HC 1048-III Health CommitteeWritten evidence from Tunstall Healthcare (PH 109)

1. Executive Summary

1.1 Tunstall Healthcare is the world’s leading provider of telehealthcare services. Across the UK, Tunstall is already working with over 80 primary care organisations and the vast majority of councils responsible for social services to commission telehealthcare services for older people and those with long-term health conditions.

1.2 Tunstall is grateful for the opportunity to contribute to the Health Select Committee’s inquiry on public health and we would like to make the following recommendations in our evidence submission:

1.2.1Public Health England should take steps to ensure it works with other government departments and agencies when delivering the public health agenda.

1.2.2Public Health England should regularly review positive examples of intervention and service delivery, and takes steps to communicate these with public health commissioners.

1.2.3The Department of Health should publish the findings from the Whole System Demonstrator programme as soon as possible and incorporate these into Public Health England’s proposals to improve public health.

1.2.4The Department of Health and Public Health England should take steps to ensure local authorities and health and wellbeing boards have the necessary support to carry out their functions.

1.2.5Health and wellbeing boards should include a section on the steps they are taking to promote joint working across public health, NHS and social care services in their joint health and wellbeing strategies (JHWS).

1.2.6Health and wellbeing boards should ensure they consult with a range of stakeholders when developing JHWS.

1.2.7The Department of Health and Public Health England should put sufficient safeguards in place to ensure local ring-fenced public health budgets are spent on genuine public health areas.

1.2.8Public health commissioners should be incentivised to deliver public health outcomes efficiently, including focusing on the prevention agenda.

1.2.9The Department of Health should include indicators in the Public Health Outcomes Framework on the management of long-term conditions, and getting carers back to work.

2. National Support

2.1 Tunstall welcomes the Coalition Government’s decision to establish a dedicated body within the Department of Health – Public Health England – to deliver high quality, evidence-based and responsive public health services nationally.

2.2 Preventing a rise in costly long-term conditions should be a priority of the new public health agenda. Around 15 million people in England have a long term condition. People with long-term conditions are the most frequent users of healthcare services. Those with long-term conditions account for 29% of the population, but use 50% of all GP appointments and 70% of all in patient bed days.

2.3 The range of issues affecting public health are multi-factorial and Public Health England will need to work with other government agencies, for example the Department for Work and Pensions, the NHS and the Treasury in order to deliver improvements in outcomes. This will be particularly important for Public Health England when seeking to deliver improvements to public health for the most disadvantaged and to address health inequalities.

2.4 The Committee should consider recommending that Public Health England take steps to ensure they work with other government departments and agencies when delivering the public health agenda.

2.5 Improved data collection and publication will be critical for improving public health and Public Health England will need to take steps to ensure this information is collected in an efficient way which can be shared and easily analysed. For local authorities, this will be particularly important given public health responsibilities have previously laid with primary care trusts.

2.6 The mainstream introduction of telehealthcare - such as Tunstall’s icp triagemanger - technology can support this. The data collected by clinicians through the introduction of telehealthcare can increase commissioners’ understanding of their population as they are provided with up to date information on a section of their population’s health needs and can therefore allocate resource effectively. As well as driving efficiency and improving patient care, this information can support local health and wellbeing boards when carrying out their joint strategic needs assessment and commissioning services effectively.

2.7 Where there is national evidence for the commissioning of certain types of intervention and service delivery, Public Health England should take steps to communicate this clearly and quickly to public health commissioners.

2.8 This will be particularly important with the forthcoming publication of the Whole Systems Demonstrator telehealthcare project. With the project expected to show benefits in relation to patient outcomes, patient experience, quality of care and efficiency, sharing the evidence widely and communicating ways for commissioners to implement new interventions will be critical to improving the public health for people in their area.

2.9 The Committee should consider recommending that Public Health England regularly reviews positive examples of intervention and service delivery, and takes steps to communicate these to public health commissioners.

2.10 The Committee should consider recommending that the Department of Health publishes the findings from the Whole System Demonstrator programme as soon as possible and these are incorporated into Public Health England’s proposals to improve public health.

3. Future role of local government

3.1 Tunstall broadly supports the decision to devolve responsibility for commissioning of public health services to local authorities and the decision to establish local health and wellbeing boards which will play a vital role in ensuring integrated services and delivery across the NHS, public health and social care.

3.2 As new bodies, Public Health England should ensure health and wellbeing boards have an adequate level of central support in order for them to function effectively. This will be particularly important in light of these being new bodies at local authority level, and local authorities are being asked to deliver more services for less, often in areas where they have had limited experience.

3.3 The Committee should consider recommending that the Department of Health and Public Health England take steps to ensure local authorities and health and wellbeing boards have the necessary support to carry out their functions.

