Telehealth to reduce compound pressures on the NHS and Social Care

Background: Mersey Care NHS Hospital Trust operates in an area of high deprivation. It s Telehealth Hub is one of the largest of its type in UK and Europe.

Mersey Care are considering expanding the telehealth service to mental health services, in alignment with the 2023/24 NHS Priorities and operational planning guidance.

Roll-out of a telehealth service for mental health has the potential to improve the integration of both physical and mental healthcare, to reduce NHS and social care pressures, but evidence of its effectiveness is inconsistent.

Aims and Objectives: We propose to evaluate the currently implemented Mersey Care telehealth service intervention against standard care not using the service.

We aim to gather evidence on the effectiveness and cost-effectiveness of telehealth care for those with long term health conditions, and on key components influencing effectiveness, uptake and impacts across socioeconomic and other marginalised groups.

Approach: We will address our aims through four research questions (RQs): RQ1: Does the telehealth service lead to reduced unplanned health care utilisation and how does this vary by sociodemographic group and service delivery type?

To address this question, we will apply quasi-experiment methods using CIPHA, a unique data platform of linked records of all 2.9 million people registered with a GP in Cheshire and Merseyside.

This will enable us to compare healthcare utilisation in an Intervention group of all patients who used the telehealth service who have diagnosed long-term conditions with a control group from within Mersey Care with similar health characteristics who did not receive the telehealth. Our primary outcome will be unplanned emergency hospital admissions.

RQ2: Do telehealth patients report improvement in quality of life, mental health, satisfaction and wellbeing, and how does this vary by sociodemographic group and service delivery type?

Using a prospective group of 2000 patients, we will analyse patient reported data collected at week 1 and week 12 after starting the telehealth service, through a patient survey investigating mental health, wellbeing, and patient satisfaction. RQ3.

What are the barriers and enablers for the effective delivery of the service from the perspective of staff and patients?

Interviews with patients using the service will investigate benefits, barriers and enablers, and potential areas for improvement. Telehealth service staff will contribute views on providing the service and on potential service expansion. RQ4 – Is the service model cost-effective?

We will conduct a cost-utility analysis using quality of life data (RQ2), service costs and information relating to emergency service use (RQ1).

We will develop an economic model that considers health outcomes, health and social care service use, informal care costs and cost of resources.

Anticipated Impact and Dissemination: Results will be shared with Mersey Care Executive, Digital and Operational boards, and other relevant NHS structures.

Wider dissemination will encompass national forums and NHS England to inform future policy, practice and service development; peer-reviewed publications. A plain language summary will be published in newsletters on websites.

Patients, healthcare professionals and the NHS will benefit from important evidence informing expansion of telehealth care in the wider NHS.