Wiltshire Technology Enabled Care (TEC) Strategy 2023 to 2028

Embracing technology, Promoting well-being and independence.

Technology is a growing part of modern-day life and can play a key role in meeting social care needs. People are not always aware of what Technology Enabled Care (TEC) solutions are available and the positive outcomes they can deliver for people. TEC, also known as telecare or assistive technology, is the use of technology to support and enhance health and social care outcomes. This technology includes devices, systems and software that enables people to live more independently and supports their wellbeing.

Our vision is to use technology to enable people to fulfil their potential, be actively involved and included in their communities, make informed decisions, have control over their lives, and be valued.

We will embed TEC within the Care Act Assessment process, so that technology is a core way of supporting improved health and wellbeing outcomes for the people of Wiltshire.

Technology will sit alongside, or in some cases may replace more traditional forms of care and support.

We will focus on what the individual wants to achieve, and then consider how technology can support those outcomes and enable independence. We will also continue to emphasise each person's strengths, using technology to support people to do more for themselves and to provide data to show that the person is becoming more independent or identify where technology can support further.

The outcomes we want to achieve by expanding the TEC offer are to:

• improve the quality of care
• promote independence
• reduce admissions to hospital and care homes
• provide care that meets individual needs
• achieve greater efficiency

There is a strong appetite to innovate and to embed a wider range of solutions into care and support provision. We will collaborate, support, deliver workshops and training, promote to all stakeholders TEC opportunities, and listen to feedback.

We will work across the council to deliver the priorities:

• raise awareness and information sharing
• develop clear pathways for TEC
• we will grow our TEC offer
• test and Learn Approach
• we will provide support to Stakeholders

In Wiltshire, we know that residents have high expectations for the lives they lead and the support services they access. People want to realise their ambitions and don't want to be held back because of their disability or health condition. As a Council, we are committed to providing high-quality, personalised support which enables people to live independently, have relationships, access paid work, enjoy good health and enjoy life.

We have one of the fastest growing older populations in the country. Older people consistently tell us that they want to continue living in their own homes and participating in their communities for as long as possible. Children, young people and adults with disabilities rightly expect to access support which enables them to build on their strengths and talents and live independent lives.

We can only meet these needs and expectations by focusing on prevention and early intervention, rather than waiting until people reach crisis point.

Technology is a critical part of how we will meet this increasing demand over the next five years and beyond. Technology is a huge part of modern-day life which continues to develop and grow every day. Social care has not always kept pace with these advances, and both the public and professionals are not always aware of what Technology Enabled Care (TEC) solutions are available and the positive outcomes they can deliver for people.

Over the lifetime of this strategy, we will embed TEC within the Care Act Assessment process, so that technology is a core way of supporting improved health and wellbeing outcomes for the people of Wiltshire. This strategy outlines how we will expand our use of TEC for the benefit of people who use health and social care. Technology will sit alongside, or in some cases replace, more traditional forms of care and support.

What we do will be led by the voices of children and young people, adults with disabilities, older people and unpaid carers. We know that people want to be in control of their lives, and their views have shaped and will continue to shape this work. The strategy is underpinned by our core values of prevention and early intervention, tackling inequalities, understanding our communities, and promoting independence.

We know we will need to change the culture of how we work, so that TEC becomes an integral part of our social care offer and is embedded within the wider changes being made by Wiltshire Council and our partners.

In this strategy, you can expect to find information about:

• our vision: why this strategy is so important and how we will work together with carers over the next five years
• local and national context: the impact of TEC on our residents and communities, the economy, and people who provide care; a summary of our local population and how we think it will change over the coming years
• co-production: how the views of people with dementia, their families and carers, the public and professionals have shaped this strategy, and how they will continue to guide and monitor the work we do
• our priorities: describing the five priority areas which have come out of the co-production work
• how we will deliver the priorities: a more detailed look at what we will do in the next five years, with measurable outcomes

Our vision:

We will use technology to enable people to fulfil their potential, be actively involved and included in their communities, make informed decisions, have control over their lives, and be valued and included within society. Leaders will empower staff to be innovative and creative and to work with people to find the right technology-enabled care solutions for their lives.

This is a vision based on hope and optimism. Whilst a special educational need, disability or long-term health condition can have a significant impact on a person's life, we know that people have ambitions, hopes and dreams for their lives. Technological solutions that help people to realise these ambitions are developing quickly, and we need to keep pace with this to ensure that Wiltshire residents are benefitting.

This vision will be supported by a "TEC First" mindset, which means that the first contact people have with Wiltshire Council will include signposting people to TEC solutions, and that everyone will be assessed to establish whether TEC could benefit them as part of their care plan. This represents a shift in our thinking - historically, solutions such as pendant alarms have been installed in case of emergencies (such as falls). Increasingly, we want to use technology to prevent such crises from happening in the first place.