3.4 We welcome the duty in the Health and Social Care Bill for boards to develop JHWS for their local area. In order to be effective these strategies must be transparent and include a section on what measures are underway to promote joint working across public health, NHS and social care.

3.5 Telehealthcare technology can help deliver better integration of health and social care services. Tunstall already works with local authorities and health trusts to breakdown traditional healthcare boundaries to deliver a single view of an individual’s care. Working with Milton Keynes, for example, Tunstall is supporting both the Council and the local primary care trust to deliver integrated health and social care services. Rather than working separately – therefore doubling the amount of data entry and making for incomplete health assessments – telehealth and telecare systems are able to monitor and combine an individual’s care records into a single source. Telehealthcare contributes to health and social care integration and reablement by:

aiding recovery and building confidence;

providing 24 hour safety and security when vulnerability is highest;

enabling scarce staff resources to be utilised more effectively;

guarding against the need for re-entry into the care system;

providing continued, low cost support beyond the initial reablement phase; and

helping to deliver the goal of 70% of people not requiring further services.

3.6 Health and wellbeing boards will need to consult a range of groups including patient groups, clinicians, voluntary organisations, primary care professionals, adult social care professionals and private providers in order to deliver effective joined up services. The health and wellbeing strategy should stipulate what discussions and initiatives the board has undertaken with such groups in order to ensure that it is providing integrated, holistic services for its populace.

3.7 The Committee should consider recommending that health and wellbeing boards include a section on what steps they will be taking to promote joint working across public health, NHS and social care services.

3.8 The Committee should consider recommending that health and wellbeing boards ensure they consult with a range of stakeholders when developing health and wellbeing strategies and details of these communications are made available.

4. Commissioning and funding of public health services

4.1 Tunstall supports the decision to allocate a ring-fenced public health budget both locally and nationally. However, locally, we believe adequate safeguards need to be put in place to ensure that the ring-fenced budget and the health premium allocated by Public Health England is spent on appropriate and effective areas of public health, rather than used to subsidise other areas of local authority responsibility.

4.2 The Committee should consider recommending that the Department of Health and Public Health England put sufficient safeguards in place to ensure local ring-fenced public health budgets are being spent on genuine public health areas.

4.3 In light of the broad scope of public health we believe it is important that local health and wellbeing boards are able to effectively scrutinise how the ring-fenced budget is being used and, in particular, to ensure that funding is used most effectively.

4.4 Given the broad nature of public health and the proposed list of activity which will be funded from the new public health budget, it will be essential that public health commissioning is delivered efficiently while at the same time seeking to deliver the best possible outcomes.

4.5 Commissioners should be incentivised to deliver improvements in public health outcomes more efficiently and it is important that the new commissioning outcomes framework reflects this.

4.6 Telehealthcare is one example of how commissioners can deliver services more efficiently. Telehealthcare can improve public health outcomes for people with long term conditions such as Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF) and diabetes and improve service efficiency. Tunstall’s mymedic health monitor measures patient’s vital signs, such as blood pressure and temperature, which are then sent across to icptriagemanager clinical software that is monitored by health professionals. Any deviation from set parameters will alert the health professionals so that patient treatment can be modified or an intervention can be made, improving outcomes. Studies internationally have shown that following the introduction of telehealthcare has seen an average reduction of admissions to hospital per year for patients with COPD of 54% and with heart failure of 38%.

4.7 Nationally, the NHS Commissioning Board and Public Health England need to ensure that there are clear channels of communications and accountability between the two, and opportunities to share examples of good practice in commissioning public health services.

4.8 These channels of communication need to be reflected at a local level too through local health and wellbeing boards. For example, we believe that the legal obligation for local authorities and local NHS services to develop JHWS will play a crucial role in encouraging local commissioners to inform one another of existing public health initiatives and for commissioners to be best informed of relevant public health advice.

4.9 The prevention agenda should be a priority of the new public health system. Up front investment in public health initiatives will result in significant savings later as a result of individuals in care needs and emergency admissions. This is particularly the case in relation to long term conditions.

4.10 Getting patients with conditions such as COPD and CHF out of hospital and back into the community is essential to improving the quality of care patients receive and helping them to live independently in a setting of their choice. Telehealthcare has an important role to play in this and can improve outcomes for people at risk of falls or stroke through earlier intervention. For example for stroke victims, guaranteeing early intervention is critical in order for patients to have the best possible outcomes and chance of survival.

4.11 The Committee should consider recommending that public health commissioners are incentivised to deliver public health outcomes efficiently, including focusing on the prevention agenda.

5. Improving public health outcomes

5.1 Tunstall broadly supports the overall structure of the proposed Public Health Outcomes Framework and we particularly welcome the decision to align the Framework with the NHS and social care outcomes frameworks, which is particularly important for individuals who have long-term care needs who often need access to social care and NHS services.

