Will telecare aid independence?

Ministers announced last week a six-month consultation on how England should care and support its burgeoning older population. It is estimated that, within 20 years, a quarter of the adult population will be over 65.

The consultation will look at how to improve care and promote independence but at a cost considered ‘affordable’ to the government.

As part of this consultation, three pilot sites have been chosen to trial ‘telecare’ – a computer-based patient monitoring and support system.

Over the next two years, some 6,000 patients in Cornwall, Kent and Newham in east London will have conditions such as diabetes and COPD monitored remotely by the technology in their own home.

The government hopes the £31m pilot will prove telecare can reduce emergency hospital admissions and dependence on care homes, and ultimately save money.

Launching the pilot last week, health secretary Alan Johnson said: ‘Improving care with new scientific advances and innovation is vital if the NHS is to continue to offer the very best services but this innovation must be at the frontline of the NHS to help people manage their conditions better themselves.’

But how does telecare work? Helen Lyndon, nurse consultant for long-term conditions at Cornwall and Scilly PCT, is the clinical lead for the telecare pilot in her area.

Explaining the new system, Ms Lyndon said: ‘All of the patients will be able to have a small computer which has a touch screen.

‘Diabetes patients, for example, may be asked to test their blood sugar levels – the testing kit is attached to the [computer] unit and they do not even have to put any of the numbers in because it is all linked up to the unit,’ she said.

‘It would talk them through a series of questions which have been set by a clinician – it might ask about health, diet or the amount of exercise they have done,’ she said.

‘If the answers are outside of the parameters that have been set by the clinician, the system will raise an alarm.

‘It all goes to a web-based system, and the healthcare worker at the other end can sit and see what is happening to all of the patients they are responsible for,’ she added.

In Cornwall, a maximum of 30 people will be monitored by one nurse at any one time. But in other countries such as the US, where telecare is well advanced, hundreds of patients are monitored in one go.

The technology was first introduced to the UK in the 1980s. However, it only began to be used, on a small scale – in the form the government now wants to pilot – at the beginning of 2000.

But is it possible for a machine to replace the role of a community nurse?

Ms Lyndon thinks that the system will not diminish the role of nursing but rather enhance the level of service nurses can provide.

‘I don’t think it is going to replace hands-on nursing care. What it will help us to do is to help patients more proactively than in the past,’ she said.

‘We have 41 community matrons here in Cornwall. They need to be able to use their resources as effectively as possible. [Telecare] means that more patients can be monitored but the community matrons can also prioritise their workload and see which of their patients are the most in need, whereas at the moment there is not any way for them to do this,’ Ms Lyndon said.

However, not everyone feels so positively towards the introduction of the technology.

Linda Nazarko, nurse consultant for Ealing PCT in London, said: ‘You have to be careful that is does not imprison people.

‘For example, it can monitor what time you get out of bed. So, if you happen to get up late one morning, it might think there is something wrong, but all you were doing was having a lie in – it should not be Big Brother,’ she warned.

‘It’s rather scary if you think about some of the technology we already have. One minute it works; the next it does not. Also, this is only as safe as the people at the other end of the phoneline, and whether they are going to respond to what is going on,’ added Ms Nazarko.

But for Marian Preece, operations manager for the Telecare Services Association, which represents UK telecare providers, it is merely a matter of trust and familiarity.

‘This is all about education – it’s new and still needs to be embraced. As with anything new it takes time to embed, so there will need to be lots of education and reassurance,’ she said.

‘It should support nurses and health professionals because it ensures that the right people
get the right amount of visits, because it means they can see the most poorly people,’ she added.

Former practice nurse Cathy Moulton, now a care adviser at Diabetes UK, has mixed views on the issue.

She says that, as the number of people with diabetes is set to increase, new interventions in technology would be welcome, especially those which enable patients to live independently.

‘It will help them because they will have a lifeline; they will be able to access the help and advice they need before things get too bad for them,’ she said.

‘But one of the biggest concerns with this would be if it reduced the number of nurses in primary care or acute care, and they were replaced by a call centre.

‘As a nurse, it breaks my heart to see a reduction in specialist nurses and we will continue to call for more,’ she added.

Telecare may indeed be proven to enhance patient care, reduce costs and allow nurses to spend more time with patients with complex needs but many may continue to question its place in the healthcare system.

‘This is a cheap alternative [to nursing] and that is why we will be looking very closely at how this develops,’ Ms Moulton said.

‘If it means you will end up with less hands-on nurses, it will not have the impact that they hope it will because there is no substitute for nurses.’

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