Conclusions and recommendations
1. We
recommend that Trusts be encouraged to identify 'clinical champions'
to promote the benefits of telemedicine within the Trust and to
ensure that the organisational and staff development requirements
to make the system workable are in place. It is crucial to establish
policies that enable the lessons of pilot programmes to be used
in clinical delivery: at present it is often the case that the
organisational requirements of integrating telehealthcare systems
into hospital and primary care settings are rarely considered
in R&D pilots. (Paragraph 17)
2. We recommend that
when telecare systems are installed in the domiciliary environment,
clinicians, technicians, health and social care workers, formal
and informal carers and, most importantly, the patient are involved
in determining the level of telecare that is suitable and acceptable
to each individual recipient. It is essential that a balance between
the use of technology and the continuation of human contact is
an important element in any such judgement. (Paragraph 21)
3. Furthermore, evaluation
needs to take account of the qualitative benefits for users and
carers over time. There is a need to develop new ways of evaluating
the qualitative benefits of new medical technologies in the long-term
budgetary cycles. Methodologies are needed that can determine
the social and economic benefits of new medical devices that fall
outside the direct costs to the NHS. (Paragraph 22)
4. We recommend that
the Department should seek to introduce a national system for
reviewing and tracking the implementation of new devices over
a number of years to ensure patient safety and efficacy issues
are closely monitored. Currently there is no clear system for
determining safety and efficacy beyond the clinical trials and
evidence-based model of the Health Technology Assessment (HTA)
programme while, there is also a need for developing more sophisticated
measures of the utility of systems for patients that reflect more
relevant criteria. Much greater patient participation in assessing
the utility of telehealthcare is required. (Paragraph 23)
5. The Department
should ensure that Primary Care Trusts (PCT) and hospital trusts
(and if possible SHAs) should commission new technologies according
to nationally approved standards (determined by the new Device
Evaluation Service [DES] in conjunction with HTA/National Institute
of Clinical Excellence [NICE]). Such standards should provide
the basis for the selection of base-line devices and technologies.
It is important that the tendency towards technology 'creep' and
uneven mix of systems that lack interoperability or require different
competences to be used should be avoided. Standardisation on clinical
based systems should be undertaken in light of discussion with
Social Services, who have a greater responsibility for telecare.
(Paragraph 25)
6. We recommend that,
when new medical technologies are introduced, protection of confidentiality
and the privacy of the individual are key factors in the decision-making
process. Privacy and confidentiality policies and protocols should
be developed, implemented and audited when new technologies are
introduced. (Paragraph 27)
7. There is also
a need for a system of reporting with regard to the utility and
limitations of telehealthcare systems or other devices that are
'near to patient'. It is clear that this will not be the responsibility
of the reshaped DES, and there is currently no national 'clearing
house, where this information might be lodged. This may well be
a function for the Healthcare Commission. (Paragraph 51)
8. The Government
has proposed some improvements to training, but these will not
be sufficient. The Department should ensure that adequate training
is in place to enable greater benefits to be derived from new
technologies. To encourage greater familiarity with the possibilities
and opportunities as well as limitations and risks of telemedicine,
training should be modified in those specialist areas that are
most likely to be primary users of telehealthcare such as pathology
and radiology. Medical schools as well as the professional bodies
should develop programmes to ensure effective training is put
in place. Training in telecare for health care assistants working
for social services and in the community also requires improvement
to gain full benefits of new technologies. (Paragraph 54)
9. The Payment by
Results scheme has been said to provide an incentive for new technologies,
given its tie-in with the 18 week treatment target for patients
(thereby encouraging Trusts to select those technologies and devices
that can speed up care to meet the 18 week target). Devices that
enable this to happen should be a key priority for the new DES.
Given that in some cases the Trust that purchases and invests
in new technologies may not necessarily be the beneficiary (or
sole beneficiary), we recommend that the Department should build
into the PbR tariff an incentive payment to offset these development
and on-going costs. (Paragraph 58)
10. There is a need
to differentiate tariffs for specialised devices/technologies
and those that relate to basic care provision to ensure that the
reimbursement structure properly reflects the level of complexity
and pattern of use of new medical technologies. (Paragraph 59)
11. We welcome the
initiatives already undertaken by the Department in this area.
Now it must ensure that it devotes adequate attention and resources
to rectifying the currently unstructured adoption of new medical
technologies. (Paragraph 60)
12. We recommend that
the Government in addition to its current proposals should address
the following issues of concern to the Committee: problems relating
to the inability to transfer budgets between holders; lack of
clinical engagement and clinical champions; the impact of practice
based commissioning on procurement; and an NHS preference for
short-term savings to be made as opposed to long-term advantages
for patients. (Paragraph 61)
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