Nick Goodwin: Can we justify the investment in telehealth and telecare?

Nick GoodwinLast week The King’s Fund hosted the International Congress on Telehealth and Telecare to a packed audience of 350 delegates with another 1600 from 59 countries watching remotely. The main attraction was some early findings from the Department of Health’s Whole System Demonstrator (WSD) Pilot Programme – the largest cluster randomised control trial (RCT) of telehealth ever conceived.
To the disappointment of some of the delegates, early DH insights into the findings were thin on the ground. Trial results were, however, reported as “encouraging,” including reductions in hospital admissions for people with COPD and a positive trend in the overall impact on system cost effectiveness.
More detailed findings emerged outside the main congress hall. Positive experiences were reported from the three localities in which the field trial was conducted:  patients, carers, nurses, and family practitioners reported positive experiences in using telehealth in Newham; in Cornwall it was reported that the technology worked safely, protected privacy and had developed good interoperability between the different e-health applications and data sets; in Kent, telehealth was thought to have been particularly beneficial in relieving the burden on carers, with the locality keen to roll out the approach.
But was such a large scale evaluation necessary to support the need for telehealth and telecare? International delegates at the congress were somewhat startled at size of the investment in the WSD Pilots – more than £31 million – of which about 12% went on the evaluation itself. Whilst the WSD trial was seen as ground breaking, doubts were raised as to its overall value and to that of RCTs in general: they are expensive and time consuming; they remain contextually specific and therefore difficult to generalise to other regions and countries, and the research evidence produced will soon be out of date due to the fast moving nature of technological innovation.

The conclusion I reached is that research and evaluation needs to be much more closely aligned with innovators and decision makers to enable them to utilise the best available evidence in “real-time.” Traditional research and evaluation studies are not conducted to facilitate such rapid knowledge transfer and those at the “coal face” of delivery rarely listen to it when it comes. New methodologies and approaches are needed and this will only come to fruition through better co-operation between scientists, professionals, product developers, and policy makers.

The evidence base is essential to support the effective transition to a new way of working, but its limitations can too often be used as an excuse to do nothing.  The time for system redesign is now.

Nick Goodwin is a senior fellow at the King’s Fund.

This blog also appears on the King’s Fund website at