Pathfinders losing their way

The government’s telehealth pathfinder scheme looks certain to fail to deliver a target of 100,000 users this year.

There are around 5,000 telehealth users in England. Last November, health secretary Jeremy Hunt identified seven pathfinders which he said would each enrol 10,000 people in telehealth in 2013.

This was the first step in the Department of Health’s project to have 3m people benefit from telehealth by 2017.

When eHealth Insider contacted the pathfinders, only one could provide figures on how many patients they planned to enrol or the scheme’s cost.

And the latest pathfinder update from 3millionlives says there is “no definite timetable” for the projects to get started.

Chris Wright, programme manager at 3millionlives, told EHI the organisation was doing whatever it could to achieve 100,000 people in 2013, but clarified that the 10,000 target per pathfinder was more of an estimate.

“I think if what we’re looking for is to actually have 10,000 people, that seems a tall order,” he said.

“We’re looking for commitment such as contract signed. That would certainly suggest that we can do it.”

One pathfinder, NHS North Yorkshire and York and the Humber, has already spent £3m on a telehealth initiative including buying 2000 telehealth devices from Tunstall. It has 645 current users.

Of the six clinical commissioning groups in the area, only one has voted to continue with the project once they take on commissioning responsibilities on 1 April.

Minutes from NHS Hambleton, Richmondshire and Whitby CCG’s November board meeting, say: “The system has not delivered the savings anticipated and does not have a good evidence base in relation to quality, safety, viability and value for money.”

Wright acknowledged that getting CCGs on board was a problem. “We would expect CCGs to be sceptical because they are very new organisations,” he explained.

“Lack of clinical engagement is one of our biggest challenges. We need to take a number of steps to address that and we’re always happy to put clinicians in touch with other clinicians to discuss telehealth.”

Another pathfinder, NHS Kernow CCG, was one of the Whole System Demonstrator pilot sites, which together enrolled 6,000 patients in telehealth and telecare nationwide.

The group issued a prior information notice in September 2012 saying it planned to procure a telemedicine service to support up to 20,000 patients.

However, the CCG’s director of operations, Andrew Abbott, told EHI this year that as a new organisation, NHS Kernow was still reviewing the outcomes from the pilot.

“We are committed to making evidence-based commissioning decisions and will be looking further to develop the role that assistive technologies can play in patient care as we continue to assess the clinical quality, patient experience and value for money of the pilot,” he said.

Wright admitted that the Whole System Demonstrator report, which looked at the results of an earlier, government-backed initiative to establish telehealth at scale in three areas, was not sufficient to convince people about telehealth.

“The WSD report lacks in that we haven’t seen great cost benefits yet, but the equipment provided to users then was six to seven years ago and the industry equipment is different now. What we need is to find cost efficiency benefits.”

Wright said a recent tender for a managed service for assistive technology, issued by Worcestershire County Council and three CCGs, was a “step in the right direction.”

The pathfinder plans to award a contract by August and will identify 1,000 patients in the first year and another 1,000 the next. If benefits are proven, numbers will increase to 10,000 over five years.

Charles Huntington, on the council’s adult and community services project team, said the project would deliver support for people with long term conditions and social care needs.

“We want GPs and nurses to see the benefits and allow technologies to be used across other areas,” he said.

“We are seeking a risk-sharing arrangement with our managed service provider, where payments are based on delivery of benefits both in terms of patients and also financially.”

NHS Kent and Medway was another of the WSD sites, which had 2,000 patients enrolled.

Alison Davis, head of innovation and lead for advanced assistive technology at NHS Kent and Medway, said the pathfinder planned to expand the service to “support thousands more people”.

The group would work with clinicians and the technology industry to develop a model to roll-out telehealth on a “much bigger scale”, she explained.

Wright believed that sharing ‘best practice’ across the NHS would help achieve the government’s goal.

“Three million by 2017 is still the ambition. I feel very positive about the level of interest,” he said.