Telecare Soapbox: Britain's Got Pendants

Hi Pam. I don't believe we have met, but it probably won't be for lack of me trying. I am pretty sure I have written to you a couple of times about the unique and profoundly useful, preventative telecare service that my company provides, and haven't had a response!

Okay, I am pretty sure I've written and when I get back to my normal PC I will check. Sorry to be provocative, and what follows is not aimed at you at all - but my point is really, that a lot of independent companies find it extremely difficult to get a foot in the door when the "telecare project officers" in many instances look to the existing suppliers of their council operated community alarm teams. Those suppliers are normally one of the big players, which is fine but the independent developers need a look in.

Then to make matters worse quite often when a telecare project officer makes the bold move to use a new piece of technology or a new service (and hurrah there are some people out there) there is quite often resistance internally from the people that refer users to telecare to change from what they are use to referring people to, and that is community alarm. Also, quite often, any internal council operated community alarm team is very resistant to the idea that the council spends money with an independent third party without involving it in the loop, they feel threatened by that spend going elsewhere, thus presenting another hurdle for sustaining new telecare initiatives.

There is a huge vested interest on many levels in community alarm and a lot of people are going to fight to maintain its grip across local authorities and its suppliers are going to fight to keep that grip.

The fact is more than 50% of people are not even wearing their "panic buttons" at any given moment. Quite often independent suppliers of other telecare complementary to community alarms (and I have heard this from several others) are not even afforded the courtesy of a meaningful response after having a taken a day out to visit a local authority at some considerable expense. This lack of common courtesy would have no place in any other form of business and is another barrier to moving beyond community alarm.

I don’t know what’s going to change this situation, perhaps it will take just the right start-up company with something that works really really well, a strong vision and the passion to keep on hammering away until things do.

Many devices, many ways of contacting the "centre", few innovative ways of responding.

I have seen many wonderful devices that would contact me if this happened and that happened - however the question is who is going to react to the event? Telecare and telehealth coupled with innovative health and social care response will make significant reductions to unnecessary hospital admissions and a reduction in bed days.

So keep the pendant, improve the call centres' ability to send an appropriate response (not just an ambulance or warden).

I think there are some interesting comments in this thread. As someone who works on the edge of telecare with a range of complimentary technologies I think Clare Humphreys' point is very valid as is Pam Mills' and in both cases the problem is the definition or more probably the perception of telecare.

I remember, as you will Steve, during the meetings leading up to the introduction of the PTG, some heated arguments about the use of 'Telecare' as an umbrella term. Some of us, largely rightly as it turned out, felt it would restrict the potential of the grant to call centre based technologies and althouth it came out as Preventative Technology the scope was exclusively telecare.

So Pam is right, not much innovation because the subject is so limited. Look outside and there is a lot of innovative technology around. Unfortunately the structure of telecare services is often similarly restricted. On many occasions we are talking to groups within social services about technology which is intended to achieve the sames goals as telecare but there is no contact with the local telecare team. It is interesting to look at Scotland where things are quite different. JIT has not been so prescriptive and a much wider range of technologies and services are being developed under their equivalent of the PTG.

Finally a comment on telehealth. I wonder if telehealth was held back for a number of years by it being seen as a way to generate more business for call centres? I suspect that hospital consultants were not too happy at having to use a call centre run by the local Housing Associaltion.

I worked with probably one of the first pieces of telehealth equipment in the 80's when a major technical problem was the introduction of the Trimphone which didn't fit the rubber couplers on the modem! This was the Huntleigh Domicialliary Feotal Monitor. This worked very well because the data was sent to the midwives at the local hospital and so the mother could immediately speak to a professional who could reassure them or take appropriate action. It's a pity this method of working didn't spread to other areas of telecare.

Although I have tried my best to involve a range of suppliers in our plans here I think the odds are against the smaller independent businesses because of a tendency of decision makers, at least in my experience to want to use the people who supply our incumbent alarm centre for equipment and the alarm centre itself to run schemes.

There can be some good thinking behind this but it is very restrictive or at least it has been here. I have had to bang my fists against the table several times to get sign off on some very small projects, a few thousand pounds - which are very well researched and fit well within out remit but operate separately to our alarm centre. I find it quite easy to get approval on projects for tens of thousands of pounds which do involve the alarm centre and buying from the large companies mentioned by the previous correspondent. I am impressed by how much work must have been involved for the small group of companies that actually have made inroads in to getting pilots underway but I do worry for them they will not get out of it what they have put in to it until there is a new way of thinking.

We have had great pilots and positive feedback about the products we have used from independents but there is still resistance to mainstream what they offer and a wish to put more resource in to our alarm centre from our managers. It is depressing for me and my co-worker to feel we have delivered some great telecare pilots and to know they are probably still going to be abandoned in favour of panic buttons.

There are clearly local authorities who have not spent their PTG and telecare grants as effectively as they might have done. They need to be identified and the effectiveness and efficiencies of their services measured objectively in an external audit as well as through an internal satisfaction survey and evaluation. This would allow best practice to be identified so that all local authorities can aim to commission services at this higher level.

Raising the bar for service quality is the next step - let's hope that the required investment is available to yield sustainable services.

I think that the Kings Fund document by Alasdair Liddell, Stephen Adshead and Ellen Burgess entitled (2009) Technology in the NHS sums things up quite well:

Example: telecare

Telecare is an example of a technology that can be implemented at a local level by social services, private providers or NHS care trusts. Despite government guidance as set out in Building Telecare in England (Department of Health 2005) and funding being available (the Preventative Technology Grant, for example), telecare has not currently become widely adopted. The main barriers that have prevented widespread adoption are as follows.

• Lack of resources to deal with the changes in service delivery that telecare may necessitate: for instance, a telecare programme requires back-end service support, such as call-monitoring centres and carers to respond to patient call-outs.


• Silo budgeting: for example, social services may commission and deliver the telecare service but the financial benefits may be realised by the local primary care or hospital trust.


• Lack of incentives to take a long-term view in decision-making: benefits may be realised on a longer timescale than the financial planning horizon and thus there are few incentives for commissioners to invest in such technologies.


• Inefficient use of trials and pilots: many pilots do not meet the requirements of clinicians to justify a broader roll-out of the technology. Furthermore, pilots such as the large-scale multisite Whole System Demonstrator programme may preclude further roll-outs of telecare services before its outcomes are published in two years’ time.


• Decentralisation of the market: in addition, as telecare provision differs within each local context, it is very difficult for commissioners to achieve economies of scale through a diversity of buying points. (p28) The actual report is well worth a read I would suggest.

Guy

Therefore let's assume that after 3 years and £80m there is a wealth of experience as to how telecare has been made sustainable from the 'pump-priming' PTG. Let's have them share this best practice so that others can benefit. I think it is important to do this soon because many of the people that were hired with PTG funds to implement programmes are now disappearing as the fund terminates.

Sustainability was one of those issues that the budget holders hardly cared about until the money ended.

In the absence of clear guidance from DH (and why should they recognise it?), we are left with individual views and, less frequently, bench marks of quality for services. There is therefore a need to compare notes, and then to produce robust auditing tools that allow processes and strategies to be measured and compared objectively. Some draft tools are already in use and have proved very effective at identifying deficiences in provision. The same tools can also find the processes and the delivery and support mechanisms that are good.

What about the DH funding some telecare academics to develop and test a new auditing tool?