Telecare in the UK: lessons from Barcelona

By Rebecca Jackson

Telecare is technology to help people live independently, usually in their own homes, for longer. Usually delivered as part of a package of care, telecare devices can include things like: bed sensors, to detect if someone is out of bed at an unusual time; fall sensors; medication reminders; and alerts on screens or over loudspeakers. Such devices have led telecare to be heralded as a new dawn in patient-centred, independent living.  However, despite initiatives  to drive its application forward, not everyone in the UK is convinced about the benefits of telecare.

Practitioners and carers are sceptical about the potential of replacing traditional care with digital models to save money and the impact that this could have on standards of care. In addition, many patients themselves are uncertain about the use of telecare and digital health solutions, with many who have telecare systems within their homes choosing to continue to interact with primary and home care services in the same way as before. Much of the academic and expert-led research and evaluation of telecare programmes in the UK by organisations such as the Nuffield Trust and the Kings Fund has found little to no improvement in service, reduction in cost or reduction in workload for care teams in areas where telecare has been deployed.

While telecare in the UK appears to have stalled, elsewhere digital health solutions are not only successfully integrated into traditional care models, but are having a positive impact on the people in receipt of care, and reducing the burden of work on care providers.

Lessons from Barcelona

In Spain, the law has guaranteed access to telecare since 2006. Economic austerity has led to individual local authorities in Spain being given control over their budgets and therefore their provision of telecare. The approach in Barcelona has been highlighted as an example of best practice in telecare.

The system there – a cooperative venture between an independent provider and the local authority – sees carers take a proactive approach to telecare. The system does not just monitor and provide assistance in times of distress, but proactively engages with service users at regular intervals to help carers provide reassurance and build relationships.

As well as the emergency measures, such as fall sensors (typically the primary use of telecare in the UK), calls are made to check up on service users, provide reassurance, deliver general public health information and to mark important occasions, like birthdays. This can help to reduce feelings of isolation and loneliness, which in turn can lead to better general health and wellbeing.

Calls can also be made to highlight important information, such  as weather warnings; safety alerts and local events which the service users may wish to attend. These calls are backed up by visits from the care team, who work for the telecare provider. These visits supplement visits from municipal care and social workers and the two teams communicate and share information via digital platforms.

Digital healthcare as an enabler

The case of Barcelona shows us how digital healthcare solutions, and more specifically telecare, can be used as an enabler – a tool to allow the local authority to pursue a joined up and preventative approach to healthcare which has positive benefits for recipients.

Such approaches could also have a significant impact on the UK’s 3.8 million unpaid carers. Telecare has the potential to reduce some of the burden and stress of caring for a relative, which in turn can have positive effects on the health of the person in receipt of care. It can also  form an effective part of reablement programmes – supporting people as they leave hospital or return to independent living.

However the approach to delivering telecare in Britain is as much about culture as it is about the technological infrastructure. Using telecare as part of a preventative, person-centred approach should produce better outcomes. In this sense, implementation of telecare in the UK still lags behind other countries. Key lessons could also be learnt from programmes in Norway and the Netherlands in relation to telecare in dementia settings.

Generally, the targeting of telecare services also differs – in the UK it tends to be aimed at elderly people with complex and diverse needs, while in Norway and the Netherlands the focus has shifted to those suffering from chronic illnesses.

Local solutions

In the UK, some local authorities have been experimenting with digital healthcare, although local authority budget cuts have meant that in many cases these have been cut back to focus delivery on the most vulnerable clients.

The lessons in digital healthcare that Britain can learn from places like Barcelona could be key to the successful roll out of digital healthcare solutions in the future. The Barcelona example highlights the enabling role that telecare can play in joining up health and social care and promoting a more preventative approach to healthcare.

Opportunities to develop telecare strategies and deliver them in partnership, as in the Barcelona model, show that it cannot be delivered in isolation, or be used as a replacement for existing carer-led services. Instead telecare has the potential to be a supporting tool to ensure effective care outcomes. It could also help care services in Britain to tackle the increasing demand of an ageing population.


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Read some of our other blogs on social care:

Digital technology in social work practice

Using social media in social work practice was the topic of conversation at a recent conference, held at the University of Stirling. With a delegate list including academics, researchers, practitioners and representatives from the public and private sectors the conversation topics were broad and wide ranging from how to use social media, what to avoid doing and how to integrate digital technologies and systems into everyday practice for social workers.

social media infographic photoPartnerships to deliver digital solutions

In March last year we told you about the partnership between a local authority and Idox who teamed up to deliver a digital case management tool to support the council social workers in their day to day practice. The ideas that were promoted during the conference not only emphasises the innovative nature of that partnership when it was developed, but also the continuing possibilities to pursue innovative digital solutions within local government to allow Idox to continue deliver efficient and positive outcomes for service users.

