'Telehealth' - Where and how would it work best?

[Iain King]

Without a doubt. I've spent most of the last c.10 years using forums, and have found them extremely useful - hence the reason I've posted on here to get people's views.

I don't however have total control over anything additional to the Telehealth equipment, but I can most certainly suggest we take something such as this forward.

 

[sugarless sue]

It would be helpful if new diabetics were given a leaflet with several different forum addresses on it as mostly,the advice is to look at the 'official' one.

As you may have seen from reading this particular forum we do not fall into line with 'traditional' thinking on diabetes and neither do many of the other forums on the net.

Giving this information out would help new diabetics to find what will work best for them and ,if they can get their diabetes under control,would ultimately save the NHS a lot of money.

 

[goji]

I used to manage care services for vulnerable people in an area where there were constant drives to cut budgets. Several years ago, social services managers became enthusiastic about promoting the use of Telecare and offered us all kinds of grants to take up the services.

It turned out that once Telecare was in place, social services' plan was to cut the number of staff to dangerous levels. Telecare would have been used as a substitute for appropriate levels of staffing rather than an adjunctive service. Managers claim to have the 'patients' best interests at heart' but really the bottom line is the budget target.

Surely a better solution to demand and supply problems would be to cut out several levels of PCT management and spend the money on training up more doctors and nurses who can spend face-to-face time with patients?

 

[Iain King]

Goji,

I truly don't believe that the introduction of Telehealth would provide a mechanism for the reduction in the number of staff; however I do believe there are a number of people who fail to look at the larger picture.

Whilst management for the sake of management is pointless, while there are improvements to be made to the NHS, management will be vital. That's not to say that clinical staff are going to suffer because of this, or that clinical knowledge is irrelevant.

The simple fact is that if we don't have NHS managers, nothing will change in the NHS; and for everyone to continue to receive care even to the level they currently do, we are going to need managers to drive efficiencies.

If we cut managers out now, you would find that instant cash burst to bring in some new clinicians; however, it's a bit like the proverb "Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime". Whilst we would be providing more staff on the frontline, we would not be strategically planning for the future. If the NHS continues the way is has done, it quite simply will go bust; thus NO care would be provided to patients, which would put everyone in a worse situation. That, or we continue the NHS as it is, and taxpayers will presumably be forced to pay more taxes to cover the costs of the NHS.

The plan for Telehealth would never be the reduction of staff. It prioritises the workload of the clinicians, by providing information via the Telehealth systems. It also provides an educational package to patients, which is hoped would increase knowledge and confidence with the condition, thus increasing the benefits to the patients two-fold: They feel confident with their condition, and don't visit hospital as much; and the money saved from reducing emergency admissions goes straight back into developing NHS services further; improving the NHS for everyone.

I'll go back to Cugila's comment: "Would you like to run your car without a speedometer, fuel gauge, oil and water gauges ??" - This is exactly what the NHS is now doing. They've realised that in order to keep going and not 'breakdown', we need to monitor, we need to improve, we need to look at new ways of working, and potentially in some areas, break the traditional mould for services which could easily work far more effectively on the same or possibly even less money.

I'd love to hear your views on how Telehealth could work.

 

[Sid Bonkers]

I'll go back to Cugila's comment: "Would you like to run your car without a speedometer, fuel gauge, oil and water gauges ??" - This is exactly what the NHS is now doing. They've realised that in order to keep going and not 'breakdown', we need to monitor, we need to improve, we need to look at new ways of working, and potentially in some areas, break the traditional mould for services which could easily work far more effectively on the same or possibly even less money.

Absolute garbage and spin.

What you need to keep your car running is a mechanic, and what you need when you are ill is a nurse or a doctor, not a manager.

All the time the NHS continues to employ 1000's of managers that are paid more than consultants but who save money rather than lives the NHS will continue to go down hill.

You've got nerve I'll say that for you, to come on a forum with 17000 critically ill people and try to say you are working in our interests. If you want us to believe that how about test strip prescriptions for all diabetics and more front line staff trained to advise and deal with diabetics.

