1. Cathy

    This is a very confusing piece (even with the definitions of their terms!) especially the assertion towards the end that:
    [quote]Telecare programmes that do not incorporate appropriate clinical services offer little or no value, or more worryingly could potentially cause harm.[/quote]
    Telehealth and Telemedicine do of course need appropriate clincial services incorporated, but this rarely applies to Telecare.

    In our experience it is more likely to be Telecare and/or Environmental Controls that will support those with MS. Telehealth (as in remote vital signs monitoring) offers little, but Telemedicine, incorporating video links, could make a significant contribution including reducing tiring journeys.

    The reality is that MS needs support for the symptoms rather than the condition as a whole. The authors are correct that MS Telecare is most beneficial as an early intervention (in fact this is true for most of the neurological long term conditions). However, many of these conditions often have protracted diagnosis pathways and because the symptoms can be variable over time they often are assessed as not meeting eligibility criteria when it comes to provision of Telecare from a Local Authority until much later on.

    Technology such as console systems with movement sensors, tablet computers, e-Readers are all becoming more common place in UK homes and all offer potential for exercise and inclusion. As these are increasingly familiar technologies maybe we should look to increase self management and deliver services using these technologies.


    A range of Condition specific exercises could be created with a clinician / physiotherapist prescribing the correct exercises to be unlocked to the patients ‘subscription’; the console system could provide monitoring/a record of their exercise program.

    Tablet computers offer a flexible touchscreen system with internet access (for portals perhaps) and the option of a handsfree phone – so as well as access to remote clinical support has the potential to work from home perhaps.

    Mobile phones could offer environmental controls (with a little adaptation of the property) and allow support to continue when the person is away from their home.

    E-readers are often lighter and less tiring to hold than a book; this technology could support a parent with MS continue reading with their child for example.

    Many of these offer early interventions with only limited eligibility criteria

  2. Kevin Doughty

    Cathy is generous in using “confusing” as her major adjective to describe this paper – I would have considered something rather stronger! I am surprised that peer review has allowed the authors to generate a list of countries where services are more developed than in England, Wales and Northern Ireland with little or no evidence to support their claims. Indeed, this suggests that the authors haven’t appreciated:
    1. telecare delivery is about services rather than technologies – and the operations of UK services are more advanced than elsewhere in the world, especially as they involve robust processes that are covered by a Code of Practice and which quality assure performance and approach, and
    2. telecare to support people with Long Term Conditions and disabilities requires imaginative use of new technologies within the home environment where clinical objectives may be secondary to those of Quality of Life and well-being of both the “patient” and their family.

    Cathy describes some of the opportunities that can be offered, and these can be supported more quickly in the UK thanks to the experiences of (too many) pilots and the emerging evidence of the WSD programmes. In particular the ALIP (Assisted Living Innovation Platform) projects funded by the Technology Strategy Board and the future DALLAS projects will help the UK’s telecare services to remain ahead of the world in delivering these services at scale.

    Fundamentally, perhaps the fundamental issue with hospital-based clinicians is their reluctance to accept that the responsibility for the support and care of people with LTCs should lie in the community, and that homecare and self-care will increasingly allow more people (rather than “patients”) to exercise choice and to employ the technologies that are now available to us all through the Internet, set-top boxes, tablet PCs and smartphones. We should be praising the fact that the UK’s primary care sector is something that other countries look at with envy – no wonder they want our help in training their doctors and nurses.

    This is why we are in such a strong position to develop models of community care that embrace homecare technologies and telehealthcare, m-healthcare and e-healthcare; these will surely be a big part of the answer to the problems of access and cost to medical services for millions of people in developing countries.