Integrated, person-centred care is seen as a driving force for building public services around individual needs. It aims to bring care out of the hospital and into the community and home to cope with the growing burden of the 3 million people who will have over three long-term conditions by 2018. It will also help acute hospitals to address the ever increasing costs associated with our aging population.
Meanwhile life in our homes and communities is becoming fragmented. One in four (2.9 million) people aged 65 and over feel they have no one to go to for help and support, according to a 2015 report from Age UK and The Campaign to End Loneliness. With research indicating that social isolation leads to higher mortality, what point is there keeping people out of hospital, if only they are left home alone, and without the necessary support?
Person-centred care will have minimal success if we do not recognise this fact; people need someone to look out for them. And current approaches are not building the foundations that society needs to help grasp the nettle of providing round-the-clock personal care.
What has developed is a situation where services are delivered according to the needs of care providers, rather than the individual customer, when it really should be the reverse. People need care when it is required by them, and not necessarily at the time when the care worker visits. Care packages are built around the ability to deliver those packages, rather than what care that person needs. Without data on who needs what, and when, care providers deliver homogenised packages of support that are manageable in the short term, but unaffordable and undesirable on the whole.
The future is digital
These problems have a solution with the delivery of new and innovative digital telecare and telehealth technology. This is good as digital offers reliable monitoring and support for vulnerable individuals 24 hours a day, seven days a week. It keeps families informed about the care of their loved one and provides the data that can enable service providers to design care packages that more precisely meet the needs of individuals, and so tailor their stretched resources to areas with the greatest requirement.
The evidence for the wider use of technology to help maintain people’s independence is clear. As early as 2005, a West Lothian telecare pilot showed how smarter homes and greater use of technology can help older people stay out of hospital and get out of hospital sooner. A more recent study - again from Scotland - shows net savings of £0.38 million over five years.
However, the tools that we are currently using are considered by many to be no longer fit for purpose. In a time of digital platforms such as Google’s Nest, which can transmit all manner of information to friends and family, many local authorities are trapped by a telecare infrastructure that uses analogue telephone lines and alarm monitoring systems that are no longer suitable to meet the demands of large swathes of the population.
It's time to move on from the analogue world of telecare and commit to building a digital infrastructure, or we run the risk persisting with public services that do not meet the needs of the citizens they were setup to serve.
UK adoption of digital telecare is mixed. In England and Wales, for example, the government has left it to localities and regions to develop their own solutions for telehealth and telecare. Multiple initiatives begin but never seem to get past the pilot stage, as can be seen with the 3million lives telehealthcare campaign.
Elsewhere progress marches on. With a clear goal of providing free care for all, and with a unified budget, Scotland is setting about establishing the delivery models and technological platform that will help to make significant advances in the way people are cared for. Decision makers, practitioners, industry and academia are making this happen. It is pragmatic, logical and driven by consumer need.
Similarly, other countries have realised that existing analogue systems cannot deliver against growing healthcare requirements and demands and are shifting to digital technology to support integrated health and care needs.
Consumers driving demand
Just as consumers are embracing the benefits that technology can deliver to support their lifestyles, so too must those whose duty it is to care for us. Health and care professionals must open their eyes to the advantages that digital can deliver. Not just for patients and citizens, but also to deliver better, quality care with fewer resources.
Some put forward that data protection is a barrier to how we share information to help deliver care. But consumers use apps and other devices to share and record information about themselves, without too much regard for data protection. If this is an issue, there are alternatives with more regard for UK data protection laws.
For others, technological standards prove an issue for sharing information - should we create new standards? I would say there is no need; multiple standards exist at European level that we can use to ensure efficient and secure transfer of information. We need to take an open approach using relevant standards that meet and safeguard consumer needs.
Ultimately there has to be a scalable alternative to pull information together for a specific purpose, focussed on individuals rights and needs. Digital technology can respect those rights and help deliver against those needs.
But this is not about technology. This is about people. We need to work in partnership with the person, their next of kin, health, care and other services to see how we can support people’s independence, and use the best in technology and practice to make person-centred care a reality.