Health and care provision across the globe is under pressure to offer the best in care to a growing population in the most efficient way possible. Different countries are responding in different ways.
In Scotland, rising demand and costs for public services mean that by 2020, the country’s 32 councils will have to spend an extra £700m on top of the £3.1bn per year spent now, Accounts Commission chairman Douglas Sinclair told BBC Scotland. He also called current approaches 'not sustainable'.
Health is also facing significant financial pressures, with Audit Scotland reporting that Scottish NHS boards will have to make unprecedented savings of £492m in the current final year. Some may not be able to achieve financial balance, as all struggle to meet the needs of a growing and ageing population.
Health and care providers are looking to deliver more person-centred services within the citizen’s home
Health and care providers are looking to address these issues by delivering more person-centred services within the citizen’s home. For many this means wider use of telecare or technology enabled care (TEC) to provide remote monitoring, responsive alarms and round-the-clock support for these individuals.
Telecare is delivering benefits; one report found that widespread, targeted use of telecare could create potential savings of between £3m and £7.8m for a typical council, equating to 7.4%-19.4% of the total older peoples’ social care budget. Savings for the NHS have also been identified, with reductions in unnecessary hospital admissions and healthcare appointments.
So with such evidence of impact, it is disconcerting to know that only around one in seven of the over-65s has access to telecare services. Such technology could help address many of the issues affecting health and care provision, but it needs investment if it is to make its contribution.
Current analogue approaches not fit for purpose
The UK needs to invest wisely. Currently most telecare systems are reliant on phone landlines – this is called ‘analogue’ telecare. But we need to invest in digital telecare if we want to maintain a society where our senior and vulnerable citizens can be cared for in an acceptable way.
The analogue delivery system is unsustainable due to increasing demands, with often tragic communication failures emerging that could be avoided. Current analogue services already report around 3% of failed call attempts between the home and response services, because they cannot communicate effectively over the new digital telephone network systems.
Analogue is preventing integrated care as its systems do not share data and knowledge efficiently between care providers, resulting in much duplication of activity. Needs are not communicated in a timely manner, meaning that people’s needs in the home are not met in a way that suits them, or the people that provide that care.
Citizens and telecoms providers are themselves moving away from analogue communication. More than three quarters of those aged 65 to 74 have Internet access at home. Mobile has surpassed the use of the phoneline in households over the past 10 years, according to Ofcom. Call volumes using ‘fixed’ phone lines are approaching half of what they were in 2010.
Telecoms companies, including BT, are keen to turn off the landline and make the switch to digital by 2025. It is inevitable that soon citizens will be living without a 'traditional' landline.
The future is digital telecare
Digital telecare is the next generation of technology that enables information sharing and supports the vision for integrated, person-centred care that is seen as a way of addressing the current issues facing health and care systems.
Digital telecare builds on existing approaches to home-based care, but makes it more efficient and more reliable. Unlike analogue systems, digital has an ‘always-on’ connection among a wider range of sensors such as smoke and heat, movement and activity, local environment, and personal alarms linked to a digital platform that can then share information with health and care providers, neighbours and next of kin to ensure that those most in need can be supported in their own home and for as long as possible.
Tom Morton
Savings would include reducing the number of unnecessary home visits where no action is required which can be up to half of all visits. Time could be saved through reliable, always-on digital monitoring that can check in discreetly on an individual’s movements, resulting in better and more informed needs assessments.
If this could cut a single unnecessary care visit for those receiving the most care – one hour from every 10 received per week – savings of more than £15m a year could be realised in Scotland alone.
Digital telecare will improve outcomes, keep people living independently for longer, and deliver this at a reduced cost to public budgets.
Scotland leads the way with its digital telecare planning
The Scottish Government already recognises the benefits of telecare, and has made significant investment in expanding current deployment. It has also recognised the future implications, and commissioned work on making the move from analogue to digital.
The resultant reports from Farrpoint have confirmed that digital telecare is more reliable, more efficient, and can provide the support through which many care needs can be addressed.
The latest report also set out the country’s options on making the move from analogue to digital. And this move came with a seemingly high price tag.
To provide digital telecare, the report reviewed Scotland’s existing infrastructure of alarm receiving centres (ARCs). ARCs are a local hub through which telecare information is passed between individual and care provider. There are currently 22 ARCs across Scotland, the report states, all of which support analogue telecare provision. These ARC systems will need replacement if the country is to make the move to digital. Potential costs of such a move varied according to the approach taken.
Doing nothing costs £14.2m per year. ‘Clustering’ the digital ARCs from 22 to eight would cost £18.6m. Keeping the same network of 22 ARCs would cost £21.5m.
The true cost of analogue care
The work is excellent, but there are some points which require clarification in the latest report.
- The ‘do nothing’ cost model assumes that the citizen will continue to bear the cost for maintaining a landline service required for connectivity to the ARC. This ‘connectivity cost’ is essential for any telecare service to operate. Under the current arrangements, the citizen pays. Under the digital plan, these costs are transferred to the state, and this increases the comparable costs shown for the digital options.
- The report does not fully quantify the benefits of a digital telecare system, but recommends a series of 'pilots' to identify benefits. But what extra benefits are we trying to prove or justify? Sweden has almost 100,000 digital telecare users. In that country, safety was paramount, as was the telecom companies’ desire to replace analogue systems with digital.
- Crucially, while there are sound figures around maintenance and replacement of systems and equipment, in my view the reports do not identify the true cost of analogue telecare. The report notes:
- The ‘do nothing’ costs do not factor in any increase in end user numbers. If the care provider is struggling now, then how will they cope with increased volumes and what is the impact on citizen outcomes?
- The ‘do nothing’ option still costs an estimated recurring £6m in annual support or maintenance.
- Response services are excluded from ‘do nothing’ costs. There is no assessment of the additional cost resulting from the unnecessary dispatch of first responders based on limited system intelligence. These hidden costs include home care, social workers, police, ambulance, fire service attendance and others who may be called out without need.
- Reductions in demand on health and care services are similarly excluded from the financial benefits.
In summary, support costs for around 300,000 analogue telecare users would essentially dwarf the equivalent cost of 300,000 digital telecare users and would not improve the safety, social inclusion or health outcomes for our citizens.
We need to draw a line under these current, unsustainable approaches. Any future deployment of analogue telecare is a wasted budget.
We need to draw a line under these current, unsustainable approaches
Arguably, Scotland is a world leader in telecare, with strategic aims and growing numbers of service users. It has invested millions in digital infrastructure, it has extensive telecare and telehealth deployment programmes, and has recently appointed a digital champion in Martyn Wallace.
Digital telecare is hardly visible in the majority of UK households that will benefit. Scotland has an integrated vision and it should lead the way in the UK and beyond.
We know the potential of digital technology, we know the overall benefits it can bring, and we know the costs of doing nothing. It is time to act now and consign analogue to the past.
