Telecare Soapbox: Britain’s Got Pendants

With this headline everyone – in the UK at least – will know what I was watching last week but it set me thinking: where did the English telecare initiative that started in 2004 go wrong? Why has it failed to deliver the stunning performance that seemed so certain after such a strong second round and getting through to the final?

Was the Telecare Policy Collaborative just a flash in the pan?

Did Building Telecare in England hit some wrong notes?

Was the Preventative Technology Grant a flawed act?

Has the PASA National Telecare Framework Agreement lost its glitter?

In short, why is it that

most of Britain is still suffering the same jaded routine (pendant alarm systems) as 10 years ago, albeit re-branded as ‘telecare’, when the Policy Collaborative was trying to boil up something fresh, daring, diverse and dynamic?

Can telecare, as originally envisaged, be rescued from the sidelined losers?

Put yourself in a judge’s seat and have your say in a comment.

Categories: Soapbox.

Comments

  1. Jo Hart

    Britain’s got pendants
    Perhaps it is because many local authorities established partnerships with existing call centres who were already monitoring community alarms. And most of those are using the same key provider……

  2. Clare Humphreys

    Britain’s got pendants
    Perhaps it also has something to do with the way local authorities use of the Preventative Technology Grant has been measured – focussing on the numbers of ‘new’ users aged 65 or over of a fairly limited subset of the technology was unlikely to encourage innovative use of technology across the board. Similarly, the initial version of the PASA framework was heavily oriented towards pendant alarm and environmental control systems with a smattering of telehealth. Even now, it offers very little of the lower level ‘stand-alone’ technologies that are often beneficial in supporting a wide-range of clients to remain independent.

  3. Tim Craig

    Britain’s got pendants
    When the US Veterans show basic telecare achieving 66% reduction in hospital admissions and 71% reduction in bed days of care, you would have thought that we should have a ministerial position driving it through. I think the big issue is that the finance and administration regime does not promote remote consultations, it militates against them – see your later article ‘New NHS tariff upsets PCTs’ financial plans’. Tim Craig

  4. Pam Mills

    Britain’s Got Pendants
    There has been a disappointing lack of new telecare devices in the market. How many new products have appeared in the last 10 years? We can only use the products that are on offer.

  5. James Batchelor

    Britain’s got pendants because …

    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.

  6. Kevin Doughty

    Britain’s got pendants

    If Steve had chosen “Britain’s got Lifelines” as his heading, would all the comments still have sounded so negative?

    The pendant has changed little in 10 years – and as a simple device to raise an alarm – it probably doesn’t need to go through too much of a transformation. On the other hand, the Lifeline has evolved from an ugly phone with a radio receiver into a genuine telecare hub, with its own clock, intelligence, inputs and outputs. Not only can it receive and process dozens of different alarm messages, it can also combine them in logical ways (to form virtual sensors), act on them to provide appropriate interventions (such as switching on lights or switching off valves i.e. smart home functions), provide programmable reminder messages and alerts, and collect data to be forwarded for Lifestyle Monitoring and similar preventive telecare applications. No doubt in the future, it will also collect vital signs data, provide information and advice on the TV, and become the interface to the Internet.

    This is why the UK leads the world in telecare, and why other countries look enviously at how telecare has been built quickly on the top of a community alarm infrastructure. Clearly not all local authorities have been able to make the most of their grants – but £100 million across the whole of the UK is small potatoes in the big world of health and social care.

    To see real changes, we need to see this sort of investment every year. Then perhaps developers will start to produce the medical sensors (such as blocked catheter detectors and stroke detectors) that would make our telecare services so attractive to the primary care sector that they would also put their money into the development of integrated services. But my guess is that they would still need a pendant!

  7. Dean Ayres

    Britain’s got pendants

    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).

  8. Steve Hards

    Further to Britain’s Got Pendants
    Now that the comments on this item have trailed off, perhaps it is time to make it clear where I stand on the questions I posed.

    First though, it is interesting that it was not until Kevin Doughty’s comment that anyone challenged my rather negative premise. While there are good things happening in places, it would appear that my doubts about progress struck a chord.

    I believe that the original telecare vision was undermined when the decision was made within the Department of Health to include ‘community alarms’ in the definition of telecare in the ‘Building Telecare in Britain’*.

    I suspect it came about because there were severe doubts (probably justified) regarding the ability of councils to deliver 160,000 truly new telecare users – the target set for the Preventative Technology Grant by the Treasury.

    Many of us thought at the time that this would be the escape hatch through which councils would slither and allow them to count new users using the old, comfortable technology. It now looks as though those predictions were correct and a lot of what has happened (or not) since then hinges on that unfortunate decision.

    * Page 8: What is Telecare?”…It can be as simple as the basic community alarm service…”

  9. Bernard Wignall

    Britain’s got pendants

    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.

  10. Mr High Blood Pressure

    Britain’s got Pendants
    And the winner is ……….a large well known UK telecare provider. can someone advise me please why the OFT has not recently investigated the alledged monoloply of the UK telecare market by a single company? and the apparant ‘hoovering up’ of PT Grant and other grants from Wales and Scotland by this well known UK provider. PASA knows only too well that almost 80% of the £80 million that has gone through the PASA NFA has been through a single company! Will the pending independent report from Wales on their Telecare Grant monies also highlight that one company beneftited more than any or all others? It could be that over 80% of Welsh money (over £9m) went to one company – is this not potentially a monopoly that should be investigated by the OFT?? Why does the TSA not do something – they know what’s happening? They are the defacto Trade Body for the industry. What is the rest of the Telecare Trade doing about this? The UK does have clear rules about business Monopolies – especially when it is our tax payers money that is being spent – and in general ‘hoovered up’ by a monopolist provider. I am going to rest now as my blood pressure has risen again.

