Stephen Johnson: Can assistive technology support people with LTCs?


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Stephen Johnson: Can assistive technology support people with LTCs?

  1. 1. Can assistive technologysupport people with LTCs?Stephen JohnsonDeputy Director – Head of Long Term Conditions
  2. 2. First a few facts ……………• A long term condition is any condition that cannot be treated but can be managed by medication and or therapy• In England over 15 m people have a long term condition• The numbers are set to increase in the next 5 to 10 years, especially co-morbitity• Treatment and care of those with long term conditions account for 70% of the total health and social care spend in England, or almost £7 in every £10 spent 2
  3. 3. DH LTC Strategy is built on a model that has been recognised internationally as best p g y practice.Adapted from the US Chronic Care Model. The three-tier model of care three tier• Tier 3 (app 250,000 people) there are high dependency needs and often multiple conditions. Care is provided using case management on a one to Tier 3 High complexity one basis. Case management• Tier 2 (app 4 million people) less complex needs and a combination of approaches, principally personalised Tier 2 20% of LTC population care planning. Disease/Care management• Tier 1 (app 11 million people) are people with relatively mild conditions under control; self care and information. Tier 1 70-80% of LTC population Self care support/management 3
  4. 4. Health care professionals may only interact with people with achronic disease for a few hours a year… the rest of the time patients care for themselves themselves… 4
  5. 5. Telehealth can help to revolutionise the management of long term conditions• Improve health outcomes• Reduce unplanned hospital admissions• People want to be independent, they don’t want to be in hospital unnecessarily i h it l il• Improvement for carers• Support community health staff• Make better use of scarce resourcesBUT it needs service change not just the kit 5
  6. 6. THE UK IS A LEADER IN THE EMBRYONIC TELEHEALTH MARKETSDespite the lack of robust UK evidence around a third of PCTs have smalltelehealth implementations and another third have p p plans for telehealthdeployment. The problem is that these pilots impact few & are uncoordinated. This map indicates levels of telehealth uptake per PCT across England 6
  7. 7. Reduce the cost and develop mobile solutions to support more Telehealth is currently focused at the topMobile phone based solutions providing of the three-tier model of carea means of sharing vital signs readingsand of giving feedback via text messageand proactive callingThis is a new market but one which Level 3 High complexityholds significant promise for prevention Case managementand enabling self care for all people withLTCs Level 2 20% of LTC population Disease/Care management Level 1 70-80% of LTC population Self care support/management 7
  8. 8. Whole System Demonstrator programme• Funded and managed by the Department of Health• The largest randomised control trial (RCT) of telehealth and telecare anywhere in the world• A two year study across 3 sites 238 GP practices and sites, over 6,000 people• Evaluation co-ordinated by 6 leading academic y g institutions (UCL, Imperial College, LSE, Oxford & Manchester, Nuffield Trust)• Fi di Findings will b published f ill be bli h d from S i 2011 Spring• Interest from around the world as it will provide the “gold standard” evidence everyone is looking for gold standard 8
  9. 9. Rationale for Whole System Demonstrators We want to know if to what extent telehealth and telecare services: – promote individuals long term well-being and independence – improve individuals and their carer’s quality of life – improve the working lives of staff p g – are cost effective – are clinically effective We wanted to do this at scale so that it is statistically significant also to generate learning for mainstreaming. g g g g 9
  10. 10. Experience to date• Early results very promising – utilisation, productivity and user satisfaction can change d ti f ti h• Keep focused on the end goal• Technology only one element of success – 10% of effort• Formalise shared learning – provide mechanisms for it• Communications, listening and consistency key• Stakeholders need continued support• What you do on a small scale does not always mean it will translate to a large scale BUT th k t success i service change fi t th the key to is i h first then introduce the “kit” 10
  11. 11. WSD has already indicated that there are elements of the LTC population who willbenefit greatly from telehealth and who, as a consequence, will use significantly less resource. There are many examples of individuals on WSD who have b h benefited f fi d from telehealth and telecare. Th l h lh d l There are life transforming examples such as one individual who has gone from spending 9 months a year in hospital to less than 10 days. There are also many instances where a potential exacerbation h b i t h t ti l b ti has been picked up and remedied prior to an emergency admission to hospital. Patient feedback on the interventions has also been very positive. iti • “I feel much more confident knowing that someone is keeping an eye on my health every day. I think it’s great.” • “Since I started using Telehealth I’ve been able to manage Since I ve my condition better.” • “It changes the whole concept of my life. I can get on with my daily activities... and am totally independent.” • “Now if my condition changes I can speak to someone quickly and they have a record and can see what has changed - they know what to do to sort it out.” 11
  12. 12. Barriers to delivery• Evidence base• Cost of kit• Lack of awareness by users• Interoperability• Workforce (skills and awareness)• Quality and standards• Incentives 12