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 When the vehicles we all drive became more complex and controlled by computerised engine management systems there was widespread feeling that many mechanics would not be able to make the switch.

Despite this, the vast majority of mechanics in local garages across the nation learned how to use diagnostic computers. They accepted that the public wanted more luxurious cars with advanced features that improved driver & passenger comfort. They realised that to stay in business they would need to serve the market and embrace new technologies.

                

Similarly, the manufacture of our vehicles was automated and robots were introduced to ensure a higher quality of product and more productive output. The workforce and their unions realised that if they didn't embrace these technologies they would lose out to their competitors. This was a time of fierce competition and price cutting in the automobile industry and involved the workforce embracing new technologies and learning how to use them to best effect.

 

We are now at a point in time when the quality and efficiency gains required of the NHS require the adoption of similarly complex technologies in many everyday health and social care settings. We change when the pain to change is less than the pain to remain as we are. Soon the pain to remain as we are will be too great.

 

The focus of DH and NHS strategy for improving care for those with long term conditions is based on case management of those with the most complex needs, greater personalisation through care planning and more holistic self-care. Technology can help facilitate these goals.

 

Telehealth and Telecare services bring care into the home, support preventative care and enable early effective interventions to prevent avoidable emergency department attendance, in patient stays and avoidable admissions to residential care. Much as we have all come to accept and use in-car sat-nav, stability control, ABS, aircon, safety systems and in car entertainment systems over the last 15 years, we expect that the public will come to accept that they have a role to play in managing their long term condition and that technology in the home and mobile technology will help them do this. In many cases the technology will be as transparent to the user as the advanced technology is to the car driver.

 

The range of remote care products will need to reflect personal preferences. Products will need to reflect the aesthetics required by the different target audiences whilst also embodying the latest innovations and being unobtrusive, durable, easy to use, interoperable and value for money.

 

The services provided will also need to reflect different levels of need. Technology is currently focused at those people with complex needs who are very high intensity users of health and social care. As the evidence of effectiveness builds, the market will grow and costs should reflect this. We will then need services that are suitable for those at risk of developing long term conditions through first diagnosis and onto day to day management for active people. 

 

Medication reminders by text message, telephone calls to warn of weather that might affect your condition and advice through your set-top box or internet on diet and exercise need to fit into people's busy lives in a convenient way. More complex technologies such as home telehealth, video conferencing and tele-diagnostics also need to be unobtrusive, use technologies we employ for other purposes and be seen as desirable. Why shouldn't these services, services that potentially liberate us, be something we seek out that, be pleasing to use and something that we are proud to have access to.

 

However, even if the technology and services are available we still have a number of hurdles to pass before remote care can be considered mainstream. Most of us, whether as patients or in our professional capacities, harbour a natural resistance to change. It is more comfortable to deal with past certainties. We base our expectations on the status quo and become overly protective of our own judgements. We are therefore defensive when confronted with new developments and try to preserve the present for as long as possible.

 

Remote care in all its forms will require brave people, who are willing to take the risk of being wrong, to engage in and invest in new forms of service. Finding the benefit of new care models is a challenge in itself, however, once it has become clear, the change is no longer painful. Every high performer lives this way every day - seeking change and taking risks for the resulting benefits.

 

The environment is right for people to take educated risks. In less than two years, the NHS will face the most severe constriction ever in its finances and radical action is required now if it is to continue to provide care free at the point of need. For this reason nothing can be off limits, particularly things that we know work elsewhere. That is why the Department of Health are investing heavily in the Whole System Demonstrators. By undertaking the most robust worldwide evaluation of telehealth and telecare we hope to provide more security for those brave enough to embrace remote care.

Written by Tim Ellis
Thursday, 13 May 2010 0:12

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