Health and Social Care Bill

Memorandum submitted by Tunstall (HS 109)

This briefing sets out the important role that telehealth and telecare technology and services can play in the delivery of health and social care services, its potential in helping to make the proposed reforms a reality and the issues that need addressing so that this can take place.

What is telehealthcare?

Telehealthcare is the use of technology to support the remote delivery of care and reassurance to older people and those with long term needs. This is divided into two broad areas. Telehealth means the remote monitoring of a patient's vital signs and their health and well-being through monitoring equipment located in their home. This enables the remote capture and relay of physiological measurements and wellbeing information for clinical review, allowing early and appropriate intervention by clinicians and enhanced self-care. Telecare is the remote monitoring of real time emergencies and lifestyle changes over time in order to manage the risks associated with independent living. This is done through a range of sensors in the home linked to a 24 hour response service.

Why should telehealthcare be considered in the health reforms?

Telehealthcare can play a key role in the delivery of the proposed health reforms in the Health and Social Care Bill and should be a central part of solutions intended to improve the efficiency and quality of care delivered. In particular, telehealthcare improves:

· Efficiency: Telehealth allows patients with long term conditions to be cared for and monitored from home, freeing up valuable NHS resources by reducing unplanned hospital admissions, bed days and re-admission rates and reducing the number of unnecessary journeys made by care staff. For example, a partnership between Tunstall and NHS North Yorkshire and York has already led to a 40% reduction in non-elective hospital admissions in that area [1] . Telehealth also assists early discharge and supports the reconfiguration of clinical services and patient pathways. Telecare delivers real cost savings for commissioners of social care through preventing or delaying the need for intensive home care packages, institutional care or hospitalisation. Efficient, integrated commissioning of telehealthcare also helps deliver improved outcomes in terms of efficiency savings and the QIPP agenda.

· Quality: By allowing patients to be cared for in an environment of their choice, telehealth allows clinicians to effectively manage a patient’s long term condition remotely, enhancing patient self-care and improving clinical outcomes. Telecare leads to earlier interventions when incidents occur and makes a real difference to a user’s quality of life.

· Outcomes: Telehealth collates real time information on a patient’s condition and helps to identify changes, leading to earlier and better-informed interventions and ultimately, better patient outcomes. It can also aid medication compliance and provide greater reassurance for family members. Telecare can play a vital role in reablement and prevent or delay the introduction of more intensive care packages for users of social care services.

· Choice: Telehealth improves a patient’s understanding of their condition, helping them to make appropriate and positive choices about their care. Telecare allows people to be cared for in the environment of their choice for longer, rather than having to move into traditional residential care settings.

· Personalisation: Telehealth helps clinicians provide tailored, personalised care designed specifically to fit the needs of the patient. Telecare is a highly-flexible, personalised care tool which can be adapted as users' needs evolve.

· Integrated working: Technology can greatly assist in the integration between health and social care services, a key theme of the proposed reforms. Tunstall is already working with a number of local authorities and health trusts across Europe to deliver a single view of the patient so that all stakeholders are joined together more closely.

What are the key issues for telehealthcare in the Bill?

The following specific issues should be addressed during the scrutiny of the Bill at Committee Stage to ensure that telehealthcare can help deliver important aspects of the proposed reforms.


· Careful attention should be paid to the alignment of powers and responsibilities of the NHS Commissioning Board, Public Health England and GP consortia in Part 1, and the involvement of local authorities in Part 5 to ensure that there is effective and integrated commissioning across traditional service boundaries.

· Commissioners should have regard to the potential benefits of telehealthcare solutions which, if commissioned properly, can deliver improved shared outcomes across the NHS, social care and public health service. In this regard, we welcome the proposed duties on the Board to promote innovation and integrated working.

· Greater clarity is needed concerning the mechanisms by which consortia will report on and justify the efficiency of commissioning and how integrated working will be monitored, particularly in terms of commissioning services that deliver improved shared outcomes across health and social care.

Choice of treatment

· Tunstall welcomes the commitments to extending patient choice in the Bill, notably in Part 1, Clause 19 (new Clause 13F) which creates a duty on the Board to promote involvement of patients and carers in decisions about the provision of services to them and enables patients to make choices.

· These rights to choice should be strengthened by a commitment to providing information about all appropriate care settings and available technology solutions at the time a patient is offered a choice and a commitment to personalise treatment and services as appropriate.

Improving healthcare outcomes

· The duties on the Board and for consortia to improve quality of services in Part 1 should be strengthened by provisions to ensure that commissioners are informed regularly by patient feedback through measures such as PROMS and have regard to the importance of the personalisation of services.

Integrated working

· In Part 5 greater regard should be given to the role that technology solutions can have in breaking down traditional boundaries and encouraging better integration of health and social care services. The health and wellbeing boards’ proposed powers to encourage integrated working should be extended to explicitly encourage joint commissioning.

About Tunstall

Tunstall Healthcare Group is the world's leading telehealthcare provider. Operating in more than 30 countries and employing over 1000 people, Tunstall supports 2.5m people around the world. Tunstall provides telehealth and telecare technology and services that enable anyone requiring support and reassurance, such as older people or those with long term needs, to lead an independent life with dignity and reassurance.

March 2011

[1] NHS North Yorkshire and York, Telehealth - a review of the evidence , July 2010