Turning evidence on technology-enabled care into action: themes from the DECIDE Impact Forum

Co-authored by Stephanie Stockwell, Senior Analyst, RAND

Across health and social care, digital tools, remote monitoring, sensors, virtual care pathways and emerging AI technologies are being positioned as part of the response to some of the sector’s biggest challenges: rising demand, workforce shortages, growing complexity of need, and the ambition to support people to live well and independently for longer.

Against this backdrop, DECIDE (Digitally Enabled Care in Diverse Environments), an NIHR-funded rapid evaluation centre led by the University of Oxford and RAND Europe, brought together policymakers, commissioners, practitioners, researchers, industry partners, patient representatives and service-user organisations for the inaugural DECIDE Impact Forum. Our aim was not simply to share findings from DECIDE’s six evaluations of technology-enabled care, but to ask a more important question: what happens next and how can we realise a vision for good tech-enabled care?

Throughout the day, participants reflected on what evaluation evidence tells us about technology-enabled care in practice, what enables successful implementation and scale-up, and what needs to change if digital innovation in health and social care is to deliver meaningful improvements for the health and social care system and for service users, carers and staff.

A series of presentations and panels fostered rich discussion and debate about how technologies and technology-enabled services can be co-designed, adopted, spread, scaled and sustained across communities and settings. Six key themes emerged.

1. Technology Is Not the Intervention – People and Relationships Matter

Technology alone rarely creates impact. Speakers emphasised that service users experience health and care primarily as relational rather than transactional. People value continuity, trust, communication and human connection. Technology typically succeeds when it supports these things.

Participants highlighted how fragmented digital systems at times create additional administrative burden, requiring health and social care professionals to navigate multiple platforms, processes and interfaces. When this happens, valuable time is diverted away from relational care and towards managing systems. The result can be frustration, disengagement and loss of trust.

The ambition for technology-enabled care should be to release capacity and time to for high quality relational health and care. Digital tools should help professionals build shared understanding, coordinate activity across teams and services, and support more coherent experiences for patients and service users. The goal then is not more technology, but better care.

2. Equity Must Move from Aspiration to Design Principle

A second recurring theme concerned equity and inclusion. A consistent message from DECIDE's evaluations is that there is no such thing as a typical patient or service user. People's lives, capabilities, preferences and circumstances differ enormously. Consequently, technology that works well for one group may create barriers for another.

Those participating in the event highlighted the importance of maintaining parallel and hybrid pathways so that people can access care in ways that work for them. For some, digital tools are empowering. For others, they can feel exclusionary, burdensome or difficult to use. Assuming that everyone wants, needs or benefits from digital interaction risks widening existing inequalities.

While digital options hold potential to improve access and convenience for many people, participants called for a shift away from talking about ‘digital first’ to talking about ‘people first’. This requires taking the emphasis away from digital options as the default, ensuring that alternative routes remain available for those who need them, and enabling digitally-enabled pathways to be part of a ‘people-first’ vision and an enabler of timelier and high quality access to health and care.

The discussion also challenged several common assumptions. Older people, for example, are often portrayed as resistant to technology, yet as one of the panellists put it “older people love tech!”. The issue is not age itself but whether technologies are designed appropriately and supported effectively. People adopt digital tools only when they meet genuine their needs.

3. Co-Production Is Essential, Not Optional

One principle attracted near universal agreement during the event - the importance of involving people in the design and development of technology-enabled care.

Speakers repeatedly warned against designing services for an "ideal" user. Such a user doesn’t exist. Real people live with multiple conditions, caring responsibilities, financial pressures and complex social circumstances. They do not fit neatly into process maps or technology specifications.

Co-design and co-production were therefore presented as essential ingredients of successful adoption. Participants highlighted examples where service users, patients and communities were involved throughout development, helping shape decisions about when technologies should be used, how they should be implemented and when non-digital alternatives might be preferable.

