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Brief analytical summaries or syntheses #30

A review of telehealth in Scotland

Summary

This government review, prepared for Scotland’s Auditor General, focuses on National Health Service (NHS) telehealth initiatives that deliver care to patients. It determines that, targeted appropriately, telehealth has the potential to help NHS boards deliver clinical services more efficiently and effectively.

Background

The use of technology in the NHS has the potential to improve the quality, delivery and efficiency of healthcare services. Telehealth is the provision of healthcare to patients at a distance using a range of technologies, such as mobile phones, internet services, digital televisions, video-conferencing and self-monitoring equipment. Telehealth can offer a number of potential benefits to patients and NHS boards, such as reducing the need to travel to outpatient clinics, providing a quicker diagnosis, and avoiding referrals to hospital for diagnosis or treatment. It also has the potential to help NHS boards deliver clinical services more efficiently. This report includes exhibits and case studies that highlight examples of the benefits delivered by telehealth initiatives.

In 2006, the Scottish Executive established the Scottish Centre for Telehealth (SCT) to support NHS boards in developing telehealth. In April 2010, SCT was integrated with NHS 24 which is the provider of national telehealth services in Scotland. Scotland is the only country in Europe that has both a national organisation with a specific remit for telehealth and a national strategy for telehealth.

Analysis and results

The NHS in Scotland is facing growing demand for its services, due to an aging population and the increasing prevalence of long-term conditions. NHS boards need to consider new models of care such as telehealth to help manage current and future demand. Targeted appropriately, telehealth offers the potential to help NHS boards deliver a range of clinical services more efficiently and effectively. To achieve this, NHS boards should consider the use of telehealth when introducing or redesigning clinical services.
The SCT was established in 2006 to support NHS boards in developing telehealth. There was a lack of clarity over SCT’s role and purpose in its first three years. The combination of the integration of SCT with NHS 24 and a new eHealth strategy provides a much stronger focus to drive the development of telehealth nationally. Although NHS boards are making use of telehealth, development and investment in this area has not been a priority.

Telehealth offers a range of potential benefits for patients such as reducing travel, receiving a quicker diagnosis and avoiding hospital admissions. Patient experience is broadly positive and there are high levels of satisfaction. The experience of NHS staff involved in telehealth initiatives is also positive. However, opportunities for them to gain experience remain limited and more training and education are needed.

Better-quality evaluations are required to provide reliable evidence on the overall effectiveness of telehealth and whether it offers better value for money than traditional patient care. Three large-scale telehealth projects in the U.K. will improve the availability of evidence. Economic modeling work suggests that using telehealth to monitor patients with chronic obstructive pulmonary disease (COPD) at home has the potential to help NHS boards avoid costs of around £1,000 per patient per year.

Conclusion

In December 2009, the Scottish Parliament’s Health and Sport Committee heard evidence on the development of telehealth in Scotland. The subsequent report noted that there are many positive examples of telehealth pilot initiatives within Scotland and that telehealth has the potential to play a significant role in helping to care for people closer to home. However, the Committee highlighted NHS boards’ lack of progress in rolling out these pilot projects more widely as part of their routine services.

Implications and recommendations

NHS 24/SCT should:

  • ensure that its new strategic framework, to be developed in 2012, contains specific and measurable objectives for developing telehealth, and that these objectives be supported by a delivery plan which sets out a clear timetable for implementation;
  • continue to work with the Scottish Government and NHS boards to identify how the implementation of national telehealth programmes will be funded; and
  • promote good practice in NHS boards in evaluating telehealth initiatives, including cost-effectiveness, and routinely analyze and share completed evaluations among NHS boards.

NHS boards should:

  • ensure that telehealth initiatives are supported by business cases that consider the long-term clinical, organizational and cost benefits resulting from the use of telehealth.

Source

A review of telehealth in Scotland