NHS Operating Framework 2009/10 prioritises telecare for older people
The NHS Operating Framework for 2009/10 provides an overview of the priorities for the NHS over the coming year, underpinned by the primary care trust (PCT) revenue allocations for 2009/10. So what did it say and what are the implications for telehealth and telecare?
The Framework uses three tiers of ‘vital signs’ with Tier 1 being national ‘must do’s’ that apply to all PCTs. Unsurprisingly, these have concentrated on the major health issues in the news today including waiting times, tackling hospital acquired infections, and patient and staff satisfaction. Maintaining health and reducing health inequalities through a focus on improving prevention is a core priority, including specific targets for improving cancer and stroke services, maternity and neonatal services, child health and obesity.
Specific priority is given in the announcement of a new prevention package for older people that will ‘initially improve falls and fracture services, foot care, intermediate care, telecare and audiology services, with the aim of enabling older people to live longer, healthier and more independent lives’ (Section 2, Para 34, emphasis added). The package is not defined but ‘will evolve’ with new enhancements added over time.Tier 2 priorities – areas where PCTs are required to focus attention but can determine locally how they deliver improvements – the guidance instructs that progress (to be based on recent and upcoming national strategies) must be made in the following areas:
people with learning disabilities
services for military personnel
people living in vulnerable circumstances.
There are no other mentions of telecare, telehealth, telemedicine or assistive technologies in the Framework, but it is clear that prioritising dementia care will involve renewed investment in such innovations (as we will soon report in our review of the National Dementia Strategy). Similarly, the core priority of improving prevention is likely to encourage PCTs to use data that help to identify at-risk individuals and to support home-based care through case management and the technology-assisted remote management of patients.
Tier 3 priorities are those that are locally selected priorities, often developed in partnership with local authorities and practice-based commissioners through Local Development Plans and Local Area Agreements.
It is clear that the Framework supports Lord Darzi’s assertion that the NHS has not realised the full potential of new technologies. But it is, perhaps, surprising that the development of new approaches to long-term conditions management – so prevalent in Darzi's vision for developing primary care through creating individual care plans and personal budgets – is confined to older people in general and dementia in particular. Indeed, The King’s Fund’s analysts argue strongly that the Darzi review and the Operating Framework 2009/10 are policies that sit side by side, but are not integrated in any real sense. Moreover, given the breadth of the agenda handed down in the Operating Framework, one wonders whether PCTs will have the energy, capacity and resources to pursue such local priorities?
Nick Goodwin is Senior Fellow at The King’s Fund and co-project lead for WSDAN