N ATIONAL POLICIES AND LOCAL RESPONSES : PROSPECTS FOR THE USE OF ASSISTIVE TECHNOLOGY AND TELECARE FOR PEOPLE WITH DEMENTIA '? Bridging the Gap Conference, London, 20 th January 2010 John Woolham 1

W HAT THIS PRESENTATION WILL COVER 1. A brief history of telecare & policy guidance 2. Responses to the Preventive Technology Grant 3. Implications for people with dementia 2

1. H ISTORY & P OLICY GUIDANCE FOR TELECARE SINCE 1998 : KEY POINTS The first attempts to use assistive technology in care settings were for people with dementia The Government has seen a key role for assistive technology for almost a decade Driving the implementation of telecare has been difficult because of formidable barriers and a lack of an infrastructure at a local level to support the widespread use of assistive technology and telecare Much work has been done by ICES (and now CSIP) to promote the wider use of assistive technology and telecare After a false start, the Government willed the means as well as visioning the future for telecare with the PTG and PIs. All of this progress raises new questions how have local authorities responded to the PTG? What might the implications of all this be for people with dementia? 3

2.R ESPONSES TO THE PTG – FINDINGS FROM A NATIONAL SURVEY Carried out as part of an EPSRC research programme Based on ICES/Telecare stakeholder collaborative databases –opportunistic not purposive. Response rate to first survey was 43% Response rate to second survey was 47% (but from self selected base of only 77 representatives) Confidence interval for first survey was just under +/- 5% 4

2.R ESPONSES TO THE PTG F INDINGS : O BJECTIVES OF LOCAL STRATEGIES 6 objectives predominated in Local Authorities with telecare strategies: support vulnerable people to remain independent by managing risks to independence Delay or prevent permanent admission into residential care Prevent avoidable, unplanned hospital admission Prevent unnecessary delays in discharging people from hospital Support carers and reduce carer stress Contribute to local falls strategies and accident prevention 5

2. R ESPONSES TO THE PTG F INDINGS : EXTENT OF AWARENESS OF PEOPLE WITH DEMENTIA IN PLANS AND STRATEGIES 80% said they wanted to prioritise the use of technology The main priority groups – in order: Older people People living with dementia People susceptible to falling People with learning difficulties People with long term conditions and chronic illnesses Intermediate care users Younger adults with physical disabilities Reasons for priority: To help people maintain their independence To provide a local response to government priorities or targets To try to save money 6

2. R ESPONSES TO THE PTG F INDINGS : FACTORS IMPEDING USE OF TECHNOLOGY Funding Concern PTG would be spent elsewhere and not on telecare Concern about what happens when funding expires Concerns about the costs of technology Achieving cultural change Lack of support by senior management Lack of support from front line staff Lack of enthusiasm by a key partner (e.g. Housing Dept, PCT) Complexities of partnership working Mad re-organisation disease Lack of awareness & knowledge about telecare Operational and service development issues Difficulties securing referrals for telecare Difficulties assessing for telecare Concerns about the reliability of telecare Difficulties in providing a social response 7

2.R ESPONSES TO THE PTG F INDINGS : T HE 2 ND SURVEY : A SSESSMENT & PROVISION, CONSENT, PROCURING & USING TELECARE Assessing and providing Some intended to provide technology just to high need/risk groups, others to people who fell outside eligibility criteria 1/3 said they intended to provide at least some AT/telecare without a full assessment – but where this was so there would be restrictions on the kinds of technology available Consent Over half said they’d use technology even if the person could not consent to its use Amongst this group, over 2/3 said they’d seek consent from NoK, almost half said they’d use an ethical protocol and over 40% said it would be subject to close monitoring Procuring and using 1/2 said they’d procure from several manufacturers: 1/3 said they’d use a single supplier Over half intended to use local call centre staff to install technology Almost 1/3 intended to use the manufacturer or supplier as installers The great majority felt that alarms would be handled by local call centres: relatives were seen as the main group who would provide the ‘social response’ 8

T HE NATIONAL DEMENTIA STRATEGY & TELECARE ‘Objective 10: ….the needs of people with dementia and their carers should be included in the development of…. assistive technology and telecare. As evidence emerges, commissioners should consider the provision of options to prolong independent living and delay reliance on more intensive services’. (p.55). Lack of evidence seen as a barrier to more widespread take up ‘ There is a more substantial evidence base to show the opportunities offered by assistive technology and telecare to enable people with dementia to remain independent for longer, and in particular to help the management of risk. But the data on newer approaches are still sparse and inconclusive. An evaluation of one scheme demonstrated cost effectiveness and reports of improved quality of life. Large-scale DH field trials of such technology are currently under way.’ (p.56). 9

3. I MPLICATIONS FOR PEOPLE WITH DEMENTIA H OW FAR HAVE WE COME IN SEVEN YEARS ? ASTRID 1998 market analysis Lack of knowledge and information about what technology could do Limitations to the design of technology Limited numbers of manufacturers and suppliers An absence of staff with skills to install and commission technology Access to AT by people with dementia non existent Now More information: e.g. ICES/CSIP work on telecare, Atdementia.org.uk Still a widespread lack of knowledge Technology is more ‘dementia friendly’ but ‘design for all’ still a long way off. A few new companies around but still dominated by a handful of manufacturers Still no ‘trusted assessor’ approach to ensure people who assess, have sufficient skills and the right skills. Access to AT now possible on the open market – but is this always a good thing? 10

3.I MPLICATIONS K EY ISSUES FOR DEMENTIA CARE 1. Mainstreaming has moved the focus away from dementia 2. What does prevention mean? 3. Prevention vs eligibility criteria 4. Long term funding 5. Limited opportunities for extending the role of assistive technology and telecare 6. Assistive technology as a substitute for social care 7. Overlooking benefits of AT in hospital or residential care settings 8. Local priorities 9. Knowledge and skill deficits 10. Unintended consequences of performance indicators 11. Person centred use or technology driven services 11

R EFERENCES 1. Marshall, M., (ed.) (2000) A Social and Technological Response to meeting the needs of People with Dementia and their Carers Hawker Publications, London. 2. Woolham, J., Gibson, G., & Clarke, P.,(2007) Local responses to the Preventive Technology Grant: findings from a two-stage survey of local stakeholders ) Woolham, J., Gibson, G., & Clarke, P., (2006) Assistive Technology, Telecare and Dementia: some implications of current policies and guidance (Research Policy & Planning Vol. 24 No. 3.) 5. Living well with dementia: A National Dementia Strategy (Feb. 2009) Department of Health, London. 12