Telehealth and Telecare have made slow progress in the UK and are still peripheral to health and social care pathways.  The barriers to broader adoption are complex.  They encourage seemingly endless pilots instead of revolutionary challenge to restricting institutions. 

Part of the problem is the fragmented, silo nature of strategic planning. The benefits of ‘better care closer to home’ and ‘putting people first’ are intuitively understood by many health and social care professionals, but a lack of targeted investment and diffuse responsibilities for driving through change in an over-complex system, are discouraging the innovators. 

Time-limited specific grants and pilot studies tend to encourage commissioners to think small.  Lead organisations for funding cannot easily forge partnerships unless the standard rules of engagement are set aside to allow truly innovative planning to develop.

What is needed is a practicable vision for whole system transformation.  Design an integrated primary health care and social care system, that straddles the boundaries of local authorities, primary care services and acute trusts, then restructure organisations, objectives and responsibilities to deliver it.   The vision is affordable, but it challenges the way we do things now and is outside our comfort zone.  Can we afford to relax our boundaries, emerge from our silos, and think patient and service user first, and organisational interests last?

Technology has now matured sufficiently to support system transformation.  The network of financial incentives and duplicated pilots and initiatives is still immature, but perhaps nurturing is not an option: maybe wholesale mutation is required.

This presentation will identify some of the boundaries to integration, how the technology can be applied in simple processes, how support services can be adapted and streamlined, and how proper information planning and collection can underpin an intelligent response to individual needs.