Case study 4 - Remote care
Providing prevention services with remote telecare technologies (Midlands case site)
Jennifer’s PhD, completed in mid-2015, investigated telecare policy and its interpretation and implementation at a site in the Midlands from a critical social science perspective. Data were gathered from narrative interviews (n = 23) with service provider and technology industry stakeholders, as well as with service users. Observations were also undertaken, involving strategic meetings at the local authority; and telecare assessment and review visits to people’s homes with frontline staff. Findings focused on the creation of ‘story-lines’ of telecare but also the discrepancies between this discourse and local experiences. People engaged with telecare to different extents, with the prevailing technology ‘script’ influencing non- or mis-use of devices. New work roles created by telecare sometimes appeared invisible or devalued. There was also a lack of meaningful involvement of service users in decision-making about telecare.
BACKGROUND TO CURRENT PROJECT
The telecare service involved is run by the borough council with additional funding from the NHS. The council has a history of working with multiple providers and has purchased equipment on what it considers a ‘needs led’ basis. This has meant they have built up an inventory of 200+ devices to enable them to respond to the diverse needs of the local population as well as ensure interoperability of technology.
In recent years the council has reconfigured some adult social care services (including the telecare team) into a single, integrated independent living team. This new structure comprises their ‘community offer’ in response to the Better Care Fund. It intends to initiate a multi-agency approach to providing prevention and reablement services that is ‘underpinned’ by technology but not ‘technology centric’. A key component is the use of video communication to aid service integration as well as providing a point of access for service users.
ISSUES TO BE TACKLED THROUGH THE CURRENT RESEARCH: ORGANISATIONAL PRACTICE AND RESPONSIBILITIES
The organisational restructure has been promoted by the council as a way of refocusing resources on preventive services and involving voluntary and community organisations to provide a range of support options for people in the community, thus reducing demand on formal health and social care services. It is seen as a way to deliver efficiencies and improved outcomes through partnership working. It has also been presented as a way of increasing practitioner engagement in the use of technology and instigating culture change within the service as a whole.
The emphasis on integrating services and reviewing organisational practice raises a number of questions about this case site’s approach to technology use and the involvement – and influence – of different stakeholders. One question is how far this is driven by a response to government policy rather than the needs of the local population. For example, in council documents the Care Act 2014 and Better Care Fund are cited as providing the impetus for change, while there is little reference to the experiences of potential service users. Similarly, the council’s telecare strategy has been dominated by the vision of charismatic individuals, with technology investment in recent years seeming to track the positive relationship between key council officers and certain industry representatives. This context for service reconfiguration highlights several issues that cut across all the case studies, including the potential disparity between the needs of service users and the priorities of health and social care systems; and the question of who is really benefitting from technology implementation.
In her role as a researcher at the Midlands case site, Jennifer is currently focused on considering the processes involved in restructuring adult social care services to embed technology as part of preventive provision. By observing frontline practice and engaging stakeholders involved in the new set-up, she will consider how the ‘ways of working’ have changed, and what the impact has been, in response to the following:
- What has been the role of professionals in the reconfiguration of services? Have they been consulted? How are they expected to adapt to the new way of working? Do they feel in control/able to contribute?
- How far is the new approach a back office/behind the scenes activity? There is little reference to it in council public documents – is it seen as inconsequential to local citizens?
- Has the organisational change been implemented independently of the service users? Are the changes seen (by the organisation) as benign with little value added by consultation with service users?
- What is the buy-in at the user end? Do the changes resonate with them at all? Is there an ethical question here in relation to institutional responsibility for the involvement of key stakeholders in change processes?
By posing these questions, Jennifer hopes to instigate a discussion about organisational practice and change that encourages senior managers to consider what is driving service change and how it is experienced by key stakeholders.