Health Service Focus

Telecare on the move

Mobile technology has the potential to revolutionise the way we think about telehealth and telecare, according to both industry and the NHS organisations who have piloted it. NHE hears more from Tobit Emmens, Head of Research Management and Innovation at Devon Partnership NHS Trust, which has been running a pilot project using one such system.

There are clear benefits for both telecare users and the NHS to technology that allows it to be used outside of a person’s own home.

Tobit Emmens, head of research management and innovation at Devon Partnership NHS Trust, told NHE more about a pilot the trust has been running using O2 Health’s ‘Help at Hand’ mobile telecare system.

Breakthrough

He told NHE: “Mobile devices and telemedicine are, for us as an organisation, one of the biggest breakthroughs. We want people to be able to get out and about, and to have the same security and safety around them when they’re out as when they’re at home.

“The boundaries we might draw as an organisation between people being at home and being out are not ones that they draw. Apart from locking the door, they don’t divide things up like that.

“What excited us about Help at Hand, is that possibly at the beginning, the perceived market was probably older people with dementia – there had been some other pilot works in villages around GPS and geo-sensing for people with Alzheimer’s.

“There was perhaps an understanding within the telemedicine world that it – and certainly m-health – is only for a certain population, whereas we wanted to work out whether we could try it in some very different populations.”

These included adult care users, including young adults with conditions such as Huntington’s. Emmens said: “That particular usage was around keeping someone safe when they tried to live normal student lives: getting to lessons, getting home, going out to the pub with friends. In some ways, that’s very similar to the way it’s used for people with dementia, but we really wanted to take it and explore it outside of that.

Unescorted leave

Another group with whom the trust piloted the system were people within its forensic services – people with mental health problems who have come into contact with the criminal justice system and are detained.

Emmens said: “Part of that process, as you step down through the levels of security, is allowing the patients to have, initially, escorted leave, and as they progress through that process, they can then take unescorted leave.

“That’s part of trying to reduce their utilisation of the health service, to help them rehabilitate and recover and to get out of hospital.”

Emmens was very impressed with the way the service worked, and said: “Mobile telecare will change the way that telemedicine is delivered in its entirety. When you ask a young person about a landline or mobile, for them it’s just their mobile. The world has changed. The information you want, on a device in your hand, wherever you are, connected to the rest of your life, is crucial.

“We would like to make this available as one of a number of telemedicine and telehealth options that patients have. We’d like to work out how we can deploy units based on need. I don’t have to go and buy 100 units, then work out who to give them to. I could buy 1 or 5 or 10. As an organisation, that’s really important for us; we’re not pressured into trying to make someone fit a technology. We can identify and understand their need, and, in some of those cases, this will be the right technology. We want more things like this in the marketplace.”

The device takes the form of a pendant or wristwatch, connected at all time to an alarm receiving centre. It has a fall-down detector and GPS tracking, and safe zones can also be defined; and if the individual moves out of this zone the receiving centre is alerted and staff can take action.

Who benefits?

In a review of the published literature by Medipex, the NHS Innovation Hub for the Yorkshire and Humber region, it was estimated that a total of £5.8m had been saved in care services across just 1,722 telecare users in England (£3,370 per person). This was based on informal observational studies, mainly between 2000 and 2010, though the authors make clear that there is an element of subjectivity, because the type and extent of care individuals would have needed without telecare has to be based on an estimate.

The need for a rigorous and scientific analysis of the costs and benefits of telecare was one of the key drivers behind the WSD research.

Asked about the resource implications for the NHS and the trust, Emmens said: “In terms of our pilot work, it’s too early to say if there were any substantial savings. However, I think other research that’s been published both before and recently, and the WSD research, shows clear advantages to both patients and users and organisations. That comes both from receiving a more personalised, higher quality care appropriate to their needs, and at the same time, allowing more care resource to be focused where it’s most needed.

“But aside from that, we think there are other significant benefits to the patient, and if that can keep them out of hospital because they’re receiving the kind of support they need and want, when they need and want, we know there are significant costs associated with an admission to hospital.

“One of the groups we used it with were selfharming and at risk of suicide.

“Patient groups tell us they want 24/7 call-up care; they want to be able to phone someone when they need that help and support.

“Something like Help at Hand gives us the ability to test whether we can automate some of that, and give people a sense of security that when they do need help, they’re able to get it, but actually they might become less dependent on health resources.

“We know that if we can stop someone entering hospital through an acute self-harm episode, or a suicidal crisis, we know that is an immediate cost saving.

“Through our earlier work, we’ve seen examples of where telemedicine can keep people out of hospital.”

Triage

There is a UK-based call centre, whose trained staff will check on a caller’s safety, and triage the call wto a relevant person or team – which could be a friend, carer, nurse, or the emergency services.

Emmens said: “Between the pilot and now they’ve gone through an accreditation process.

“You can really personalise the response to someone needing help; it’s an absolutely fantastic feature and a big step forward.”

Keith Nurcombe, managing director of O2 Health, said: “The health and social care landscape in the UK is changing rapidly – more people require long term care, resources are under pressure, patients are demanding more choice – providers are being asked to do a lot more with a lot less. We believe there is huge potential for technology to help – in terms of giving patients more independence as well as reducing the cost and resources required for building-based care.”

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