John Woolham is Senior Research Fellow at the Social Care Workforce Research Unit in the Policy Institute at King’s. John leads a seminar on Wednesday 21 February 2018: Telecare for older people: are we getting the best out of it? (1,347 words)
RiPfA, and its sister organisation, Research in Practice (RiP) work primarily with local authorities to encourage the use of evidence based practice. As someone who has a local authority background and has always been keen on promoting the use of good quality evidence, the opportunity to take part in a RiPfA organised event wasn’t one to pass up on. It was also the first time I’d led a webinar. It’s definitely odd being in what’s effectively a studio, with a computer screen containing a clock (so you don’t overrun) your power point presentation, and a video of you as a ‘talking head’ – pretty much the same thing as participants see. You can’t see them of course, but they can send you messages. What could possibly go wrong? Well, quite a lot, actually. The fact that it didn’t owed much to the skills of Leo Heinl from RiPfA who managed the technology. Leo is a fellow ‘biker too, so we talked motorcycles a bit, but that’s another story.
My presentation was entitled ‘What does evidence informed telecare look like?’ and was – to rather a large extent – based on research on telecare we have been leading at King’s over the last couple of years. The study, funded over 14 months by the NIHR School for Social Care Research, became known as the UTOPIA project: Using Telecare for Older People In Adult social care.
My presentation began by suggesting here has been an interesting divergence between evidence and practice in relation to telecare in England. The Department of Health commissioned a major trial of the effectiveness of telecare and telehealth several years ago to address what was then a gap in evidence: policy guidance – ‘Building Telecare in England’ had been published but the evidential foundations were several small to medium sized evaluations of pilot studies – one of which was my own. These had all concluded that telecare could both save money and also help maintain higher levels of independence. It therefore seemed to have been widely expected that this large scale trial – which became known as the ‘Whole System Demonstrator Project’ (WSD) would validate policy decisions that had already been made. This didn’t turn out to be the case: the WSD project team concluded that outcomes for telecare users were not significantly better than those of people who received more traditional forms of care.
By then, of course, local authorities were having to respond to the austerity policies of the coalition government and many – despite the WSD evidence – continued to invest significant sums of money in setting up and running telecare services. The WSD findings were largely ignored or seen as flawed, unhelpful or out of date by local authorities. I was puzzled by this. Why would cash-strapped local government continue to invest in something that a recent study had argued was demonstrably ineffective? Though I did think the WSD findings were flawed (no research is perfect) to write it off was odd. After all, it was, and remains, the largest randomised controlled trial on telecare in the world. Although you could argue that they should have followed participants up for longer, been more selective over who was recruited, or taken responsibility for assessing for and deciding on what kinds of technology to install, it was, at the end of the day, a pragmatic, real world trial and to have taken over local authority roles in assessing for and deploying technology would have massively increased its cost. So what was going on? Was I missing something?
The presentation then summarised key findings from our online survey of local authority telecare leads completed earlier this year. This achieved an overall response rate of 75% and so is probably a reasonably reliable picture of local authority telecare use at the present time. A full report of the findings of this survey is available.
Amongst other findings, the webinar reported on the following findings from this survey:
- though strategic and operational goals for telecare were usually well aligned, these tended to focus on delaying need for support and maintaining independence through using telecare to manage risk and keep people safe and to support family carers: all objectives aligned with the need to save money and less on some quality of life issues: for example, we found only one authority using technology to address problems of loneliness and social isolation. Almost half of local authorities that took part in the survey said they were using, or proposing to use telecare as an alternative to hands-on, face-to-face care.
- Though assessments for telecare appeared to be fairly holistic and person-centred, they were sometimes not done for some devices or in some contexts, and were not always completed in the person’s home. Reviews were often done by telephone and may have focused more on the technology and whether it was working than on the person and whether it properly met their needs.
- Most local authorities sourced their technology from a limited range of suppliers and manufacturers and the range of devices used was not very diverse.
- Training was provided to people who assessed for telecare in 80% of local authorities in the survey, this was most frequently provided by manufacturers and suppliers (and may have focused more on how a device worked than how to match need with technology), almost none was formally accredited and the duration of training was usually short.
- The quality of information available to the public about telecare and assistive technology varied between authorities.
- Not all local authorities were able to offer a 24/7 response service. Fewer of the shire counties responding offered a response service.
In the final part of the webinar, the implications of these and other findings were considered, and I speculated if the rejection of the WSD and the creation of alternative sources of evidence may have prevented local authorities from a critical examination of the effectiveness of the telecare services they provide. If this is correct, then the survey’s evidence suggests that to improve, they may need to improve the infrastructure behind telecare implementation and management. This might mean invest more in training telecare assessors, extend the range of telecare devices available, develop mobile response services in those areas that do not have such a service, and for some local authorities to make better information available: particularly for direct payment users and self-funders who wish to use telecare.
There was time for an interesting question and answer session at the end. To my relief, I finished on time. One thing I didn’t mention was Dartington Hall which is set in beautiful Devon countryside and is a major cultural hub in this region. I went to a newly opened vegan restaurant for something to eat after I’d said my piece. It was busy, and full of people who seemed a bit like me I suppose – middle class, leftish, Guardian reading – you know the type. I don’t know why, but despite being a veggie, I was tempted to ask, while queueing – for my – delicious vegan lunch – for a Big Mac, fries and a cola….
John Woolham is Senior Research Fellow at the Social Care Workforce Research Unit in the Policy Institute at King’s. John leads a seminar on Wednesday 21 February 2018: Telecare for older people: are we getting the best out of it?
Disclaimer and acknowledgements
The findings presented in this report were made possible by research funding from the National Institute for Health Research (NIHR) School for Social Care Research. The views expressed in this publication are those of the author and not necessarily those of the NIHR, School for Social Care Research, Department of Health or the UK National Health Service.
The author is grateful to local authority telecare managers who took the time to respond to this survey and for their often detailed and very helpful insights and Directors of Adult Social Care Services who supported the completion of the survey in their local authorities.
The author also wishes to offer grateful thanks to the Advisory Group for the UTOPIA project. Advisors commented on the questions it was proposed to use, suggested additional questions, suggested changes to how questions were phrased and offered other valuable advice and support that helped the survey achieve a good response from local authorities.