First published February 2006, updated May 2021

A recent Government Green Paper on reforming adult social care services, ‘Independence, Wellbeing and Choice’ placed the spotlight firmly on promoting preventative care that enables people to stay in their own homes (Table 1). It has also highlighted the role that telecare can play in helping to deliver these services. This Green Paper has formed the basis of this month’s White Paper ‘Our health, our care, our say: a new direction for community services.’

Recommendations are one thing. But hard cash is another. The Government has put its money where its mouth is, with the £80 million Preventative Technologies Grant set to transform the design and delivery of health and social care services for local authorities and their Primary Care Trust (PCT) partners.

The purpose of the grant is to develop long-term and sustainable service delivery improvements by using low-level support to prevent later crises, maintain well-being and independence and avoid more costly care. Community alarms and telecare can support older people and enable them to live safely and securely at home for longer, reducing admissions to residential care and hospital. As the funding is not ring-fenced, it can be distributed by local councils to healthcare schemes as they deem appropriate and no bids are required. However, councils with social services responsibility and relevant stakeholders need to have plans in place well before April 2006 in order to meet the target of 160,000 additional people benefiting from the technology. So, how do these parties go about devising and putting their plans into action before the April 2006 deadline?

Table 1. Independence, well-being and choice: our vision for the future of social care for adults in England 

This Green Paper sets out a vision for adult social care over the next 10 to 15 years and how this might be realised. It invites everyone to give their views on the vision and the ideas set out in the document, as well as to contribute new ideas to the debate.

The Green Paper is intended to provoke discussion on:

  • How the Government can offer more control, more choice and high-quality support for those who use care services
  • How the Government can harness the capacity of the whole community, so that everyone has access to the full range of universal services and an opportunity to play a full part in society
  • How the Government can improve the skills and status of the workforce to deliver the vision.

The key proposals to deliver this vision include:

  • Wider use of direct payments and the piloting of individual budgets to stimulate the development of modern services delivered in the way people want
  • Greater focus on preventative services to allow for early targeted interventions, and the use of the local authority well-being agenda to ensure greater social inclusion and improved quality of life
  • A strong strategic and leadership role for local government, working in partnership with other agencies, particularly the NHS, to ensure a wide range of effective and well-targeted provision that meets the needs of our diverse communities
  • Encouraging the development of new and exciting models of service delivery and harnessing technology to deliver the right outcomes for adult social care.

Step one: setting aims and objectives

It is vital to plan well, setting out aims and objectives and a clear vision of how telecare can be integrated into an existing model of care or create a new methodology. Careful planning will help authorities to make the most of the Preventative Technologies Grant and telecare delivery, ensuring all stakeholders are engaged and clear about the goals and their responsibilities from the start.

A good place to start is to evaluate existing care provision and examine how this can be further developed and expanded using telecare technology. Knowledge and experience gained from other successful telecare projects can be applied to help this process (e.g. could temperature extremes, flood and gas sensors be installed to monitor an individual’s home environment and personal well-being to provide support the instant it is required, rather than routine daily or twice daily checks?). Using telecare technology in this way not only helps to reduce some of the burden on care providers, it also preserves the dignity and quality of life of the individual. It is also helpful to examine current provision for specific client groups, i.e. people with dementia or learning difficulties to establish what role telecare could have.

Step two: The policy context – Government plans

The Government is convinced of the potential of telecare to deliver real and tangible benefits to vulnerable people, local authorities and healthcare providers, with Liam Byrne MP giving the unequivocal endorsement that: ‘Telecare gives people the confidence to live their lives in the way they want – independently, on their own terms, and with the peace of mind that comes from knowing that if something goes wrong, help is on its way.’

The Government also recognises that as the population ages, it is not feasible to continue to deliver care and support in the same way and that the commitment to offering independent living and choice to vulnerable people needs to be balanced with more efficient service delivery, given the financial burdens on the NHS. Telecare technology not only pays for itself but can also deliver savings that can be redeployed according to client need by providing cost-effective, low-level yet pro-active and preventative care, and fulfils many of the aims of wider policies like the National Service Frameworks as well as more local service delivery targets.

Step three: financial modelling for your area – what is needed?

There is no hard and fast financial model that can be applied unilaterally, but Section 31 of the Health Act 1999 provides flexibilities for local authorities and health trusts to pool funding to achieve agreed joint targets. This may provide an ideal framework for the financial management of grant funding as well as supporting the kind of integrated working required for effective implementation. Careful measurement and evaluation of telecare implementation is essential in order to highlight the cost benefits associated with introducing telecare into care provision, and these in turn should be utilised to drive further system modernisation and improvement.

Step four: a case in point

The Going Home Staying Home project, based at Foyle Health and Social Services Trust, has successfully introduced telecare into a pioneering new approach to health and social care for older people. Telecare solutions have enabled the supported discharge of 335 people in the area to date, giving them the care they need in their own homes, thereby reducing instances of bedblocking, alleviating some of the pressure on the NHS and saving over £250,000 in resources to date. As a result of impressive savings – 163 bed days and £550 per referral – the project has been extended to become part of the Trust’s mainstream healthcare provision.

Another project is one from Southwest Staffordshire PCT and is an innovative medication reminder initiative, which was launched to remind older people to take vital medication. A LifeLine unit requires the user to confirm that medication has been taken and automatically raises an alert to care service providers if no response is made. Telecare is being used to reduce the costs and hospital admissions associated with not taking medicines as prescribed, benefiting the Trust and the people in its care.

Step five: drawing up a telecare business plan

When drawing up a telecare business plan, one of the most important aspects to examine is how the service will be implemented by mapping the route to the service user in detail. Every aspect of deployment from who will assess and install, to who will manage the stock and who will monitor and respond to alerts needs to be considered in detail and protocols formulated and communicated. Resources can then be allocated accordingly as part of the plan, whether inhouse or outsourced, and any training needs addressed.

Step six: assessing telecare needs

Health and social care and support needs to be tailored to the individual, and not vice versa. The Single Assessment Process is being developed in order to drive efficiencies and in turn this should generate a specialist assessment for telecare. All stakeholders in the process therefore need an understanding of telecare solutions and appropriate applications, along with clear criteria and the protocols which need to be applied for its use. Specialist software is now available that will identify possible telecare solutions for clients that can then be discussed and agreed with them.

Step seven: evaluation framework

It is important to set out how the telecare programme will be evaluated in advance. What framework will be used to measure the success of the programme, and how will this success be measured? Quantitative data will highlight the cost benefits and associated savings in NHS resources that telecare delivers, by reducing bed-blocking and the need for round-the-clock care and residential care home places. Collecting qualitative data is equally as important, as this demonstrates how telecare can improve the quality of life for the individual, allowing them to remain in the familiar surroundings of their own home for longer. Evaluation must be planned from the outset with future eventual outcomes in mind – such as once the success has been quantified, what will the next steps be?

Conclusion

By following these guidelines, local authorities will be better prepared to benefit from the £80 million Preventative Technologies Grant, develop telecare services to deliver advanced levels of care and give people the freedom and independence to remain in their own home.