22. Telecare in the community
Resolution submitted by the RCN Ethics Forum
That this meeting of RCN Congress supports the implementation and use of telehealth services in the community for patients with chronic long term conditions
Report on this debate
June Clark, Chair of the RCN Information in Nursing Group, proposed this resolution and gave examples of the way that technology is currently being used to transform health care in the community. She added that a massive programme of education is needed to support the implementation and use of technology in health care, saying "new skills needs new ways of working."
Paul Wainwright seconded the resolution saying that patients with long-term conditions could benefit from telecare, giving them independence and improved quality of life.
Bernadette Medcalf, warned that the data on which nurses will base their decisions will only be "as good as the people who input it."
Bryan Williamson also expressed reservations, saying there is a danger that resources will be diverted from existing, effective services.
Many delegates thought that telecare was the way forward for community nursing. Kathy Moore supported the resolution saying telecare is a valuable resource to assist with the independent living agenda, but no substitute for face to face nursing.
Maria Bryson works in e-health and says "technology is there to help you" and that it "doesn’t and never will take the place of nursing."
June Clark replied to call on nurses to adapt and change to people’s and society’s needs and to integrate technology into daily practice.
| For | 284 | 94.98% |
|---|---|---|
| Against | 15 |
5.02% |
| Abstain | 2 |
| For | 112 |
85.5% |
|---|---|---|
| Against | 19 |
14.5% |
Background
There are 17.5 million patients across the UK with chronic long term conditions. An ageing UK population looks set to have a major impact on the number of patients using services, and the nature and cost of health and care required. In nursing resource terms, moving care into the community is not necessarily cheaper or more efficient. Added to which, the anticipated shortage of community nursing services, and the lack of informal and voluntary carers, make current strategies for care in the community unsustainable.
The rapid development and deployment of new health and social care that harnesses the potential of telecommunications technologies, such as the provision of remote care at home (telecare), is evident across the UK. ‘Telehealth solutions’, the generic term used for remote health care provision, can offer effective treatments for some conditions and improve the management of others, offering gains of independence, autonomy and quality of life for those with chronic long term conditions. Telehealth may also help curtail the escalating costs associated with the care of patients with chronic conditions such as diabetes, heart failure, hypertension, asthma, epilepsy and mental health problems, and thus divert NHS funding to other sections of the population.
Investment in telecare solutions has been limited and uneven, with different strategies deployed across the UK. The Welsh telecare development strategy, launched in October 2005 is currently supported by funding of £37.6 million, whilst a more modest £8.35 million of telecare start-up funding was made available in 2007 by the Scottish Executive. Northern Ireland, for its part, will see further development of the European Centre for Connected Health, which will take forward the introduction of new technologies as a means of caring for people with long-term conditions. In England, the Department of Health has allocated £80 million funding through its Preventative Technology Grant ― small in comparison to the £23 billion programme of investment for Connecting for Health.
Technology should not be seen as a means of shoring up inadequately resourced nursing services, or as a substitute for the ‘live’ nurse-patient relationship, but as an effective tool to support nursing practice; care should always remain needs-led and not technology driven. Telehealth should thus be introduced at the right time, to the right people and by using the right means.
The RCN has recently established an e-Health Programme Board to examine the impact of new technologies on the provision of care services across all UK health and social care environments. The Board will commission and support ongoing work to ensure RCN members have access to the right resources, policies, guidance and learning opportunities to enable them to continue to provide optimal care in a modern and technology-enabled health care service.
Using technology as a core element in the delivery of person-focused health and social care will bring to the fore ethical issues ― particularly with regard to resource allocation and nurse-patient relationships ― that are the concern of every member. An informed debate at Congress will position the RCN and its members at the forefront of this important agenda.
References and further reading
NHS Wales (2007) Informing health care: information technology at the heart of patient care: implementation planning, Cardiff: NHS Wales. Available at: www.wales.nhs.uk/ihc (Accessed 31 January 2008) (Internet).
RCN Telecare electronic newsletter is available from: www.rcn.org.uk/information/telecare (Accessed 31 January 2008) (Internet).
Scottish Government Telecare in Scotland Joint Improvement Team website is available at: www.jitscotland.org.uk/action-areas/themes/telecare.html (Accessed 31 January 2008) (Internet).