National policy and guidance combines these two perspectives through its growing emphasis on engaging people in decisions about their own health and care and on enabling people to manage their own health.

This section explores:

The patient perspective: better access and more choice and control
The health professional and service perspective: cost effectiveness, improved outcomes and reduced service utilisation
The ‘system’ perspective: national policy and guidance
The changing environment: facilitating digital health

The patient perspective: better access and more choice and control
People using services today have very different expectations of both services and health professionals from in the past, influenced by changes in society and the wider impact of new technologies.  They expect to have better access to services and more choice and control over their treatment and care.

People are used to using technology in other aspects of their life, and increasingly expect to use it to optimise and better support their health and care.  In 2014, 59% of all citizens in the UK had a smartphone and 84% of adults used the internet.  However, when asked, only 2% of the population reported having had any digitally enabled transaction with the NHS.  Despite this, there is evidence that people will use technology for health and care, given the opportunity. There are 40 million uses of NHS Choices every month (of which some 5 million are views by care professionals who regard this service as a trusted source of information and advice). The internet-based sexual and general health service, Dr Thom (now part of Lloyds online), has seen 350,000 individuals sign up as users.

Having access to their own health information and being able to collect their own health data, can give people a greater sense of ownership as well as encourage health behaviours and a more proactive approach to self-management.  At the same time, self-monitoring can also be more convenient than visiting a health service.

Similarly, teleconsultations, whether by ‘phone or online, can be more convenient than having to physically attend an appointment and can also make consultations more accessible for people who find it difficult to travel, or would need to travel long distances – for example when specialist care is not provided close to them.   They can also minimise risk for people who might be at risk of cross infection, for example cystic fibrosis and during some cancer treatments.

Working with services and health professionals to determine which technologies work best for each individual, means that people can use the technology to take more control of their own health and care.

Read Michael Seres’ article in the Guardian arguing that patients are ready for technological change, and the NHS needs to catch up.: Why can’t patients receive blood results via text or use Skype for appointments.
The health professional and service perspective: cost effectiveness, improved outcomes, and reduced service utilisation
A number of successful projects have shown that, when well implemented, Technology Enabled Care Services have the potential to improve outcomes, reduce service utilization and associated costs.

By saving on travel time, tele-consultations can potentially allow health professionals to hold more appointments with people they would otherwise have to visit in their homes.  Teleconsultations also avoid the risk of cross-infection for patients.

Self-monitoring can reduce the number of appointments an individual needs, but can also allow data to be taken more frequently.

The largest example of telehealth is the Whole System Demonstrator randomized control trial launched in 2008, which provided telehealth services to some 3,100 patients in three parts of England (with a further 3,000 in the control group). The participants had been diagnosed with COPD, heart failure or diabetes. Recruitment of these patients and installation of equipment took 17 months, after which the trial was monitored for 12 months. The results showed that telehealth:

delivered significant reductions in mortality (a 45 percent difference in mortality);
reduced emergency admissions by 20 percent;
led to 14 percent fewer elective admissions and 14 percent fewer bed days.
The overall costs of hospital care were £1,888 less than those for the control patients (which was not statistically significant).

Differences in hospital use were most marked at the start of the trial when there was a distinct rise in admissions of the control group (which arguably could have been due to increased awareness by patients and/or clinicians).

Other smaller scale examples which have shown a positive impact on service utilization include:

Airedale, West Yorkshire:  In Airedale, West Yorkshire, care home residents have quickly embraced an initiative that gives them the opportunity to tele-access clinicians from the local hospital over a secure video link.  A reduction in local hospital admissions of more than 45% has been reported among that group of people.

Harrogate District Hospital – Introducing telehealth support to patients that have been admitted with six key conditions – pulmonary embolism, atrial fibrillation, headache, hypertension, pneumonia and urinary tract infection –has enabled patients to be discharged earlier, allowing them to be monitored from home during the “risk period”.  It has also greatly reduced the workload for local GPs, helping to cut time and costs.  The Hospital also reports that it is hugely beneficial for the patients, as it empowers individuals to self-manage their conditions and eliminates the distress associated with unnecessary hospital stays and lengthy follow-up appointments.  Read more about telehealth in Harrogate District Hospital.

