Select Committee on Health Minutes of Evidence

Annex C(2)

Tele-Health Query

  The Chairman asked:

  Can I throw in a question of tele-health and whether we have any coherent strategy in that direction. Again, this Committee frequently receives very impressive information on development in other countries and the potential for tele-health within the United Kingdom. There is great frustration within private industries involved in tele-health that the NHS is so slow to adopt what in other countries is normal practice. Is that an area you are looking at? Is that somewhere where we will see changes in the near future?

  (Mr Douglas) I am not sure of the answer on that question, I will have to come back to you on that. I do not know the answer on that.


  Tele-health is an integral part of the "Delivering 21st Century IT Support for the NHS", (, published June 2002), which sets out the Government's strategic implementation plan for delivering the NHS Plan vision.

  The NHS Plan sets out a number of areas where specific telemedicine and telecare development is expected:

    —  "Ambulances will be equipped with video and monitoring equipment so that victims of accidents can get the most appropriate care while they are being taken to hospital" (1.12)

    —  "The consulting room will become the place where appointments ... are booked, test results received and more diagnosis carried out using video and telelinks to hospital specialists" (1.14)

  The implementation plan sets out a number of phases for programme delivery that allow the impact of improved IT to be made early, with sustained, incremental increases in functionality. Phase 1 will concentrate on some key tools and pieces of infrastructure. Successive phases will then add to the portfolio, with increasing sophistication of function built onto proven infrastructure and data quality. Phase 2 (January 2006—December 2007), which will be firmly defined during calendar year 2003, includes the establishment of:

    —  Broadband access implemented at recommended access speeds across local and wide area networks in the NHS.

    —  Telemedicine established in all GP surgeries for ECG, skin disease.

    —  Patient / Citizen Portal available via Internet, Digital TV, wireless devices.

    —  Ambulance telemonitoring implemented in 20 per cent of all emergency response vehicles.

    —  Home telemonitoring available in 20 per cent of homes requiring it.

  Phase 3 (January 2008-December 2010), which will be firmly defined during calendar year 2006, includes the establishment of:

    —  Ambulance telemonitoring implemented in 100 per cent of all emergency response vehicles.

    —  Home telemonitoring available in 100 per cent of homes requiring it.

  There is considerable activity already taking place; a notable example is the Cornwall electronic patient record pilot that has implemented a successful use of telemedicine to support minor injuries units, and there is fairly widespread take-up of teledermatology services. The recent NHS Digital TV pilots explored the potential for tele-health through a range of services including:

    —  "NHS Direct in Vision" (talking to and seeing an NHS Direct nurse);

    —  a system for booking an appointment with a GP through the TV;

    —  an SMS text messaging reminder service for children's vaccination dates, and

    —  a call-back service to ask for further information from a local service.

It is intended to develop these pilots further in line with the NHS Plan target : "By 2004 it [NHS Direct] will be providing health information via digital TV as well as via the telephone and internet."

  Tele-health projects have been deployed in numerous NHS Trusts, driven by enthusiasts and early adopters of this technology. But as the committee has noted, there is often frustration within industry—and the NHS—at the rate at which this technology is taken up more widely, and persuading decision-makers to adopt these solutions. There are some good reasons for this, and in comparing England or the UK generally with other countries, we need to take into account the different contexts of other jurisdictions. A tele-health solution that is successful in, say a small scale/high density context, will not necessarily deliver equivalent benefits elsewhere. Another important issue is that to deploy tele-health solutions effectively it is necessary to look at the business processes involved. The complexity of the issues in managing the cultural change involved, and more importantly, ensuring that patient safety and clinical effectiveness are not compromised, must not be under-rated. There have also been technology problems. Much early effort has been exploited because systems employed were proprietary, non-interoperable and therefore difficult to deploy more widely. Individuals move on, leaving a knowledge gap, and funding for tele-health solutions has been difficult to maintain against competing priorities. Traditional networks have (until now) failed to provide broadband communications within sensible geographical and cost parameters.

  This is now changing through the work of the NHS Modernisation Agency and the rapidly increasing pace of "Delivering 21st Century IT Support for the NHS". Appropriate use of information technology, will reduce duplication of expensive healthcare facilities, improve and expedite patient services and will lead to a more coherent and ubiquitous delivery system for healthcare.

  To deliver a tele-health strategy there needs to be a robust information infrastructure that is both secure and able to provide high bandwidth to many (often remote) locations, including patient's homes when required. It must be able to prioritise traffic so that video conferencing with simultaneous high-resolution scanned images are available. The reprocurement exercise for NHS networking services that is currently under way will create the necessary fixed-wire network capacity that will greatly facilitate the take-up of tele-health implementations, and the requirements specification is being drawn up with that in mind.

  The Wanless Report published earlier this year, and the Government's response to it, clearly demonstrates the Government's commitment to establishing this infrastructure through the national strategic programme. An essential part of this programme is to work with industry to enable the NHS to make the most effective use of modern technology, and this will be the key role of the recently appointed Director General of NHS IT, Richard Granger.

  The appendices summarise the key policy drivers, and give examples of tele-health solutions in the NHS.

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Prepared 4 December 2002