What we don't need is to be sent off with a phone number to call for advice from some faceless telephone script reading school leaver. That's if its possible to get passed the recorded option messages or stand listening to the background musak whilst waiting 15 minutes for the call to be answered by a real person

 

[Iain King]

Sid,

I could provide a response; however I can see where I'm not welcome. So with that, I'll continue to view the forum (if that's OK), but I'll refrain from posting. I would still like to learn within a personal capacity.

I would like to add, that you have the wrong impression of both NHS managers and Telehealth. I'd like the chance to show why; so please feel free to contact me via PM. In addition, if you would like a response to your post, I'm more than willing.

 

[Sid Bonkers]

Please don't let me stop you from posting Iain, I just gave my opinion to your posting and I would be amazed if my opinions are shared by everyone on this board.

I apologise if my comment that you "had a nerve" seemed a little aggressive. I don't know you personally and my rant was not meant to be directed at you personally more at a system that I disagree with.

It was just a rant that is not going to change anything, I realise that hospitals will continue to be 'managed' despite what I believe, so if I can influence your management decisions in some way then so much the better, but I cant do that if you stop posting.

I will try to be more constructive in the future if answering your posts.

How many carbs in humble pie?

 

[Iain King]

'Cooks.com' turned up the following recipe for Humble Pie. It doesn't state carb content, but you may be able to work it out from the below.

3 eggs
1 stick butter, melted
1 1/2 c. sugar
2 tbsp. flour
2 tbsp. vinegar
1 tbsp. vanilla
1 unbaked 9 inch pie shell

Preheat oven to 300 degrees. In a medium bowl, combine eggs, butter, sugar, flour, vinegar and vanilla. Blend well. Pour mixture into pie shell. Bake for 45 minutes.


Now, onto the thread in hand... I'll go through your two posts, and see if I can provide a response to some of your questions/statements.

Absolute garbage and spin.

Whilst I agree there is some of that in every sector; especially the public sector, and partly in the NHS; that's not what I'm doing. As I said before, I'm here to learn for my personal experience; albeit it ties in to my career. Unfortunately the thread has de-railed into a conversation about Managers in the NHS, as apposed to how Telehealth could actually work.

What you need to keep your car running is a mechanic, and what you need when you are ill is a nurse or a doctor, not a manager.

I agree. But your mechanic doesn't monitor your oil pressure/temperature, water temperature, fuel levels, etc. You do this.
It's the same for healthcare. Whilst clincians do monitor your health, in addition to providing excellent healthcare where it's needed, it would be the purpose of Telehealth (alongside other care) to provide the knowledge to people to be able to monitor their own levels, and learn from this.

All the time the NHS continues to employ 1000's of managers that are paid more than consultants but who save money rather than lives the NHS will continue to go down hill.

I truly believe that the NHS is facing an up-hill struggle, but we are going up-hill.
I believe I've already answered this point already in my previous posts, but if you'd like another answer, please let me know. I would however like to point out that I am a long way off being paid what a Consultant is paid!

You've got nerve I'll say that for you, to come on a forum with 17000 critically ill people and try to say you are working in our interests. If you want us to believe that how about test strip prescriptions for all diabetics and more front line staff trained to advise and deal with diabetics.

I was extremely concious that my posting here, without having diabetes, and without being a clinician, may attract some negative attention. I don't believe I have spoken out of turn thus far on the forum; and am fairly confident I won't. As I've mentioned, I can't personally comment on the state of test strip prescriptions; however perhaps in the long term, we will reduce the requirement for the strips anyway, due to a better education for newly diagnosed right from the outset.

What we don't need is to be sent off with a phone number to call for advice from some faceless telephone script reading school leaver. That's if its possible to get passed the recorded option messages or stand listening to the background musak whilst waiting 15 minutes for the call to be answered by a real person

That isn't what Telehealth is. It's a monitoring system where the clinician monitors your health, and calls you; not the other way around. I'm more than happy to answer any questions people have about how the system works.

