Long-term Conditions
and Telehealth in North
Yorkshire & York
Kerry Wheeler, Assistant Director of
Strategy – Programme Lead for
Telehealth
The big picture - NYY
• North Yorkshire has a population base of 794,532
• LTC affects a significant proportion of the total population;
176,000 people registered on QOF; 50,000 with Diabetes, COPD
and Heart Failure
• Patients with a LTC are more intensive users of healthcare
services
• NHS NYY estimates a 14% increase in the population by 2020,
with more people living longer and an estimated 22% increase in
those aged 65+ years / 50% over 85s.
• Prevalence of LTC rises with age
• Financial challenges in NHS
Why Telehealth?
• An enabler to support implementation of LTC care pathways fragmented
• Emerging (inter)national evidence base
• Non-elective admissions increasing by 5-10% a year against a
background of reduction in financial allocation; expectation that
care is provided in a different way
• LTC - frequent cause of admissions to hospital. Example: COPD
spend is circa £10 million with £3 million on primary diagnosis;
• Rurality of NYY leads to issues regarding access to services and
efficiency of service delivery
• “Push” from NYCC – significant impact from telecare
• Support from the SHA to act as a pioneering site for the region
How did we start the Project?
• April 09 - PBC Consortia approached NYY to implement
Telehealth across 4 Localities (Whitby,
Hambleton/Richmondshire, York & Selby) as part of phased
approach within longer term programme.
• June 09 – 120 units, 2 Suppliers, establishment of project team,
internal steering group and executive board
• Sept 09 - Commenced implementation through Community Staff.
Early evaluation through YHEC showed positive impact
• Dec 09 – Procurement of 2,000 Telehealth units for full scale
roll out across NYY
• April 10 – Commencement of 3-year contract with Tunstall
Healthcare
• September 2010 – Phase 2 monitoring commenced
Which LTC are part of the
Telehealth programme?
• 6,705 Heart Failure patients and 11,505 COPD patients in NYY,
with an estimate of 1,000’s more undiagnosed.
• LTC with trackable vital signs indicative of health deterioration;
e.g. COPD exacerbation / reduction in oxygen saturation levels,
heart failure decompensation / increased weight through fluid
accumulation
• Diabetes as a co-morbidity to COPD and Heart Failure
Progress over last 12 months......
• Commenced work with Clinicians on redesign of care pathways
for COPD, Heart Failure and Diabetes – July 2010
• Telehealth within pathways as a clinical tool (enabler)
• Process about system change and selection of appropriate
patients, not deployment of units
• Pathways completed & signed off by PBC and Commissioning
Executive in October 2010 – NICE and Map of Medicine
compliant
• Service specifications and KPIs included in contracts from April
2011
• By Locality – savings plan based on implementation of pathways
and deployment of telehealth
• Ongoing clinical engagement across all sectors
Progress over last 12 months......
• Community Staff all trained and largest referrers – clinical
advocates
• 47 out of 100 Practices visited to discuss Project. 85 Practices
now with patients on telehealth units
• 7 Practices referring and directly managing Patients – 34
patients in total
• As at 20 June 346 “live” Patients on units, almost 500 referrals
• Monthly performance dashboard – as at end of May 2011, 54%
reduction in non-elective activity (150 patients for 6+ months)
• Alert rate to clinicians – 3%
• Telehealth website – nyytelehealth.co.uk
Focus during 2011/12
• Full deployment of units by March 2012
• Key Projects:
• Deployment of 1,000+ units to COPD & Heart Failure
Patients from York Trust
• Deployment of 100+ units from Haxby Group Practice (2nd
largest Practice in NYY)
• Rapid deployment of T-Health Project within Scarborough
Trust – 100+ units to Heart Failure Patients
• Support to Craven GPCC and Harrogate GPCC on delivery
of QIPP plans
• Project reports through Central QIPP Board at PCT
• Work with LMC on QOF plus GMS/PMS incentives
• Work with the Nuffield on independent evaluation of the
Project
What are the benefits of
Telehealth?
• Alerts clinicians to priority patients / early warning of clinical
deterioration
• Provides easily accessible, historical, and current trend data and
health interview responses, to all clinicians involved in the
patients care.
• Supports clinical decision making and monitoring during changes
in the patients therapy
• Patients more in control and confident to manage their own
condition leading to improved quality of life
• Potential to support Early Supported Discharge Schemes from
acute hospitals
The common questions – clinical
engagement
• What is the evidence for telehealth?
• What impact will this have on my workload? (3% crucial)
• Will we get paid for the extra capacity required to do this –
shift in workload?
• How do I select the right Patients and set alert limits?
• What are the costs for this? (either upfront or post PCT
funding)
Commissioning Telehealth...
• Clinical engagement pre-procurement
• Dedicated management support to take Project forward
• Clear reporting/governance for Project to Board
• Identify clinical champions
• Good Comms/PR essential – mixed messages
• Telehealth – clinical tool to facilitate service change
• Prove not just another short term initiative
• Patience!