Thursday, 15 December 2011

Technology works (“if delivered properly”)

Posted on December 15, 2011 at

Telecare and telemedicine can improve health outcomes and save money, argued the Prime Minister last week.[1]

The Whole System Demonstrator (WSD) programme was set up by the Department of Health to attempt to, amongst other things, explore the evidence base as to the effectiveness and cost-effectiveness of these technologies. This week the Department of Health (DH) published the headline findings from the WSD.[2]

The findings are striking. “If delivered properly, telehealth can substantially reduce mortality, reduce the need for admissions to hospital, lower the number of bed days spent in hospital and reduce the time spent in A&E” argued the DH.

The randomised control trial of over 6000 patients found that if delivered properly telehealth can deliver:
• 15% reduction in A&E visits,
• 20% reduction in emergency admissions
• 14% reduction in bed days
• 8% reduction in tariff costs
• 45% reduction in bed days

Now this won’t be news to many. Many have made similar claims of effectiveness before (Companies selling these technologies, Government, local authorities, voluntary sector), but having this new data is very good news. There should however be a real note of caution. The short paper implies more questions than answers. The “if delivered properly” caveat needs to have been explained. Sadly the three page report feels too much like it was rushed out in order to give the Prime Minister something to announce.

Our report on Centenarians [3] published at the end of November highlighted a very interesting piece of research from Cambridge. “60% of interviewees aged over 90 had had a fall and that of these, four in five were unable to get up after at least one fall and almost a third had lain on the ground for an hour or more.” Yet in these cases, call alarms were widely available but not used [4]; a good example of technology not being delivered properly.

Even if there is a convincing case that technology, “if delivered properly”, can save money and improve health outcomes, we probably need to know more about how much it may cost and how possible it will be to “deliver properly”.

The Whole System Demonstrator seems to be revealing good news. But in a time of fiscal austerity and an ageing population, will commissioners have the resources to properly invest not just technology, but also the support package needed to ensure that the financial and health outcomes are maximised?

David Sinclair
2. 3. Living Beyond 100 is available at: 4. Fleming and Brayne, 2008; Cambridge City over 75-Cohort. BMJ