By John Woolham
When the Department of Health (DH) published its Building telecare in England guidance in 2005, there was some concern about the strength of evidence behind this policy. To settle the issue, it commissioned a major study – the Whole System Demonstrator Project (WSD).
The research team working on this study randomly allocated 2,600 people from over 200 GP practices in three local authority areas into two groups: one which received telecare as well as ‘traditional’ care, and one that received care but not telecare. The study recruited people receiving a minimum level of social care service (or those considered as needing it) including people with mobility problems, a history of falls or at high risk of falling, or who had impaired capacity with a live-in or nearby carer or a carer who was deemed to face difficulties.
They followed up these two groups after 12 months to find out if telecare produced better outcomes for those who received it. At the time, evidence from earlier project evaluations of telecare preceding the DH guidance had all suggested that telecare could play a major role in supporting continuing independence, helping to avoid unnecessary hospitalisation or permanent admission into care. There was, perhaps, a general expectation that the WSD research would ‘seal the deal’ by validating the policy.
Outcomes no better
This didn’t happen. The WSD concluded, in 2013, that telecare didn’t produce better outcomes for people who used it. It found no statistically significant differences between the two groups in terms of mortality, proportions admitted to permanent residential or nursing care, number of weeks over which domiciliary social care was provided, and numbers of inpatient admissions – either elective or emergency. It also found no differences in respect of length of in-patient hospital stays, or the number of contacts with GPs. Finally, no difference was found between costs of hospital, social care and general practice.
These findings were published when adult social care departments faced unprecedented budget cuts. Many had already set up telecare services and invested heavily in telecare based on the premise that it offered better and more cost-effective outcomes. To-date, there’s little evidence they are scaling back on telecare due to WSD findings, and some evidence for significant investment. For example, in 2014, Hampshire council agreed to invest £20.7m in telecare over the following five years.
Indeed, the WSD findings largely seem to have been ignored. All of this is rather troubling to anyone supporting evidence based, or informed practice or policy development. If telecare doesn’t work, then why are council adult care departments still using it?
A research team led from the Social Care Workforce Research Unit at King’s College London are currently exploring this issue in the UTOPIA study, funded by the School for Social Care Research. This study is trying to find out what local authorities want to achieve from using telecare, the things that promote and hold it back and how it’s actually used.
The research team has already interviewed telecare managers in a sample of 25 local authorities and gone back to four of these to interview other people involved in assessing, installing and responding to telecare. The final stage of the study is an online survey to all telecare lead managers in England. This survey is currently ‘live’ and all English local authorities are invited to take part. The link is here.
If you’re reading this and you’re a local authority telecare lead manager, or you know someone who is, and your local authority hasn’t yet completed this survey the research team would really like you to do so! The findings from this research will be made available to local authorities and it is hoped that they will contribute to the more effective use of assistive technology and telecare.
John Woolham is senior research fellow at the Social Care Workforce Research Unit, King’s College London. His email is firstname.lastname@example.org