Our starting point is the needs, wishes and aspirations of each person. We focus on what the individual wants to achieve, and then consider how technology can support those outcomes. We will also continue to emphasise the strengths, assets, and potential of each person, using technology to support people to do more for themselves and to provide data to show that the person is becoming more independent or identify where technology can support further.

We will promote the use of technology to support people of all ages to live safely and independently in their own homes and communities. We will harness the potential of technology to enable people to take positive risks in a safe way.

To improve outcomes for people and to meet our key challenges across health, care, and housing, we will focus on four core objectives:

1. we will develop a TEC offer that empowers people, supports them to manage their self-care and stay safe, and enables them to live healthy, independent lives
2. we will embed a "TEC First" culture across our workforce. Staff will be enabled to use their creativity to find new solutions. We will use evidence and data to assess and evaluate what works for people
3. we will work with our partners, particularly across the NHS, social care and housing. We will take a One Council approach to promoting TEC, underpinned by our core principles of prevention and early intervention
4. we will use technology to enable people to fulfil their potential, be actively involved and included in their communities, make informed decisions, have control over their lives, and be valued and included within society. Leaders will empower staff to be innovative and creative and to work with people to find the right technology-enabled care solutions for their lives

These are ambitious plans, and to expand our TEC provision at this scale, Wiltshire Council will commission a provider to deliver a wellbeing technology offer that is tailored to people's needs and expectations. Supporting tools will be provided to raise awareness and confidence among the workforce and to demonstrate how innovative solutions can support people and help to deliver more effective services in an ever more challenging environment. 

What is Technology Enabled Care

Technology Enabled Care (TEC), also known as telecare or assistive technology, is the use of technology to support and enhance health and social care outcomes. This technology includes devices, systems and software that enables people to live more independently and supports their wellbeing.

The appetite for digital technology in society has never been greater. Most people use a smart phone on a daily basis and over 20 million adults' own smart speakers in their homes in the UK. The COVID-19 pandemic highlighted opportunities for using digital solutions as part of health, social care, and housing provision.

Wiltshire Council has traditionally invested in the more reactive TEC provision (for example: alarms, pendants and associated peripherals to support emergency response), but there are significant opportunities to develop a more proactive TEC offer and embed a Technology First culture at every point of contact within Wiltshire.

Examples of technology currently commissioned in Wiltshire and/or the rest of the UK include:

• independent living: TEC in Wiltshire can help people maintain their independence and live in their own homes for longer. TEC provides support with daily activities, such as medication management, reminders for appointments and tasks, and assistive devices for mobility and communication
• remote Monitoring and Support: TEC also allows providers to monitor remotely the wellbeing of customers. This includes sensors that are placed in the home to detect falls, changes in movement patterns, or emergencies. These can be worn by the person or fixed in the home. Data is used to provide timely interventions and support, including TEC response visits, which reduces the need for emergency or crisis care
• care coordination and communication: TEC facilitates effective communication and coordination between professionals, people receiving care, and their families or caregivers. Digital platforms, mobile applications, and online portals are used to share information, update care plans, and ensure consistent communication
• safety and security: Smart home systems, wearable devices and remote monitoring technologies help detect emergencies, ensure proper medication management, and provide alerts in case of potential risks or dangers.
• data and analytics: TEC can generate data that can be analysed to identify trends, patterns, and potential areas for improvement within Wiltshire, supporting evidence-based decision-making, resource allocation, and the development of even more personalised care planning.

Local profile

The 2021 Census showed that Wiltshire's population has grown by 8.4% since the previous Census in 2011 - a higher rate of increase than the national average (6.6%).

Wiltshire's population is also ageing: 21.8% of people are aged 65 and over (compared to 18.4% in England), with 3% aged 85 and over. Wiltshire was one of only three local authorities in the South West whose 65 and over population grew by more than 30% between 2011 and 2021. 

The tables below show how the age distribution in Wiltshire has changed since the turn of the century. Since 2001, the median age has increased from 39 to 44, and the percentage of the population who are aged 65 and over has increased from 16.45% to 21.72%. Over 40,000 more people aged 65 and over live in Wiltshire today than did in 2001.

The total population for the 2001 census was recorded at 432,973. The median age was 39 years old. 

The total population for the 2001 census was recorded at 470,981. The median age was 42 years old. 

The total population for the 2001 census was recorded at 513,411. The median age was 44 years old. 

Wiltshire's Joint Strategic Needs Assessment forecasts that the population of those over 85 years old will almost double between now and 2040.

People are generally living longer and healthier lives than ever before. However, our Joint Strategic Needs Assessment shows that these gains are not enjoyed equally across the population. For example, there is still a shocking gap between life expectancy for adults with long-term mental illness and/or learning disabilities and life expectancy of the general population.

