Gadgets don’t care

One of the quaint and sometimes appealing aspects of western
societies like the UK’s are their attempts to picture the future in
“artist’s impressions”. In the 1920s and 1930s, there were
illustrations of women of the future, supported by a battery of new
mechanical aids, able to lounge about with magazines and friends
until their husbands came home, instead of having to toil at
housework. In the 1950s people were given glimpses of themselves
whizzing about the sky in personal aircraft or speeding along
enormous roads, getting everywhere fast. In the 1970s and 1980s we
were portrayed in a new “leisure society”, courtesy of automation.

Now a new image of the future is quietly making itself felt in the
world of health and social care – telecare. The question is, are
its advocates, including the government, on to something genuinely
new and helpful, or could they be getting it as disastrously wrong
as these earlier visionaries?

Telecare is a simple idea. As the government website says:
“Telecare schemes typically involve the use of remote sensing or
surveillance technology to monitor vulnerable people in their
homes, triggering an alert to an external party where there is
cause for concern. Like many simple ideas, though, telecare raises
complex issues.”

It is interesting how much thought and preparation seem to have
gone into telecare. Fact sheets are already available giving
information on telecare and ethics, the independent sector,
governance, risk management and the policy context. There’s an
updating implementation guide. The effort and critical
consideration that have been put into telecare’s development so far
seem impressive.

The fact sheet on user involvement is a good example. It is
strongly signed up to the principles of user involvement and sets
out a checklist of key questions for user involvement at strategic
and operational levels. It contains a clear reminder that local
authorities and health trusts have a responsibility to consult.
Here, though, some warning bells begin to ring. The government has
already signed up for an £80m pilot on telecare, but to the
best of this author’s knowledge, there has been no systematic
consultation with service users or their organisations. Such an
independent user-led exercise urgently needs to be set in
train.

The government cannot be accused of trying to duck some of the
complexities of telecare in its background discussions. There is
serious recognition of the “big brother” potential and “compliance”
issues raised by telecare. That’s not to say these are resolved and
the call for “early discussion with service users” suggested in the
Telecare Implementation Guide makes particularly good
sense.

If telecare is a solution, it is not yet clear who has identified
the problem. The care services minister, Liam Byrne, has said: “It
is not realistic to plan to deliver [social] care support services
in the way that we do at present. We must embrace new ways of
working.” He is right. But in the consultations with service users
that have accompanied the green paper on adult social care,
Independence, Well-being and Choice, what they have
emphasised is a better system of providing support that does away
with the stream of often poorly motivated and underskilled agency
staff who pass through their door. Service users want quality,
well-supported staff with whom they can develop a positive
relationship. They draw a strong distinction between just getting
the basic personal support that maintains physical functioning and
the crucial social support they want that makes it possible for
them to live independently. It is this latter that they do not
often receive.

In recent years, there has been talk of using chimpanzees and
robots to help maintain disabled, frail and older people at home.
But I have never heard an older or disabled person call for the
development of either. Telecare must not be added to this
discredited list unnecessarily.

Ian Philp, the Department of Health’s national director for older
people’s services, has already said in the context of telecare that
“from an older person’s point of view, the human factor is the most
important”. As he suggests, telecare must primarily serve the
rights and interests of the individual. There will be many
competing pressures that may make this easier said than done. But
if telecare is not to join the roster of other discredited
innovations in social care, from care management to quasi-markets,
then its piloting and implementation, from the word go, must give
priority to issues of equity, informed consent, choice and user-led
evaluation.

Peter Beresford is professor of social policy, Brunel
University, and is involved with the psychiatric system survivor
movement