I apologise if my comment that you "had a nerve" seemed a little aggressive. I don't know you personally and my rant was not meant to be directed at you personally more at a system that I disagree with.

Thank you for the apology. As for the 'system'; I can certainly see how you may have come to your view of managers within the NHS. This is because the NHS is scrutinised by the news on almost a daily basis, and the people providing the news do not truly understand the system. This is then cascaded to the general public, who in turn are dismayed at the state of the NHS and its employment of managers.
In reality, as I've previously mentioned, the NHS will not survive without managers. It will also not survive without clinicians. It will also not survive without everything else that makes up the NHS.

It's not too dissimilar to me saying (for example) that I believe all Police Officers do is try to catch people speeding, because that's where the revenue lies. In reality, that's only a very small part of the operation, but the news pick up on this, and again, it's cascaded to the general public.

If I can give you any more information/answers, then please let me know. I'm more than happy to do this. I would of course appreciate everyone's input to how Telehealth could work in response.

 

[sugarless sue]

Nice answer Ian ,except for this comment!

As I've mentioned, I can't personally comment on the state of test strip prescriptions; however perhaps in the long term, we will reduce the requirement for the strips anyway, due to a better education for newly diagnosed right from the outset.

The best education for any diabetic is self education on how their diabetes affects them.This can only be done by them being able to test and assess what foods in particular affect their blood sugars. If more type 2 's were educated and encouraged to use test strips properly then they could ,potentially ,save the NHS a lot of money in the long run because they would not automatically develop the complications which cost so much to look after.

 

[Iain King]

Sue,

I definitely agree. Prevention is always better than cure (or treatment for conditions where we cannot cure)!

I did add 'perhaps' into the sentence though, to cover myself! I don't know enough (yet) about strips; but I'll try to find out more.

 

[sugarless sue]

If we can convert just one ,Ian ,......maybe you can cascade the info to others and cause a domino effect amongst NHS managers and PCT's.We can but hope anyway!

 

[Sid Bonkers]

Thank you for the apology.

No problemo

As for the 'system'; I can certainly see how you may have come to your view of managers within the NHS. This is because the NHS is scrutinised by the news on almost a daily basis, and the people providing the news do not truly understand the system. This is then cascaded to the general public, who in turn are dismayed at the state of the NHS and its employment of managers.

Whilst I will admit that everyone is influenced by the media to a greater or lesser degree that is not the main reason for my cynicism, my wife works as a lowly paid secretary in a hospital and she hears first hand from doctors and nurses how stretched they are and how they have to reach their targets. Arrr targets, I was referred by my GP to see an orthopaedic consultant due to back pain and associated neuro pain in my leg , now as you are aware all referrals have to be seen within 18 weeks for targets to be achieved. I was seen within 3 weeks and sent for an MRI scan the following week WOW, great service, I was then refereed to physiotherapy for the neuro pain in my leg. Now as I was referred to physio from within the hospital and not from my GP my referral didnt count towards the targets so I waited 9 months for my first physio appointment. Targets are just manipulated to show there are no waiting lists, I know different.

That isn't what Telehealth is. It's a monitoring system where the clinician monitors your health, and calls you; not the other way around. I'm more than happy to answer any questions people have about how the system works.

Now on the face of it that sounds great, but are you not trying to run before you can walk? Read any post from a newly diagnosed diabetic on this forum and you will see how confused and frightened they can be left after their diagnosis. I myself was given brilliant advice from a very knowledgeable diabetes nurse after being diagnosed in hospital, unfortunately I have since heard nothing from her or my GP for the last 6 months. now if these people don't have the time to spend with their patients now, how will they manage when they are given monitoring to deal with as well

It's a monitoring system where the clinician monitors your health

Clinician? will this be like the clinicians who run the swine flu hotline? Apologies again for my cynicism but the swine flu hotline has been a complete farce manned by tele operators with no medical knowledge whatsoever. How are 2.5 million diabetics going to be monitored by an all ready stretched NHS?

