What does the evaluation of the Scottish Telecare Development Programme tell us? Is it time for a leap of faith?
Paul Trueman & Sophie Beale
The Scottish Telecare Development Programme (TDP) represented a commitment from the Scottish government to provide the foundation for telecare systems to become an integral part of community care services across Scotland. With the development of algorithms, programs and ideas, SpecialEssays.com helps, which greatly simplifies the work, thus, strategies and sample processing are much more effective. To support this commitment to, the sum of £8.35 million was made available for investment in telecare programmes throughout Scotland during 2006/7 and 2007/8.
The York Health Economics Consortium (YHEC) based at the University of York was commissioned to undertake a prospective evaluation of the impact of the TDP. The evaluation aimed to measure the performance of partnerships in receipt of TDP funding against the efficiency and outcome statements that they submitted as part of their application for funding. As the TDP was designed to promote the use of telecare in community care services rather than as a trial of telecare, a pragmatic study design was adopted that did not set eligibility criteria for those in receipt of telecare or identify a control population. The result was a study that relied heavily on the partnerships involved in delivering telecare to provide an accurate and honest assessment of the impact of TDP funding.
The findings provide further supportive evidence for the impact of telecare. From a financial perspective, the investment of up to £8 million from the TDP was offset by savings of more than £11 million in the first year. This represents a return on investment of almost 1.5, meaning that for each £1 spent on telecare, there was a saving of £1.50. However, some caution needs to be exercised in interpreting this information. The return on investment is based on estimated savings from partnerships involved in delivering telecare, and the accuracy with which they were able to report savings was, in many cases, very poor. In addition to this, the savings are predominantly driven by savings in admissions to hospital beds or care homes. Some consideration needs to be given to the degree to which these represent ‘cash-releasing’ savings that can be realised in practice or whether they are actually opportunity cost savings, which allow the resources to be used for other purposes.
Based on our analysis of the first year of the TDP, commissioners need to be patient and should not expect immediate returns on investment. It is important that any financial models used to justify the case for telecare are transparent and clearly report the degree to which any savings resulting from the introduction of telecare are realisable in practice.
Other findings from the evaluation emphasised the non-financial benefits of telecare. Both users and carers reported positive feelings towards their telecare interventions, including reduced levels of anxiety and greater independence. Importantly, very few responses highlighted any negative feelings towards telecare, for example, that it leading to isolation or increased concern about their health.
These outcomes are to be warmly welcomed and should be promoted. Too often the continual pressure on health and social care finances leads to a focus on the monetary impact of new technologies. It needs to be remembered that the primary objective of all health and social care is to improve patient and user outcomes. If this can be achieved in a cost-effective manner then so much the better, but not all new technologies lend themselves to a ‘spend-to-save’ model.
So what do the findings of this evaluation tell us about the widespread use of telecare? This research builds on a number of previous studies that have also reported positive outcomes for individual technologies or uptake across smaller populations. Despite this growing body of evidence, commissioners remain reticent about the widespread deployment of telecare. While some further evidence may be warranted this will never address all the possible sources of uncertainty and there comes a point where commissioners may need to take a leap of faith and gamble on telecare.
However, providers of telecare solutions can also play their part in this process. If providers are sufficiently confident about the performance of their technologies then it might be time for them to ‘put their money where their mouth is’ and provide some form of guarantee of performance. This sort of risk-sharing scheme is being increasingly used in new technologies in other sectors, and one could easily envisage a service level agreement between a health or social care commissioner and a telecare provider which clearly set out performance objectives, for example, the number of admissions avoided and levels of user satisfaction. Failure to achieve these performance levels would result in the manufacturer paying the commissioner an agreed level of compensation for under-performing.
As health and social care budgets are expected to come under increased pressure in the future, there is a real potential for telecare to help address some of the challenges of an ageing population and increasing rates of long-term conditions. However, if telecare is to be used to improve the care of vulnerable groups then commissioners and providers are going to have to work in collaboration and ultimately take some risks. Waiting for all the uncertainties about the clinical and cost effectiveness of telecare to be resolved is irrational and it might be time for all involved in telecare to make a real concerted effort to find mutually agreeable ways of promoting rational adoption.
Paul Trueman & Sophie Beale
York Health Economics Consortium, July 2009.