Scottish social care providers must not wait for the limitations of analogue telecare to appear before adopting digital
With current approaches to Scotland’s social services labelled unsustainable, and health care similarly under pressure, Tom Morton of Communicare247 urges providers to realise the potential for digital technology now.
Tom Morton says Scotland needs to act now on digital telecare - Photo credit: Communicare247
Health and care providers across the globe are under pressure to offer the best services they can 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. That’s according to the Accounts Commission chairman, Douglas Sinclair, who has described 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 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 to £7.8m for a typical council, equating to 7.4% to 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 that only around one in seven of the over 65s have 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 are 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, and there have been tragic communication failures 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.
People’s needs are not communicated in a timely manner, meaning that they 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 and mobile has surpassed the use of the landline in households over the past decade. Call volumes using fixed phonelines are approaching half of what they were in 2010.
Telcos, 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 between a wider range of sensors such as smoke and heat, movement and activity, local environment, and personal alarms.
By linking these to a digital platform that can share information with health and care providers, neighbours and next of kin, those most in need can be supported in their own home and for as long as possible.
And there are benefits to providers, too: a reduction in the number of unnecessary home visits where no action is needed; saved time through reliable, yet discreet monitoring of an individual’s movements; and better and more informed needs assessments.
To put this in perspective, moving to a system that identifies a single unnecessary care visit a week for those receiving the most care – just one hour from every 10 received per week – could release more than £15m a year of current budget spend.
How Scotland can lead the way
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 consultants Farrpoint to carry out work looking at the move from analogue to digital.
Its report sets out the costs of one element of implementing digital telecare – upgrading the country’s 22 alarm receiving centres, which are local hubs that pass information between individuals and care providers, and depend heavily on analogue technology.
We can keep these ARCs, which would cost £14.2m per year. Or, the Farrpoint report states, we could cluster around eight new digital ARCs, which would cost £18.6m per year. Upgrading the existing network of 22 ARCs to digital would cost £21.5m per year.
However, the report admits that this increase in costs is mainly down to the state paying for connectivity. At the moment, the citizen pays for his or her landline, but under the digital plan these costs would be transferred to the state.
Also, the calculations don’t include any consideration of an increase in service users. Costs to serve an extra 100,000 analogue telecare users would essentially dwarf the equivalent cost of 100,000 digital telecare users and would not improve the safety, social inclusion or health outcomes for our citizens.
Moreover, the report does not provide any costs for the unnecessary call out of response services, such as home care, social workers, police, ambulance or the fire service, that would occur with analogue services. Reductions in demand on health and care services are similarly excluded from the financial benefits.
It is also disappointing that the report recommends a further series of pilots to identify benefits – what extra benefits are we trying to prove or justify?
We need to draw a line under these current, unsustainable approaches. Any future deployment of analogue telecare is a wasted budget.
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 27 of the nation’s councils have recently appointed a joint chief digital officer in Martyn Wallace.
Scotland could lead the way in the rest of the UK, where digital telecare is hardly visible.
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 confine analogue into the past.
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