Dr Kevin Doughty, of the University of York’s Centre for Usable Home Technology speculates on the prospects for successful mainstreaming of telecare in the UK.
We are now four months into the Preventative Technology Grant in England, while Wales and Scotland eagerly await the arrival of their grants. We should expect nearly 200,000 vulnerable people to be receiving a new telecare service by this time in 2008. Is this a reasonable expectation? Will services be so patchy or so inefficient that only a small fraction of the people who could benefit from telecare will actually be helped? Worse still, might telecare be introduced in such a piece-meal small-scale manner that it fails to facilitate a change in the way that we think about service delivery?
There is more than a suspicion that the level of funding available is not going to be enough to fund a full service. Of course, this was never the intention. Rather, local authorities (and eventually their health counterparts) would top up the grant to implement the changes in processes and procedures that would be necessary to operate a telecare service. How many authorities are thinking of match-funding their PTG, let alone making investments at the levels made by West Lothian which has given them a whole-systems approach (and well over 2000 telecare households) that has attracted the attention of every developed country in the world?
It is now apparent that most local authorities will use their PTG for introducing a limited level of telecare. Some of the early adopters, to whom we can be thankful for giving us the evidence of success, are seeing telecare as an important vehicle for their journey into the future. Certainly they see technology (including electronic patient records, video conferencing and robotic assistants) as essential components of their vision for service improvement. So are they making multi-million pound investments in technology? Some are – the London Borough of Newham is committing over £3.5 million over the next two years to mainstream a telecare service that has been piloted for little over a year. Their officers are clearly convinced of the business case – so much so that it will be a free service for those meeting their eligibility criteria! Just as important, they have the full support and backing of their Mayor and their elected members. Could it be that Social Services departments elsewhere are failing to engage with councillors? My experience is that when elected members are involved at an early stage, they become the champions of telecare. They are certain to be close to the public and are not slow to see how changes in health and social care delivery can be sold to their electorate. If they were a bigger part of the planning process, perhaps the closure of a hospital will be seen as more of a success story for service redesign rather than the disaster that is usually reported in the press.
In Wales, telecare grants are generous in terms of the funding possible per individual at nearly £900 per head. However, the funding is ring-fenced as a capital grant which can only be spent on equipment. In other words, other sources of funding must be found for coordination, assessment, training, maintenance, monitoring, administration and, of course, response services. A long-term strategy is therefore essential to demonstrate how the introduction of telecare will help to reengineer services if only to convince the treasurer or Director of Finance that they must invest to save. This is likely to see councils working together more to help reduce costs and share best practice. Welsh Councils might then adopt a more standard approach with common protocols, service specifications and equipment inventories. All this will make service delivery more efficient through joint commissioning with response teams operating seamlessly across borders. Perhaps some English local authorities should look to the West for some ideas on how to increase the impact of their grants.
Dr. Kevin Doughty is Deputy Director of the Centre for Usable Home Technology at the University of York, and also an independent consultant to national and local government organisations, housing associations, technology designers and telecare service providers. e-mail: firstname.lastname@example.org