Abstract

Objectives: We have been investigating the implementation of remote care (both telecare and telehealth) across the UK since 2000. From the perspective of a decade of policy initiatives and research, we will explore the factors that have shaped the evidence agenda and implementation of this long-term care innovation and the prospects for its future expansion.

Data and Methods: Our research is based on several research projects, including the evaluation of the Whole System Demonstrator programme(WSD, an attempt to drive implementation and policy through rigorous evaluation of outcomes and processes. Collectively this work forms the largest body of research on organisational aspects of remote care implementation, including detailed ethnographic case studies in five sites implementing remote care during the Preventative Technologies Grant, three Whole System Demonstrator sites, and six other sites. Across all sites we conducted over 250 interviews with front-line staff, managers in health and social care organisations, suppliers and policy makers.

Results: This research provides lessons on the way national policy can help to stimulate local innovation activity and on the factors that influence implementation and scaling-up. Funding attached to the PTG programme helped to pumpprime remote care, and was not ring-fenced, allowing local organisations respond as they chose. This allowed experimentation but was only partly successful in producing evidence and translating this into decisions to support activity around scaling-up local schemes. In order to reposition remote care away from impassioned enthusiasts conducting small-scale pilot projects it was necessary to improve the evidence-base for its impact. To achieve this, the WSD involved a large randomised controlled trial. It is apparent across all the sites we investigated, however, that further expansion may be constrained by conflicting perspectives on ‘evidence’.

Policy implications: With continued policy support, remote care services have developed, albeit largely incrementally. Further expansion will require careful consideration of the future policy levers that can be put in place to incentivize adoption, encourage fragmented and often competing long-term care providers to collaborate and stimulate the remote care supply industry.