Health Service Focus

Telecare commissioning in Cheshire West and Chester

Is Cheshire West and Chester Council commissioning telecare and telehealth services in the right way? Kate Ashley reports from a session at the International Telecare and Telehealth Conference 2012, led by Charlotte Walton, strategic commissioning manager at the council.

A lack of evidence, staff resistance and the ever-changing nature of technology all present serious obstacles to a larger scale roll-out of telehealth and telecare. But how can these be overcome to reap the potential benefits?

The International Telecare and Telehealth Conference 2012 saw a range of informative and honest break-out sessions covering these issues, including consideration of how one council has commissioned services.

NHE attended a session led by Charlotte Walton, strategic commissioning manager at Cheshire West and Chester (CWaC) council, who described its commissioning journey, including the opportunities and challenges of telecare.

The CWaC journey

CWaC has moved from multiple providers to a single, amalgamated solution covering training, assessment, installation, repairs, removal, maintenance and monitoring of service users via provision of a non-clinical triage service.

The service has achieved growth, but Walton said there is still “a way to go”, including a need to move from combined to integrated services, and break down internal silos. There is also a need to significantly grow the service to help meet national targets on telecare.

In terms of integration, CWaC is considering how direct payments and personal health budgets could fit in with telecare, as well as how more patients can be encouraged to selfrefer.

And CWaC is working to integrate telecare with reablement, with around 60% of new customers being referred from the hospital team, and the local NHS is encouraged to consider telecare as an option when discharging patients.

Additional staff training is needed to improve identification of potential service users and remodel telecare packages to ensure it is effective and relevant, Walton added.

Evidence base

She highlighted particular challenges in the analysis and planning stages of the commissioning cycle, especially around evidence to support the use of telehealth.

The impact on people’s quality of life is “incalculable”, but commissioners are nevertheless charged to produce hard evidence that validates investment in telecare.

Measuring these outcomes can be complex, and she posited that financial savings are given “disproportionate” priority to other benefits in telehealth, compared to other commissioned services.

The evidence base, such as it is, from the WSD was described by Walton as “disappointing”. Much more data will be needed to build an effective business case for telehealth on a large scale.

Councils are under increasing pressure to deliver savings in a variety of formats. While it is “common sense” that such a positive impact on people’s lives will lead to cashable savings, there is a need for reliable data, and questions still arise on the viability of extrapolating from small numbers to whole populations.

Staff resistance

There is a huge need to achieve buy-in from staff, which throughout the conference was highlighted as a key difficulty. Walton described how any changes need to be as simple as possible to avoid staff resistance, as well as simple to manage with dwindling resources.

Telecare is still seen as “an optional extra” in the NHS, she said, and stated that this needs to change. If clinicians are trained and expecting to use telecare equipment, this could help considerably.

It can be very hard to get telecare off the ground, Walton admitted, with some GPs and community matrons acting as champions for the cause, whilst others remain completely opposed. Influencing this pathway is difficult and considerable time and effort is needed to redesign services.

However, she acknowledged that there is little time or headroom for clinicians to consider this with all the reform and restructuring currently ongoing in the NHS.

Walton recommended changing the way staff and services work before commissioning new equipment, as it can be difficult to know what to buy unless you consider what you want to achieve first. Unless there is service redesign, spending on telecare can represent a significant waste of money, she warned.

Overwhelming choice

Technology is constantly changing and updating, so any model needs to be flexible and allow evolution. Walton urged fellow commissioners to “think about the technology second”, and highlighted the need to work differently, not just procure new equipment for the sake of it.

She added that telecare cannot operate as a single strategy and needs to be integrated with every other service offered. Telecare should be considered when building homes, and informing the way all services are shaped.

Speaking directly to providers in the audience, Walton explained a number of issues with the way they were currently offering services. She said it often felt as if the council was presented with new equipment that they were then charged to find a use for, rather than as a solution to a specific problem. There was an “overwhelming” amount of information, which made it very difficult to choose the right products and services, and ultimately “doesn’t feel very helpful”, she said.