Alignment with business plans, Bath and North East Somerset, Swindon and Wiltshire (BSW), and other strategies

This strategy aligns with and supports implementation of national and local priorities:

• Care Act 2014
• NHS Commitment to Carers 2014
• National Carers Action Plan 2018
• NHS Long Term Plan 2019
• People at the Heart of Care: Adult Social Care Reform White Paper 2021
• Health & Social Care Integration White Paper 2022
• Wiltshire Council Business Plan 2022 to 2032
• Wiltshire Joint Health and Wellbeing Strategy
• Wiltshire Independent Living Strategy 2022
• Wiltshire Autism Strategy 2022
• Wiltshire Carers Strategy
• Wiltshire Dementia Strategy

The ADASS report, Time to act to save social care in England (adass.org.uk) (opens new window) identifies the need to harness the potential of digital technology:

We want to move from a system where digital technology is an add-on and digital innovation processes too often exclude people who draw on care and support, to one in which appropriate and affordable digital tools enhance the experience of providing and drawing on care and support. We want to ensure that there is appropriate and affordable technology to support the delivery of care and support systems, and this supports integrated working

Scope of the strategy

This strategy will support people and their carers irrespective of age. The strategy focuses on people who live or are registered with a GP in Wiltshire (excluding Swindon). We recognise the need to work together to develop a seamless response, as people need joined-up support to enable them to live a good quality of life, we will work in partnership across health, social care, the voluntary and community sector.

This strategy has been developed through extensive co-production. Its vision, aims, and objective are informed by the views of a variety of stakeholders.

In Spring 2023, around 300 people took part in workshops, meetings, one to one discussion, and online surveys and polls. This engagement was commissioned by Wiltshire Council and led by Wiltshire Centre for Independent Living (WCIL), the feedback is summarised in their report entitled 'Technology Enabled Care Report Spring 2023', which can be found on their website: WCIL - Reports (wiltshirecil.org.uk) (opens new window).

Wiltshire Council has also been one of six 'test beds' for the Technology and an Ageing Population Inquiry (housinglin.org.uk) (opens new window), led by the the Housing Learning and Improvement Network (LIN).

Opportunities to expand the use of Technology Enabled Care (TEC)

A range of stakeholders have provided their views and suggestions on the current position of technology within the Council and opportunities to enhance the TEC offer. Stakeholders included representatives from the voluntary and community sector, customers and carers, adult social care operational teams, Children's services, commissioners, Public Health, service providers, housing providers, Information Technology and Digital Transformation.

There is a strong appetite to innovate and to embed a wider range of solutions into care and support provision, especially for adults with learning disabilities and/or dementia.

The following are clear opportunities to expand the use of TEC.

Wearable smart technology: 

• falls detection / prevention
• dehydration detection / prevention
• dedication prompting and adherence confirmation

Discharge to Assess bed monitoring:

• activity monitoring - Connected Care systems
• epilepsy episode detection / prevention
• applications to support and guide people with MH/LD/A

Prompting / routine-based apps:

• proactive welfare checking
• environmental
• control systems
• applications to support and guide people with MH/LD/A

Direct stakeholder quotations from co-production and engagement

GPS wearable technology undoubtedly saves lives - it was vital when helping to find one of our residents who had wandered, fallen and was stranded overnight. - Mental Health Team.

We provide a lot of sleep-in support just in case, but a TEC and support model approach could be so much better. - Learning Disability South Team.

I would prefer to stay in my home with carers and the help of technology. - Individual response within WCIL TEC report.

Activity Monitoring TEC in Wiltshire has historically relied on practitioners analysing the data themselves - clear dashboards enable us to assess and make the right decision for everyone, it is brilliant evidence for the Care Act assessment. - Ongoing Support Team (West).

It's made me realise that I need to get my backside into gear to get these things in place. It's the little things like being able to turn the lights on and off by myself. Even the little things can make a big difference. - Individual response within WCIL TEC report.

As a provider within the Local Authority, our budgets are different, we have to show return on investment for the TEC that we deploy - In-House Learning Disability Services.

We get around 7,000 contacts every month and deal with 85% at first point of contact - there are cases where TEC would help people, but we can only signpost unless they have Care Act eligible needs. - Advice and Contact Team.

With a bit of technology, some people will be enabled to stay in their own home and be independent. This will save money in the long run. The cost of the TEC will be less than paying for a residential home. - Individual response within WCIL TEC report.

We are living in a digitally enabled world where technology is increasingly part of our society. We want technology to empower our children and young people supporting them to increase their independence, access activities alongside their peers in their local communities, and to reach their full potential. We will explore assistive technology solutions that can provide additional support for children and young people. For example, to transition to independent living and integration with their peers or to support families caring for children with additional needs in their own home. - Children's and Young People Services Commissioning.