 

[Iain King]

Whilst I will admit that everyone is influenced by the media to a greater or lesser degree that is not the main reason for my cynicism, my wife works as a lowly paid secretary in a hospital and she hears first hand from doctors and nurses how stretched they are and how they have to reach their targets. Arrr targets, I was referred by my GP to see an orthopaedic consultant due to back pain and associated neuro pain in my leg , now as you are aware all referrals have to be seen within 18 weeks for targets to be achieved. I was seen within 3 weeks and sent for an MRI scan the following week WOW, great service, I was then refereed to physiotherapy for the neuro pain in my leg. Now as I was referred to physio from within the hospital and not from my GP my referral didnt count towards the targets so I waited 9 months for my first physio appointment. Targets are just manipulated to show there are no waiting lists, I know different.

Now 18 weeks is something completely different, and nothing to do with the improvements that are being sought by the team I work in. 18 weeks is a national, Department of Health, target. Unfortunately there's nothing anyone at a PCT level can do about that, and especially not me (incidentally one of the lowest paid members of my PCT).

Now on the face of it that sounds great, but are you not trying to run before you can walk? Read any post from a newly diagnosed diabetic on this forum and you will see how confused and frightened they can be left after their diagnosis. I myself was given brilliant advice from a very knowledgeable diabetes nurse after being diagnosed in hospital, unfortunately I have since heard nothing from her or my GP for the last 6 months. now if these people don't have the time to spend with their patients now, how will they manage when they are given monitoring to deal with as well

We have just set up a Community Diabetes Team, who are specially trained, and have their whole time assigned to do just this. We're not trying to achieve a quick win with Telehealth; merely complement the work that has already gone in to the Diabetes Service.

Clinician? will this be like the clinicians who run the swine flu hotline? Apologies again for my cynicism but the swine flu hotline has been a complete farce manned by tele operators with no medical knowledge whatsoever. How are 2.5 million diabetics going to be monitored by an all ready stretched NHS?

I can't speak for the entire NHS, but our PCT, as above, has the team to manage the system.
One example (I don't know actual numbers, but that doesn't matter) of how the system could work would be:
5 members of community diabetes team
They see 10 patients per day each. 50 patients in total. Some of these patients may not need to see them, and are doing very well on their own.
So, with Telehealth, they monitor everyone's readings, and work down the list in a priority order, enabling them to see the same amount of patients, but based on those people who need the most attention.
Add to that, people are educating themselves by using the system.

As I've said, it's just an example. This is why I'm here, to ask how it may work better.

 

[Sid Bonkers]

5 members of community diabetes team
They see 10 patients per day each. 50 patients in total. Some of these patients may not need to see them, and are doing very well on their own.
So, with Telehealth, they monitor everyone's readings, and work down the list in a priority order, enabling them to see the same amount of patients, but based on those people who need the most attention.

Hi Iain, it sounds a good initiative in principal and if it identifies the patients most at risk that must be a good thing, I wonder though whether those who 'need the most attention' will be conducive to change and you might be ignoring those who want to actively help themselves.

I wish you good luck though, any help is better than non at all

 

[Iain King]

Hi Iain, it sounds a good initiative in principal and if it identifies the patients most at risk that must be a good thing, I wonder though whether those who 'need the most attention' will be conducive to change and you might be ignoring those who want to actively help themselves.

I wish you good luck though, any help is better than non at all

Actually that's a very good point. I definitely want to make sure that those people who do want to take control are included. I think in the long term, it will be something that is offered to those people when they're first diagnosed, but I'll need to make sure that if people would like it, they can opt in to it at a later stage. I know from personal experience (not with diabetes) that I've been offered something that I don't think I want at the time, but then realise it may be the best thing for me.
You've certainly triggered my thinking about ensuring that happens - thanks!

