Impact of IP telephony on UK telecare systems

The Telecare Services Association (TSA) in the UK has recently released a white paper addressing the impact of a fundamental change to the [grow_thumb image=”” thumb_width=”150″ /]UK Public Switched Telephone Network (PSTN) that is now being contemplated. This change will eventually see the replacement of the current PSTN and Integrated Services Digital Network landline networks with IP telephony (the type of phone connectivity that has been commonly used in most modern office environments for some years).

Two years ago BT, who essentially owns practically the whole of the UK PSTN, proposed that the change of their network would be completed in 2025.

This has an impact on the telecare services to the extent that many telecare alarm devices in use connect to the call centres via the PSTN and hence such devices and/or the infrastructure used by suppliers of such services will need to be upgraded when the underlying network is changed. There are, according to the TSA paper, 1.7 million users of such devices in the UK.

The TSA is essentially the UK industry body for telecare and telehealth and as such it is understandably trying to raise awareness of the need for both the commissioners and suppliers of these services to prepare for the change. This paper is said to be a result of gathering views from “key stakeholders” related to this change.

The potential impact, however, seems to be somewhat exaggerated. It should be remembered that the UK very successfully underwent another major switch-over not that long ago in 2012 – from analogue to digital TV. It required every analogue TV in the country to be either fitted with a set top box or replaced with a digital TV.

TSA also suggest that this changeover be used as an opportunity to roll out more internet based digital health functionality to end users. Of course, such functionality is already widely appearing in the form of health monitors, exercise and medication reminders etc. and are not dependent on the switch over. So it is unfortunate that the paper flips between the two topics and asserts a dependence of internet based digital services on the PSTN switch-over.

The document feels more like marketing material than a white paper with about 1/3 of it taken up by irrelevant photographs of random happy smiling or laughing (mostly older) people. It reminded me of some of the material that came out the the 3 Million Lives project. If only our elderly people living alone or in our care homes were as happy as this!

The paper is available to download here.

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  1. Mark Baker

    My thoughts too when I read it Chris. Definitely comes across as encouraging people to take the opportunity to spend lots of money upgrading now. Why? 2025 is 8 years away and I wouldn’t be at all surprised if there were some technological advances during that period that will make much of today’s offer look very old hat.

    You are also probably right that a means will be found to allow “old” analogue equipment to carry on being used on the new lines as with digital tv, after all it is not just telecare systems, but burglar alarms, fire alarms and many others that will be affected.

    We all need to be aware of this and keep a watchful eye on it, even take it into consideration in our future purchasing, but rushing out now to make wholesale changes to existing equipment is very likely to be a huge waste of time and money. Already some telecare equipment suppliers are being very bullish in their approach, no doubt seeing this as an opportunity to make a quick buck whilst there is still a good degree of ignorance and confusion in the marketplace. I’m sure in 6 years time they will be quick to tell those they have convinced to change already that hey have an even better version that is specially designed for the new digital networks (and at a special cost too).

    Digital does open up a lot of potential opportunities, as the paper says, but they are not a necessity for everyone and although we should be continually aware of these, rushing headlong into mass provision for all could lead to rejection from the service user/client. Learning to understand what is available in the market and then working with health and social care to “prescribe” a suite of equipment should be the way forward, but let’s not chuck out the simple tried and trusted “button and a box” telecare that so many of the 1.7 million rely on just yet.

    A final thought though is that we also mustn’t go to the opposite extreme of burying our heads in the sand, that is a sure way of getting bottoms kicked. We must get the balance right over the coming years.

    • Chrys Meewella

      Mike, I agree, particularly about not burying our heads in the sand!

      We also need to decouple the analogue to IP telephony conversion from the creation of digital applications for the care setting – applications that use broadband and have no real link with the conversion BT is proposing.

  2. Just to play devils advocate, yes there will definitely be better tech in years to come, but why deprive residents, patients and customers of the wellbeing and safety benefits of digital systems just because there’ll be something better in the future.

    Every tech will always get better, but the step change from analogue to digital is so great that waiting till a slighter better version is available short-changes those who could benefit in the meantime.

