'Virtual doctor' revolution to cut down on GP visits: Why the NHS wants more of us to use high-tech health monitors in our homes
00:40 GMT, 14 August 2012
For the past year there has been a caring new man in 71-year-old Vera Swanson’s life.
Every morning, shortly after she has made her first cup of tea of the day for herself and her husband James, her new man’s smooth voice politely guides her through a health check.
Together they take her temperature, blood pressure, oxygen levels and pulse.
The government hopes the 'telehealth' revolution could soon connect millions of patients to 'remote care' from their own homes
He’s thoughtful, asking if her breathing is better or worse than the day before.
It isn’t that a dashing young GP has moved in with Vera, a retired hairdresser, who was diagnosed three years ago with chronic obstructive pulmonary disease (COPD) — but he might as well have.
Vera, of Haxby, North Yorkshire, is a guinea pig in a ‘telehealth’ revolution which, the government hopes, could soon connect millions of patients to ‘remote care’ from their own homes.
Patients with chronic conditions can monitor their own vital signs daily, with easy-to-use equipment that ‘talks’ them through each step.
The data is then automatically transmitted via the telephone line to a central control run by the company that supplies the equipment.
If a patient’s readings are outside their pre-set limits, an alarm is triggered and the patient is immediately contacted.
As far as Vera is concerned, telehealth is ‘the best thing since sliced bread’.
Normally, she might see her GP or practice nurse every few months and, if a problem develops in the meantime, she could find herself relying on out-of-hours GP cover or facing a dash to hospital for emergency treatment.
Then, a year ago, she was recruited into a telehealth scheme being run by North Yorkshire and York Primary Care Trust.
Vera was sceptical at first, but now says: ‘I think this should be in everybody’s home’.
Her vital signs, and those of the other 500 patients enrolled in the scheme, with COPD, heart disease or diabetes, are measured daily using equipment linked wirelessly to her telephone line.
The whole session takes under five minutes and, if a problem is detected, she is contacted by her own dedicated telehealth nurse.
Paul Burstow, the minister for care services, claimed at a conference in March that telehealth 'could save the NHS up to 1.2 billion over five years'
Normally, problems with COPD, such as infections, can be easily treated, but patients often leave it too late to get help, leading to unnecessary and expensive emergency admissions to hospital.
Telehealth patients such as Vera are given medication ‘rescue packs’ to keep at home — containing, in the case of COPD patients, antibiotics and steroids — and after a chat with their telehealth nurse can quickly prevent a problem becoming a crisis.
The Government also thinks telehealth is the best thing since sliced bread — but for a very different reason from Vera’s.
According to the Government, seven out of every ten hospital beds are occupied by patients with long-term conditions like Vera’s, and 70p out of every NHS pound is spent on them.
Paul Burstow, the minister for care services, claimed at a conference in March that telehealth ‘could save the NHS up to 1.2 billion over five years’ — a sizeable sum for a health service trying to save up to 20 billion by 2014.
Of course, that’s not how the Government is selling the technology to elderly patients.
In December, David Cameron said the aim was ‘to make an extraordinary difference to people; dignity, convenience and independence for millions.
‘We’ve trialled it, it’s been a huge success, and now we’re on a drive to roll this out nationwide.’
But research I’ve carried out for the British Medical Journal suggests the government is jumping the gun.
True, telehealth has been trialled.
The Whole System Demonstrator programme — a 30 m three-and-a-half-year trial launched in 2008, involving 6,000 patients and 230 GP practices — was one of the most complex ever carried out by the NHS.
The Government has cherry-picked some impressive-sounding figures from the only part of the study yet to be reported, claiming, among other things, that the trial shows telehealth will reduce expensive hospital admissions.
But the jury is still out — not only on whether telehealth is capable of saving the NHS money, but also on whether, in the long run, it is good for patients.
The job of analysing the mountain of data has been divided up between five academic institutions.
And because this is a strictly academic exercise, before their papers can be published they must be ‘peer-reviewed’ — a vital process of evaluation by independent experts, designed to ensure published results are credible and useful.
Yet in an extraordinary move — more than six months before the first paper was published in the BMJ in June — the Government took it upon itself to publish ‘headline findings’ from the trial.
Telehealth, it claimed, could deliver ‘a 15 per cent reduction in A&E visits, a 20 per cent reduction in emergency admissions, a 14 per cent reduction in elective admissions, a 14 per cent reduction in bed days, an eight per cent reduction in tariff costs’ and ‘a 45 per cent reduction in mortality rates’ — a ‘quite unexpected and truly extraordinary’ finding, according to Mr Burstow.
That would indeed be extraordinary — amounting to 60 lives in a year in the trial group.
But what isn’t yet clear is what part, if any, telehealth itself played in this finding.
A similar-sized American trial published last year in the New England Journal of Medicine found no improvements for heart-disease patients.
And while many of the patients in the NHS study were at low-risk of death and hospitalisation, another U.S. study found a higher death rate for patients using telehealth.
The researchers suggested the difference could be blamed on an increase in the number of medical interventions among the telehealth patients.
Burstow’s unbridled enthusiasm contrasts with a more measured response from Jennifer Dixon, director of the Nuffield Trust which carried out the research behind the paper.
‘We’re not quite sure why there were slight reductions in mortality,’ she said.
Furthermore, ‘there were not statistically significant reductions in costs.
So it doesn’t on the face of it look as if telehealth is really going to produce the cost savings and health (improvements) that we’d hoped.’
None of the Government’s claims for telehealth seem to stand up to scientific scrutiny.
In January it declared: ‘At least three million people with long-term conditions and/or social care needs could benefit from using telehealth’ — and then signed an agreement with some of the big names in the telehealth industry.
This, it said, was ‘a demonstration of the commitment from both sides to work together to accelerate the use of telehealth’, to enable ‘millions of people to receive the significant benefits evidenced in the trials’.
The first results were still five months from publication.
In March, addressing a telehealth conference, Paul Burstow shocked many present by showing contempt for the vital peer-review process.
Then he produced another dubious statistic. Telehealth, he claimed, ‘could save the NHS 1.2 billion over five years’.
When GPs sought evidence for the claim, the Department of Heath refused to supply it, saying that to do so would ‘undermine ministers’ and officials’ space for consideration and debate’.
That, as Richard Vautrey, a Leeds GP and spokesman for the British Medical Association told me, ‘just leaves people very suspicious’.
Indeed, anyone who attended the same conference as Burstow would have heard a less optimistic take from one of the researchers at the London School of Economics who had worked on the yet-to-be published paper, who said telehealth was unlikely to prove cost-effective when measured against the ‘cost-effectiveness threshold’ set by NICE.
The current threshold is 30,000 a year; LSE research was likely to show telehealth costs would be closer to 80,000.
Meanwhile, the telehealth bandwagon, propelled by industry marketing and the enthusiasm of a government, is rolling on.
Vera likes it; so does Dawn Watson, her telehealth nurse, who finds that by working remotely she can now manage more than 200 patients, instead of a normal fulltime caseload closer to 30.
But whether telehealth will do any of them, or the NHS, any good in the long run remains unclear.