Should we invest in newer forms of telecare?
Mr Adam Steventon is Senior Research Analyst Nuffield Trust. As David Oliver’s recent blog mentions, there’s much interest at present in the potential of telecare to help frail older people maintain their independence at home. Telecare can take many forms. Since the Department of Health’s Building Telecare in England report, the number of pendant alarms in England has increased to around 1.5 million. Some local authorities are now beginning to invest in newer forms of telecare like automatic falls and bed occupancy sensors. Advocates have claimed that telecare can deliver benefits for older people and their carers while reducing costs – the latter happening through reduced admissions to care homes and hospitals, and shortened of length of stay in hospital by virtue of faster discharge with the safety assurances that come from telecare. However, evidence about the effect of telecare on use of care services has been scarce, with several systematic reviews commenting on a paucity of high-quality research. As social care budgets become more and more strained, the need for robust evidence will increase. If telecare is cost effective, then increased adoption might be an efficient route to providing better services at lower overall costs. But if telecare is not cost effective, then the money might be better spent elsewhere – for example, being a bit less restrictive with eligibility for domiciliary care. In recognition of the need for evidence, in 2006 the Department of Health announced three large “Whole Systems Demonstrator” sites in Cornwall, Kent and Newham in England. This provided the opportunity for a large, randomised-controlled trial of telecare, with 2,600 participants. We believe it is the largest such trial undertaken. In the trial, which reported in this month’s Age and Ageing, we examined the newer generation of telecare devices, such as falls and bed occupancy sensors. While traditional telecare alarms require action on the part of the user (for example, to wear a pendant alarm and push a button), these newer devices are designed for remote, passive and automatic monitoring. Our comparison group received usual care, which might include more basic forms of telecare like pendants. The paper that presents our analysis of administrative data. We found no convincing impact of telecare on duration of domiciliary care, admissions to care homes, admissions to hospital, length of stay, or general practice contacts. However, we could only track publicly-funded care services over one year, so there might have been impacts over longer time frames or on other forms of support. It may be that the effect of telecare depends on the way it is introduced and integrated into wider forms of support, including informal carers, social workers, general practices and physicians. Telecare might therefore have benefits in other settings or for other client groups. It may also be that the benefits of the technology are not manifest in changes in service use, but rather more subtle outcomes in terms of patient or carer anxiety. Decision makers should therefore examine future papers from the Whole Systems Demonstrator trial, once these become available. Work led by researchers at City University will test for impacts of telecare on outcomes for service users and carers. A team at the London School of Economics is conducting a formal cost effectiveness calculation – as they use self-reported rather than administrative data, they will be able to examine services not available from the administrative data, such as paramedics. Although our analyses were limited, we were able to test the claim that telecare reduces admissions to hospitals or care homes. Based on the findings of this particular trial alone, there is no convincing evidence to justify the public sector to invest in telecare from purely a cost saving perspective.