    Now of course I would say this because our company, Appello, are a major proponent of digital Telecare, but I can back it up with real customer feedback……we surveyed 100’s of residents who’d had their analogue warden call system upgraded to our digital Smart Living Solutions and the feedback was overwhelmingly positive…90% agreed or strongly agreed that the video capability and speed of response made them feel safer and the majority felt the upgrade had improved their wellbeing.

    Although 2025 is 8 years away, that doesn’t mean that analogue will work well until that date. The current level of analogue Telecare alarm failure rises each quarter and is already at a level that means every month, across all the UK providers, tens of thousands of telecare alarm calls fail before they reach a monitoring centre. Couple that with the analogue connection time being c90secs, vs <4 secs for digital, and you have some very compelling reasons why this isn't just a sales pitch, but a real driver of better safety and wellbeing for those vulnerable individuals who depend on Telecare.

    • Chrys Meewella

      Thanks for your comment. I am glad you declared your position as being from Appello as it helps me to see your point of view.

      I am not familiar with your products and your website is, shall I say, unfortunately a bit low on their details. I would be pleased if you were able to forward some technical literature to help better appreciate them. But making an educated guess I expect your Smart Living Solution doesn’t do all its digital communication over an IP telephone line but rather over some broadband link. And that is a critical point that seems to have got lost. The TSA document also seems to be confused as soon as the word “digital” is used.

      I am very pleased to see the innovative digital applications that are under development and are increasingly coming to market for the elderly in a care setting. WiFi and broadband are now sufficiently common place enablers and it is pleasing indeed to see those being so exploited.

      I can’t comment on the data you quote regarding alarm failure rates. Do you know the origin of that data? As far as I know the BT PSTN network is no less reliable today than it has been for many years.

  3. Tim Barclay

    Hi Chris, in answer to your question, the data on analogue telecare alarm call failed attempts comes from alarm receiving centres and isn’t a result of the reliability of the PSTN network, it’s an issue with the analogue telecare DTMF signalling tones struggling to traverse the increasingly IP networks of BT & other Telco’s.
    In Appello’s case in June ’16 we saw 3% of analogue telecare alarm calls fail initially before eventually reaching our monitoring centre, in June ’17 it was 7% and last month it was 9%. These calls are initiated from a variety of end-customer devices, from both sheltered schemes and individuals homes and from all the major manufacturer’s. The % of initial failures will continue to worsen QoQ and YoY as more of the networks the calls travel across are geared for IP.
    I hope that helps.
    Best regards

  4. Mark Baker

    Hi Tim,

    When you responded to Chris last November I put a note in my diary to follow up on the stats that you presented. I’ll admit that the 7% and 9% rates for last June and July sound quite shocking especially when compared to the previous year.

    Do you have the corresponding figures for this June and July yet, as it will be interesting to see if there has been another upward trend for failed calls. Quickening growth could perhaps be taken as an indicator of BT moving faster than expected.

    It would also be interesting to hear from other monitoring centres, to see if similar trends are the norm.



  5. Mark Baker


    I had expected that Tim would tell me they were still rising, something which I found interesting when he first mentioned it, as it wasn’t the experience of the monitoring centre we use or two or three others, who I know of, that were willing to share the information.

    They all use monitoring platforms from either Tunstall or Jontek and when you read the article you posted the link to, it would appear that it is only Appello that are having these difficulties.

    Perhaps a broader study of failure rates could be conducted by the TSA to see if the problem lies with the in home equipment, the lines or the monitoring centre?

    There is an awful lot of money at stake on the outcome of whether or not existing analogue equipment will work in the future and I have seen Tim’s statistics used many times to support the case for wholesale change to GSM/IP. People should be able to point to an independent study of more than one monitoring centre as the basis for their decision on whether to stay as they are, make a gradual transition or move immediately to a fully digital service.

    Nobody is doubting that digital can bring enhanced service to all, but not everyone needs “enhanced”, “new” or “improved”. They are very happy with what they have, it meets their needs and to most is reasonably priced. Much of what is being offered under the digital umbrella is far from reasonably priced and comes with a lot of bells and whistles, which are of minimal regular benefit to the end user.

    I fear the current march towards digital is at risk of being hi-jacked by opportunistic people and businesses, that can only see the income that wholesale and early change would bring. I don’t count Tim and his company amongst those, but by providing those (unaudited?) stats on call connection rates, he may have inadvertently helped their case.