How do we get better at-home based support and prevention? How far should local government go in terms of its role and responsibility of prevention in the community? How proactive is it prepared to be, to support those who are lonely and isolated, or those where there may be some concerns? Linda Sanders poses the questions, and tries out some answers…
I VISITED THE Tunstall Spain telecare monitoring centre in Barcelona recently and was overwhelmed by the scale of their offer and the emphasis on outbound, proactive calls. 65,000 people - around 12 per cent of their over-65 population - are being supported by telecare. This is a scale unheard of in this country. What makes it really special is the call centre – you feel a constant buzz and hear some really positive conversations which is in contrast to the crisis and reactive reassurance calls provided here in the UK. This is, of course vital. But there is a true mixture of prevention and response in the Spanish centre.
It may be a call to Mrs X because it’s her birthday and she’ll be on her own. Or Mr Y who’s just come out of hospital. A calendar of calls from health promotion, advice to keep safe, accident prevention, hot or cold weather warnings and advice. This proactive approach is hugely impressive.
In Barcelona the scale of the implementation is in the context of significant financial restraint plus a recognition there are still things that can be done to support people in the context of a medium to long-term preventative invest-to-save approach.
When I think about the potential in terms of linking with public health and healthy lifestyles I’m really excited about the possibilities. It’s made me think about prevention in a different way. To move away from a highly targeted, crisis model to a much more universal model.
So what’s the problem with targeted prevention? There is a lack of research about the effectiveness of targeted prevention but it needs a leadership leap of faith, particularly with the overwhelming case for supporting more people at home. It is important to ensure that Better Care Technology is seen as integral to a whole system shift, in order for some of the potential barriers in relation to perceptions of technology to be overcome. What is clear is that an effective telecare service requires a high quality responder service.
I’ve now worked in four authorities where I’ve been party to helping to ensure that the potential of telecare is realised. Through a shared leadership endeavour, it is important to ensure the right people are in place alongside a financially aligned good business model. It’s about capturing the imagination of members, assuaging the fears and anxieties of the public, partners and members that this is about “techie stuff”; viewing telecare as an essential complementary activity rather than a replacement for personal contact.
Telecare, when part of whole system redesign, helps achieve significant financial savings, increasing the number of residents not requiring further services and reducing long-term residential placements. Such successes provide a compelling developing evidence base.
How to succeed with better care technology? Don’t let it drift. The difference I think I’ve made is ensuring an unequivocal focus on making sure the change process is seen through, ensuring that better care technology is a leadership priority across the system so things don’t drift. It’s not an optional extra. There needs to be determination that to make it work relies on capturing the hearts and minds of a lot of people across the system – it’s vital to reach the tipping point and then for the momentum to be sustained.
Key champions emerge and then need supporting across all organisations and this makes a real difference. It might be that a key housing partner sees it as an important opportunity to enhance their traditional social alarm offer. It might be that a particular focus is on integrated discharge teams, senior hospital management and hospital staff. Having confidence in the technology and service is key in assuaging the natural fears and concerns that the hospital staff feel on discharging people where genuine anxiety about how someone is going to cope with a return home 24/7.
Telecare is a ‘game changer’ in that confidence is created to help manage family and staff’s natural anxieties and concern that a need for help will be responded to 24/7. They know that if something happens in the middle of the night, there will be help there if needed. These simple messages can have an amazing impact and increases the confidence of the support available in the community.
But looking at prevention at scale – would the Barcelona model work here? As indicated when you’re doing something differently at scale, it becomes a game changer. It’s not messing around at the edges. Clearly we don’t want to place people into a care home setting if that can be prevented because that is invariably not what people want and as part of a ‘promoting independence’ philosophy there’s something really preventive by thinking at scale.
Better Care Technology and proactive calling spans both health and care and needs to be mainstreamed to see people safely through old age or other disability or health problems. An assistive technology widespread offer, rather than only at crisis or during a difficulty allows a different and positive conversation to take place with health, carers and individuals about the role of ‘Better Care Technology’ within a preventative offer across social care.
So in answer to my original question - Yes, local government should prioritise prevention in the community. Without the leadership commitment politically, and from the DASS, DPH and other health partners, Better Care Technology won’t get traction and won’t be as effective as it could be. We need to embrace with passion and commitment the difference that empowering people to stay longer at home as independently as possible can make. Better Care Technology should be at the heart of the integration of health and social care.
ADASS Telecare Lead
Adult Social Care Director, Wolverhampton
See other Better Care Technology blogs
- Sally McIvor, Blackburn with Darwen
- Joy Hollister, London Borough of Havering
- Tony Zaman, London Borough of Hillingdon