Delivery at Scale 3millionlives Stephen Johnson Deputy Director Head of Long Term Conditions

2 WHY ?

3 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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5 5 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 1 Self care support/management Tier 2 Care management Tier 3 High complexity Case management The three-tier model of care

6 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

7 EVIDENCE ?

8 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

9 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: /bmj.e3874 First paper published 22 June 2012

10 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 technology Not buying the kit

11 OPPORTUNITY

12 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

13 Barriers to telehealth Market Building Quality Standards Organisational Readiness Awareness Levers & Incentives Evidence & Business Case

14 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

15 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

16 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

17 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

18 LEGACY

19 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 healthcare We can lead or we can follow

Stephen Johnson Deputy Director Head of Long Term Conditions