The outcomes we want to achieve by expanding the TEC offer are to:

• improve the quality of care
• promote independence
• reduce admissions to hospital and care homes
• provide care that meets individual needs
• achieve greater efficiency

Through embedding a TEC first approach, Wiltshire Council and partners will be able to:

• demonstrate improved outcomes across all ages, customer groups and care settings
• empower people and communities
• achieve savings through cost avoidance and some cost savings with support packages by reducing direct carer support

This strategy sets out the vision and outcomes that people have told us are important in relation to Technology Enabled Care (TEC). We know that we have a way to go to make this vision a reality in Wiltshire. However, we have a TEC team to support, raise awareness, and drive these required changes to ensure we work together to achieve excellence. We will co-produce a detailed action plan of how we will achieve these aims and improve outcomes for people.

Achieving our aims and improved outcomes 

The following will be reflected within the action plan.

We will raise awareness of TEC across the Council and wider partners by:

• prioritising training to staff and the public. We will regularly run and update in-person and virtual training on the latest TEC solutions and the outcomes they can deliver
• using the virtual e-learning tool to train all staff within social care and as a core component of any induction training
• focusing training on scenarios, alongside product and solution training
• publishing an online catalogue of current TEC solutions to all stakeholders
• developing the TEC Champion role in Wiltshire and upskill them to work with TEC Advisors to raise awareness across teams and organisations
• producing clear information in a variety of formats (including videos) of common TEC solutions, showing how they work and how they can benefit residents, this will include case studies of solutions from around the UK
• increasing the use of TEC to prevent crises (such as falls), not just react to them
• developing an interactive website that caters for staff, residents, care providers and wider stakeholders providing both information and an online referral pathway

We will develop clear pathways for TEC by:

• ensuring that TEC is considered as part of all Care Act Assessments and reviews, so that technology supports care packages wherever possible
• integrating TEC referral pathways with Social Care Case Management System (currently Liquidlogic)
• creating clear signposting for self-funders, providing useful, accessible information about TEC, and ensuring pathways for self-funders accessing reablement are easy to understand
• deciding, as a council, whether to continue the policy of only funding TEC for those that have two or more eligible needs under the Care Act (ee will clearly publicise this decision)

We will develop our TEC offer by:

• ensuring 60% of all social care packages include TEC as a core component by the end of 2027/28. This is a radical but achievable increase - around 2,300 additional care packages with TEC provision
• supporting people being discharged from hospital by providing them with a simple, pre-programmed TEC solution such as a mobile alarm device
• using smart sensors and analytics platforms within reablement and enablement to learn changes in behaviours and activities around movement, hydration, nutrition and provide insights to support early intervention and prevention ahead of crisis
  • increasingly moving towards proactive use of TEC, alongside reactive use
• enhancing the current TEC offer at the Independent Living Centre, including supporting people with buying their own products and showcasing what is available / possible
• providing local places for people to view and test equipment
• providing remote and in-person TEC support, including integrated TEC assessment support for practitioners and sourcing support to identify new and innovative solutions

We will continuously test and learn to develop our approach, as follows:

• use data to enrich our intelligence and insights - we will not capture data for the sake of it, but ensure we use it to continuously improve and learn
• develop a structured approach to funding through various sources and application funds
• analyse our Return on Investment (ROI) for TEC
  • this will include setting up an Application Programming Interface (API) tool to enable us to report clearly, use and understand data across different systems; and developing a Benefits Realisation approach to track ROI
• test different solutions in Wiltshire, with a view to moving to a "digital by default" approach to new TEC service users, and to move all existing users over to digital ahead of the national switch-off of analogue telephony
• evaluate and use this learning to inform the wider roll-out of TEC

We will provide support to stakeholders, as follows:

• develop a shared language across our networks. We will ensure that the key messages of proactivity and independence are understood and reinforced
• work closely working with the Bath and North East Somerset, Swindon and Wiltshire (BSW) Integrated Care System (ICS)
• engage with the ICB to understand joint commissioning opportunities, including pharmacy medication dispensing provision
• engage with the voluntary and community sector to ensure TEC provision is joined-up
• support TEC suppliers to be compliant with Information Governance rules
• work with our Council ICT teams to ensure integration between TEC and stakeholder infrastructure
• support care providers to understand how TEC fits within their care delivery, so that TEC is a core part of supporting people to live independently, and not seen as an add-on
  • this will include exploring installing sensors in private and communal spaces, linked fire and smoke detection as well as video door entry
• support informal carers through remote monitoring, respite, medication management which can provide peace of mind and practical assistance