Features: May 4th, 2007

Telecare – A Personal View on Personalised Care

By David Hinchliffe

Having spent all my adult life either professionally or politically involved in health and social care, I have no doubt that the future of care provision in both sectors is being profoundly affected by remarkable advances in telecare, telehealth and assistive technology.

Moreover, as someone who has dedicated much of his political energy to arguing for a unified health and social care system, I take delight in celebrating the fact that these advances will play such a vital role in helping to develop a more personalised social care model.

First-hand experiences and professional interest have provided me with a valuable insight into the issues faced by older people and those with long-term needs such as dementia, and the steps we need to take to make care services relevant to now.

Close to home and personal

The first experience is personal and frankly quite painful. It relates to the time when I was first in Parliament, when my widowed mother’s health was increasingly affected by dementia. Growing forgetfulness and confusion had necessitated moves over several years from the family home, first to a bungalow and eventually into a sheltered housing complex.

The bungalow was less than 10 minutes walk from the family home and the sheltered housing unit perhaps 20 minutes away, but this latter had as much familiarity as Outer Mongolia as far as she was concerned.

The sheltered housing warden could not have been more sympathetic, but the fact was that my mother’s condition saw her fall neatly into the no-man’s-land between the perceived responsibilities of health and those of social care. She did not fit into either category and so seemed to escape everyone’s responsibility.

The end result was a failure to provide even the most basic supportive services to assist the sheltered housing warden, and yet another totally inappropriate, and in my view unnecessary, admission to residential care. There, my mother joined any number of other elderly people who had been similarly displaced from their homes and communities by the lack of a coherent and holistic health and social care system.

Beyond categorisation

I learned that if you did not neatly fit a category, you were unlikely to get the service. I learned first hand of the arbitrary dividing line between health and social care, a line which none of the dozen or so Secretaries of State for Health I have known personally could ever – in any way – define.

I accept over the last two decades our front-line professionals have become much more skilled at the early identification and treatment of problems of the kind my mother faced. And multi-agency working is much more the norm, although political cowardice has meant no government has yet chosen to end the division between free health provision and means-tested social care.

The second experience I want to relate happened later than the first. If it had been the other way around, I have no doubt that my mother’s experience could have been very different.

In the early 90s, I was part of the Parliamentary Labour Party’s distinctly Old Labour Opposition Health Team, serving as Shadow Health Minister with responsibilities for personal social services and community care. It was here that I first discovered telecare.

My first visit as Shadow Minister to see Tunstall’s telecare facilities came as a profound shock. At the time, the main emphasis in Government policy concerning older people was on the massive expansion of institutional care.

Independence, not dependence

Between 1981 and 1993, when the community care changes involving local authority assessments were introduced, Mrs Thatcher’s Government had spent over £10 billion, through Supplementary Benefit and Income Support top-ups, funding an explosion in the provision of residential care and nursing homes. My criticism was that the Government was investing in dependence not independence.

On encountering telecare, my eyes were opened to the fact that the continued care in the community of at-risk elderly people – and other groups – could be underpinned by increasingly sophisticated systems designed to assist them and monitor their well-being and independence.

My late mother’s circumstances could have been quite radically changed through the use of technology which would have enabled her to continue living semi- independently in sheltered housing for considerably longer than she did. As well as contact with 24/7 support – which was not available when her warden was off duty – her confusion and occasional wandering could have been monitored through devices which would have alerted help and attention when necessary.

I am very proud of the fact that the policy document – New Directions in Community Care – published by the Labour Party while I was Shadow Minister was the first by any of the major parties to signal the fact that telecare and telehealth would be playing an increasingly central role in the direction of policy in years to come.

And one of the biggest regrets of my political life is the fact that the development of assistive technology during my time in Parliament was held back by the failure to develop organisational arrangements in health and social care, which would incentivise its use.

Realising the benefits

However, while we have still to bridge the divide between health and social care, there are now a number of distinct positives of great importance to the increased use of telecare. In most areas of the country it should be easier now than ever before to mutually explore and implement the benefits of telehealth and telecare.

The fact that the January 2006 White Paper on community services encompassed both health and social care was a much bigger advance than many people may realise. It demonstrated that national government is finally developing an understanding that the two sectors are wholly interrelated. It also shows that the Department of Health regards local partnership working, not as some luxury add-on, but as an absolute mainstream essential.

Alongside the White Paper, of course, has been the crucially important introduction of the Preventive Technology Grant in encouraging the use of assistive technology.

I want to make it clear that my belief in telehealth and telecare is not just based on the fact that it represents a better use of taxpayers’ money. It is to me fundamentally about its contribution to improving the quality of life of those who may be facing a learning or physical disability or mental or physical incapacity.

It is about giving them, and in particular their carers, the reassurance that independent and semi-independent living can take place in a safe and secure environment where risks can be monitored, managed and help made available when needed.

Transforming care

Last January’s Government White Paper pointed out quite clearly that the very near future will see technology alongside telecare which can enable, for example, the self monitoring of blood pressure, heart rate and glucose measurements. It made clear that spirometric and cardiac readings from in the home can also be fed through to health professionals to enable the monitoring and the early detection of problems, minimising or eliminating the need for hospitalisation.

On my last visit to Pinderfields Hospital in Wakefield, 2 years ago, the consultants there told me that one third of the patients occupying hospital beds didn’t need to be there. They had been admitted for tests and screening which could and should have been undertaken within primary care or within their own homes.

This experience is not untypical, and recent Government reports suggesting potential NHS savings through good practice of some £2.2 billion underlines this point.

The increasing availability of telemedicine monitors can transform our ability to manage chronic disease and long-term conditions in the community and shift the balance away from a reliance on hospitals and long term institutional care. Assistive technology will increasingly embrace health and care at the same time. Home monitors delivering both clinical data and social care information will become the norm, and we need to anticipate here and now what this will mean for how we organise our health and social care services locally and how we shape our future professional roles.

We must anticipate the ability to treat far more people within primary care settings and within their own homes. We must plan for the likelihood that the current telecare monitoring centres may in the future need to be transformed into what is more akin to clinical triage stations which offer the individual a comprehensive range of health as well as social care support. We must anticipate our primary care centres – hopefully combined with social care – also offering such multi-disciplinary monitoring.

In the not too distant future patients will not necessarily need to be in cottage hospitals or primary care centres to access a consultation or receive the care and support they need. They will be where they most want to be: safe, in their own homes.

David Hinchliffe is a former Labour MP for Wakefield and Health Select Committee Chairman.

More information is available from: www.tunstall.co.uk