This 2020health White Paper builds on the previous report Healthcare without walls: A framework for delivering telehealth at scale to explore lessons learnt at the world's largest user of telehealth services: the US Veterans Health Administration (VHA). As a large publicly funded system delivering comprehensive services to a veteran population of 23m and with an annual budget of over £30bn, the VHA has many parallels with the NHS. Extensive studies show that the VHA consistently provides a better quality of care than other health systems in the US, and at a lower cost.

The key recommendations for the NHS outlined in this report include: to achieve the staffing and logistical efficiencies seen in the VHA, the NHS needs to find ways to deliver a step-change increase in the scale of telehealth implementation; those who manage the delivery of telehealth need not be local to the patient but do need to interact closely with the responsible clinician in primary care/community care; telehealth should be established as a centralised care coordination service on a local/regional basis rather than something additive to existing Community Matron, District or Practice Nurse workloads; and targeted patient selection is essential, based on strict criteria of who benefits.