December 2009: WSD Pilot Update: Newham
Newham Whole System Demonstrator Trial
The Whole System Demonstrator (WSD) trial – the largest of its kind anywhere in the world – is responding to the needs of an ageing population and the implications this will have for the future of health and social services. This is reflected in the fact that the health care budget is set to double in the next 15 years.
The two-year trial funded by the< Department of Health aims to provide a national business case to measure the benefits of assisted technologies in the homes of people with long-term health and social care needs. Along with the two other sites, Kent and Cornwall, the Newham WSD trial aims to: 1) help frail and vulnerable people live independently by helping to manage the risks of daily living (telecare), and 2) empower people with long-term conditions to understand and manage their own health (telehealth). Both areas have significant potential to reduce the burden on the UK health system.
The Newham WSD trial is specifically evaluating the impact of telehealth and telecare technology on:
- cost-effectiveness and associated costs for the NHS
- user outcomes and clinical effectiveness
- qualitative studies to determine the experiences of telecare and telehealth users
- organisational factors that may facilitate or impede its adoption and integration.
The London Borough of Newham is one of the most deprived areas in the UK and the second most diverse, with more than 100 languages spoken. Out of a population of 270,442, 8.5 per cent are over 65 and 17.3 per cent have a limiting long-term illness. Newham also has the highest diabetes rate in the UK, as well as the highest death rate from stroke and COPD.
More than 1,500 participants are now involved in the Newham trial; they were identified through patients’ GP and social care records and through the development of eligibility criteria based on careful consideration of local characteristics and demographics. The trial encompasses four clinical areas: diabetes, heart failure, COPD, and the frail and elderly.
One of the main strengths of the recruitment process was the relationship that has been built between local health care professionals and the WSD project team. It was vital that the aims and benefits of the trial, and its importance, were thoroughly explained to people with long-term conditions, health professionals, the NHS and the local community of Newham as a whole. The key to this relationship was gaining the support of patients’ frontline contacts, such as GPs, clinic staff, nurses and social workers.
Another strength of the recruitment process was the organisation of patient data. This continues to evolve through the searching, testing and refining of data, for when the project requires the technology to be rolled out. Informing patients, carers and clinicians has been another positive outcome thus far. Constant communication through each phase of the recruitment and implementation process is the key. Various communications channels were used, including a step-by-step leaflet, product catalogues, a WSD trial website and WSD newsletter updates, to name a few. User involvement events have also been set up in partnership with Newham Age Concern, encouraging participants in the trial to share their experiences with others.
However, our assumption that all those who were eligible would want the technology proved to be the biggest challenge in the recruitment process. There were unexpected user dropouts at every stage. These were due to various factors, ranging from some people not wanting to be reminded of their health condition, to those who claimed they were not unwell enough to benefit from the service. Another challenge was the large percentage of non-English-speaking residents in Newham, given that the recruitment materials were in English.
Challenges aside, the recruitment process was a success. Nationally, there are now more than 6,000 people participating in the WSD trial, and we are already seeing extremely positive results – most notably from the users themselves.
More people are now living with a long-term condition than ever before, so it is important that information and care pathways are integrated to deliver better services, and to develop a business case for their effectiveness so that they can be available for all.
Visit www.newhamwsdtrial.org for more information and user case studies.
Martin Scarfe is Newham WSD Project Director