It’s an exciting time to work in social services commissioning. Technology is transforming large swathes of public service delivery in highly innovative ways and social care has been a big beneficiary, with robots tackling loneliness, voice assistants reducing falls and gaming technology preventing hospital admissions.
But it’s also a daunting time to commission technology enabled care (TEC) services. The old order of telecare – dominated for decades by social alarms provided through statutory bodies such as local authorities, health providers and housing associations - is changing, as the UK’s telecoms infrastructure is upgraded to digital connectivity by 2025.
A digital shift over a period of six to seven years presents local authorities with an opportunity to fundamentally redesign their TEC systems, taking advantage of emerging digital technology so they can provide proactive, not reactive services. But it also presents them with many challenges. One of the biggest is around quality assurance, particularly how they can guarantee network resilience and availability, data accuracy and cyber-protection in this new digital world. Over 1.7 million vulnerable people depend on TEC services and as equipment is upgraded and provision is moved to broadband networks, lives must not be put at risk.
Standards are critical here. Most traditional telecare services are controlled by alarms or hubs, linked to receiving centres. They use trusted, analogue telephone lines to exchange voice calls and limited data in real-time and they are supported by battery back-ups in case mains power fails. Their processes and structures are governed by established industry standards and service expectations. However, many of the underlying assumptions change with the digital shift of telecommunications.
In the future, local authorities will be able to call on a widening spectrum of suppliers and a range of new devices that will connect people digitally (in their home or on the move) to a rich ecosystem of app software, inter-connected networks and data analytics. Commissioners need to ensure that users and carers can continue to trust emergent technologies and services.
Ultimately, local authorities must drive this [TEC] transition, harnessing it as a catalyst to deliver innovative care solutions that improve outcomes for service users whilst continuing to keep them safe and secure
Existing regulations that prescribe design solutions may soon appear increasingly outdated. Standards will move away from statements of how systems should be constructed to what service capabilities they should enable. In the future, quality guidelines will need to accommodate a range of service and technology solutions, whilst ensuring the reliability and safety of future care applications.
This all represents a major change for local authorities providing TEC to their residents and there are a number of crucial points to consider going forward. The first is around the implications for procuring and operating technology in a digital environment. For example, councils need to develop procurement specifications that extend to include performance, reliability, availability and interoperability. Conditions around maintainability, usability and accessibility must be thought through, as well as ensuring that suppliers can evidence their compliance with these requirements. Finally, local authority commissioners and procurers must look at how they will independently assess these specifications.
For digital technology-enabled care to be effective and safe, councils must make changes to their service delivery and systems. But how can they begin this planning process? One way is to examine the main issues at stake. For instance, the potential for combining health, housing and care networks, data from the home environment, private pay and statutory equipment as well as from medical and non-medical grade devices will present huge opportunities in terms of proactive care services, but it will also pose interoperability and information governance challenges. How will local authorities re-design service delivery to tackle information security challenges around identity, cyber protection, data control, data storage and consent? The same questions must be asked about variable geographic access, quality of connectivity, service reliability and data accuracy.
As emerging technologies are increasingly used in health, the NHS is responding in a number of ways. NHSX, a unit set up to manage digital and data across the health service, has also been tasked with enforcing technology standards. The National Institute for Health and Care Excellence (NICE) has published updated standards for digital health technology so commissioners have an idea of the type of information to ask for from technology developers.
Local authorities too, must respond quickly to the new digital care environment. Social care commissioners must ensure that digital TEC systems are reliable, and system and service performance accountability is clearly defined by procurement teams. One way to do this is by working closely with technology suppliers so they understand fresh demands around TEC, particularly when designing and integrating digital solutions.
Another way forward is the adoption of compliance assessments, to ensure TEC services and systems follow and achieve the latest standards. TSA, the national body for technology enabled care services offers one such accreditation scheme.
But ultimately, local authorities must drive this transition, harnessing it as a catalyst to deliver innovative care solutions that improve outcomes for service users whilst continuing to keep them safe and secure.