The telecare industry hasn’t grown as quickly as expected. What is holding it back, asks Douglas Brown

The government sank £80 million in helping local authorities adopt preventative technology, and new consumer-led ways of buying services represent an unprecedented opportunity for growth in the sector. So why is the industry still struggling?

Like most nascent industries, telecare means different things to different people. At its heart, it is the use of technology to monitor remotely the needs of social and healthcare service users in their own homes. The first generation of telecare includes equipment long-familiar to council social services departments, such as panic alarms and call bells.

The second generation encompasses more automated tools like sensors which, for example, tell a central computer how recently a person’s fridge door has been opened. If enough time passes without the sensors being triggered, the computer alerts carers who can visit the person’s home and make sure all is well. The systems themselves are potentially big business: American IT giant Intel announced last month that it is getting into the US market.

The advantages, say the manufacturers, are clear. Tunstall, which has an 80 per cent share of the supplied equipment market in the UK, claims telecare gives local authorities (LAs) a return on investment of five times. But even with money from the government designed to kick-start LAs into using the technology, they aren’t picking it up.

“Every local authority had access to the £80 million preventative technology grant [PTG] pot which was meant to be the catalyst for change and would embed telecare in services,” says Alison Rogan, marketing director at Tunstall. “It’s coming to a close in March 2009 and only 30 per cent will be able to take it forward.”

The firm conducted research into this incongruity. “We asked 157 directors and assistant directors of social care why,” says Rogan. “They replied: the cultural change required; funding; training; partnerships; the lack of public demand – which is daft when you think about it; and a lack of evidence for it – which is also daft.”

Steve Davies, managing director of Invicta Telecare, believes that the cash wasn’t a big enough incentive in the first place. “At the start, very few local authorities were actively engaged in telecare,” he says. “Although that £80 million sounds like a lot of money, spread across the local authorities it didn’t go so far.” He’s more optimistic than Tunstall, though, pointing to “pockets of very good examples” around the country. “It’s becoming much more embedded and much more routine, particularly as people’s understanding of what the technology can do improves.”

Paul Gee, chief executive of the Telecare Services Association (TSA) describes what he sees as a “multi-speed England”. He says: “This is a classic market development curve where the early adopters see, without proof to three decimal places, the benefits.” Meanwhile, he adds, “many are waiting for the evidence that if they invest x the return will be y.”

But Anne McDonald, director of community wellbeing at the Local Government Association, paints an altogether more positive picture. “Something like 90 per cent of councils have got contracts with Tunstall which suggests they have pretty good coverage,” she says. “Whether they have got as comprehensive an approach as Tunstall would like is another matter.” She adds that she is “not convinced you would find any councils with no telecare at all.”

The key mistake, says Doug Miles, chairman of the London Telecare Group, was that the PTG money wasn’t ring-fenced for telecare. “There are huge gaps between those authorities who are doing it well and those that are still on the starting blocks.” That discrepancy is what the grant should have been used for, he argues.

Paul Gee at the TSA agrees: “Gordon Brown [when Chancellor of the Exchequer] said he would use £80 million to equip 160,000 homes with assistive technology. I would have thought that was fairly clear,” he says. “The government believes in not dictating from the centre and we support that… I would applaud the idea of trusting local government. But I think it’s a shame that opportunity was passed up.”

The focus of the industry seems now to be shifting from persuading local authorities to convincing consumers to install telecare systems. That’s particularly important with the growth of personalised care and budgets which enable social service users to direct LA funds towards the care they choose. Anne McDonald says: “The majority of stories about the success of personal budgets include telecare within them.” She describes, for example, “the woman who got for her parents a reminder for her mother with dementia to go to the toilet.”

To succeed in this market, though, its incumbent upon the provider sector to make sure their services are well known, says Steve Davies of Invicta. “We need to make sure we’re ready for it. We need to move people’s aspiration from needing it to wanting it – a shift in consumer perspective. To that end, the London Telecare Group has convinced ClearChannel, the advertising display company, to run posters for telecare in bus shelters between campaigns by other advertisers.”

So far, however, telecare companies have found the public even tougher to win over than councils. Many people are wary of installing equipment to monitor every move in their own homes. “The issues around ethics and privacy are important ones,” says Steve Davies. “It can seem like Big Brother but compare having sensors with the issue of somebody coming round three times a night to see if you’ve soiled the bed or if your fridge has been opened versus being found dead on the sofa.” He adds: “People can make informed decisions about the degree to which privacy can be used.”

The media could be persuaded to showcase what telecare can do, he says. “It would be great if we could persuade one of the soaps to put in sensors in the home of one of their families.”

Anne McDonald agrees. “You have to have an educated public,” she says. Radio 4’s popular serial The Archers features a character with dementia, Jack Woolley, she points out. “Rather than people saying, ‘I heard Jack Woolley having a Philippino carer,’ they could be saying ‘I heard [his wife] Peggy putting in a sensor’.”

Telecare providers also find that social workers need to be convinced, even when their LA employers and service users themselves are interested in the technology. Paul Gee says: “Many people in social care have a resistance to technology and that’s because of their belief that care is delivered best by people not by technology. And that’s a genuine belief. But my response is that there are 50,000 vacancies in social work today.”

In other words, it is in social workers’ interests to use telecare as it can help them use their limited resources efficiently, he argues. “The question is how can technology be used most effectively for the carer and most appropriately for the service user.”

Providers might have to accept that local authorities, social workers and consumers will vary in their degrees of acceptance of telecare, though. There is certainly no sign that another cash injection along the lines of the PTG will be forthcoming from the government. The debate now needs to move on, Doug Miles says: “It’s about time the industry started to forget about special grants and got on with actually doing it.”