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The widespread deployment of telehealth (TH) has been conducted in the absence of any clear understanding of how acceptable these devices are to patients. One potential limitation of the widespread deployment of TH is that patients may refuse. Moreover an understanding of the reasons for refusing to use TH devices will provide an understanding of the barriers.

This investigation from the Whole Systems Demonstrator (WSD) programme, a pragmatic cluster randomised controlled trial into the effectiveness of TH, examined reasons for patients in the intervention cohort of the trial refusing TH, and the potential barriers to its deployment.

Active rejection of the TH intervention was the most frequent reason for withdrawal. After examination of trial-related, health, socio-demographic, cognitive, emotional and behavioural factors, patients diagnosed with diabetes, as opposed to heart failure or chronic obstructive pulmonary disease, and patients’ beliefs about the acceptability of the intervention predicted whether or not they withdrew from the trial because of the intervention.

Beliefs that the TH intervention resulted in increased accessibility to care, satisfaction with equipment and fewer concerns about the privacy, safety and discomfort associated with using TH equipment predicted continued participation in the WSD trial. Findings suggest that potentially modifiable beliefs about TH predict those more likely to reject the intervention. These findings have important implications for understanding individual differences in the acceptance of TH and subsequent success in mainstreaming TH in healthcare services.

In the summer of 1998 the National Health Service (NHS) Confederation in the UK used the opportunity provided by the celebrations marking the 50th anniversary of the NHS to engage in an exercise designed to stimulate thinking about the future of health services in Britain. A key part of this involved the creation of two possible future environments of the NHS. These became known as “the Madingley Scenarios”. In this article, the context of this work is briefly outlined before describing the main drivers that are shaping this environment (technology and information, new power structures, the changing relat ion ship with the living environment, and the effect of social and cultural change). The scenarios themselves are then outlined followed by some reflections on the value of this work in healthcare and beyond.