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7.14 pm
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart):
- Information is the key to the modern age. The new information age offers possibilities for the future limited only by the boundaries of our imaginations.
Last month, I was delighted to open officially a telemedicine system, which links the accident and emergency departments at Bolton, Burnley and Bury with the maxillofacial and oral surgical unit in Blackburn royal infirmary. Experts at Blackburn can now quickly assess patients with facial injuries. Treatment begins immediately under expert supervision without the need to travel long distances. Patients are transferred to the in-patient unit at Blackburn only when necessary. For many patients, that will mean avoiding the 20-mile round trip to the specialist unit, and allow them to remain close to their families. It is a fascinating example of the NHS using new technologies to improve patient care.
Before I explore the use of telemedicine further, let me explain the wider need for change. The Government are committed to building a new NHS, which is faster, fairer and more convenient for patients and fit to face the challenges of a new millennium.
The extra resources that the Budget made available to the NHS give us an excellent opportunity to modernise its services. We have set out a 10-year modernisation programme to renew and reform the NHS. It aims to transform services, widen access, foster quality and modernise government.
We have achieved a lot: we are modernising every casualty department that needs modernising, getting more doctors and nurses into the NHS, setting up new additional services like NHS Direct and walk-in centres. Of course, we are providing the extra resources that the
health service needs. We have been turning the NHS around and, in the process, laying the foundations for modernisation.We have announced the modernisation action teams, which will consider the variation in practice and performance in the NHS and provide a unique opportunity to work with patients and professions to modernise the NHS and reinvent it for the new century.
The teams will devise solutions and work towards the creation of a national plan for the NHS. The national plan will embrace all those who share a commitment to the founding principles of the NHS but who have an equal determination to modernise its practices.
One of the ideas from the initial meeting of the teams was the potential use of a patient-held smart card to enable patients to gain access to their medical history. That is an example of the innovative ideas that emanate from the teams and will be taken forward in the coming months.
Telemedicine and telecare will play a vital part in modernisation. They are not new medical disciplines but tools that allow services to be delivered in a new way. They will provide services for patients, when and where they need them. That is happening at Blackburn.
People often associate telemedicine with video conferencing and perceive it simply as a patient in a remote location connected to a doctor by a video link. However, it is much more than that. It is about using simple as well as complex technology to ensure that patients get the right treatment at the most convenient place, from doctors and nurses who are able to make the best use of their specialist skills. Telemedicine and telecare can potentially be applied to all aspects of the NHS.
My hon. Friend the Member for Dartford vividly described examples in his constituency. Good work is being done throughout the country. I shall outline some examples to show the range of options that telemedicine offers. In Lewisham, a specialist mental health team is using telepsychiatry to link to a local GP. Video conferencing is partly used in place of referral to a specialist unit. The patients remain in the care of the local team that they know and trust. Equally important, the stigma that is sadly often associated with attending a specialist mental health unit is avoided.
In Bradford, the Anchor housing trust is working with British Telecom on a telecare system that monitors people who are at risk in their homes. Alarms are automatically generated for the carer should something go wrong. That enables people who have such a system to lead a more independent life, secure in the knowledge that they will get help if they need it.
In Cornwall, the A and E centres at Treliske and Truro support a number of nurse-led minor injury units in the community using video conferencing and teleradiology links. Patients have access to specialist care where they need it and avoid the long journey in to one of the main A and E units. That is especially important in rural areas.
The needs of patients must ultimately drive developments in telemedicine and telecare. Building on the work of recent years, they are increasingly seen as real options for effective health care delivery. Clearly, the evidence base is still being established, but a lot can be done now. For example, Peterborough hospitals NHS trust has links from eight local GPs to the specialist
dermatology services. Images and e-mail referrals can be sent via the NHSNet for diagnosis and triage for referral. I was interested to hear my hon. Friend's concerns about confidentiality, but the NHSNet provides a much more secure system than the web. Patients avoid unnecessary referrals and journeys and receive a quicker diagnosis, reducing the stress associated with waiting for results.My hon. Friend has also described the work in Newcastle, where a telemonitoring service is being used in the home to monitor patients suffering from chronic illnesses. That is a perfect example of social services and health care providers working together for the benefit of patients. The patients have said how much they value the reassurance the system gives them; they know that someone can help them if there is a problem, especially at night.
Key to the wider development of telemedicine and telecare is our belief that they should be implemented only where there is good evidence that they are a safe and appropriate solution to the clinical needs of patients. We are building on the earlier work in telemedicine, ensuring that patients receive the best care in the right place at the right time from the right people.
Under the pathology modernisation programme, the United Bristol Healthcare NHS trust is setting up the Avon virtual pathology laboratory service and using telepathology to provide faster and more reliable access to a range of laboratory services, allowing quicker resolution and better consensus for difficult diagnosis.
