Healthcare without walls A framework for delivering telehealth at scale John Cruickshank November 2 01 0

Supporting authors Gail Beer Eleanor Winpenny Julia Manning

This report is supported by

Healthcare without walls Contents

About the Authors 4 7. Enabling Scale 59 A 7.1 Sharing of best practice 60 About this Publication 5 7.2 Procurement model 62 7.3 Industry Readiness 64 1. Executive Summary 6 7.4 Technical prerequisites 70 Table 1.1 – Summary of recommendations 8 8. Conclusion 75 2. Introduction 12 2.1 Aim 12 A. Appendix: Telecare developments 76 2.2 Background 12 B. Appendix: Teleconsultation developments 81 2.3 Approach 16 C. Appendix: Other NHS examples 88 of telehealth at scale 2.4 This Report 17 D. Appendix: Relevant EC Communications 90 E. Appendix: List of Contributors 92 3. Policy Context - the need for action 18 F. Appendix: On-line Engagement 94 3.1 NHS White Paper 18 G. Appendix: Glossary 95 3.2 Long Term Conditions 18 H. Appendix: Summary of Key Evidence 97 3.3 Whole System Demonstrators 25 I. Appendix: Disruptive Innovation 100 J. Appendix: Some international experience 102 4. Commissioning and Funding 27 4.1 Evidence 28 4.2 Local Business Cases 29 4.3 A national business case? 32 4.4 Funding / Reimbursement 34

5. Care Redesign 36 5.1 Care Delivery Model 36 5.2 Patient experience 40 5.3 Clinical Engagement 44

6. Service Delivery 48 6.1 Education and Training 48 6.2 Service Model 51 6.3 Governance and regulatory matters 55

3 Healthcare without walls About the Authors

Lead Author - John Cruickshank Series Editor - Julia Manning John is a Consultant Director at 2020health and an Julia studied visual science at City University and became independent expert in NHS IT, having been intimately a member of the College of Optometrists in 1991. Her involved in its development continuously over the last 25 career has included being visiting lecturer in clinical years. In March 2010, John wrote the influential report practice at City University, visiting clinician at the Royal Fixing NHS IT: A plan of action for a new government. Free , being a founder member of the British His passion for healthcare IT began in the mid 1980s Association of Behavioural Optometrists and working when he project managed one of the first successful NHS with Trusts in south east London. She was implementations of a hospital-wide electronic patient a Director of the UK Institute of Optometry for 6 years, record. As a leading management consultant in the field, took post-graduate studies in diabetes and founded Julia he has held leadership roles in the healthcare practices of Manning Eyecare, a specialist optometry practice for major systems integrators and consultancies at UK and people with mental and physical disabilities which was European level. Through his work, he has gained deep bought by HealthcallOptical Ltd in August 2009. Julia is experience of NHS culture, processes, people and systems. a founder and Chief Executive of 2020health.org which He has personally advised over 100 different NHS Trusts she launched at the end of 2006 as the first web based, and acted as a core advisor at a national level to two clinician-led, independent Think Tank for Health and published NHS IT strategies in the 1990s. John is a Technology. It uniquely focuses on bottom-up policy graduate in economics and management science from St development by front line professionals focusing on the John’s College, Cambridge. themes of technology and management. Publications include Not Immune: vaccination policy in the 21st Associate Author - Gail Beer century; Practice-based commissioning: not what it says Gail is a Consultant Director at 2020health, having on the tin; Responsibility in healthcare: changing the worked in the NHS for over 30 years latterly as an culture; NHS IT: A plan of action for a new government; Executive Director at Barts and the London NHS Trust. Implementing value-based pricing in the UK; Cutting the She trained as a general nurse at St Bartholomew’s costs without cutting the services and Health, disease and Hospital before undertaking a course in Renal at unemployment: The Bermuda Triangle of Society. She the Royal Free Hospital. After a number of senior nursing has blogged on many health and technology issues and posts within London she moved into management taking wrote on the history of her profession in ‘60 years of the a Masters in Health Management at City University, NHS’ (St. James’s House, 2008). before becoming Director of Operations at BLT. Since leaving Barts and the London she has worked as an Project Researcher - Eleanor Winpenny independent consultant in healthcare. Gail was a member Eleanor studied Natural Sciences at Clare College, of the team that produced the Independent Review of Cambridge University, graduating in 2006. She then NHS and Social Care IT Commissioned by Stephen went on to complete a PhD in Developmental O’Brien MP, Chaired by Dr Glyn Hayes. Neuroscience at Cambridge, looking at the growth of new neurones in the brains of mice. Eleanor has taken a step away from medical research and into the world of healthcare policy and delivery, focussing on how improvements and efficiencies in health and care provision can improve patient outcomes.

Please address all correspondence to: [email protected] 2020health.org 83 Victoria Street London SW1H 0HW

4 Healthcare without walls About this Publication

‘HealthCare without Walls: A framework for delivering Our work reflects on interviews with over 60 varied telehealth at scale’ is an independent report designed to organisations from governmental, NHS and council inform the future NHS strategy for telehealth. stakeholders to professional bodies and charities as well as industry. 2020health would like to thank all those who This idea developed from our recent report ‘Fixing NHS engaged with us during the work, whether for interviews, IT: A plan of action for a new government’ in which we workshops or through our on-line campaign. This report identified that the NHS had yet to exploit telehealth and would not have been possible without their expertise and other related tele-technologies well. insight.

In this report, we look at the rapidly developing problem This study was made possible through unrestricted, for the NHS in treating people with long term conditions educational grants from Accenture, BT, iSoft, Medtronic, and how this can be improved by telehealth technology. Pfizer Health Solutions, Tunstall, TPP and Vodafone. International evidence tells us that telehealth has a key 2020health are very much indebted to them for their role to play in systemic improvements to healthcare by support. reducing unplanned hospital admissions, making best use of scarce clinical resources and empowering Julia Manning individual patients. This report makes recommendations Chief Executive, 2020health.org for government, the NHS and industry more broadly. November 2010 www.2020health.org

2020health.org Disclaimer 83 Victoria Street London SW1H 0HW The sponsors are not responsible for the views expressed T 020 3170 7702 E [email protected] in the report or the accuracy of the content. This is solely Published by 2020health.org the responsibility of the author. All facts have been cross- ISBN 978-1-907635-12-0 checked for accuracy in so far as possible. The views Price £15.00 expressed in this document do not necessarily reflect those © 2010 2020health.org of Accenture, BT, iSoft, Medtronic, Pfizer, Tunstall, TPP and Vodafone – or any associated representative All rights reserved. No part of this publication may be organisation. reproduced, stored in a retrieval system, or transmitted in any form or by any means without the prior written permission of the publisher.

5 Healthcare without walls 1 Executive summary

One of the greatest strategic issues facing our NHS is how Through a comprehensive redesign of care pathways, we manag