188体育

Thank you Chris [Ham, King鈥檚 Fund].

Hopefully, most of you here today are reasonably fit and well.

You鈥檝e all managed to make it here to the King鈥檚 Fund, so by definition you鈥檙e all fairly independent.

But for many people in England, the story鈥檚 more complicated than that.聽 For people with Long Term Conditions, life can be an endless succession of doctor鈥檚 appointments, nurses visits and time spent in hospital.

For them, being independent - doing what they want and going where they please, when they please - can often be a luxury they can no longer enjoy.

That was the case for Joe Barr.聽 By the age of 60, so hardly old - a little younger than you Chris, if you don鈥檛 mind me saying - he had developed a number of long term conditions, including COPD, diabetes, kidney disease and obesity.

His whole life was built around his conditions.聽 He probably felt like he spent more time in NHS waiting rooms than he did with his wife and their two dogs!

Of course, Joe鈥檚 story is far from unique.聽 There are around 15 million people in England who have long term conditions.聽 And as our population ages, that figure is only going to increase.

But, Joe鈥檚 story didn鈥檛 stop when he became ill.聽 For luckily for him, he lives in Cornwall and was part of a pilot project to test the benefits of telehealth technology.聽 A project that, in his words, provides 鈥渁 brilliant service鈥� that means, 鈥淚 can take responsibility for my illnesses.鈥�

Now you wouldn鈥檛 be here if you didn鈥檛 already know about the Whole System Demonstrator, so I won鈥檛 explain what it is.聽 But I do want to shout from the rooftops what it鈥檚 done.

What it鈥檚 done for people like Joe and for thousands like him across Cornwall, Kent and Newham.

Quite simply, it gave Joe his life back.

By understanding his own particular needs and then integrating specific technologies into his care plan, he now has his independence and, to a significant degree, his health.

He knows that his condition is being monitored and that if anything is heading in the wrong direction it can be jumped on immediately.

He can have friends and family round when he wants鈥�
He can go where he wants鈥�
He can do what he wants鈥�
鈥�and that鈥檚 because he no longer has to stay in all day waiting for the doctor to call;

鈥�because he no longer has to spend hours in hospital waiting rooms,
鈥�and because his vital signs are monitored constantly, anything that could be serious is picked up before has a chance to become so.

Just now I said something important.聽 Telehealth worked for Joe because it first understood his needs and then looked at how technology could support those needs.

It started with the patient, with the person.聽 Not with the technology.
But all too often, this is the reverse of what happens.聽 Someone in a PCT sees a nifty piece of kit, buys a load in and then wonders why it ends up gathering dust in a cupboard somewhere.

Good telehealth or telecare is not about technology, it鈥檚 about people.聽 Empowering people to live their lives as independently as they can.聽 Technology can play an important role in that.聽 But it will only ever fulfil its potential if it is integrated into a properly designed patient care plan.聽 If it supports what a particular individual actually needs.

It鈥檚 the same with whole system of health and social care.聽 Up until now, each part has organised itself around its own needs.
Hospitals around what a hospital needs.聽 GP practices around what GPs need.聽 Social care providers around what they need.

And we鈥檝e ended up with a confused, disjointed, fragmented mess.

What we need more than anything in the years ahead is to take the approach that Joe鈥檚 team took with him.聽 They started with Joe鈥檚 needs and built the system around him.

If I get sick and need help, it doesn鈥檛 really matter to me who provides it.聽 Whether it鈥檚 the NHS, a local authority or someone else.聽 I just want good, seamless care.

But it matters very much if my health care is not integrated in to my social care.聽 If GP is not linked in to my social care.聽 If the hospital that treats me doesn鈥檛 involve me, my GP or my social care provider in drawing up a discharge plan.

Fully integrating care means starting with the person in the middle and working out.聽 It means making care more effective.聽 It means managing conditions better and preventing small problems from developing into major incidents.

And if this is the way that we approach telehealth and telecare, the potential benefits - for people using it, for healthcare professionals and for the NHS as a whole - are enormous.

