We have conducted a feasibility study to establish whether ENT tele-endoscopy would be a suitable method of service delivery for patients who live in the Shetland Islands. Ten clinics were conducted over a period of 17 months using ISDN-based videoconferencing at a bandwidth of 384 kbit/s. A total of 42 patients were seen in Aberdeen via videoconferencing for a head and neck cancer assessment. Feasibility was confirmed after the first 20 patients, following positive feedback from all concerned and the absence of any significant clinical or technical problems. A total of 42 journeys was avoided, each journey saving 123 kg CO(2) per person. A preliminary cost analysis showed that the threshold at which tele-ENT became cheaper than travel was a workload of 35 patients/year. The actual workload during the pilot study was 29 patients/year. A national telemedicine service for the initial assessment of potential malignancy has the potential to reduce unnecessary transfers to specialist centres, with accompanying reductions in carbon emissions.

Neurology consultation using VL is safe and effective as well as acceptable, and the necessary skills were acquired rapidly by a telemedicine-naive neurologist. Telemedicine using VL can contribute to waiting list reduction, and is likely to be most useful in rural areas.

Hall, Jenny et al 2016 Technology Enabled Care (TEC) Introduction: Public service reform in Scotland is focusing on prevention and early intervention with the aim of breaking cycles of inequality and poverty. Public bodies are expected to play a full part in delivering these improved outcomes with leaders and their teams working collaboratively across organizational boundaries to ensure that services are shaped around the needs and demands of individuals and communities.The Scottish Government's 2020 Vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting.NHS Highland health board in Scotland covers an area of over 32,500 square km. With a population of 320,000 it is one of the largest and most sparsely populated Health Boards in the UK. NHS Highland care home places for older adults are provided by care homes owned and managed by a mixture of local authority/health board, private organisations and the voluntary sector. In the care home sector improved outcomes for individuals are expected to come about by preventing adverse situations through the use of anticipatory care and planned care models.Latest care home census data indicates that close to 57% of care home residents in the NHS Highland area are affected by dementia (both medical and non-medically diagnosed). Access to specialist psychiatric expertise for staff and for residents affected by dementia presents challenges in this rural context due to long gaps between consultant visits and the anxiety and stress related to travel to secondary care for appointments in between consultant visits. TEC psychiatric clinics have been introduced to address these challenges.Practice Change Implemented: Nurse led TEC older adult psychiatry clinics were introduced in three rural care homes in NHS Highland with the aim of providing improved access to psychiatric care services, reducing unnecessary admissions, reducing antipsychotic use for people with dementia and improving the management of behavioural and psychiatric symptoms of dementia.Hall; Technology Enabled Care (TEC) provision for the care home sector in the Scottish Highlands: video conferencing in care homes.Stakeholder groups involved in the psychiatric clinics included the service provider (NHS Highland), technology enabler and facilitator (Scottish Centre for Telehealth and Telecare, SCTT), care home managers and staff, care home residents/family members, occasional care home users (day care and lunch clubs) and other wider community users such as GPs, social workers, hospital consultants, pharmacists, community nurses.Key Findings and Highlights: The direct impact on residents has been quicker assessment, treatment review and regular monitoring. Residents and family members believe that it is more responsive to their needs.

Introduction: With an estimated 4000 people currently living with dementia in the Highlands of Scotland and predictions of a 100% increase in incidence in the next 20 years, there are significant challenges facing NHS Older Adult Psychiatry services and Care Home providers. Geographic dispersal and rurality add to the difficulties of providing a community based, quality service. Creative and innovative responses require to be found to meet these increasing demands. When patients were reviewed face to face there were no occasions where the assessment and/or management plan made during the video conferencing was found to have been inaccurate. This level of input without utilising telemedicine would involve a significant amount of time travelling for staff and high travel costs. There is the added benefit of a reduction in carbon emission by reducing the number of journeys from the base hospital to the care home. Conclusion: Technology such as video conferencing can be used successfully with the elderly, even those living with moderate to severe dementia within a care home environment, to improve access to treatment, improve patient outcomes and reduce costs.

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