5.2 Telehealthcare technology can play a crucial role in supporting commissioners to deliver more integrated services for patients, helping to improve outcomes and deliver more efficient services. By delivering telehealthcare solutions, Tunstall has already demonstrated success in working with local authorities and NHS commissioners to provide personalised, integrated and tailored care to those with long-term care needs; thereby helping patients to better manage their health needs and deliver better public health outcomes.

5.3 Telehealthcare will have a key role to play in improving the outcomes in Domains: 2, 3, 4 and 5, in particular the introduction technology in the home can have in the following areas:

5.3.1Domain Two: Supporting people with long term health needs to better manage their conditions independently and in the community

5.3.2Domain Three: Helping healthcare professionals to monitor an individual’s vital signs and lifestyle changes, and support them in better managing their health needs

5.3.3Domain Four: Telehealthcare can play a vital role in re-ablement and the prevention of more intensive care packages or admission to hospital

5.3.4Domain Five: Appropriate and timely introduction of telehealth or telecare technology can allow for quicker interventions by healthcare and social care professionals, thereby potentially saving lives

5.4 Overall, Tunstall supports the current indicators proposed within the Public Health Outcomes Framework and the criteria chosen in determining these indicators for public health. However, Tunstall are calling for the development of indicators on the “percentage of people with long-term care needs feeling supported to manage their condition” and the “percentage of patients with long-term care needs who say they are confident that they can manage their own health”.

5.5 Empowering individuals to better understand their own health needs and to have greater confidence in managing their own condition can act as proxy in helping to deliver better outcomes in public health. Evidence from the Picker Institute has shown that improved patient engagement can improve patient experience and health outcomes.

5.6 By delivering telehealthcare solutions, Tunstall has already demonstrated success in working with local authorities and health commissioners to deliver personalised and tailored care to those with long-term health needs; thus allowing them to live independently in the community.

5.7 Telecare, for example, has shown success in improving the experience of care, both for users, by enabling them to live independently and for carers, by giving them greater confidence that the person they are caring for has access to immediate help 24 hours a day. Satisfaction surveys conducted by NYCC have found that: 95% of users felt telecare equipment made them feel safer, whilst 87% believed telecare helped them carry on living at home.

5.8 The Committee should consider recommending that the Department of Health include the indicators set out above in the Public Health Outcomes Framework on the management of long-term conditions.

5.9 The benefits extend beyond improvements in well being to the individual concerned. There are also broader benefits to carers as a result of increased support and reduced anxiety. Consideration should be given to including carer wellbeing, captured through the proposed carers survey as a joint public health and social care outcome indicator. Carers role in preventing ill health for the person they are caring for is critical and it has been estimated that carers save health and social services £119 billion a year as a result of the unpaid care they provide.

5.10 That is why another indicator which should be considered is the ability of carers to take up employment. Many carers unfortunately have to give up full and part time work in order to fulfil their care duties. This not only affects the wellbeing of the carer, but is a huge loss of a potentially productive workforce. Thus whilst the employment of people with long term conditions is a welcome indictor, we believe an additional indicator focused on the employment should be considered for inclusion in domain 2.

5.11 The Committee should consider recommending that the Department of Health include the indicators within the Public Health Outcomes Framework on the ability of carers to take up employment.

6. Patient empowerment

6.1 As set out above, one of the key ways of improving the country’s public health will be through empowering individuals to have a greater understanding and ownership of their own health. By providing individuals with an enhanced understanding of their own health needs, real progress can be made on delivering the prevention agenda and in so doing reduce the projected burden on health and social services over the coming years.

6.2 Telehealthcare can improve an individual’s knowledge of their particular condition. Tunstall’s myclinic enables a group of patients within a common location, for example a residential home, to participate in a collective telehealth programme. It provides patients with individualised monitoring plans, while enabling shared use of a terminal and appropriate medical device peripherals to measure vital signs such as blood pressure, pulse rate and blood oxygen levels. This proactive approach helps to reduce the need for visits to and by clinical staff, alleviating the demand on the healthcare system and supporting people in a community setting.

6.3 In supporting people with long term conditions, the technology has already demonstrated success in improving public health, making patients feel empowered and confident in making decisions about their care, which is critical when maintaining their independence, improving their health and wellbeing.

6.4 By providing real time information to individuals and clinicians about their health, users of telehealthcare services have reported high levels of satisfaction (>90% compliance and >85% satisfaction), an improved ability and confidence to manage activities of daily living, and reduced anxiety.

6.5 The Committee should consider recommending that local authorities are incentivised to commission public health services which empower individuals and help prevent more serious complications and conditions from developing.

June 2011

Prepared 28th November 2011