Julia Manning is Chief Executive of 2020Health.
The Veteran’s Health Association (VHA) is a major part of the Department of Veterans Affairs in the USA, which delivers federal benefits and patient care to veterans of the armed forces. Its mission is “to keep patients healthy”, and to that end, it employs 225,000 staff in 153 hospitals and a number of other centres, delivering healthcare services to about 23 million veterans. In 2010, the VHA’s annual budget for medical care was £30 billion. In 2004, a RAND corporation study noted that the VHA was superior when compared to other American healthcare systems in 294 measures of quality. It is a shining example of universal coverage that has been able to deliver high quality healthcare and value for money. On these figures, if they were running the NHS, the cost to the Exchequer would be just £81bn, a reduction of 26% on current spending.
2020health today launches its latest report: ‘Telehealth: What can the NHS learn from experience at the US Veterans Health Administration’. As debates still rage about Obamacare, and with the US traditionally held up for derision as having a "no credit card, no healthcare" system, the VHA has transformed, spending the last ten to fifteen years implementing Care Coordination with Home Telehealth as an integral element to improve veterans' healthcare, providing “the right care in the right place at the right time.” The initial purpose of the programme was the vigorous control of chronic conditions and post-traumatic stress disorder (PTSD), but it has now been expanded to primary prevention of the above conditions, with for example, obesity management programmes.
It was not a sticking plaster solution. The way people worked, the way care was planned and delivered had to change. It required a new role to be developed in the form of Care Coordinators, who were usually former nurses or social workers, to oversee patients using telehealth. It also required an electronic health record so patients and professionals could access data easily, and patients could learn more about how to look after themselves. The NHS spends 70 percent of its budget on the 15 million individuals that have one or more long term conditions. This number is expected to increase by 23 percent within the next twenty years, due to our aging population, yet it still seems to lack the sense of urgency to meet the rising demand that an extra 3.5million people will create. The “3 million lives” telehealth programme that is being launched today by Health Minister Paul Burstow is an important step forward.
However, the learning from the VHA shows that success will depend on strong, senior leadership; investment in the organisational infrastructure including training; implementation at scale (bulk buying of kit) and an electronic health record. None of these things as yet are in place, nor do we know who will provide them, and there is going to be none of the upfront investment that kick started the VHA programme. The USA (well, Bill Clinton who appointed Dr Ken Kizer to run the VHA, to be precise) have given us an excellent role model for the NHS in terms of scaling up new care management services involving telehealth. We would be foolish to ignore their experience.