PRIME Minister David Cameron has hailed telehealth as having the potential to make an “extraordinary difference” to patients living with long-term illnesses.
But pitfalls in the introduction of the technology have been exposed in a £3.2m programme to buy 2,000 telehealth units in North Yorkshire. Nearly two years since the programme was launched only 410 of the units are in use.
Mr Cameron’s claim last month follows a trial involving 6,200 patients in London, Kent and Cornwall who had their vital signs monitored at home using telehealth devices. It found that, if properly delivered, telehealth could reduce deaths by 45 per cent, cut emergency hospital admissions by 20 per cent and lead to a 14 per cent fall in planned hospital stays.
The North Yorkshire scheme has seen some successes, with a 34 per cent fall in emergency hospital admissions of those using telehealth for six months or more.
But expected NHS savings of more than £3m within its first year amounted to less than £200,000. Some 1,600 units of unused telehealth devices for patients with ailments including heart failure, chronic obstructive pulmonary disease and diabetes are instead languishing on shelves in a bonded warehouse.
Officials at North Yorkshire and York Primary Care Trust (PCT) say the project began in May 2009 when a number of GP practices put forward cases for reinvesting savings in telehealth.
This led to the creation of a strategy to use the technology across the county.
A £300,000 pilot of 120 devices began in September 2009, two-thirds of the cost funded by the regional health authority.
Only 48 had been used by the time it was decided in February 2010 to buy 2,000 devices, mainly on the strength of “anecdotal evidence” about their success.
Internal auditors who examined the project failed to find any evidence to justify the scale of the roll-out.
It appeared officials chose to buy 2,000 units because it was the largest number the PCT could afford using £2.2m of its own money, plus a further £1m from the regional authority.
The responsibility for selecting a supplier was delegated to five senior executives after PCT board was warned a rapid decision was needed as it faced losing the funding if a decision was not made before March 31.
The group selected Selby-based firm Tunstall from one of four bidders trying for the three-year contract.
The internal audit report points to a number of failings. It said: “The most significant gaps relate to a lack of evidence justifying the decision to invest in 2,000 telehealth units and the absence of a fully documented business case determining the roll-out of the project.
“The absence of a business case led to a lack of clarity on the decision making and approval process. In addition, it has also not been possible to locate any documentation that explains the rationale for the scale of the project.”
The report found “probity was achieved” in approval of the expenditure to fund the project and the procurement complied with PCT rules and regulations.
But it added: “At the time of the contract award there was no process in place for the evaluation panel to sign to declare that they had no conflicts of interest. This was a verbal process and was not documented. Consequently, transparency and an adequate audit trail for this part of the process were not in place.”
The report said there was no project board to drive the scheme forward and the departure of a key officer weakened the project. This was former director of strategy David Cockayne, one of the executives involved in the procurement process, who left the PCT in August 2010 to work for Tunstall.
The original bid envisaged 1,500 units being used by March last year delivering savings of £3.4m through reduced hospital attendances. But largely owing to poor engagement with GPs, only 350 were in use by June and less than £200,000 had been saved,
The report, completed in October, said: “As a significant number of the units procured have not been installed and therefore benefits from the system have not been fully achieved, it is not possible to conclude at this stage that value for money has been achieved.”
It said in future officials should draw up full business cases to support the rationale for major procurement projects, complete with options and estimated costs.
Kerry Wheeler, the PCT’s assistant director of strategy, said a charter setting out a vision for supporting patients with long-term conditions using telehealth had been drawn up in 2009.
“Following the completion of the charter, the strategic health authority agreed to support the PCT, both in principle and financially, as a pioneering site for telehealth in the region,” she said.
A spokesman for the strategic authority said it considered the bid in line with its processes for approving PCT investment plans.
“A detailed business case was not required in this instance because the amount was within the PCT’s own delegated approval limits, in line with Department of Health guidelines.”
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