Avoiding social media pitfalls

Aside from poor infrastructure, like a lack of wifi, and seemingly impenetrable work computer firewalls, both of which came up regularly in discussions, one of the main reasons social workers did not use social media was fear, uncertainty and worry of the repercussions should something be posted or liked which was deemed inappropriate.

Rachel Wardell, the director of Services at Warwickshire council gave a talk on utilising Twitter in an appropriate way and outlined the “7 stages of Twitter” for new and advanced users. She suggested that Twitter was actually a great way for social workers, teams and managers to make connections and share best practice across the profession. She discussed how links initially forged on twitter by a follow or the sharing of an article developed into partnerships and trips to visit areas of best practice to observe and learn from fellow professionals.picjumbo.com_HNCK1814

However for many social workers, and their management teams, social media use can still be problematic, with the BBC reporting earlier in the year that there had been a rise in the number of council workers being punished for misconduct relating to social media. For social work teams the pressures and implications are even more significant. In discussion with Birmingham University’s Dr Tarsem Singh Cooner some of the delegates highlighted examples of colleagues who had been accused of bringing the profession into disrepute and some extreme instances where they had been removed from cases at the request of service users who had seen a post on their social media account which was not secured with privacy settings.

While most were keen to stress that these were individual mistakes and misjudgements there was still anxiety about the increasingly blurred boundaries between public and private, the importance of relationship building and personal experience for social workers interacting with service users, but the necessity to remain professional. The phrase ‘social workers are human too’ was used regularly by those advocating the use of social media and that councils should use a level of common sense and discretion when dealing with incidents involving staff and social media. However, the general consensus appeared to be that social media should be treated with caution:

  • use a separate work and personal account
  • use an alias
  • employ maximum privacy settings
  • don’t post anything that could potentially bring the profession or your conduct into disrepute
An example (from my own Twitter) of how Twitter can be used to document conferences and interact with professionals

An example (from my own Twitter) of how Twitter can be used to document conferences and interact with professionals

Making social work ‘appier

One of the big developments which has become increasingly popular as a tool to engage social work in digital technology is the creation of apps. Many of the conference discussions were on the benefits of using an app, how they can be utilised fully in their roles as training tools and information providers or how they can be used to encourage participation and communication in aspects such as feedback.

Anne Campbell from Queens University Belfast discussed the development of a series of information-based apps which focused on child development. Another app covered the knowledge of social workers and social care teams of drug and alcohol in substance misuse cases, including symptoms, street names for abused substances and the studies which use examples of substance misuse in social work and adult and child protection cases. She discussed the importance of using practitioners and service users to develop the app, to ensure it was fit for purpose and easy to use. She also highlighted the potential for her apps, which currently operate in a Northern Irish context, to be developed and diversified to account for differences in policy in Scotland, the Republic of Ireland and England and Wales.

Screenshot images of the apps

Screenshot images of the apps

There is a potential for software development in the future which would see more secure data files more easily accessible via personalised secure apps and document drop apps, which could be shared across a number of sectors, including health, social care and education. Delivering the digital infrastructure platforms to develop and successfully run integrated systems and sharing platforms such as these would require huge investment from local authorities, and would potentially provide the opportunity to work in conjunction with specialists, such as Idox, to develop software which is supportive, flexible and fit for purpose.

Apps

Iphone apps. Image by Daniel Go via Creative Commons

Using social media to create connections

The final part of the afternoon was characterised by case study style discussions, where speakers presented their own experiences, both positive and negative of using social media and stressed the importance of social media as a way to create connections. The connections spoken about included connections between practitioners, to create a more extensive community of best practice within the social work profession, connections between service users and social workers, many of whom feel more comfortable communicating via social media, and finally creating connections between service users to help them provide support to each other. This was something specifically highlighted by the team from Lothian Villas in East Lothian.

Lothian Villas have been using a closed, invite only Facebook group as a forum to interact with young people staying with them during a period in residential care. Members can post on the page, while others respond giving advice and reminiscing, much like a traditional family would do. That, according to Ewan McKay, is vital for allowing children who have come from care to build and maintain relationships and have happy memories of their childhood which can go on to shape how they behave as adults in the future. They can also then pass their memories and advice onto the children who are coming through the system after them.

Other groups spoke about the use of document sharing sites, digital presentation sites and networking sites like LinkedIn to create and document continuing professional development (CPD), a core part of social workers’ continuing improvement and the maintenance of standards.

 

The conference highlighted the massive steps forward which have been taken and the desire for drive and innovation in digital infrastructure to take public services, and their delivery onto digital platforms. This would allow for greater connectivity between professions such as social work and other service providers in health and education resulting in more efficient services, producing better outcomes for service users. Using digital platforms well, including apps, sharing websites and personal social networking sites such as Twitter will allow practitioners and local authorities to ‘join up’ services to promote more holistic, person-centred care at a local level while allowing professionals to build a network of best practice and document their own CPD. Digital media in social work practice could potentially be a key enabler in improving practice and generating positive outcomes for service users.


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