1. Can assistive technology
support people with LTCs?
Stephen Johnson
Deputy Director – Head of Long Term Conditions

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
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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
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4. Health care professionals may only interact with people with a
chronic disease for a few hours a year…
the rest of the time patients care for themselves
themselves…
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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 resources
BUT it needs service change not just the kit
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6. THE UK IS A LEADER IN THE EMBRYONIC TELEHEALTH MARKETS
Despite the lack of robust UK evidence around a third of PCTs have small
telehealth implementations and another third have p
p plans for telehealth
deployment. The problem is that these pilots impact few & are uncoordinated.
This map indicates levels of telehealth uptake per PCT across England
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7. Reduce the cost and develop mobile solutions to support more
Telehealth is currently focused at the top
Mobile phone based solutions providing
of the three-tier model of care
a means of sharing vital signs readings
and of giving feedback via text message
and proactive calling
This is a new market but one which Level 3
High complexity
holds significant promise for prevention Case
management
and enabling self care for all people with
LTCs
Level 2
20% of LTC population
Disease/Care management
Level 1
70-80% of LTC population
Self care support/management
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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
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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
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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”
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11. WSD has already indicated that there are elements of the LTC population who will
benefit 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.”
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12. Barriers to delivery
• Evidence base
• Cost of kit
• Lack of awareness by users
• Interoperability
• Workforce (skills and awareness)
• Quality and standards
• Incentives
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