The headline findings from the Whole System Demonstrator are staggering.

鈥⒙犅� 聽A 20% fall in emergency admissions
鈥⒙犅� 聽15% fewer visits to A&E
鈥⒙犅� 聽14% fewer elective admissions
鈥⒙犅� 聽14% fewer bed days
鈥⒙犅� 聽And an 8% reduction in tariff costs

And while this is primarily about improving lives rather than saving them, there was a 45 percent - yes, 45 percent - difference in the mortality rate between those using telehealth and those in the control group.

Quite unexpected and truly extraordinary.

And all of this has a significant cost implication for the NHS.聽 Already, 7 out of 10 in-patient beds are occupied by people with long term conditions.聽 Around 70p in every NHS pound is spent looking after them.

By keeping people out of hospital, by reducing the time they鈥檙e there when they have to be and by being far more targeted and efficient with the use of NHS resources, we estimate the widespread use of telecare and telehealth could save the NHS up to 拢1.2 billion over five years.

But this is not just a case of me saying we will do it, clicking my fingers and then it all happens.聽 What this government more than any other before it understands is the limits of its own power.

Once, a government might have set a target.聽 Say, for 50% of people with long term conditions to have telehealth or telecare support by 2015.

That would certainly get people moving.聽 We might even hit the target.聽 But it would probably miss the point.

PCTs would buy in loads of stuff and much of it might even be put into people鈥檚 homes.聽 But would it reap the rewards we know it can?聽 I doubt that.

We need local providers and local commissioners to look at the needs of their communities and make decisions based on the clinical and social needs of their patients.聽 If technology can help, then we need to remove all barriers to it playing its part.

But the way to do that isn鈥檛 to impose it from above, but to make it easy to do and leave it to the best judgement of people on the ground to see through.

At the moment, there are several issues to deal with, several barriers in the way.

Initially, there was a lack of evidence that it can work on a large scale.聽 The Whole System Demonstrator has taken care of that.聽 The evidence is compelling and we haven鈥檛 even started to delve into the detail yet.

But people need to know about it.聽 To understand what it can do.聽 To know how best to utilise it.

There are also technical issues to get over, such as a general lack of interoperability and confusion over incentives.

And of course, this stuff doesn鈥檛 come for free.聽 Whatever the long term savings, there are some substantial initial costs.

That鈥檚 why the Department of Health is working with industry and with the medical professions to remove those barriers.

鈥⒙犅� 聽To raise awareness of what is available and how to make the most of it,
鈥⒙犅� 聽To move towards standards for interoperability,
鈥⒙犅� 聽And to look at innovative ways that providers and commissioners can pay for telehealth and telecare, such as through ongoing contracts.

Few people buy an iPhone for cash up-front, they pay for it through a monthly contract.聽 So why couldn鈥檛 a community nursing provider pay for a remote blood pressure monitor in a similar way?

We鈥檙e already seeing exactly this in places like Gloucestershire, where the PCT is working with Tunstall, one of the largest telecare and telehealth companies.

Tunstall cover the up-front costs such as clinical engagement, pathway re-design and training.聽 They then supply NHS Gloucestershire on a per patient, per month basis.聽 Any costs savings the PCT makes through things like reduced hospital admissions can then be re-invested back in to front line NHS services.

鈥⒙犅� 聽NHS Gloucestershire avoids the need for large up-front costs,
鈥⒙犅� 聽The supplier builds a relationship with a customer it would otherwise not have had,
鈥⒙犅� 聽And the patient gets their life back.

A win-win-win situation.

With the right incentives and the right business model, the benefits for everyone can be huge.

And in time, costs of the equipment will fall.聽 Costs in the UK are significantly higher than in the US.聽 No wonder when we have about 6,000 users and they have almost ten times that number just within the Veterans Association.

But we鈥檙e looking at a potential customer base of 3 million.聽 Just think of what a market of that size can do in terms of innovation and economies of scale.

We need to change the way we do things.聽 Working in partnership with industry, with the NHS, social care, the voluntary sector and, importantly, with patients and with carers to get this right - from the bottom up.

