Implementing new models of care is not easy – and especially so when organising community-based services that aim to tackle the challenges of more chronic disease and greater levels of emergency care.  

One of the more interesting approaches of the past few years has been the Virtual Ward and we recently published a report, funded by the National Institute for Health Research Service Delivery and Organisation Programme, looking at three early examples of Virtual...

After several years in gestation, the Whole Systems Demonstrator (WSD) trial of telehealth is now producing a steady stream of outputs – most recently in the form of a paper looking at whether telehealth changed the frequency with which people used GPs and practice nurses.

The WSD, one of the largest trials of its type in the world, focussed on one use of telehealth as a form of remote monitoring and support to help people better manage their chronic health conditions – which in this study meant either...

Back in 2002, I learned a valuable lesson: The patient’s view is paramount.

Building user involvement in Motor Neurone Disease was a service improvement project at King’s College Hospital that included an in-person support group, newsletter, dedicated telephone group, and an online asynchronous message board or ‘forum’.

As the lead researcher wound down the project, the team found there were two young patients, diagnosed in their early 20s, still using the forum to communicate.

That’s when I...

At last! We found evidence of an intervention which improves quality and reduces hospital costs. Is it telehealth? No! Is it greater competition? No!

It is care by Marie Curie at the end of life. People receiving the home-based Marie Curie Nursing Service were more likely than matched patients to die at home, according to their wishes, rather than in hospitals, and less likely to have unplanned hospital care.

This was our first excursion into examining the impact of home-based care from the 'third' sector – hopefully the first of many.

On...

The purpose of predictive risk modelling is to segment a given population on the basis of their risk of experiencing a particular outcome, for example an emergency hospital admission (Billings and others, 2006).

This is often used for case finding, where appropriate prevention techniques are matched to each risk stratum. High risk patients will be a small minority of the total population, and the form of the intervention will change depending on the level of risk.

The highest risk patients might receive a personal...

Telehealth is increasingly being advocated as a way to monitor patients remotely and better manage long-term health conditions. The Nuffield Trust was part of the largest randomised controlled trial in this area, “the Whole System Demonstrator” (WSD) – the initial results were published earlier in the summer.

We held a seminar with practitioners, researchers and funders to discuss the remaining research that needs to be done, post WSD. Priorities were identified as;...

As a nation we probably have the best information on health care in the world.

Data on service use, cost, and increasingly quality, across the whole population and for some years, and large chunks of it available at person-level (suitably anonymised) and linkable wherever the patient receives care.

Useable to track costs, assess substitution of care, stratify the population by risk, track cohorts of patients through time, assess impact of interventions, spot good quality and efficient care, develop business cases for invest to save innovations, shape clinical behaviour, develop...

Earlier this year, Dr Phillip Lee MP proposed that patients should be sent an annual NHS ‘bill’ by their GPs, setting out the exact cost of the care they had received over the previous twelve months.

The idea was that it would help people understand the value they get from the NHS and reduce the chance of our free-at-point-of-use service being taken for granted.

The proposal remains an idea and, whatever people think for and against it (e.g. not least that cost and value are...

In the Whole System Demonstrator (WSD) trial, a team of researchers studied the impact of installing telehealth technologies in patients’ homes to monitor their vital signs such as blood sugar levels. 

Debate continues over whether the findings justify the Government’s policy of encouraging the NHS to invest more in telehealth. At the same time, the trial has raised a potentially even more significant discussion. 

How useful are randomised controlled trials...

The potential value to the NHS of learning from the international experience of the electronic medical record (EMR) system, VistA, was identified in the January 2002 NHS Information Authority White Paper:Open Source Software and the NHS.

Ten years on, and several billion pounds of investment later, the NHS is still without a satisfactory comprehensive electronic medical record system.

Open-source software has gone from strength to strength...

The first results of the largest randomised controlled trial on telehealth were published in the British Medical Journal last week. Of the five arms of the Department of Health-funded 'whole system demonstrator' (WSD) trial, the first (conducted by a team here at the Nuffield Trust) examined the impact on hospital admissions and costs.

The headline results so far: patients receiving telehealth care had just 0.14 fewer emergency admissions in the one year of follow up; and...

This week, the British Medical Journal published the first results from one of the world’s most complex randomised controlled trials. Researchers at the Nuffield Trust led this analysis, which relied on collecting over a billion records of administrative data from more than 250 health and social care organisations.

The trial’s aim was to evaluate “telehealth” – a way of using technology to support people with long-term health conditions such as diabetes, heart failure or chronic obstructive pulmonary disease....

Earlier this autumn, I had the opportunity to visit the Hospital2Home virtual ward project in New York. Like other virtual wards, this project aims to reduce the risk of unplanned hospital admission for people at high predicted risk of admission. 

I was particularly interested to visit this project because it has strong partnerships with health care, social care and charitable organisations, and it cares for some of the most vulnerable people in...

I recently had the opportunity to visit the Toronto virtual ward as part of my Management Fellowship role working with researchers at the Nuffield Trust who are evaluating the costs and benefits of the virtual wards in Croydon, Devon and Wandsworth.

The virtual wards work just like hospital wards, using the same staffing, systems and daily routines, except that the people being cared for stay in their own homes throughout.

The purpose of...

Last month, the Department of Health confirmed that it was ditching its plans for a single clinical record system for England. Instead, IT policy will be devolved to local NHS organisations. On the face of it, this new emphasis on local flexibility may sound appealing but we should not forget the potential hazards that come with fragmented IT.

The original plan would in essence have created a single set of medical records for all patients, to which patients could grant access to clinicians working in any part of the NHS. The alternative we are now facing will be a separate, partial...

Last month, the Commons’ public accounts committee published a pretty damning report on the NHS National Programme for IT in England, Connecting for Health.  The committee’s analysis looked specifically at the development of a single care record.  This is a set of electronic notes for each patient that can – with the patient’s permission – be accessed by clinicians working in different parts of...

This week, the summary care record is back in the news.  At the moment, if you become critically unwell and are taken unconscious to an A&E department, the doctors and nurses looking after you will typically have no idea of your past medical history, your allergies or what medicines you are taking. This is because they usually have no way of accessing your GP clinical record....

This morning I logged in to my bank account on my smartphone, checked my balance, transferred some funds, and rated the service received for a book that I ordered online—all before my morning shower.  I then sent an email to my boss explaining that I would be late today because it was going to take me most of the morning, including travel time, to attend a ten minute follow-up appointment at my local outpatient clinic. Why is health care so far behind the times?

This was the topic we recently explored at a breakfast session at the Nuffield Trust’s 2011 Health Strategy Summit....

I was in Lisbon last week to speak at a chronic disease workshop run by the National School of Public Health.  Both the English and the Portuguese health services currently face a significant funding squeeze, and policymakers in the two countries see chronic diseases as an area ripe for potential cost savings.  However, in Portugal the focus is on different chronic diseases from those on which we concentrate in this country. Moreover, the emphasis in Portugal is on reducing the expected costs of these chronic diseases, whereas in the UK we tend to focus on preventing the...

Starting in April 2011, NHS hospitals in England will not be paid for “avoidable” readmissions occurring within 30 days of discharge.  As Trust finance officers begin steeling themselves for this change, they may be interested in a Canadian project designed to predict and avoid such readmissions. 

Known as the Toronto Post-Discharge Virtual Ward, the project borrows a concept first developed...