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Health Services: Pilot Schemes

Volume 472: debated on Thursday 21 February 2008

To ask the Secretary of State for Health (1) for what reasons his Department's Whole System Demonstrator project sites in (a) Newham, (b) Kent and (c) Cornwall did not go live in accordance with the expected timetable; and when he expects each such project site to begin providing services to patients; (183559)

(2) what the (a) target population and (b) evaluation criteria are of the Whole System Demonstrator project sites in (i) Newham, (ii) Kent and (iii) Cornwall;

(3) what the (a) titles and (b) dates of all documents held by his Department are which concern the (i) planning and (ii) implementation of the Whole System Demonstrator pilot sites in (A) Newham, (B) Kent and (C) Cornwall; and if he will place in the Library a copy of each such document.

The Long Term Condition Whole System Demonstrators (WSDs) promised in the White Paper “Our Health, Our Care, Our Say” are exploring the effectiveness of telehealth and telecare in supporting integrated care for those with complex health and social care needs.

The demonstrators involve the provision of integrated care supported by telehealth and telecare to thousands of individuals over a two year period. The demonstrators are charged with determining the business case for the effectiveness of this model of care. This is being facilitated by the development of a robust independent evaluation drawing upon relevant academic expertise.

The development of the evaluation methodology, in conjunction with the three sites, has been complex and a number of research design and operational issues have had to be addressed. However, since a randomised control trial provides an unbiased, balanced, and reliable method for determining whether the complex intervention is effective we have allowed more time for the evaluation methodology to be developed than originally planned. There has also been a requirement for review by a multi-site research ethics committee. We have delayed launching services on a large scale until the evaluation methodology is approved because we want each installation to contribute to the knowledge base we are generating.

Our revised timeline has the evaluated roll out of WSD services commencing in April 2008.

The three WSD sites will be subject to a single evaluation and as such the target population and evaluation methodology is common across all three sites. It is essential to clearly define the target population for the WSD programme so that the results of the detailed evaluation can be set in context. The criteria proposed for individuals in the trial is as follows:

individuals with health care needs of any age who are at risk of current or future hospital admission, due to at least one of the following conditions: heart failure, chronic obstructive pulmonary disease or diabetes. The detailed severity criteria is defined using quality outcome framework indicators.

individuals with social care needs aged 18 and over who:

are currently in receipt of, or considered to have a need for night sitting;

receiving seven or more hours per week of home care or 3.5 or more hours per week of home care plus a meals service (defined by individual not household);

receiving one or more days per week of day care;

have had a fall or who are considered at high risk of falling;

a live-in nearby informal carer facing difficulties carrying their current burden of responsibilities; and

cognitive impairment/confusion people fulfilling this criterion who are unable to provide written informed consent and do not have a primary informal caregiver available or an advocate will not be approached to participate in the questionnaire study.-

individuals with both health and social care needs as defined above.

The evaluation has been designed to assess the impact of the addition of telehealth and telecare in an integrated care setting on:

patterns of health and social care utilisation;

user reported quality of life, independence and psychological well-being;

carers' quality of life;

practitioners working lives and relationships with patients/service users;

clinical effectiveness; and

cost effectiveness of care.

The WSD sites are being supported by the Department, and their project management partner KPMG, to ensure that each site manages to the principles outlined by the OGC's Managing Successful Programmes (MSP) guidance. All the sites have a requirement to produce and manage a consistent set of programme documentation. Each site has a dedicated WSD team and reports to the Department with a weekly flash report and a monthly progress report.

A comprehensive list of planning and control documentation has been produced by each site. The nature of such documentation is that it evolves over the lifecycle of the programme and so there are multiple versions of many documents that reflect this evolution. For each of the three programmes, and their associated sub-projects, there are for example project initiation documents, project plans, risk/issue and dependency logs and communications plans.

The planning documentation contains commercially sensitive information and so it would be inappropriate to place the information in the Library.