nursing assistance is means tested and you pay in full if the patient has assets of £21,000 or more.

http://www.ucarewecare.com/nursing-home-fees.php

Mike may have low-cost healthcare assistant cyborgs slated for 2010 delivery - this would be one of the more realistic CfH targets. Meanwhile I believe most people would rather be paying for carers on the ground than toys for the boys.

Ahem CfH reinventing again ...Social Care is doing this

26 Jun 08 23:15

Perhaps CfH is trying another way to claim roll out of systems - ooh here's one someone else prepared earlier. Social Care Departments have been given money to roll out or commission Telecare solutions over the last 2 years. Because this didn't happen the CfH way, it has largely happened, but probably with inadequate publicity.

And I suggest that the two GPs commenting here talk to their local Intermediate Care teams, or check their Local Authority websites. or see http://www.icn.csip.org.uk/telecare/index.cfm?pid=296 for a list. Telecare is well developed, with reasonably robust devices able to detect a variety of conditions around the home (panic buttons, falls detectors, gas detectors, pressure pads on chairs or floor, doorswitches, pill jars ...).

Its not perfect, but it can be pretty robust, and give the patient, carers and relatives peace of mind. And it should not replace carers on the ground, but can summon assistance or just reassurance at other times.

This does need telecoms links back to a call centre, and in turn, a chain of people who can respond appropriately. This needs development and tying into the various NHS teams. I believe the technology has a place, and that we in health can and should seek out the Local Authority arrangements, utilise the Telecare, and develop it, as Telehealth solutions can easily be added on for these patient groups to these systems.

So I'd be grateful if Mike sticks to the rhetoric, and pushing standards, and that clinicians and social care workers, supported locally, build local whole-system structures, rather than have another parallel NHS national initiative cutting across us.

It is sadly true that many health and social workers will retire by the timescales he indicates, and with an ageing population, we will have to use technology to fill some of the gaps.