Would you trust this machine to act as your GP The device set to save the NHS over 1billion-a-year
21:00 GMT, 5 May 2012
It is a compact box smaller than a landline phone.
With the help of a few discreet attachments, it can monitor heart rate, blood pressure, glucose levels, weight and general health.
Connected to a call centre, it knows if a prescription is overdue or needs adjusting.
Well-connected: A teleheath box with a message saying it will monitor 'vital signs'. The aim is to have the system in three million homes within five years
For anyone needing to regularly visit a GP – often time-consuming or even stressful – it must sound like an ideal solution.
Known as telehealth, this is how the Government hopes health will be managed at home: not in the future, but from now.
Four major manufacturers, including Philips and Bosch, are vying for position in a market worth around 7 billion and projected to be worth more than 17 billion by 2026.
The aim is to have the system in three million homes within five years.
Within the decade the attachments, such as arm cuffs, will be dispensed with and a microchip implanted under the skin will constantly communicate the state of our health to ‘the box’.
David Cameron is championing this revolution – in which private companies lease equipment for a monthly payment to local NHS providers – as a cost-effective way to get patients to self-manage a range of chronic conditions such as diabetes and lung disease.
Almost two thirds of health and care expenditure in England is associated with long-term conditions; 15.4 million people suffer from one, and the number is rising fast.
The hope is that telehealth will save the NHS 1.2 billion a year in GP hours, hospital beds, ambulances and carers.
Yet critics fear home-managed healthcare will lead to social isolation for vulnerable patients, and warn against risking the loss of the comfort of face-to-face GP consultation.
Home help: A patient using a telehealth system to monitor his blood pressure. The hope is it will save the NHS 1.2 billion
‘The technology has been around in various guises for a few decades, such as in pendants that act as fall alarms, for less mobile individuals,’ says Simon Arnold, managing director of Tunstall, the UK’s largest telehealthcare provider.
‘This is called telecare. There are around 1.7million users in Britain today.’
Telecare is used to describe gadgets which manage risks to an individual’s living environment, such as smoke alarms, and the alarm pendants, which can be worn round the neck. But telehealth goes further.
‘Effectively patients are monitored 24 hours a day in their own homes,’ says Arnold.
‘It saves them from spending hours in waiting rooms, or admitting themselves to hospital if they deteriorate.’
Telehealth staff are not medically trained, but criteria are agreed with a patient’s doctor; any fluctuation in daily results is immediately flagged up.
A monitoring centre will call the patient.
‘Should there be no response they immediately call friends, family, the GP, a nurse or emergency services,’ Arnold says.
The patient is alerted to the need for, or receives, vital medication before a condition becomes life-threatening.
There are only 5,000 users but initial results are very promising: it’s saving patient time and public money.
The world’s largest randomised control trial of telehealth ran from May 2008 to September 2010, when 3,030 patients spent at least 12 months with a system at home.
Results showed a 20 per cent drop in emergency admissions, a 15 per cent drop in A&E visits and 14 per cent fewer bed days.
Users were also 45 per cent less likely to die than non-users of telehealth.
The downside is patients have less contact with doctors and carers.
‘Social isolation and loneliness are a concern,’ says GP and Clinical Commissioner Dr Jonty Heaversedge.
‘It’s not just visits from a doctor which are reduced, but potentially visits from carers and district nurses.
'Identifying an imminent crisis requires much more than just the monitoring of a patient’s vital signs.
'There is still no system that can beat the clinical judgment of an experienced doctor.’
But June Smith, 68, has tried the system and says: ‘No one, no matter how lonely, really wants to spend time at the doctors. It can be hard to travel if you’re feeling unwell.
'Going to the GP is more likely to raise my blood pressure than anything else.’
June, from York, credits telehealth with restoring her independence. She is a widow and suffers from diabetes and a heart condition.
Early last year, she began to suffer problems with water retention and was eventually admitted to hospital with heart failure.
After returning home from hospital she was offered a telehealth system.
‘I kept getting a very fast heartbeat and was nervous about doing anything,’ she says.
‘But I took my blood pressure every time I wanted to leave the house as well as daily checks. If my oxygen levels went down they called me up immediately and checked I was OK.
'After a couple of weeks I felt much more confident about going out. I learnt to manage the condition myself.’
But is user error a concern Arnold says it is ‘very low. Nothing has to be typed in so there’s little room for human error.’
June says: ‘I once took my blood pressure incorrectly.
'As soon as I realised I’d put my arm into the wrong part of the cuff I contacted them. They were about to call to check I was OK.’
There is already a move towards epidermal electronics: electronic skin patches which stick on skin and can measure heart rate and other vital signs.
Professor John Rogers of Illinois University and his team have been developing the patches, which are no thicker than a human hair.
Information is transmitted to computer or mobile phone and then to a doctor for analysis.
Professor Rogers believes they will eventually be available for those in good health to pick up early signs of disease.
And Arnold says: ‘It’s likely one day we’ll all have under-the-skin implants to monitor day-to-day health.’