Select Committee on Health Written Evidence


Memorandum by BUPA (MT08)


  BUPA welcomes the Committee's Inquiry; notes the slow uptake of technology such as remote monitoring, and outlines how a telecare network could help meet government health targets. We point out the benefits of such a network and endorse the conclusions of the HITF. We recommend clearer central responsibility for improving telecare within the NHS and suggest how the independent sector could help the NHS to develop new technologies in telecare.


  1.  BUPA is a global health and care organisation with eight million members and over 40,000 employees in 192 countries. We are a provident association, which means that any profit we make is re-invested in better health and care services. BUPA's interests include health insurance, hospitals, nursing and care homes, health assessments, occupational health and recruitment services.

  2.  BUPA's subsidiary—Outcome Technologies is a dedicated outcomes service provider providing software and services for the collection and management of outcomes data, information and knowledge. Outcome Technologies (OT) is closely connected with new medical technology developments within the NHS.

  BUPA is submitting this evidence on behalf of OT and other companies within the Group.


  3.  The NHS Improvement Plan said that "evidence indicates that telecare can bring substantial benefits in providing people with greater choice over their care, assisting people to remain in their own homes, reducing inappropriate admissions, facilitating discharge from hospital, and providing advance warning of deterioration in a patient's condition 7.2." However, the Interim Wanless Report[1] also said that "the UK has historically been slow to adopt and diffuse technology, leaving it lagging well behind many other major countries".

  4.  BUPA is clear that faster adoption of a range of telemedicine technologies could greatly improve health services in the UK. To exploit this potential, a network of related services will be required. NHS and independent sector organisations can contribute to this network, which would consist of:

  4.1  Remote monitoring

  Patients with long-term conditions such as heart disease can be monitored at home using new technology such as implantable defibrillators, or monitoring systems which will record data such as their weight, blood pressure, and blood oxygen.

  4.2  Telephone advice

  Trained nurses and operators can remotely monitor the condition of large numbers of patients and either give advice to them directly, or refer them to other professionals for further treatment.

  4.3  Data analysis

  The data about individual patients' conditions can then be shared, yielding evidence about effective treatments and so providing the basis of valuable research. These findings will help health services to focus in future on improving outcomes, rather than just the process of care.

  4.4  Chronic disease management

  The network of remote monitoring, telephone advice and data analysis will contribute to better chronic disease management. This in turn will help to empower patients, providing them with greater choice and control. It may also reduce the burden on the system by cutting down unnecessary admissions to hospital and facilitating early discharge.

  5.  The Department of Health's recent paper Supporting People with Long-Term Conditions recommends this approach. It calls for the NHS and social care organisations to identify all the long term conditions patients in each health community, stratify them to match care to their different needs, and "over time, develop a system of identifying prospective very high intensity users of services." The paper highlights the need to use data to drive planning and use technology to establish registers of patients with long term conditions. Specifically, it suggests a need for "more systematic tools and processes for extracting data and enhanced data management skills." These are all areas in which independent sector organisations could work closely with the NHS.

  6.  Telecare—defined as the network of monitoring, advice and analysis we have outlined—could play a major role in implementing government policy on long term conditions. The major benefits would be:

    —  Greater choice and empowerment for patients, who may be enabled to become experts in their own care.

    —  Potential reductions in expensive and unnecessary hospital admissions, which are already stretching hospital budgets.

    —  Helping to reduce the impact of known trends towards higher levels of long term conditions and towards greater co-morbidity.

    —  Integrating parts of the health and social care services more closely.

    —  Better planning and swifter implementation of improved services, based on accurate data and research.


  7.  BUPA also noted the conclusions of the Healthcare Industry Task Force with interest. The key areas which need to be underlined and turned into effective policy are:

    —  Improving device evaluation

  The proposed new Device Evaluation Service is welcome but evaluation should not be restricted to specific devices—it should extend to researching what works best in providing services for people with long term conditions.

    —  More support for innovation

  Currently, organisations have to make all the initial investment in innovative IT and service designs themselves. The Department of Health's proposals for long term conditions need seedcorn funding to ensure that innovation takes place.

    —  Improving procurement processes through regional focus and significant clinician involvement

  While steps have been made to improve procurement processes, a national approach could yield dividends. The independent hospital industry has benefited from the new national approach to procuring services such as Independent Sector Treatment Centres and so a similar national drive for telecare—possibly headed by the DH Commercial Directorate—would also be welcome.

    —  Building R&D capacity

  BUPA and other organisations already have a strong R&D base but further investment in providing evidence of the effectiveness of telecare technology is required.

    —  Developing a pilot for Healthcare Technology Co-operatives based on existing centres of excellence within the NHS

  BUPA would be interested in collaborating in a virtual Centre of Excellence to prove the model for long term care outlined above.


  8.  BUPA has identified a number of obstacles to the faster uptake of new technology within the NHS. These include the continuing strain on PCT finances; the fact that there is no one agency with clear responsibility for ensuring swift uptake of telecare technology in England, and the need to improve the links between the NHS and independent organisations.

  9.  While central funding for innovation would be welcome, perhaps the main policy recommendation for the Committee to discuss is locating clear responsibility for improving telecare within the NHS. The NHS Improvement Plan said that the Department "will monitor the development of telecare and will ensure that the benefits are realised in the NHS when cost-effective approaches have been identified." Unpacking this statement, the first step would be for the Department to take a lead on identifying the most cost-effective technologies. Rather than just passively monitoring the development of telecare, a more active encouragement of innovation would be welcome. This requires a dedicated lead within the Department of Health. At national level, this lead should actively facilitate links between industry and SHAs.


  10.  New technologies in telecare need to produce evidence that they are cost-effective and above all that they produce better outcomes for patients. BUPA and its partner organisations can help to produce this outcomes data, analyse it and so demonstrate effectiveness.

  11.  The process of data analysis we have described is already being used to support research in trials of new drugs. The technology linking patients to the research database already exists and is well proven. It now needs to be applied to service development and greater patient empowerment.

1   Securing our Future Health: Taking a Long-Term View-Interim Report November 2001 HM Treasury.

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