Is there a clearer role for telecare in adult social care that will deliver better outcomes for older people?

Introduction

Telecare devices aim to help older people by compensating for disabilities or impairments. It is claimed to support the independence of people using it, reduce unpaid carer workload and save councils and the NHS money by preventing unnecessary hospitalisation or moves to care homes.

Early studies, based mostly on small scale projects, invariably suggested positive outcomes. These, and lobbying by the AT/telecare industry led the Department of Health and Social Care (DHSC) to provide an £80 million Preventive Technology Grant to support rapid upscaling of telecare use. Guidance was also published, and the DHSC also funded a large scale clinical trial of telecare’s impact, which became known as the ‘Whole System Demonstrator’ project. This found no evidence that telecare improved outcomes for users. Despite these findings, local authorities (LAs) continue to invest in telecare; notably in a continuing context of financial austerity.

Objectives

The UTOPIA (Using Telecare for Older People In Adult Social Care) study was intended to provide a better understanding of:

• What strategic aims telecare is intended to serve for older people and what local evidence is being collected to enable LAs to assess if these are being achieved;
• How telecare is deployed;
• To describe what data is being collected to enable LAs to monitor if intended strategic aims are being met.

Methods

The study took place between April 2016 and May 2017 and used a three stage, mixed-method design: (1) interviews with telecare lead managers in a representative sample of 25 LAs, (2) additional interviews with five to six key stakeholders from four of the 25 sites, chosen to offer a cross section of different approaches to AT/telecare implementation, and (3) an online survey of all English LAs. This achieved an overall response rate of 75%. Qualitative data from interviews were transcribed and analysed using NVIVO and survey data used SPSS.

Findings

• Telecare is seen by many as a way for local authorities to address rising demand with shrinking resources, and as a substitute for personal care.
• Only a fraction of the potential of assistive technology has been exploited. Data could be used to identify loneliness, for example.
• Local authorities need to consider if different professional groups have the full breadth of skills and experience needed to optimise telecare use.
• More investment in training might help better equip telecare assessors with the skills to enable recipients to get the best out of telecare.

Resources

Report

Woolham JG, Steils N, Fisk M, Porteus J, Forsyth K (2018) The UTOPIA project. Using Telecare for Older People in Adult Social Care: The findings of a 2016-17 national survey of local authority telecare provision for older people in England, Social Care Workforce Research Unit, King’s College London, London.

Journal article

Steils N, Woolham JG, Fisk M, Porteus J, Forsyth K (2019) Carers’ involvement in telecare provision by local councils for older people in England: perspectives of council telecare managers and stakeholders, Ageing and Society, published online.