The ‘system’ perspective:  National policy and guidance
National policy and guidance are increasingly driving the implementation of digital health, both through specific projects and programmes to promote their use – such as NHS England’s own Technology Enabled Care Services (TECS) programme – and through the promotion of TECS as a key tool in enabling other aims to be achieved.

Relevant policy and guidance includes:

The Five Year Forward View

The mandate

The TECS programme

Framework for Action
The Five Year Forward View
Better use of technology and data is increasingly being promoted as a key tool in supporting and enabling the developments needed to reshape the health and care system in response to the Five Year Forward View.  Aspects of The Five Year Forward View that TECS can support the NHS to achieve include:

Targeted prevention through the continuous remote monitoring of vital health signs which can detect a downturn in the patient’s health before it becomes a serious exacerbation.
Empowering patients and supporting people to manage their own health by giving them access to real-time data.
Supporting the delivery of new models of care that are coordinated around patient need and combine their physical health, mental health and social care needs.

Read more
The Mandate
The Mandate from the Government to NHS England April 2014 to March 2015 tasked NHS England with making ‘significant progress towards three million people with LTCs being able to benefit from telehealth and telecare by 2017’.

Read more
The TECS programme
NHS England’s Technology Enabled Care Services (TECS) programme supersedes the 3 Million Lives campaign and is focussed on delivering a set of practical tools and resources on how to commission, procure, implement and evaluate so as to maximise the value of these types of solutions and services.

Read more
 Framework for Action – Personalised Health and Care 2020
The National Information Board’s Framework for Action – Personalised Health and Care 2020 sets out what we can start doing across the system to create the conditions for local organisations to make better use of information and technology. TECS supports a number of the proposals set out in the NIB framework, including:

Enabling individuals to make the right health and care choices through supported self-care, and telecoaching and self-care apps that support behaviour change.
Giving care professionals and carers access to all the data, information and knowledge they need – through real-time digital information on a person’s health  status.
Supporting care professionals to make the best use of data and technology – by supporting members of the health, care and social care workforce to develop the knowledge and skills to embrace the opportunities of information.
Assuring best value for taxpayers – by encouraging the use of technologies that reduce the cost and improve the value of health services.

Read more about the policy context in the NHS Commissioning Assembly’s Technology Enabled Care Services: Resource for Commissioners.

Back to overview of National policy and guidance
The changing environment: facilitating digital health
The potential to achieve real benefits through the implementation of digital health technologies is being driven by the wider environment in which health services are working.  Key changes include the increasing access to these technologies, the skills, knowledge and ability of patients to use them, and the investment in developing digital health being made by the commercial sector.

There is increasing access to the technology that facilitates digital health
The installation of high-speed broadband services into homes and businesses across the country, and the spread of 4G services, continues apace. By 2020 there will be a significant increase in the percentage of over-65s who have smartphones and access to broadband.  As a result, a growing number of older people, or those that are going to become elderly over the next decade, will have access to technology and data services in their own homes and on the move, and be enthusiastic and expectant users.
People are ‘tech savvy’ and already using technology to support their health and engagement with health services
In April 2015, more than 184,000 appointments were booked and nearly 50,000 cancelled online, and more than 406,000 repeat prescriptions requested. It is not only the “tech generation” which is using the service – more than a quarter of patients are over 55, and the oldest user, at the Bilston Health Centre in Wolverhampton, is 91.As well as being increasingly adept in managing their health at the touch of a button or screen, patients are also becoming health information experts via online information portals such as  In the past two years, the number of monthly visitors to this site has nearly trebled, from 6 million to 16 million. Patients use it for authoritative advice written by qualified UK doctors, for online wellness tests such as MyHealth and to engage with expert patient forums for a variety of conditions. 
The commercial sector is investing in developing technology to support health careThe National Information Board, in its report Personalised Health and Care 2020 , outlines how commercial sector investment in technology services for the health and care system is growing.  Recognising both the scale of the UK and global health and social care market, institutions and companies are investing in developing technology and data-enabled services focused on health and care.  The immediate targets are ‘healthy lifestyle’ services, often combining wearable devices with remote biometric data analysis, the results of which are interrogated on a smartphone.  This architecture is readily transferable to the management of long term conditions and mental health.

Irrespective of what path is followed by the NHS and social care system, these developments will proceed rapidly, driven by investments made by the commercial sector.  Work is needed at both national and local level to ensure that developments driven by the commercial sector respond to the values and goals of public policy.

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