Under our A and E modernisation programme, North Bristol NHS trust is developing a telemedicine link by which X-rays and other images can be relayed between hospitals. East Kent hospitals NHS trust will link minor injuries units at Buckland and Deal hospitals to two full A and E departments, using telemedicine to provide access to specialist advice. In another innovative development, Avon ambulance service is linking ambulances to A and E departments using telemedicine. The national database of telemedicine provides many more examples of the excellent work that is being done to provide real benefits for patients across the country.
Telemedicine and telecare have the potential to transform a patient's experience of the health service by reducing inconvenience, shortening journeys and avoiding unnecessary referrals. They also present new opportunities to deliver and configure services and, as my hon. Friend has said, new opportunities for professional development. I recognise what he said about the need for changes in attitudes and work practices if telemedicine and telecare are to flourish. If we are to realise their full potential, we must be willing to communicate and work across professional and organisational boundaries.
The health service has made real progress in recent years, and I pay tribute to the enthusiasts whose energy and vision have carried us so far. Telemedicine and telecare are already being promoted and used in many examples such as NHS Direct, the information strategy, the national service frameworks, the A and E and pathology modernisation programmes, walk-in centres and the health action zones innovation fund.
We recognise the need for further research and I understand my hon. Friend's desire to ensure that telemedicine is evaluated. Our health technology
assessment programme is evaluating two telemedicine applications and on-going research is being carried out to underpin both "Information for Health" and telemedicine policy development.My hon. Friend will be aware of the national beds inquiry, which we published for consultation on 10 February. It shows that, in any scenario, it is probable that the number of beds in the whole system, including those in intermediate care, nursing homes and residential homes, will need to increase. It suggests that the trend of the past 30 years--more hospital bed reductions--can no longer keep pace with the changing needs, additional activity and new services that the NHS will provide. It takes a whole-system perspective and considers hospital beds in the context of developments in primary care, community health services and social care as well as hospitals.
The facts revealed by the inquiry support the Government's plans to build a new bridge of NHS care for older people between hospital and home by developing a wide range of intermediate care services to prevent avoidable admissions, enhance rehabilitation and enable as many people as possible to maintain or regain functional independence in their own homes.
The Government have looked critically at telemedicine and telecare to see what can be done to bring about further development, and will continue to do so. We want telemedicine and telecare to be seen as options for service delivery. We have already said that, from 2000, all health improvement programmes and associated strategies will need to demonstrate that telemedicine and telecare options have been considered. We hope that that will be one way of ensuring that they are involved in the development of the health service, and will be introduced if they prove to be a way of including it.
I was struck by my hon. Friend's observation that the system in itself does not always involve a huge amount of capital investment. The necessary service can be provided at relatively low cost, but with tremendous benefit to patients.
Telemedicine and telecare are likely to play an important part in the addressing of national priorities. They will also have an impact on the provision of health-care information, providing links to NHS Direct, the national electronic library for health, the NHSNet and the electronic patient record.
In building a modern NHS and improving services for patients, we are focusing on the real opportunities that telemedicine and telecare represent. They will make it possible to deliver services more effectively, to move specialist expertise out of hospitals and into primary care, and to create the framework that is necessary to ensure that specialist skills are more widely accessible. The challenge will be the requirement to harness the information revolution to ensure that patients receive the best treatment, at the right time and in the most convenient place.
Our vision is of an NHS in which services are shaped around the convenience of patients. That means embracing technology to provide faster services. It means direct booking of hospital appointments, shorter waiting times for treatment, more rehabilitation services and more use of telemedicine, the internet and NHS Direct to bring care closer to home.
It is easy to underestimate the true impact of new technology. Two years after inventing the telephone,
Alexander Graham Bell made a famous prediction: he firmly believed that one day all cities and all companies would have telephones, and people would be able to talk to each other on them. That was greeted with cynicism at the time. In the same way, some people now feel that telemedicine may be a cheap option, and that it may not be possible to deliver such a service.My hon. Friend, however, has seen the quality of the images being transmitted, and knows about the consultation that is possible between specialists who can exchange ideas and experience. When telemedicine is implemented well, the patient will often receive almost a better service, because that service draws on a much wider range of resources and expertise than is possible in conventional medicine.
Telemedicine is an extremely useful example of what we mean by modernisation. It also illustrates the fact that all the changes in the health service have a single aim: to improve the service to the patient by harnessing the skills of all NHS staff, while also harnessing the new technology. That may sometimes mean that certain people must take a deep breath and realise that technology is moving on, but it is in all our best interests.
I am grateful to my hon. Friend for raising an issue that is often overlooked. I am delighted to have been able to support his commitment to telemedicine. I assure him that the Government are determined to support that commitment, and will continue to do so.
- Adjourned accordingly at twenty-nine minutes past Seven o'clock.
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