And to show just how committed we are to this, we鈥檝e signed a Concordat with industry trade associations signalling our clear commitment to work together and to spread the benefits at scale and at pace.

Now, there are issues that come from a potential market of that size.聽 Principally, the problem of broadband capacity.
It鈥檚 true that many of those who stand to benefit from telehealth and telecare will live in rural areas.聽 Areas that are not particularly well served in terms of broadband access.

That鈥檚 why, where the numbers don鈥檛 stack up for businesses to invest in broadband infrastructure by themselves, we are willing to step in to tip the balance.

That鈥檚 why we earmarked over half a billion pounds in the Spending Review to support broadband rollout in rural areas.聽 And why we鈥檙e running 4 pilot schemes in places like Cumbria and North Yorkshire, to see how we can most effectively bring the benefits of broadband to the countryside.

There is also the issue of people within the NHS and social care not having the skills and understanding of the potential benefits of the technology.

That鈥檚 why we鈥檝e asked the NHS Institute to develop a support programme to make sure that patients and staff are properly engaged and helped to make the most of these technologies locally.

This will include developing a series of 鈥榟ow to鈥� guides and advocacy campaigns to build patient support and to win over sceptical clinicians and managers鈥�

鈥� making sure that everyone realises that this is about improving outcomes - improving lives - not about wasting money on expensive and unnecessary kit.
As Joe said, 鈥渋n the beginning [my consultant] would not look at the reports and pass them back to me.聽 Now when I go he asks me where my last six month鈥檚 readings are!鈥�

Winning this argument locally will be the key to unlocking the benefits that the Whole System Demonstrator has shown are possible.

If local clinicians in NHS Trusts, in voluntary or independent sector providers are convinced that this is money worth spending鈥�
and if local commissioners are convinced that this is an approach worth supporting鈥�

鈥� then the pursuit of better outcomes for patients and greater value from stretched budgets will drive progress far faster and far more effectively than any imposed target ever could.
Cornwall, for example, is so convinced of its value that they want to bring the benefits to 30,000 people over the next 5 years.

This is what has happened in the pilot areas, and it is what is increasingly happening beyond them too.

Like in Croydon, where three GP practices are using telehealth technology to monitor patients remotely.聽 If they feel unwell, they can talk to a nurse or their doctor on the phone, with all the relevant clinical information readily available.

鈥⒙犅� 聽This saves valuable time if there鈥檚 something wrong,
鈥⒙犅� 聽it avoids wasting everybody鈥檚 time if there isn鈥檛,
鈥⒙犅� 聽it鈥檚 far more convenient for the patient and the clinician,
鈥⒙犅� 聽and the results already show that the costs of the programme have been covered and savings are being made.

Our modernisation of the NHS and of social care is all about enabling people to take the initiative, putting people in control of their own care and treatment鈥�
putting local doctors, nurses and other health professionals in charge of how their money is spent鈥�
and making sure that whatever we do, it is always focussed on improving outcomes.

The proper use of telehealth and telecare has the potential to be a triple whammy - to hit all three objectives in one.

鈥⒙犅� 聽Helping to give patients like Joe their lives back.
鈥⒙犅� 聽Putting health professionals in charge of the technology rather than the other way around.
鈥⒙犅� 聽Improving the quality of people鈥檚 lives, keeping them out of hospital and keeping them far more healthy.

All of this will play a big part in the Information Strategy that we鈥檒l publish soon.聽 The way that a patients records can be accessed, added to and shared electronically will be one of the key benefits of telecare and telehealth.

Giving people control of their own information, building that information around the individual rather than having numerous separate records dotted around all over the place, will offer real clinical benefits.

It鈥檚 been said that, whatever the concerns about security and privacy, nobody ever died because someone had seen their data.聽 On the contrary, many have died because they hadn鈥檛.

Technology, no matter how amazing it might be, is just a tool.聽 But in the right hands and used in the right way, this is a set of tools that can make a very big difference indeed.

Thank you.