Intended for healthcare professionals


Choice and responsiveness for older people in the “patient centred” NHS

BMJ 2004; 328 doi: (Published 01 January 2004) Cite this as: BMJ 2004;328:4

Telecare and the new community care regulations

Rowland and Pollock’s editorial presents part of the story. Telecare
– the use of information and communications technology (ICT) to reduce
the risks of home-based care – is widely seen as having potential to
reduce delayed discharges and improve patient choice over the location of
their care. It is possible to imagine a model whereby telecare forms an
element of an individual’s care package, along with domiciliary and home
nursing care, conventional assistive technology and home adaptations, and
medication and therapy.

It is not well known that the government has set ambitious targets
for the widespread introduction of telecare by December 2010. Rowland and
Pollock note that the £100m per year allocation to pay reimbursement costs
resulting from delayed discharges ‘underestimates the underfunding and
current lack of capacity in the community care sector’. This sum needs to
be seen in the context of possible investment in telecare. In February
2003 the Government made available £133.4m to support home and
intermediate care via the Integrating Community Equipment Service (ICES)
initiative. In addition, intermediate care and extra care housing is being
expanded – for example, the Department of Health is making available £87m
to be spent within 2004-06 to provide an additional 1,500 Extra Care
places. Funding for telecare should also be available under the Integrated
Care Record System (ICRS) and the Office of the Deputy Prime Minister’s
Supporting People initiative.

So far telecare has been limited to a small number of pilot and
demonstration schemes, but these suggest that it may have substantial
benefits in reducing capacity constraints in the care system. However,
these benefits can only be reaped if the discharge regulations allow the
relationship between the acute sector and social and housing services to
develop in a constructive way. A benchmark of two days, after which fines
have to be paid by social services in individual cases, ignores the whole
system nature of the health and social care system. For complex
individualised care packages including telecare, even if the technology
installation is straightforward, the short time period is not realistic.
Regulations which give incentives to reduce the average discharge time,
instead of focusing on the time for individual cases, are far more likely
to reduce delayed discharges and provide appropriate care to patients than
the proposed system. Under such a regime telecare could maximise its

There are major challenges in meeting the telecare implementation
targets, partly because there is no clear responsibility for telecare. In
particular, there need to be clearer links with the ICRS and ICES
(Integrating Community Equipment Service) initiatives. Clear funding lines
and specific budgets for telecare still need to be established and
business models which embrace health, social services and housing
departments will have to be agreed. However, the potential for using ICT
to help support a modernised, consumer-focused care delivery model is
greater now than at any time.

Competing interests:
None declared

Competing interests: No competing interests

05 January 2004
James Barlow
Chair in Technology & Innovation Management
Steffen Bayer and Richard Curry
Imperial College London. Business School