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.
SUGGESTED RESPONSE
Tele-health is an integral part of the "Delivering
21st Century IT Support for the NHS", (http://www.doh.gov.uk/ipu/whatnew/procstratsummary.pdf,
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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