Analysis: What next for telecare?
Telecare may not cut costs, but it could have other benefits for patients, says Adam Steventon, lead researcher on the DH’s Whole Systems Demonstrator trial
There’s been growing interest in the potential of telecare to help frail people maintain their independence at home. Though 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. And some local authorities are beginning to invest in newer forms of telecare like automatic falls and bed occupancy sensors.
Some advocates have claimed that telecare can deliver benefits for older people and their carers while reducing costs - the latter happening through reductions in admissions to care homes and hospitals, as well as a shortening of length of stay in hospital (through facilitating faster discharge to a safer place in the community). Evidence about the effect of telecare on use of care services, however, has been scarce, with several systematic reviews concluding that no high-quality studies exist.
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 is reported in Age and Ageing, we examined the newer generation of telecare devices, such as falls and bed occupancy sensors. While traditional telecare alarms required 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 has just been published presents our analysis of administrative data. We found no convincing impacts of telecare on duration of domiciliary care, admissions to care homes, admissions to hospitals and 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.
Like all results, ours come with a range of uncertainty – for example, we could not rule out a reduction in the proportion of people admitted to hospital by as much as 13% (although it is also possible that an increase of 3% occurred).
It may be that the effect of telecare may depend 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 of 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. And a team at the London School of Economics is conducting a formal cost effectiveness calculation; as they use self-report rather than administrative data, they will be able to examine services not available from the administrative data, such as paramedics.
Though 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.
Adam Steventon is a senior research analyst at the Nuffield Trust and was a lead researcher in the Whole Systems Demonstrator trial