By John Woolham, senior research fellow at King’s College London
Telecare doesn’t produce better outcomes for people who use it. This stark message was the finding of a large, Department of Health funded clinical trial, known as the ‘Whole System Demonstrator’ project (WSD), which concluded several years ago. But, despite this finding, and the adult social care spending cuts which continue to this day, local authorities have not scaled back investment in telecare.
The UTOPIA (Using Telecare for Older People In Adult social care) project, led by staff from the Social Care Workforce Research Unit at King’s College London, has produced new findings about why and how telecare is used for older people. They raise the possibility that it might not have been telecare itself but the ways it was used that led to the WSD findings. The study also suggests that given the strategic importance many councils now place on telecare, the infrastructure needed to implement it effectively may not be as robust as needed.
The study involved a survey of all 152 English local authorities with social care responsibilities between November 2016 and January 2017 with a response rate of 75%. Key findings found that only a minority of local authorities said their telecare strategies had been produced collaboratively with local NHS or other partners and in most, telecare did not seem to be referenced within their carers’ strategy.
A large proportion of local authorities did not appear to have telecare services accredited to national/international codes or standards. Though many participants felt telecare saved their local authority money, most were unable to offer clear evidence of this. All participants saw telecare as playing a major role in keeping people safe by preventing accidents – and thereby maintaining independence – and to support the role of family carers. There was much less focus on the use of telecare to promote social contact, alleviate loneliness and enable older people to spend their leisure time in ways they found meaningful.
Some local authorities had integrated telecare within operational teams (so assessments for and decisions about telecare were made by care managers). Elsewhere, specialist workers in different teams assessed for and deployed telecare. In some places, only one professional group – for example, care managers – were responsible for assessing for telecare, and in others assessments could be carried out by a range of ‘front-line’ professionals.
Though responses suggested that assessments were relatively holistic, there were also differences. For example, though over 90% said they focused on the person’s ability to mobilise and move around, just over 50% said they considered the ability of the telecare recipient to problem solve. Most of the assessment tools used had not been validated to ensure they measured what they were intended to measure.
The survey also revealed assessments were not always carried out before telecare was deployed (for example, to support hospital discharge). In a fifth of local authorities there was doubt as to whether an assessment was subsequently completed. Though most local authorities offered training for telecare assessors, this was usually provided by telecare manufacturers and suppliers, and training was often very short.
Almost no training was delivered by a college or university, or led to any formal qualification. Most local authorities bought their telecare from a small number of manufacturers or suppliers and there seemed to be a tendency to use a limited range of devices. Not all local authorities had a paid 24/7 response service and where a family carer could not be identified to act as a responder, telecare was often not offered.
The survey findings offer an up-to-date description of telecare use for older people.
The overall response rate means the findings are fairly reliable and have a number of implications. The provision of telecare before assessment is likely to lead to a poor match between need and device, and the lack of involvement of the recipient and their family in decisions about what to provide may lead to the subsequent abandonment of telecare by some people. The quality of training offered to telecare assessors was very varied.
The reliance on telecare manufacturers to provide a great deal of this training, and its short duration, suggests much of it may have been about how a device worked, rather than deeper questions about whether it is the best solution to the identified need. Some of this might have essentially been a marketing opportunity as much as training. The lack of a wide range of devices in some local authorities may also be a problem, as the available devices might not fully meet the actual needs.
Investment in training, and the development of different purchasing arrangements to enable a wider range of devices to be obtained would help. Our findings suggest some local authorities should consider what they need to do to provide telecare services which deliver the outcomes everyone wants.
The full report of findings from this survey is available for free. The first author and contact for any queries is John Woolham, senior research fellow at the Social Care Workforce Research Unit, at firstname.lastname@example.org.