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How can we empower people to take better care of their health?

By Carol Hughes
23 January 2019

Last year Matt Hancock outlined his vision for a more prevention-focused healthcare system. But how feasible is this? Carol Hughes clinical and operational lead for health technology services at Mersey Care NHS Foundation Trust explains her views.

Mr Hancock said: ‘By using new digital technologies, to help people make informed decisions, with more access to primary and community care, and with more social prescribing, all aimed at stopping people from becoming patients in the first place.’

He could have been describing the telehealth service that I help run in Liverpool.

Over the last four years we’ve built up a service that puts people in control of managing their own health and so far it’s reached more than 7,000 people, with over 1,000 people using it every day. Positive results include improved health while 76% of patients have more confidence.

Mersey Care NHS Foundation Trust’s telehealth service supports those with heart failure, type 2 diabetes, COPD (chronic obstructive pulmonary disease) or a combination of these conditions. Around 30% of people in Liverpool are affected by these conditions and this has major implications for our acute services.

Our philosophy is based around empowering patients by helping them to really understand their condition and over the course of a few months reach a point where they can self-care.

We use technology that works through a tablet device or smartphone and allows patients to take readings on their vital signs ­– blood pressure and oxygen levels-from the comfort of their own home. These are then fed into a clinically-led monitoring centre where I and other nurses are based.

The team look for any early warning signs of deterioration and take whatever action is appropriate – perhaps calling the patient to talk them through the steps they should take to manage their condition.

The idea is to prevent what can turn into a cycle of doctors appointments and ultimately avoidable hospital admissions. Patients reported outcomes show 30% of people using our telehealth service have reduced healthcare use and 90% have an improved sense of health and wellbeing. Separate research has also demonstrated a 22-32% reduction in winter hospital admissions due to COPD.

It’s always reassuring to have statistics like these to demonstrate that a new way of working is having a tangible impact. But what they don’t necessarily convey is the fundamental shift that it’s brought about and the transformative effect it has had on people’s lives.

Because the real measure of success of a service like this is whether the use of technology brings about sustained change in patients’ behaviour and genuinely puts them in control.

From working with people every day we can see how it really engages patients in actively managing their condition so that they can spot the warning signs. For example,  technology enables them to watch educational videos and complete questionnaires. It builds their confidence, makes them more informed and in doing so makes them champions of the service. People want to tell others about telehealth and encourage them to use it.

There’s sometimes a tendency to view the increasing use of digital technology with a degree of cynicism. Isn’t it just a way to save money while creating a rather distant faceless system that pulls patients and healthcare practitioners further apart?

Well, the success of telehealth in Liverpool is very much down to the human element while the technology is simply an enabler. Some people need more one-to-one help than others but what the technology does is bring a richer range of information and advice to their fingertips on a device they’re familiar with and in their own home.

It’s a powerful and effective way to reinforce health messages because people are more receptive to information provided in their own home. Up to 50% of information given in hospitals or GP surgeries is forgotten by patients. Also, people are more comfortable in their own surroundings and they tell us things they don’t tell a doctor or nurse.

Telehealth isn’t for everyone and that’s why our nurses make home visits to assess whether the service is suitable for that person.

For those who do use it, rather than worrying about their health and struggling to get an appointment with their GP, they are better informed about their condition and know that one of our nurses is available at the touch of a button.

We’ve also found that telehealth makes people far more assertive. Whereas previously they might have been worried about their health but reluctant to seek help, now they understand what’s happening and feel able to ask for support before things escalate. Now that’s the definition of a preventative approach.

Carol Hughes is clinical and operational lead, Health Technology Services at Mersey Care NHS Foundation Trust.





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