The future of social care? Evaluating the shift from reactive to proactive care technologies

Telecare – the use of alarms and sensors connected to remote monitoring systems – has been used for decades in England’s social care services. Used to detect events such as falls, it helps people to remain independent at home with the reassurance that someone will respond in an emergency.  

The latest innovation in telecare is the use of ‘connected care’ platforms, which use AI technologies to collect data from a range of sensors around the home and to detect changes in people’s day-to-day living patterns. Changes that might indicate risk for adverse health events (such as increased bathroom use as an early sign of an infection) can be flagged by the system, so that professional or informal carers can intervene early to prevent the situation from getting worse. These proactive remote monitoring technologies are being used by some local authorities in England as part of their adult social care services, with the aim of improving service users’ wellbeing through prevention of falls, illness, and malnutrition.  

The DECIDE (Digitally Enabled Care in Diverse Environments) centre is a partnership programme between the Nuffield Department of Primary Care Health Sciences, University of Oxford and RAND Europe, funded by the NIHR Health and Social Care Delivery Research (HSDR) programme. It is a rapid evaluation initiative focused on technology-enabled remote monitoring in health and care with a focus on inclusion, digital equality and diverse environments. 

As part of the programme we did a scoping review of academic and grey literature as part of a rapid evaluation of technology-enabled remote monitoring in adult social care services. After reviewing sources available up to July 2024, we found there isn’t much solid evidence or data about how home sensors are being used or tested or tested to help provide social care before problems happen.  

While the grey literature referenced a number of initiatives to implement proactive remote monitoring within specific local government settings, there were few examples of robust evidence from independent evaluations. The reported case studies in the literature were for initial implementation stages, and most evidence of evaluation was smaller-scale and qualitative; quantitative data for capturing system-level outcomes was notably absent. We found no examples where proactive remote monitoring had already been scaled up to the level of a standard service offer within local government organisations.   

We identified three key insights from the literature:  

• There is consensus among decision-makers on the potential benefits of home sensor technologies for the social care system. The sensors could help make sure care workers visit people only when and where they’re needed maximising workforce efficiency. They could also help spot problems early, so people get help sooner and might not need serious or expensive care later on.  

• However, there is a mismatch between these anticipated benefits and evaluation approaches. To really prove that home sensors save money, make the care system more efficient, or improve people’s quality of live, you’d need large-scale studies that track health, care use and outcomes over a long time period. But in our review we didn’t find any. examples of quantitative data on longer-term outcomes being used to evaluate these technologies.  

• There is a significant knowledge gap on end user experiences. The literature most strongly reflects the perspectives of sector leaders, organisational decision-makers, and technology suppliers. While service users and people in their care networks have reported some perceived benefits of proactive remote monitoring technologies, some difficulties of ongoing use have also been documented. It is crucial to understand how use of these technologies generate new roles, responsibilities, and (often hidden) work for social care service users, their family members, and the care staff responsible for engaging with and responding to the technologies.  

Overall, we found that there is emerging evidence that home sensors are starting to be used in social care and they might have some benefits when used for proactive remote monitoring in social care. However, we don’t know much about what it’s actually like for carers and service users using these technologies – the existing evidence is limited to small numbers interviews with carer/service user interviews within only a handful of independent evaluations.  

There is also a lack of quantitative data to properly measure the longer-term, system-level outcomes and impacts of using these preventative telecare technologies.  

These gaps informed the mixed-methods design we decided to use for collecting and analysing new primary data for three case studies in DECIDE’s evaluation of technology-enabled remote monitoring in social care. These ongoing case studies aim to fill the current gaps in the literature and inform how technology-enabled remote monitoring can best support equitable, effective social care. 

Read the full literature review at: https://www.phc.ox.ac.uk/research/decide/publications-and-outputs/literature-reviews 

Read the full evaluation report at: https://openresearch.nihr.ac.uk/articles/5-71. 

Read more about the DECIDE team at:  https://www.phc.ox.ac.uk/research/decide