Our latest feature comes from Inhealthcare, and covers the topic of how “remote monitoring is the golden thread that runs through NHS recovery and transformation.”
By Bryn Sage, CEO of Inhealthcare
If anything can help tackle the current and future challenges facing healthcare, remote monitoring can. In guidance for 2023/4, NHS England has told providers to prioritise recovering core services and productivity, make progress in delivering the key ambitions in the Long Term Plan and continue transforming the NHS for the future. The use of remote monitoring to support patients at home runs like a golden thread through all of these goals.
In this article for HTN, we demonstrate how simple, tried and tested remote monitoring like virtual wards is already helping NHS teams to improve health outcomes, create efficiency savings and generate capacity in the system. We explain how the approach will increasingly become mainstream over the coming years. We also warn about an emerging risk in commissioning some services. And we look into the future with the launch of new services that take advantage of the latest technologies.
Manage high blood pressure at home
To illustrate how remote monitoring is transforming healthcare, consider our work with Surrey Heartlands, an integrated care system covering a population area of 1.1 million people. In the area, an estimated 142,000 people are living with hypertension, of whom one third are at high risk of stroke and heart attack. Inhealthcare helped the ICS to deliver a remote monitoring service to manage high blood pressure at home and reduce emergency hospital admissions and attendances at GP practices.
Surrey Heartlands used the same technology that underpinned our Oximetry at Home service across southern England, the UK’s biggest remote monitoring exercise of the pandemic. A local trial involving four GP practices found the blood pressure service helped 53 per cent of users move from high to normal threshold within three months and 56 per cent of them had achieved this through adopting lifestyle changes such as increasing exercise or changing their diet. The ICS has since added more than 2,000 patients to the service – and is adding 200 more per month – and early indications suggest it is achieving the same positive results. The service also improves NHS productivity by removing the need for nurses to transcribe countless readings.
Fewer emergency attendances and GP appointments
Using a simple device provided by the NHS, patients record their blood pressure and heart rate readings on a twice-daily basis. Patients submit these for clinical review via a choice of communication channels including email, SMS text message, app or phone, making the service fully inclusive. Inhealthcare automatically analyses the readings, calculates averages, alerts healthcare professionals if thresholds are breached and uploads readings onto GP systems. It sends feedback and helpful information to patients, asks them to test themselves again if necessary or contact their clinical teams or NHS 111 if there are any concerns about their readings. Previously, clinicians had to make contact with patients personally to remind them to take readings and provide advice, adding extra work to an already stretched caseload and budget. Clearly, the service creates significant capacity gains within the system.
Studies have shown the importance of supporting patients to manage their conditions through lifestyle changes to improve health, wellbeing and satisfaction – known as patient activation. People reporting the highest levels of patient activation had fewer emergency attendances and admissions, fewer GP appointments, shorter stays when admitted for elective care and were less likely to miss appointments. The service is designed to help patients reach the highest level to overcome inertia and work with clinicians to achieve their health goals and reduce the need for unplanned care.
‘Helping me to feel in control’
We take painstaking care in co-designing services with clinicians so they are centred around the needs of patients. Mr Gurmit Bhamra, a patient in Surrey, said: “It means I can monitor my blood pressure without having to go to see my GP every two or three days and I have become more aware of what the blood pressure readings mean. As a result of monitoring and submitting my results my medication has been changed, and I have also made some lifestyle changes to help manage my blood pressure better. I have been doing regular exercises at home every day, as well as moving and walking more, and I have changed my diet – eating less, especially in the evening. These small changes are already helping me to feel in control and have had a positive effect on reducing my blood pressure.”
North of the border, Inhealthcare is working with NHS Scotland to roll out a similar remote monitoring service, which is now live with a number of health boards. At least 1,000 hypertensive patients have signed up and there are plans to add up to 50,000 people to the service. It is just one of 17 remote monitoring pathways developed in partnership with the NHS in Scotland. Others support conditions including asthma, COPD, heart failure, chronic pain, irritable bowel syndrome, depression and undernutrition in care homes.
