Delivery at Scale

3millionlives

Stephen JohnsonDeputy Director

Head of Long Term Conditions

stephen.johnson@dh.gsi.gov.uk

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WHY ?

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A few facts ……………

• NHS - over 1 million patient contacts every 36 hours

• In England over 15 m people have a long term condition with numbers set to increase in the next 5 to 10 years, especially co-morbidity

• People with long term conditions use 72% of inpatient beds, 68% of out-patient appointments and 55% of GP appointments

• Treatment and care of those with LTCs account for 70% of the total health and social care spend in England, or almost £7 in every £10 spent

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Health care professionals may only interact with people with achronic disease for a few hours a year…

the rest of the time patients care for themselves…

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LTC generic model

Adapted from the US Chronic Care Model.

• Tier 3 - there are high dependency needs with multiple conditions. Care is provided using case management on a one to one basis.

• Tier 2 - less complex needs but still multiple conditions; care management through personalised care planning.

• Tier 1 - people with conditions that can be managed with support and information; self care/self management

Tier 1Self care support/management

Tier 2Care management

Tier 3High complexity

Case management

The three-tier model of care

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This is about improving people’s lives, making a difference, giving people control, confidence and empowerment

Supporting people to live life with a long term condition rather than having their condition dominate their life

Using all the tools available including telehealth and telecare

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EVIDENCE ?

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The Whole System Demonstrator programme

• A DH funded RCT focused on gathering evaluated evidence of telehealth and telecare

• Announced in 2006, designed in 2007, launched in 2008 as a two year study

• Across 3 sites (Newham, Kent & Cornwall), 238 GP practices and over 6,197 people – diabetes, COPD and CHD

• Five themes– Theme 1 - impact on service use– Theme 2 - participant reported outcomes and clinical effectivness– Theme 3 - cost and cost effectiveness– Theme 4 – participant, carer and profesisonal experience– Theme 5 – organisational challenges to adoption

• Evaluation co-ordinated by 6 leading academic institutions

• Different suppliers at each site

• Sites were rural, urban and mixed – so results will translate

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Hospital use and mortality during trial

Control group (n=1584)

Intervention group (n=1570)

Absolute difference (95% CI)

Percentage difference (95% CI)

Admission proportion (%)

48.2 (n=763) 42.9 (n=674) -5.2 (-8.7 to -1.8) -10.8% (-18.1% to -3.7%)

Mortality (%) 8.3 (n=131) 4.6 (n=72) -3.7 (-5.4 to -2.0) -44.5% (-65.3% to -23.8%)

Emergency admissions per head

0.68 (1.41) 0.54 (1.16) -0.14 (-0.23 to -0.05) -20.6% (-33.8% to -7.4%)

Elective admissions per head

0.49 (1.31) 0.42 (0.99) -0.07 (-0.15 to 0.01) -14.3% (-30.6% to 2.0%)

Outpatient attendances per head

4.68 (6.81) 4.76 (6.74) 0.08 (-0.39 to 0.55) 1.7% (-8.3% to 11.8%)

Emergency department visits per head

0.75 (1.58) 0.64 (1.26) -0.11 (-0.21 to -0.01) -14.7% (28.0% to -1.3%)

Bed days per head 5.68 (15.10) 4.87 (14.35) -0.81 (-1.84 to 0.22) -14.3% (-32.4% to 3.9%)

Tariff cost per head (£)

2448 (4099) 2260 (4117) 188 (-474 to 98.8) -7.7% (-19.4% to 4.0%)

Source: Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial (Steventon A and others) BMJ 2012;344:e3874 doi: 10.1136/bmj.e3874

First paper published 22 June 2012

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Understanding what WSD tells us

• A better quality of care, lower mortality rates and reduced unplanned hospital admissions are within reach

– mortality by 45%– emergency admissions by 20%– A&E visits by 15%– bed days by 14%– elective admissions by 14%

• Busts the myth of lower quality of life as a result of isolation

• Cost benefits are achievable – we need to get the price point right

• Technology alone does not bring the change – you need service transformation

• Patients on the whole like this type of intervention and age is no barrier

The key is service transformation with technologyNot buying the kit

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OPPORTUNITY

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Looking ahead to the future• People will live longer, with more LTCs especially multiple co-morbidities

• More freedom and choice will be the norm

• Today’s teens/twenty-somethings will be tomorrow’s decision makers and healthcare users – they are growing up with technology

• People will want to live their lives as they want, with fewer hospital visits, not tied to clinics of bricks and mortar and will see technology as common place

• Telehealth will play a major role in that future - the question is not ‘if’ it will happen but ‘when’

• In 30 years time we will look back in disbelief at how we use hospital beds

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Barriers to telehealth

MarketBuilding

QualityStandards

OrganisationalReadiness

Awareness

Levers &IncentivesEvidence

&Business

Case

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Three Million Lives

• Not a traditional campaign – we are not setting national targets

• Will need a new offer from industry (low capital cost, revenue based with risk share)

• Will mean NHS/social care responding to that offer by building different service models

• Government will need to create the right environment for success

• Will mean growing awareness and support amongst patients & workforce

• This is about transformational change

• One of six high impact innovation changes in Innovation Health & Wealth

Improve 3 million lives within 5 years

www.3millionlives.co.uk

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Industry Leadership Group

• TSA• ABHI• Intellect• Medilink UK• BT Health• Tunstall• Technology Strategy

Board• Air Products• Harmoni

• Philips• Telehealth Solutions• Bosch• Peaks and Plains Housing

Trust• S3 Group• Cisco• O2 Health• Pfizer• Care Innovations• Circle - Invicta Telecare

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Roles and Responsibilities

• Government – Create the right environment for delivery – New tariff for assistive technology– Make it a priority in NHS Operating Framework– Delivery linked to CQUIN (IH&W)– “How to Guides” and implementation support (framework contracts, benchmarking for costs) for the

NHS and social care

• Industry– Capital investment & technology roll-out– Partnership development & support– Interoperability solutions & industry code of practice– Patient and Professional awareness & marketing (e.g. media campaign)

• NHS– Scope opportunities for use of assistive technology– Build clinical and operational advocacy– Engage with industry & key local stakeholder groups (including Local Authorities)– Trajectories for roll-out in business planning (2012/13)

Supported by an overarching communications programme

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Willing to challenge beliefs, values, norms, rules.

Able to develop and share a vision.

Ability to make decisions quickly.

Good project management skills.

Team worker.

Determined & resilient.

Pragmatic.

Empathetic.

We need leaders to make a change

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LEGACY

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• People in control of their lives

• More freedom and choice

• People will live their lives as they want, with fewer hospital visits, not tied to clinics of bricks and mortar and technology is common place

• More flexibility for carers

• Better decision making

No doubt in my mind TH/TC will transform healthcareWe can lead or we can follow

Stephen JohnsonDeputy Director

Head of Long Term Conditions

stephen.johnson@dh.gsi.gov.uk