Making use of evidence in commissioning practice: Insights into the understanding of a telecare study’s findings

Abstract

Background. This paper discusses findings from a study of English Local Authority (LA) Adult Social Care Departments (ASCDs) that explored how managers use telecare. A decade earlier, a large clinical trial, the ‘Whole System Demonstrator’ project (WSD), funded by the Department of Health (DH) investigated telecare’s effectiveness in promoting and maintaining independence among users. It found no evidence that telecare improved outcomes. Despite these conclusions, the DH did not change its policy or guidance, and LAs did not appear to scale back investment in telecare. Aims and objectives. The present study explores how English ASCDs responded to WSD findings and why investment continued despite evidence from the WSD. Methods. Data were obtained from an online survey sent to all telecare lead managers in England. The survey achieved a final response rate of 75%. Findings. The survey asked questions focused on awareness and use of research in general, and specifically knowledge about the findings of the WSD. Most respondents were highly critical of the WSD methods, and its findings. Discussion. Critical examination of telecare manager views found widespread inaccurate information about the trial methodology and findings, as well as the wider political and policy context that shaped it. Conclusions. The WSD could not explain why telecare did not deliver better outcomes. A more nuanced understanding of the circumstances in which it might achieve good outcomes has received little consideration. LA difficulties in using evidence in telecare commissioning potentially leaves the sector at risk of market capture and supplier induced demand. key messages Social care services in England continue to invest in telecare despite evidence it does not produce better outcomes for older users.

Generalizable evidence for telecare effectiveness is not well understood by commissioners/providers.

Better use of evidence is needed for telecare to be effective for older people.

Without independent evidence there is a risk of ‘market capture’ by manufacturers.