 

[lionrampant]

You might be feeling a little singled out right now Iain, but rest assured most people do understand that the problem is not one simply of costly managers taking up space. We are caught up in yet another chapter of British* Market Capitalism that started with Thatcher and was adopted by New Labour to sway Middle England to it's cause. The application of market principle and corporatism (not the good kind) to public services has led to improvements in some areas, but devastating failures in others. The availability of testing strips to T2 patients is one example; the closing of diabetic specialist wards, and the use of nurses rather than dedicated consultants to manage patients care are others. I cannot comment on non-diabetic areas, although first hand experience is not necessary to understand why the current system is failing it's most important stakeholders.

One example is the existence of Healthcare Assistants (I think that's the right name) who are subordinates of nurses, and are often directed to engage directly in patient care. We have created a system where many healthcare professionals are seeking a way to move the dirty, difficult or time-consuming jobs on to some peon beneath them. The increased use of nurses as active participants in surgery, as discussed on BBC Radio today, highlights this problem in a very alarming way.

Now I am not an opponent of the NHS. Unlike many Americans, for example, I believe one of the most fundamental principles of a humane and decent society is that everyone has the right to medical care. Even the afore mentioned British version of Market Capitalism (flawed though it may be) recognises that a healthy population is a productive population - although many devotees would prefer the responsibility to lie with private providers. My concern is that in our rush to avoid traditional social democratic values (again the result of the politically admirable drive by the Thatcherite and New Labour to unleash free market forces at every level of society) we are undermining what the NHS is meant to be in the first place.

Now you're probably sitting there thinking, "what in hell does this have to do with my telehealth idea?". Well, while your own personal goals may be laudable the very notion that front line diabetic care and education can be provided via such a system fails to take into account the human factor. People like to be able to be in a room with someone, they like to be able to communicate face to face (literally). It's one of the reasons video conferencing has failed so miserably to be accepted by the general public. And of course the reason it fails to take those factors into account is because it is still being driven, no matter how subtly or subconsciously, by a desire to make the system as productive as possible on paper. Not as caring, not as effective on a human level.

Give people limited resources and soon efficacy is sacrificed for numerical productivity. It's the classic problem within any public body operating under market conditions. It is also paradoxically the same thing that happens under the far left command-economy style systems. Far right, far left, far from perfect.

Again I should stress that this is not an attack on your personally - in fact it is far from it. In my opinion you are simply another victim of the political movement that has brought us all to this point. You no doubt have had great difficulty seeing the part you play within this overall subversion of the NHS' founding principles, and that's precisely why the process is so effective.

Maybe telehealth can work - maybe it can't, I'm just afraid we're approaching all these problems from the wrong angle.

*a very unique experience that is different from all other western and far eastern engagements with such philosophy - unique in it's absolute failure.

P.S. Wow. Too much Red Bull today. :lol: :shock:

 

[chewy08]

I'm too tired to go looking through all my old posts. Have a look back and if you can find a thread by a guy called Martin Buchanan - his son was diagnosed and the adventure that followed was worrying. Or the woman whose daughter was diagnosed at Easter and had to wait months to be taught how to count carbs (er, little vital especially on MDI, no?). Sorry I can't cite specifics threads, too tired :shock:.

Count carbs, ive been diabetic or near 7 years and ive only just been offered the luxery of the that, i had one dietician appointment of which i was given no follow up, and have now had to take it upon myself to get them to give me an appointment,

sorry this is going off the point slightly.

Iain, this sounds like a preety good idea, if it cut down on my trips to the doctors and consultants then gotta be worth a crack surely

 

[lionrampant]

I'm too tired to go looking through all my old posts. Have a look back and if you can find a thread by a guy called Martin Buchanan - his son was diagnosed and the adventure that followed was worrying. Or the woman whose daughter was diagnosed at Easter and had to wait months to be taught how to count carbs (er, little vital especially on MDI, no?). Sorry I can't cite specifics threads, too tired :shock:.

Count carbs, ive been diabetic or near 7 years and ive only just been offered the luxery of the that, i had one dietician appointment of which i was given no follow up, and have now had to take it upon myself to get them to give me an appointment,

And, to quote myself, the hits just keep on coming. :shock: