Hostname: page-component-848d4c4894-wzw2p Total loading time: 0 Render date: 2024-05-12T19:08:26.885Z Has data issue: false hasContentIssue false
  • English
  • Français

Remote care technologies, older people and the social care crisis in the United Kingdom: a Multiple Streams Approach to understanding the ‘silver bullet’ of telecare policy

Published online by Cambridge University Press:  11 February 2020

Andrew Eccles Open the ORCID record for Andrew Eccles [Opens in a new window]
Andrew Eccles*
Affiliation:
School of Social Work & Social Policy, University of Strathclyde, Glasgow, UK
*
Email: andrew.eccles@strath.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

The policy announcement in November 2018 by the Secretary of State for Health and Social Care that: ‘from today, let this be clear: tech transformation is coming’ indicates that confidence in care technologies, so apparent over the past decade in policy circles, remains unabated. This article suggests, based on evidence of significant limitations in technological solutions to care needs, that this confidence is misplaced. The focus is on remote care technologies – primarily telecare – which involve the passive or real-time monitoring of recipients, the majority of whom will be older people. These information and communication technologies (ICT) have been heralded by politicians, policy makers and industry interests alike as a solution to the challenges of demographic change and social care demand. While the research evidence suggests telecare works well for some people, in some circumstances, there are also significant complexities in its use, challenges presented to care relationships, and conflicting interpretations around its efficacy and cost-effectiveness. These critical issues have been marginalised in the mainstream discourse around telecare policy. This article explores the dissonance between this policy and the available evidence, drawing on a Multiple Streams Approach to analyse the emergence of, and continued confidence in, telecare policy based on a congruence of views across policy interests. To the extent that social care for older people is now in crisis, the article argues that the discourse around telecare represents an example of ‘silver bullet’ thinking: that is, too much focus on a single policy solution to address complex problems. Accordingly, the crisis in social care has deepened, without alternative policy proposals being available to address it. The renewed push for ICT-based solutions to this crisis in social care ought therefore to be viewed with some concern.

Keywords

remote care technologiestelecareolder peopleMultiple Streams Approach
Type
Article
Information
Ageing & Society , Volume 41 , Issue 8 , August 2021 , pp. 1726 - 1747
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ackrill, R, Kay, A and Zahariadis, N (2013) Ambiguity, multiple streams and EU policy. Journal of European Public Policy 20, 871–887.CrossRefGoogle Scholar
AKTIVE Consortium (2013) The Role of Telecare in Meeting the Care Needs of Older People: Themes, Debates and Perspectives in the Literature on Ageing and Technology. Available at https://www.emeraldinsight.com/doi/pdfplus/10.1108/JET-04-2017-0016.Google Scholar
Audit Commission (2004) Implementing Telecare: Strategic Analysis and Guidelines for Policy Makers, Commissioners and Providers. Available at https://lx.iriss.org.uk/sites/default/files/resources/57-Implementing%20Telecare%20-%20Audit%20Commission%20National%20Report%202004.pdf.Google Scholar
Barlow, JG, Curry, R, Chrysanthaki, T, Hendy, J and Taher, N (2012) Remote Care plc: Developing the Capacity of the Remote Care Industry to Supply Britain's Future Needs. Available at https://spiral.imperial.ac.uk:8443/handle/10044/1/11727.Google Scholar
Beale, S (2012) Evaluation of the Scottish Government's telecare programme. In Ballantyne, N and Lamendola, W (eds), Human Services in the Network Society. New York, NY: Routledge. pp. 63–76.Google Scholar
Berge, M (2017) Telecare – where, when, why and for whom does it work? A realist evaluation of an Norwegian project. Journal of Rehabilitation and Assistive Technologies Engineering 4, 1–10.CrossRefGoogle Scholar
BMJ (2018) New health secretary pledges £0.5bn to transform technology in NHS. BMJ 362, K3201, 1.Google Scholar
Cairney, P (2012) Understanding Public Policy. Basingstoke, UK: Palgrave Macmillan.CrossRefGoogle Scholar
Cameron, D (2011) We've Got to Change the Way We Innovate, the Way That We Collaborate, and the Way That We Open Up the NHS (Transcript of speech). Available at https://www.gov.uk/government/speeches/pm-speech-on-life-sciences-and-opening-up-the-nhs.Google Scholar
Care Quality Commission (2017) The State of Adult Social Care Services 2014–2017. Available at https://www.cqc.org.uk/sites/default/files/20170703_ASC_end_of_programme_FINAL2.pdf.Google Scholar
Carrasqueiro, S, Ramalho, A, Esteves, A, Pereira, C, Martins, D and Marques, L (2017) Report on EU State of Play on Telemedicine Services and Uptake Recommendations. Available at https://ec.europa.eu/health/sites/health/files/ehealth/docs/ev_20171128_co09_en.pdf.Google Scholar
Cartwright, M, Hirani, S, Rixon, L, Beynon, M, Doll, H, Bower, P, Bardsley, M, Steventon, A, Knapp, M, Henderson, C, Rogers, A, Sanders, C, Fitzpatrick, R, Barlow, J and Newman, S (2013) Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised control trial. British Medical Journal 346, 1–20.CrossRefGoogle Scholar
Clark, M and Goodwin, N (2010) Sustaining innovation in telehealth and telecare. Whole System Demonstrator Action Network, London, WSDAN briefing paper. Available at https://www.kingsfund.org.uk/sites/default/files/Sustaining-innovation-telehealth-telecare-wsdan-mike-clark-nick-goodwin-october-2010.pdf.Google Scholar
Clifford, P, Padda, K, Brown, O, Saunders, R and Demarche, C (2012) Investing to Save: Assessing the Cost-effectiveness of Telecare. Available at https://imosphere.co.uk/cdn/files/resources/telecare-cost-saving-study.pdf.Google Scholar
Collinson, P (2016) Social care: why are we beyond the crisis point? The Guardian. Available at https://www.theguardian.com/society/2016/dec/12/social-care-crisis-funding-cuts-government-council-tax.Google Scholar
Deloitte (2017) Telecare feasibility study. Feasibility study for the provision of universal telecare services for the over 75s. London, Deloitte. Available at https://www.ehealth.scot/wp-content/uploads/2017/11/2017-11-20-Telecare-Feasibility-Study-Report-FINAL-1.pdf [Accessed 15 May 2018]Google Scholar
Department for Business, Innovation and Skills (2013) The Technology Strategy Board Triennial Review. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/253593/bis-13-1073-triennial-review-of-the-technology-strategy-board.pdf.Google Scholar
Department of Health (2011) Whole System Demonstrator Programme: Headline Findings: December 2011. Available at https://www.gov.uk/government/publications/whole-system-demonstrator-programme-headline-findings-december-2011.Google Scholar
Department of Health (2012a) A Concordat Between the Department of Health and the Telehealth and Telecare Industry. Available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216757/Concordat-3-million-lives.pdf.Google Scholar
Department of Health (2012b) Telehealth and Telecare Could Save NHS £1.2 Billion (Press release). Available at https://www.gov.uk/government/news/telehealth-and-telecare-could-save-nhs-1-2-billion.Google Scholar
Digital Health (2008) New Government Funding for Telecare. Available at https://www.digitalhealth.net/2008/09/new-government-funding-for-telecare/ [Accessed 15 July 2013]Google Scholar
Dobrev, A, Meyer, I, Muller, S, Kubitschke, L, Hammerschmidt, R, Korte, WB, Husing, T, van Kleef, T, Otto, S, Heywood, J and Wrede, M (2013) Coping with an Ageing Population: Learning from Good eHealth and Telecare Practices: The eCare Benchmarking Study. Bonn, Germany: European Commission.Google Scholar
Dunn, Cavelty M and Suter, M (2009) Public–private partnerships are no silver bullet: an expanded governance model for critical infrastructure protection. International Journal of Critical Infrastructure Protection 4, 179–187.CrossRefGoogle Scholar
Eccles, A (2010) Ethical considerations around the implementation of telecare technologies. Journal of Technology in Human Services 28, 44–59.CrossRefGoogle Scholar
Eccles, A (2015) Telecare technologies and isolation: some ethical issues. Smart Homecare Technology and TeleHealth 3, 81–90.CrossRefGoogle Scholar
Equality and Human Rights Commission (2011) Close to Home: An Inquiry into Older People and Human Rights in Home Care. Available at http://www.equalityhumanrights.com/uploaded_files/homecareFI/home_care_report.pdf.Google Scholar
Ethical Frameworks for Telecare Technologies for Older People at Home (2011) EFORTT: Ethical Frameworks for Telecare Technologies for Older People at Home: Final Research Report. Available at http://www.lancaster.ac.uk/efortt/documents/Deliverable%207%20Final%20Research%20report.pdf.Google Scholar
Exworthy, M (2008) Policy to tackle the social determinants of health: using conceptual models to understand the policy process. Health Policy and Planning 23, 318–327.CrossRefGoogle ScholarPubMed
Exworthy, M and Powell, M (2004) Big windows and little windows: implementation in the ‘congested state’. Public Administration 82, 263–281.CrossRefGoogle Scholar
Fischer, F (2003) Reframing Public Policy: Discursive Politics and Deliberative Practices. Oxford: Oxford University Press.CrossRefGoogle Scholar
Fujimoto, M, Miyazaki, K and Von Tunzelmann, N (2000) Complex systems in technology and policy: telemedicine and telecare in Japan. Journal of Telemedicine and Telecare 6, 187–192.CrossRefGoogle ScholarPubMed
Goodwin, N (2011) Can We Justify the Investment in Telehealth and Telecare? Available at https://www.kingsfund.org.uk/blog/2011/03/can-we-justify-investment-telehealth-and-telecare.Google Scholar
Ghosh, J (2011) Cash transfers as the silver bullet for poverty reduction: a sceptical note. Economic and Political Weekly 46, 67–71.Google Scholar
Greenhalgh, T (2012) Whole System Demonstrator trial: policy, politics, and publication ethics. British Medical Journal 345, 1.CrossRefGoogle ScholarPubMed
Greenhalgh, T (2017) How to Implement Evidence-based Health Care. Chichester, UK: Wiley-Blackwell.Google Scholar
Greenhalgh, T (2018) How to improve success of technology projects in health and social care. Public Health Research and Practice 28, e2831815.CrossRefGoogle ScholarPubMed
Greenhalgh, T, Procter, R, Wherton, J, Sugarhood, P and Shaw, S (2012) The organising vision for telehealth and telecare: discourse analysis. BMJ Open 2, 1–12.CrossRefGoogle ScholarPubMed
Greenhalgh, T, Shaw, S, Wherton, J, Hughes, G, Lynch, J, A'Court, C, Hinder, S, Fahy, N, Byrne, E, Finlayson, A, Sorell, T, Procter, R and Stones, R (2016) SCALS: a fourth-generation study of assisted living technologies in their organisational, social, political and policy context. BMJ Open 6, 1–13.CrossRefGoogle ScholarPubMed
Greenhalgh, T, Wherton, J, Papoutsi, C, Lynch, J, Hughes, G, A'Court, C, Hinder, S, Fahy, N, Procter, R and Shaw, S (2017) Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. Journal of Medical Internet Research 9, e367.CrossRefGoogle Scholar
Greenhalgh, T, Wherton, J, Papoutsi, C, Lynch, J, Hughes, G, A'Court, C, Hinder, S, Procter, R and Shaw, S (2018) Analysing the role of complexity in explaining the fortunes of technology programmes: empirical application of the NASSS framework. BMC Medicine 16, 1–15.CrossRefGoogle ScholarPubMed
Greenhalgh, T, Wherton, J, Sugarhood, P, Hinder, S, Procter, R and Stones, R (2013) What matters to older people with assisted living needs? A phenomenological analysis of the use and non-use of telehealth and telecare. Social Science & Medicine 93, 86–94.CrossRefGoogle Scholar
Greer, S (2015) John W Kingdon: agendas, alternatives and public policies. In Lodge, M, Page, EC and Balla, SJ (eds), The Oxford Handbook of Classics in Public Policy and Administration. Oxford: Oxford University Press, pp. 417–432.Google Scholar
Healthcare Improvement Scotland (2017) Making care better - better quality health and social care for everyone in Scotland: A strategy for supporting better care in Scotland 2017-2022. Available at http://www.healthcareimprovementscotland.org/previous_resources/policy_and_strategy/strategy_2017-2022.aspx [Accessed 12 October 2018]Google Scholar
Hendy, J, Chrysanthaki, T, Barlow, J, Knapp, M, Rogers, A, Sanders, C, Bower, P, Bowen, R, Fitzpatrick, R, Bardsley, M and Newman, S (2012) An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator. BMC Health Services Research 12, 1–10.CrossRefGoogle ScholarPubMed
House of Lords Economic Affairs Committee (2019). Social Care Funding: Time to End a National Scandal (HL 392). London: The Stationery Office.Google Scholar
Hudson, B and Henwood, M (2002) The NHS and social care: the final countdown? Policy and Politics 20, 153–166.CrossRefGoogle Scholar
Hunn, N (2013) NHS Claims 200% of Global Telehealth Users. Available at http://www.nickhunn.com/nhs-claims-200-of-global-telehealth-users/.Google Scholar
Innes, A, Morice, A and Faruqi, S (2012) Re: Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. British Medical Journal 344, 1–15.Google Scholar
Ipsos MORI (2017) How Britain Voted in the 2017 Election. Available at https://www.ipsos.com/sites/default/files/2017-06/how-britain-voted-in-the-2017-election_2.pdf.Google Scholar
Jarrett, T (2018) Social Care: Forthcoming Green Paper (England). Available at.Google Scholar
Jarrett, T (2019) Adult social care: the Government's ongoing policy review and anticipated Green Paper (England) House of Commons Library Briefing Paper 8002. Available at https://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-7903#fullreport [Accessed October 7 2019]Google Scholar
John, P (2102) Analyzing Public Policy, 2nd Edn. London: Routledge.Google Scholar
Johnson, B (2019) Another £1.8bn for the NHS, then I'll tackle social care. The Sunday Times. Available at https://www.thetimes.co.uk/article/another-1-8bn-for-the-nhs-then-ill-tackle-social-care-hq5wd3fwv.Google Scholar
Kamphof, I (2013) Samenwerken. Over mensen en dingen in zorgnetwerken. Ethische Perspectieven 23, 124–136.Google Scholar
Kingdon, A (1995) Agendas, Alternatives and Public Policies, 2nd Edn. New York, NY: Harper Collins.Google Scholar
Kingdon, A (2011) Agendas, Alternatives and Public Policies, Updated 2nd Edn. Boston, MA: Longman.Google Scholar
Lintern, S (2012) Survey finds 91pc of people have not heard of telehealth. Health Services Journal. Available at http://www.hsj.co.uk/news/survey-finds-91pc-of-people-have-not-heard-of-telehealth/5047579.article#.UlRRjtKsim4 [Accessed 15 July 2013]Google Scholar
Lowe, C (2013) Telehealth Soapbox: Time to Bid Farewell to the WSD? Available at http://telecareaware.com/telehealth-soapbox-time-to-bid-farewell-to-the-wsd/.Google Scholar
Marx, GT (1995) The engineering of social control: the search for the silver bullet. In Hagan, J and Peterson, R (eds), Crime and Inequality. Stanford, CA: Stanford University Press, pp. 225–246.Google Scholar
McConnell, A (2010) Understanding Policy Success. Basingstoke, UK: Palgrave.CrossRefGoogle Scholar
Means, R, Richards, S and Smith, R (2008) Community Care, 4th Edn. Basingstoke, UK: Palgrave.CrossRefGoogle Scholar
Mort, M, Roberts, C and Callén, B (2013) Ageing with telecare: care or coercion in austerity? Sociology of Health & Illness 35, 799–812.CrossRefGoogle ScholarPubMed
Mort, M, Roberts, C and Milligan, C (2009) Ageing, technology and the home: a critical project. European Journal of Disability Research 3, 85–89.CrossRefGoogle Scholar
Moser, I and Thygesen, H (2015) Exploring possibilities in telecare for ageing societies. In Barnes, M, Brannelly, T, Ward, L and Ward, N (eds), Ethics of Care: Critical Advances in International Perspective. Bristol, UK: Policy Press, pp. 111–123.CrossRefGoogle Scholar
NHS Digital (2017) Adult Social Care Activity and Finance Report: Detailed Analysis, England 2016–17. Available at https://digital.nhs.uk/data-and-information/publications/statistical/adult-social-care-activity-and-finance-report/adult-social-care-activity-and-finance-report-england-2016-17.Google Scholar
Office for Life Sciences (2015) Digital Health in the UK. London: Deloitte.Google Scholar
Office for National Statistics (2019) Living Longer: Is Age 70 the New Age 65? Available at https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/livinglongerisage70thenewage65/2019-11-19.Google Scholar
Oliver, D (2018) Will robotic automation solve social care? BMJ 363, 1–2.Google ScholarPubMed
Oudshoorn, N (2011) Telecare Technologies and the Transformation of Healthcare. Basingstoke, UK: Palgrave.CrossRefGoogle Scholar
Parliamentary Office of Science and Technology (2014) Telehealth and Telecare. Available at http://researchbriefings.files.parliament.uk/documents/POST-PN-456/POST-PN-456.pdf.Google Scholar
Petticrew, M and Roberts, H (2006) Systematic Reviews in the Social Sciences. Oxford: Blackwell.CrossRefGoogle Scholar
Phillips, D and Simpson, P (2018) Changes in Councils’ Social Care and Overall Service Spending in England, 2009–10 to 2017–18. Available at https://www.ifs.org.uk/publications/13066.Google Scholar
Phillips, J (2007) Care. Oxford: Polity.Google ScholarPubMed
Pols, J (2012) Care at a Distance. Amsterdam: Amsterdam University Press.CrossRefGoogle Scholar
Pols, J and Moser, I (2009) Cold technologies versus warm care? On affective and social relations with and through care technologies. European Journal of Disability Research 3, 159–178.CrossRefGoogle Scholar
Pols, J and Willems, D (2011) Innovation and evaluation: taming and unleashing telecare technology. Sociology of Health & Illness 33, 484–498.CrossRefGoogle ScholarPubMed
Poole, T (2006) Telecare and Older People. Available at https://www.kingsfund.org.uk/sites/default/files/telecare-older-people-wanless-background-paper-teresa-poole2006.pdf.Google Scholar
Postema, TRF, Peeters, JM and Friele, RD (2012) Key factors influencing the implementation success of a home telecare application. International Journal of Medical Informatics 81, 415–423.CrossRefGoogle ScholarPubMed
Rawat, P and Morris, JC (2016) Kingdon's ‘streams’ model at thirty: still relevant in the 21st century? Politics and Policy 44, 608–638.CrossRefGoogle Scholar
Reuters (2019) New UK PM Johnson's Arrival Speech in Downing Street. Available at https://www.reuters.com/article/us-britain-eu-leader-text/new-uk-pm-johnsons-arrival-speech-in-downing-street-idUSKCN1UJ28E.Google Scholar
Robinson, S (2012) Telecare's ‘£1.2bn Savings’ Remain in Doubt. Available at https://www.gponline.com/telecares-12bn-savings-remain-doubt/article/1135469.Google Scholar
Saraceno, C (ed.) (2008) Families, Ageing and Social Policy: Intergenerational Solidarity in European Welfare States. Cheltenham, UK: Edward Elgar.CrossRefGoogle Scholar
Scottish Government (2008) Telecare in Scotland: Benchmarking the Present, Embracing the Future. Available at http://lx.iriss.org.uk/sites/default/files/resources/1204629144-TDP%20-%20TDB%20-%2015%20Feb%202008%20-%20Benchmarking%20Report.pdf.Google Scholar
Scottish Government (2012) A National Telehealth and Telecare Delivery Plan for Scotland to 2015: Driving Improvement, Integration and Innovation. Available at http://www.scotland.gov.uk/Resource/0041/00411586.pdf.Google Scholar
Technology Strategy Board (TSB) (2013) Assisted Living Innovation Platform (ALIP). Available at http://www.aal-europe.eu/wp-content/uploads/2013/06/Telecare_LIN_eNewsletter_February_2013_dallas-copy.pdf.Google Scholar
Telecare Services Association (2016) Available at https://www.tsa-voice.org.uk/news/dallas-telehealth%E2%80%99s-reboot-reviewed/ [Accessed 27 January 2019]Google Scholar
The King's Fund (2011) International Congress on Telehealth and Telecare. Available at https://www.kingsfund.org.uk/audio-video/moira-mckenzie-it-innovation-integrated-care [Accessed 17 July 2013]Google Scholar
Tunstall (2009) Support for Carers: Solutions for Independent Living. Available at http://apac.tunstall.com/Uploads/Documents/New-Support-for-Carers.pdf.Google Scholar
Woolham, JG, Steils, N, Fisk, M, Porteus, J and Forsyth, K (2018) The UTOPIA Project: Using Telecare for Older People in Adult Social Care: The Findings of a 2016–17 National Survey of Local Authority Telecare Provision for Older People in England. King's College London. Available at https://kclpure.kcl.ac.uk/portal/files/87498580/Utopia_project_report.pdf.Google Scholar