1. Whole System Demonstrator programme Stephen Johnson Deputy Director – Head of Long Term Conditions

2. Technologies for what purpose?
The second half of the 20th century saw major improvements in communicable disease treatments and surgical advances
The first half of the 21st century will see increases in non-communicable diseases and improvements in care of people with long term conditions
Technology is readily used and accepted in the treatment of many acute interventions – CT, MRI, x-rays, etc
But can technology be used to improve the care of people with long term conditions?

3. ………….Yes, at least that is the claim, but where is the evidence?
Back in 2006 it was recognised the evidence base was not as robust as we would have liked
So we secured funding and set out to fill that gap
WSD was born (3 sites, 6000 people, 238 GP practices, making it the largest RCT of TH/TC in the world)
2007 to 2008 sites were selected
2008 – 2009 patients recruited (easy this RCT thing isn’t it!!)
2009 to 2010 patient data collected
Jan 2011, data to evaluation team
Now? – well now the data is being evaluated and peer reviewed prior to publication

4. What will WSD tell us? Question 1 2 3 4 5 THEME Nuffield
NO. PARTICIPANTS REQUIRED 1
Nuffield
Does the introduction of telehealth or telecare result in reduction in service utilisation and costs of care?
5721 participants
Combined Model 2
UCL
What is the effect on carer burden, self-care behaviours and quality of life? What predicts whether people will use the service as planned? What is the clinical impact?
3445 participants
470 informal carers 3
LSE
What is the cost−effectiveness of the introduction of telecare & telehealth?
Professional interviews 4
Man’r
Oxford
What are the service users, informal carers and health and social care professionals’ experiences of telehealth and telecare?
234 interviews so far.
Participants & informal carers.
Health & social care professionals. 5
Imperial
What organisational factors facilitate or impede the sustainable adoption and integration of telehealth/telecare?
48 key WSD managers and commissioners in health & social services. Staff from 3 WSDAN sites and 3 non WSD related sites

5. What have we learnt?
Technology is only part of the story, you must re-design services to maximize the benefit of the technology
That includes looking again at skill mix and facilities
Clinical engagement is essential, but takes time
Patients are suspicious, and building trust takes time
Patient data was not as good as we thought, disease registers were out of date of inaccurate
Some population groups were very difficult to reach
Good project/programme management is essential
What you do on a small scale does not necessarily scale
But…………………………..

6. If you get it right, and focus on the whole system
Work across traditional
organisational
boundaries
Build clinical
advocacy
Re-design care
pathways
Share
Information
Re-train
staff
Develop interoperable
systems
Educate patients and
the public
The rewards are significant…………………..

7. the key to success is service change not just introduce the “kit” and hope for the best!
BUT

8. Remember why we are doing this
The number of people with long term conditions is growing (15.4m now, but up to 18m within 20years) and they account for 70% of spend
People with LTCs live with their condition every minute of every day, not just the 3 to 6 hours they are with a professional
8760 hours in a year, that leaves a lot of time
Telehealth and telecare should help more people to lead a better quality of life, be more independent and spend fewer days in hospital
Remind ourselves why here today – why focus so much energy
For starters – large and growing population – 15 million in this country
Range of conditions with differing severity – some have single condition can manage well, some have range of conditions that limit them and others have range of complex health and social care needs that severely limit their ability to cope

9. What next?
This will need significant leadership at all levels as well as raising awareness of what can be achieved and how to use the technology properly
But to lead needs a direction - align incentives, re-train staff, develop interoperability, embed common standards and reduce high unit costs
Government has already committed to support an industry led Code of Practice and invest in DALLAS
Yet more could be achieved by encouraging “patient pull” (showing that there is an alternative to using traditional buildings), using the media to give sustained information and ensuring NHS is supported to change

10. Head of Long Term Conditions
Stephen Johnson
Deputy Director
Head of Long Term Conditions