Three thousand people with long-term conditions or social care needs will be randomly assigned to receive either telecare, telehealth, both, or usual care, as part of the largest UK trial of these technologies. The problem is that health and social care systems are under growing pressure from an ageing population with multiple chronic illnesses. Telecare (sensors and alarms in the home) and telehealth (remote monitoring of vital signs) promise to help people live independently while reducing hospital visits, but their real-world effectiveness and cost-effectiveness have never been rigorously tested at scale. Previous studies were small or lacked proper controls. This pragmatic cluster randomised controlled trial, embedded within three Department of Health Whole System Demonstrator sites, will measure clinical outcomes, costs, and return on investment across three groups: people with COPD, heart failure, or diabetes; those with social care needs; and those with both. It will also capture patient, carer, and professional experiences, and identify organisational barriers to adoption. If the research shows that these technologies improve outcomes and save money, it will give NHS commissioners and local authorities the evidence they need to invest in remote monitoring and home-based support at scale. If not, it will prevent wasteful spending on unproven systems. Either way, the findings will shape how the UK integrates technology into community care for the next decade.
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BackgroundMultidisciplinary teams in PCT and Local Authority partnerships, with an established record of joint health and social care working, have been designated by the Department of Health as Whole System Demonstrator sites. As laid out within the white paper, Our Health, our care, our say: a new direction for community services, these WSD sites are implementing integrated care and otherinnovations as part of a ‘whole systems redesign’ (Secretary of State for Health, 2006). ‘Whole systems redesign’ is being supported through advanced assistive technology (AAT: Telecare and Telehealth) for individuals with long-term conditions (LTCs) and/or complex health and social care needs. Aims• To determine the effectiveness, cost-effectiveness and return on investment of the addition of AATs (telecare and telehealth) delivered alone or in combination, to whole systems re-design.• To examine the service user, informal carer and professional experiences of telecare and telehealth• To determine the organisational factors that facilitate or impede the adoption of telecare and telehealth Plan of InvestigationA pragmatic cluster randomised controlled trial design, with an embedded factorial component. The additional effectiveness of AATs to ‘whole systems care’ will be evaluated in three population groups that are the focus of the WSD sites:1. Individuals with at least one of the following long-term index conditions:a. COPDb. Heart failurec. Diabetes2. Individuals with social care needs & their informal carer (where available)3. Individuals with social care needs who have at least one of the 3 long-term index conditions (above) and their informal carer (where available). The trial will include a comparison of telecare or telehealth with usual (whole systems) care, in the firsttwo groups, whereas for the third group a balanced factorial design will also permit assessment of the combined effectiveness of these two interventions. Potential ImpactThis project is designed to provide a comprehensive evaluation of the value of introducing advanced assistive technologies (telecare and telehealth) across health and social care. It will determine the organisation of the distribution of AATs within the Whole System Demonstrator Sites plans for roll-out of services thus permitting a robust real-time evaluation. This project will provide information as to the potential benefits of AATs at an economic, organisational, clinical and individual level. It will influence future investment in these technologies by providing commissioners and policy makers with information and evidence relating to the integrated management of people with long-term conditions and social service needs.
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