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Guest blog: Accreditation to the EU Telehealth Code

 

Guest blog: Accreditation to the EU Telehealth Code

Richard Stubbs, ex Newham WSD Programme Manager and currently Telehealth consultant to East London NHS Foundation Trust, reviews the experience of supporting the first organisation to be accredited to the EU Telehealth Code of Practice with Florence and Motiva.

Telescope

Contributing to development

Its been a long journey but East London NHS Foundation Trust’s telehealth service has become the first to be accredited under the EU Telehealth Code of practice.  We learned that we had succeeded with our application on  9th September but kept it quiet so that we could announce at our Trust’s AGM.

Newham has been a test site for the development of the EU Telehealth Code since the first draft was released in April 2012 and has provided ongoing feedback into its development.  Code development within the European Commission funded TeleSCoPE project was led by Dr Malcolm Fisk and Roberts Roze of the Health Design and Technology Institute of Coventry University. The project had twelve partners in Belgium, Bulgaria, the Republic of Ireland, Hungary, Italy, Slovenia as well as the UK.

I helped mainstream Newham Council’s telecare service and was well aware of the value of the Telecare Service Association’s accreditation, but my experience of mainstreaming telehealth services in East London Foundation Trust convinced me that a  different approach was needed. Telehealth is about patient empowerment and support for behaviour change, it is not an emergency service like telecare.  Telehealth can be embedded into the day to day work of clinical staff, as is the case with our Diabetes Specialist Nurses,  and does not necessarily require a dedicated control centre and specialist staff. Our feedback and support for the European Code’s development was mainly to ensure that this wider scope was recognised.

The Code was launched at the European Telemedicine Conference in Edinburgh on 29th October 2013. It provides a robust quality benchmark and is for all countries of the European Union, fitting  closely with the direction set by the European Commission’s eHealth Action Plan 2012‐2020. After the code was agreed DNV –GL, a global organisation that is one of the top three certification bodies in the world, was appointed to undertake the accreditations. DNV-GL has office bases in over 100 countries and in the UK works for the NHS Litigation Authority to deliver risk assessment; standards development and maintenance; and provide education services to NHS organisations in England.

 

Why did ELFT apply?

ELFT is an organisation that is extremely concerned about the quality of its services and the Code provided assurance of compliance with good practice. It provided a stimulus to improve the service and focused attention on areas of weakness. In December ’14 I carried out a review of compliance with the code and of the 54 areas of compliance specified we met 20, failed 22, were uncertain about 8, complied with 3 others apart from web publishing and 1 was not applicable.  In spite of the obvious challenge for ELFT there was a clear requirement to improve the service we offered and we anticipated that there would be reputational benefits that would be of help when tendering to provide telehealth services should we achieve accreditation.

From a personal perspective the challenge of accreditation was satisfying for me. I  have been a consultant for the greater part of my working life, and have specialised in initiating services. The problem for me, as a creator rather than completer, is to achieve sufficient motivation to tie up the loose ends so that someone else has everything they need to take over my role when I move to the next job. The challenge of achieving this accreditation provided the motivation I needed.

 

Our Services

ELFT’s telehealth services are offered by its Diabetes Specialist Nursing Team and its Telehealth Team. The services cater for people with COPD, diabetes, heart failure and hypertension and are based on a step up/step down model. We use the Philips Motiva TV based solution for those at highest risk of hospitalisation who are most often people with co-morbidities; the Florence text based system for those needing active support for their self care; and the Motiva Guide for those who can benefit from a once a month call about their health. All our services aim to support patients learning about their condition and exercising effective self care.

 

The accreditation process

A great deal of work was required. As the first to apply for accreditation, and with no accreditors at the time to give guidance, I decided to fall back on to what I would want to have received in my role as an EC expert assessor. Basically it would be something that would make my job as easy as possible so I decided that we would produce a compliance manual that would quote the individuals in ELFT who had responsibility for policy in all of the areas of compliance.

The production of the manual was far from easy. The telehealth service is provided by what had been the Community Services provider arm of Newham PCT, which had almagamated with East London NHS Mental Health Trust when PCTs had been abolished. As may be guessed the challenge of integrating the policies of the two organisations had been substantial and although a lot of progress had been made there were areas that had not been resolved. I became on first name terms with ELFT’s company secretary as we tracked down and identified who was responsible for all the policies and resolving outstanding  problems relating to them!

Nevertheless by 19th June the Trust’s Telehealth and Integration and Development Board approved a statement that, setting aside web publishing, affirmed that it had achieved full compliance with respect to its telehealth services - though recognising that in two areas it had met the letter but not the spirit of compliance and would work to resolve this. Rather ironically the problems related to the fact that telehealth was so well integrated within services in general that separate PROMs (Patient Recorded Outcome Measures) and PREMs(Patient Recorded Experience Measures) did not exist for telehealth itself rather they were subsumed within those of the services that used telehealth for some of its patients.

The actual assessment visit featured three DNV-GL assessors and Malcolm Fisk as an observer. Although I have never experienced one I am told it was very much like a CQC inspection with management staff interviewed in depth. My confidence that we had all aspects covered was undermined when we were asked “what is our policy on policies?” Fortunately our Associate Medical Director remembered her amusement that such a thing actually existed and we managed to locate it. It was a fair question though such things tend to be seen as “just the way things are done” and the fact that there are policies for them can easily be forgotten.

As both “sides” recognised when going in to the accreditation process it was a learning exercise for both. I thought DNV-GL did a good job and the only thing I was unhappy with was that I had told our front line staff that they should be prepared to be questioned and in practice, due to time constraints, not one was interviewed. I am fairly sure that this won’t happen in future accreditation assessments and have been advised that this has now been firmly built into the standard assessment process.

 

The benefits

A surprising benefit has been clarification of reponsibilities for the service within ELFT. There had been a tendency for general job descriptions, which simply failed to recognise the different roles and expertise required to deliver care remotely. These have now been replaced by clear descriptions of the role and work required to deliver a telehealth service. A major benefit of resolving the issue of job desciption is improved clarity as to training requirements leading to an agreement with City University for us to work together to develop accredited telehealth training that meets our requirements.

The other main benefit for the service so far within the Trust is an Improved web site presence and service visibility. As yet it is far to early to say whether accreditation will result in more work opportunities for the Trust’s telehealth services, but there is already considerable international interest in what we are doing. So we hope that Commissioners locally will be more inclined to look favourably on the telehealth services that we have to offer! Most importantly we are convinced our services have improved in both quality and resilience as a result of this exercise, which will be of benefit to all the patients that we support.

 

Richard Stubbs

richard.stubbs@newham.net