Importantly, several contributors argued that co-production should be viewed as an ongoing relationship rather than a one-off consultation exercise. This means we that initial co-design of a tech-enabled service needs to be complemented with ongoing learning from co-implementation – bringing in feedback and learning from the experiences of those delivering and receiving a service. Technologies evolve, people's circumstances change and services adapt over time. Meaningful involvement therefore needs to be continuous. This reflected a message that we came back to throughout the day: successful innovation depends on long-term collaboration, shared learning and mutual adaptation.

4. Scale Depends on Infrastructure, Not Just Innovation

A fourth theme focused on the challenge of building platforms that can support impact at scale. Many attendees described a landscape characterised by duplication, fragmentation and limited interoperability, and the need to develop shared infrastructure if technology-enabled care is going to have impact at scale.

This has important implications for commissioning and procurement. Current approaches often encourage short-term projects, repeated business cases and cycles of pilot funding. Participants described organisations becoming trapped in "pilotitis"—continuously demonstrating value but never receiving the support required to embed and scale successful approaches.

The problem is compounded by the mismatch between what commissioners can easily measure and what patients and staff often value the most. Reassurance, confidence, continuity and prevention are potentially meaningful outcomes, but they are not always captured within traditional performance metrics or funding cycles.

Recommendations focused on new commissioning models, clearer standards and practical implementation infrastructure. Participants highlighted opportunities for commissioning guidance, standard contracts and other mechanisms that support sustainable adoption while still allowing innovation and local adaptation.

5. Learning and Capability Matter as Much as Technology

Several participants observed that health and care systems often assume that once technology is available, implementation will naturally follow. The evidence suggests otherwise. Technology-enabled care requires new skills, new ways of working and new forms of collaboration.

Discussion highlighted the need to invest in capability at multiple levels. This includes workforce training, digital literacy, implementation expertise and leadership development. It also includes supporting policymakers and commissioners to understand complex systems change rather than focusing solely on technological solutions.

Examples shared during the day illustrated how relatively simple interventions can make a substantial difference. Exposure to practical demonstrations of technology-enabled care, for instance, increased professionals' willingness to recommend and use digital solutions. Participants also highlighted the importance of informal learning, peer-to-peer networks and better sharing of implementation experience across organisations. Too often, valuable lessons remain localised, resulting in repeated mistakes and missed opportunities.

6. Evidence Must Keep Pace with Innovation

The final theme concerned evaluation and evidence generation.

Many participants reflected on the role that rapid evaluation can play in supporting implementation and policy development. Rather than evaluating technologies only after large-scale rollout, there was strong support for formative approaches that work alongside programmes during design, testing and early implementation.

For instance, AI-enabled technologies are already being deployed and are increasingly central to future policy ambitions. Yet their scale and potential consequences mean that robust evidence is needed to understand effectiveness, safety, equity and unintended consequences, as well as scope for gradual improvement. The challenge for evaluation is therefore not simply to determine whether technologies work, but to understand for whom they work, under what circumstances and why, and how they can be adapted over time to respond to feedback and emerging needs This calls for a new model of evidence generation – one that is iterative and perhaps more formative than summative.

Looking Forward

The evidence generated through DECIDE demonstrates that digital innovation can support care closer to home, improve access, enhance prevention, strengthen self-management and help services respond to increasing demand. However, these benefits are not a given.

Impact depends on designing for real people rather than ideal users. It depends on building infrastructure rather than accumulating pilots. It depends on supporting learning, developing capability and creating the conditions for collaboration. Above all, it depends on ensuring that technology strengthens rather than replaces the human relationships at the heart of care.

Discussions at the DECIDE Impact Event reinforced that there is no shortage of innovation. The task now is to create the conditions in which innovation can translate into sustainable, equitable and meaningful improvements in health and care. As one participant observed during the day, if the goal is speed, organisations can act alone. If the goal is lasting impact, they must work together.

That challenge – and opportunity – will shape the next chapter of technology-enabled care.