Scaling up remote monitoring
The success in Scotland shows the benefits of a centralised approach to procurement. Inhealthcare won the NHS Scotland contract to support the scaling up of remote monitoring services across the country. This aligns with the Scottish government’s digital health and care strategy to transform and enhance the health and wellbeing of citizens through the use of digital technology. Remote monitoring is becoming mainstream.
In England, the NHS leadership is reforming the way the health service works with suppliers to make it easier for innovators and SMEs to get their products through the door once by presenting the NHS as one organisation and ensuring that contracting is more straightforward. NHS England’s chief commercial officer Jacqui Rock has launched the new Central Commercial Function with the aim of simplifying and professionalising the routes through which NHS organisations procure goods and services. It is hoped this will have a similar impact on the scaling up of remote monitoring.
Best possible value for money
There is an emerging risk in procurement with some technology providers giving their services away “for free” or at low cost, especially in times of need as we saw during the pandemic. Once they are fully embedded, the modus operandi is to introduce big price increases at contract renewal for the continuation of services. This goes to show there really is no such thing as a free lunch!
At the very least, technology providers should be able to offer full integration with all major GP and hospital software systems, truly digitally inclusive communication channels and data reporting capabilities. With the government’s devolved and data-driven approach to allocating funding, it is essential that NHS providers can demonstrate that patients are getting the best possible care while taxpayers are getting the best possible value for money.
Looking to the future, we will continue to expand existing services. In East Anglia, Norfolk Community Health and Care NHS Trust is expanding a successful remote monitoring service with Inhealthcare to help increase life expectancy and improve quality of life for patients diagnosed with heart failure. The trust is rolling it out across the rural county to provide extra support to newly referred people with the long-term condition.
Significant reduction in hospital bed days
The service allows patients to monitor their vital signs at home and relay readings via a choice of communication channels to clinicians who monitor trends and intervene if readings provide any cause for concern. Analysis of the six months before and after introduction showed a significant reduction in hospital bed days, A&E attendances, GP visits and out-of-hours appointments.
Rhona Macpherson, lead heart failure nurse at Norfolk Community Health and Care NHS Trust, said: “We are expanding the service because it has been successful and we have found it to be very useful in making sure every patient has a care plan that is right for them. It gives extra support to patients at home and gives us the ability to monitor them very closely while promoting self care. Our NHS colleagues across Norfolk are keen to get involved.”
Virtual ward for cancer patients
As well as expanding existing services, we are also launching new ones that take advantage of new technologies. Inhealthcare’s technology platform has open APIs for connecting to a diverse range of medical devices, from weighing scales to wearable patches, which means we can accommodate the latest advances. And as remote monitoring expands as a market, so too will the types of condition we can support.
For example, Inhealthcare has developed a virtual ward for cancer patients. It is a perfect example of how technology can help enhance healthcare: remote monitoring for cancer patients receiving chemotherapy helps to better manage side effects and improve quality of life, according to 2021 research published by The BMJ.
Cuts administrative workload
Our oncology service was co-designed with NHS clinicians to provide support at home to cancer patients who are undergoing chemotherapy and immunotherapy. It captures vital signs readings and any side effects that patients might be experiencing as a result of their treatment. If any fall out of range or side effects flagged, the service generates an alert for clinicians to follow up with the patient. This means patients can be prioritised by need and sent advice on managing any side effects. It also cuts administrative workload, freeing up capacity within oncology teams. Importantly, the service helps vulnerable patients to avoid unnecessary trips to clinic. More generally, cutting unnecessary travel can help the NHS along the road to meeting net zero targets, which is true for all our services.
To repeat, if anything can help tackle the current and future challenges facing healthcare, remote monitoring can. It is like a golden thread that runs through the recovery of core services and productivity, delivering the key ambitions in the Long Term Plan and transforming the NHS for the future.
Bryn Sage is chief executive of Inhealthcare and a council member of industry group techUK’s health and social care board.