  11. Mr Blood pressure just about under control

    Britain’s got pendants
    Why isn’t someone going to do anything about the monopoly? Well PASA do OK counting the spend that goes through their books so they can claim added value, TSA is funded by the community alarm centres that make their money from providing products from the monopole provider, and the smaller inovative companies have given up saying anything because no one is listening. Should we start talking about Continu Alliance and the barriers of entry?

  12. anon

    my experience

    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.

  13. inside outside

    Throw it away

    The problem is that too many people base success of telecare on the number of connections you have, Community Alarm providers bragging on how many telecare users they have at every meeting you go to. It should not be about the numbers and targets it should be about specific pieces of equipment to benefit the users.

    You have examples of the PT Grant being wasted just to get the number of users up. Examples include Community Alarm Services spending the money on giving every person in sheltered housing a pendant, flood detector, smoke alarms and then claiming they are all Telecare users and recording this as an increase in the use of telecare. The use of the grant in this way seems to be a waste of money as stated above the majority of people will have put the pendant in a draw because they do not need the equipment. Surely the PT grant could have been used a lot better targeting specific equipment mainstream or non mainstream to benefit the end user.

    The use of the grant to throw equipment out there to be able to brag on numbers of telecare users just leads to people seeing the equipment as a waste of time. Community Alarm providers need a good shake up and the merging of providers has to be continued why does every local authority have to have one? Surely by merging and having local control centers with remote responses the savings could be reinvested into telecare to help those who require telecare and want telecare in their daily lives. Lets not forget the end user and talk about the benefits to specific peoples lives an stop this waste of money on “Oh WE HAVE 1000 TELECARE USERS!!!!” when in fact the majority have had equipment forced on them.

  14. Kevin Doughty

    Britain’s got pendants

    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.

  15. An academic view

    Britain’s got pendants

    Before the PTG was announced I an many other academics, including Kevin made it very clear to the DH that unless the infrastructure was in place with very clear guidance on assessment and service delivery as well as response services then the PTG would be wasted.

    In reality, I am pleased to see it is not wasted, I do take the point that one company has made substantial profits out of this but this is the fault of the DH for not heeding the warnings.

    At least now Telecare is a phrase that some people understand and do not run when it is mentioned. Some people are successfully being helped by Telecare to live independently. What is the biggest shame is the evidence exists on how beneficial Telecare is before the PTG was announced but the need to get the money out took preference to common sense.

    I do also consider that the DH’s view on steadfastly promoting an impartial free market approach can also be blamed for any failure. Lack of clarity, lack of guidance and lack of foresight by the DH is where I place the deficiencies. That said I do also see the successes and these are many.

  16. Guy Dewsbury

    Britain’s got pendants

    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

  17. Kevin Doughty

    Britain’s Got Pendants

    The King’s Fund is a good read but:

    1) it focuses on the problems of introducing technology into the NHS (rather than into local authorities and their service providers), and

    2) it was written in 2008.

    My experience is that the understanding of telecare, the processes required for efficient operation, and the general support available, have all increased significantly during the past twelve months. Perhaps it has been the prospect of making services sustainable, or the end of grants, but there is now a core of competent people up and down the country who know how to deliver telecare services. Best practice is emerging so we should be looking for it and giving praise where it is due rather than lamenting how it could have been done better.

  18. DF

    Britain’s Got Pendants – share the learning

    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.

  19. an Academic view

    BGP: best practice

    I agree with Dr Doughty’s two comments, although what I do find difficult is the words that are bandied around. For example the words ‘best practice’ seem to mean different things to different people depending on their own type of investments. As there are no common universally agreed definitions of ‘best practice’ how can people judge what is ‘best practice’ apart from people saying that what they are doing is ‘best practice’ and hence unless we argue against them it must be!

    From my experience, there is a wealth of experience out there some very interesting things and some not so interesting. What I am concerned about is the notion of ‘best practice’ is used something that needs to be clarified and standardised so there is a benchmark for all to adhere to.

    The TSA have tried to provide some notions of good practice in their new code but this is far from ‘best practice’. What I consider ‘best practice’ might not be what the DH consider ‘best praxctice’ and also might not be what anyone else considers ‘best practice’ to me it is a laden term with little meaning these days apart from to imply others who do not understand the term are somehow less.

  20. Kevin Doughty

    Britain has pendants

    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?

  21. alex

    the use of telecare in many instances in tied to tenancies where an individual has to pay this extra charge whether used or not, many people have their own support systems in place and many disabled people work also. surely it’s not right to enforce extra charges for those on low incomes and what if they’re living with someone who provides care? telecare should be a support system available to those who need it and is vital to many people but to charge extra and enforce this as a condition of a tenancy is totally wrong and costs the benefits system a fortune for unused systems when it’s paid for by housing benefit. it’s not an income source for housing providers at the cost to tax payers or individuals , it’s one of a range of a support system which could be provided for nil cost

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