Back in October 2010 Telecare Aware readers were raising doubts about the cost-effectiveness of North Yorkshire and Yorks’ PCTs procurement of 2000 telehealth units. [In fairness, not all the £3.2m project cost went to equipment supplier Tunstall. We understand that nearly £1m of it went to project consultants Ernst & Young.]
Now the local paper reports “The programme is the biggest* telehealth project ordered by a single organisation in England but an internal audit report by North Yorkshire and York Primary Care Trust (PCT), seen by the Yorkshire Post, has failed to find any evidence to justify its scale.”
The Yorkshire Post has four takes on this story and reveals a few more interesting facts:
NHS chiefs face ‘wasted millions’ row over hi-tech telehealth plan
Devices hailed by Cameron languish on shelves
Long-term sick to get benefit of distant monitoring
Review urges adoption of new health technology amid worries over finances
UPDATE Sunday – and another one…looks like the ‘health chiefs’ are trying to do some damage limitation. (Or else it is the end fragment of something else…)
Electronic monitoring speeds recovery and return to independent living
* There has since been the Gloucsetershire procurement of 2,000 telehealth units from Tunstall. Project cost £5million.
UPDATE Wed 25th – eHealth Insider has some additional information. “The audit found no evidence to explain why so many devices were purchased, other than ‘anecdotal’ reports that the decision was “not based on any prevalence or other data, but rather on the maximum number of units that the PCT could afford.” Yorks telehealth delays run up costs.
UPDATE Thur 26th – the story is flexing its legs with more people wading in. Here are the more interesting ones…
- Pro-telehealth David Hinchliffe (former MP and Chair of the Commons Health Select Committee) [and ex-adviser to Tunstall] lays into the local GPs: GPs lagging behind times over use of telehealthcare units [worth reading]
- An American take: Telehealth failure a cautionary tale for U.S. (fierceHealthIT) based on Management in Practice’s Practices offered cash to refer patients to telehealth item – worth viewing for the end of page comment by a GP in Gloucestershire, which has an even costlier project – see * above.
- Then there’s the item by the GP’s own paper, The Pulse: GPs urge ministers to rethink telehealth drive as low takeup in pilot area revealed. Definitely worth reading the comments here.
- NHS has to pay docs to put life-sign sensors in patients’ digs The Register mangles it a bit.
- Kerry Wheeler, assistant director of strategy for NHS North Yorkshire and York, denies that incentives are being offered to GPs…they are [just] a “small payment to cover the initial workload associated with identifying and referring patients” ‘No cash incentives’ to promote GP health systems The York Press.
Well, you know where you read it first, 15 months ago.
Interesting articles and clearly bad for the whole industry. However it was inevetable with the general over-hype of telehealth system capability, but this is nothing new. New technologies are generally over-hyped then comes the disillusion to be followed by disruption, normalisation and exploitation of the real benefits without all the hype.
It will be tragic if the usual excuses are made, blaming clinicians to adopt the technology, resistance to change, poor management of the implementation etc. Sounds familiar? The point is that if the technology is fit for the purpose for which it is deployed and benefits can be seen by the patient, provider and commissioner then it will most likely be a success.
This particular project sounds as though it did the opposite of the approach strongly recommended by the DoH QIPP work streams via Sir John Oldham. Sir John’s mantra is to re-organise the (NHS) system first then and only then consider kit. This one was clearly kit first and NHS system second.
It seems to be the large scale of these contracts (and hence the very high costs) that cause all the problems – and then lead to bad press because of the potential for waste. In each case, it seems as if a local NHS organisation has money to burn – especially at the end of the financial year (or at the end of an organisation’s life) – and this is exploited by the equipment providers. Perhaps nobody would blame them for taking advantage of poor procurement procedures and, as evidenced by negative outcomes and high charges, some pretty poor NHS managers. It is almost inevitable that auditors are going to start asking some searching questions. It would be good to get some answers too!
But perhaps this is where telecare was 7 or 8 years ago with Preventative Technology Grant holders believing the hype of salesmen rather than finding things out for themselves.
Hopefully, there are more informed sources of information out there today, and when the full results of the Whole System Demonstrators come out, commissioners will be able to make their own minds up how many AT, telecare and telehealth systems they need, and how much they should be paying for the equipment or for a service based on it. It isn’t rocket science, so hopefully neither the NHS nor local authorities will be enticed by organisations wanting to manage the services for them at exhorbitant fees.
The opportunity is there to offer new tariffs that are realistic enough to create a healthy competitive market which will quickly drive down costs. Then, and only then, will the large-scale of equipment ordered by Yorkshire and Gloucestershire be justified.
So Phil is right, until all the results and outcomes were available, only the foolish (or the easily influenced) would consider large scale procurement.
Totally agree with the comments above. NHS PCTs are going to make the exact same mistakes as LAs did 6 years ago. They are going to listen to the stories of the salesmen, they are going to purchase kit and then realise the kit does not fit into their service so they will squash it in – as an add-on.
Service redesign; holistic pathways; partner sign up (GPs, GPs, GPs people!); ask for expert advice from LAs or others that have been through this already.
Northern Ireland is the next one to watch – fingers crossed.
Don’t forget – everyone needs a flood detector!
One more thing with regards to Ernst and Young – did NYY get some pathway redesign and did they implement them? answers on a postcard
The 2000 units model is emerging as a trend! Another PCT in South East was on the brink of signing a similar contract but I strongly advised them against the plan.
This project could’ve been a big success. Though consultants etc can be blamed for bad advice it’s commissioners who have final responsibility.
It would be interesting to find out if the communication cost for each unit has been accounted for in the final cost. Has NYY paid ongoing communication fees for all these 2000 units from day one? If so, they might still be paying a big figure on monthly basis in addition to the cost of devices.