Browsing by Author "Fisk, Malcolm"
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Item Open Access Advancing Health Information Technology Roadmaps in Long Term Care(Elsevier, 2020-01-24) Doughty, Kevin; Fisk, Malcolm; Alexander, Gregory; Livingstone, Anne; Georgiou, Andrew; Hornblow, Andrew; Dougherty, Michelle; Jacobs, StephenBackground: Our purpose is to provide evidence that health information technology should be a mainstay of all future health and social support services for older people globally, both within and across community and residential care services. Methods: This work was conducted in two phases. In phase I, the authors conducted a focused exploration by selecting a convenience sample of four long term care health information technology roadmaps, developed by members of four different long term care health information technology collaboratives in United States, Australia, United Kingdom, and New Zealand. During Phase II the research team carried out an extensive systematic review of existing literature sources (2000-2018) to support roadmap assumptions. Results: Using converging domains and content, we offer recommendations among five aged care roadmap domains: Strategy/Vision, Continuing Care Community, Services and Support Provided, External Clinical Support, and Administrative. Within these domains we provide recommendations in five content areas: Innovation, Policy, Evaluation, Delivery Systems and Human Resources. We recommend future strategies for LTC HIT roadmaps that include 61 emphasis areas in aged care in these content areas and domains. Conclusions: The roadmap provides a navigation tool for LTC leaders to take a strategic and comprehensive approach as they harness the potential of health information technologies to address the challenges and opportunities of LTC in the future.Item Embargo Age-Friendly Standards: The Challenge of Co-Production with Older People(IGI-Global, 2020-05) Waights, Verina; Holland, Caroline; Huchet, Estelle; Fisk, MalcolmAs the European population ages, there is an escalating need for age-friendly standards to support development of effective products and services involving information and communication technologies (ICT), thereby improving usability for all consumers, including older people. Co-production with users through inclusive and participatory processes provides several benefits to standardization, including enhanced understanding of market needs, clearer identification and mitigation of risks, and increased legitimacy of the standards developed. Ideally, co-production includes users from a range of backgrounds. However, older people, especially those aged over 80 years, are often the least likely in the population to be involved. This paper reports on barriers and challenges to inclusive co-production from the perspectives of a range of stakeholders participating in the European Commission-funded project, PROGRESSIVE: Progressive Standards around ICT for Active and Healthy Ageing. It identifies potential ways to improve the participation of older people in the co-production of standards.Item Metadata only Carers’ Involvement in Telecare Provision for Older People in England: Perspectives of Council Telecare Managers and Stakeholders(Cambridge University Press, 2019-10-08) Steils, Nicole; Woolham, John; Fisk, Malcolm; Porteus, Jeremy; Forsyth, KirstyThis paper explores telecare manager and other ‘stakeholder’ perspectives on the nature, extent and impact of family and other unpaid/informal carers’ involvement in the provision of telecare equipment and services for older people. Data used in the paper are derived from a larger study on telecare provision by local councils in England. The paper aims to add to the growing evidence about carers’ engagement with electronic assistive technology and telecare, and considers this in the context of typologies of professionals’ engagement with carers. How carers are involved in telecare provision is examined primarily from the perspectives of senior managers responsible for telecare services who responded to an online survey and/or were interviewed in 2016 as part of a wider study. The perspectives of three unpaid carers were captured in a separate strand of the main study, which comprised more detailed case study interviews within four selected councils. Thematic and comparative analysis of both qualitative and quantitative survey data revealed the varied involvements and responsibilities that carers assumed during the telecare provision process, the barriers that they needed to overcome and their integration in local council strategies. Findings are discussed in the context of Twigg and Atkin's typology of carer support. They suggest that carers are mainly perceived as ‘resources’ and involvement is largely taken for granted. There are instances in which carers can be seen as ‘co-workers’: this is mainly around responding to alerts generated by the telecare user or by monitored devices, but only in those councils that fund response services. Though some participants felt that telecare devices could replace or ‘supersede’ hands-on care that involved routine monitoring of health and wellbeing, it was also acknowledged that its use might also place new responsibilities on carers. Furthermore, the study found that meeting carers’ own rights as ‘co-clients’ was little acknowledged.Item Open Access COVID-19 and the Ageing Workforce: Global Perspectives on Needs and Solutions(BMC, 2021-10) Pit, Sabrina Winona; Fisk, Malcolm; Freihaut, Winona; Akintunde, Fashola; Aloko, Bamidele; Berge, Britta; Burmeister, Anne; Ciacâru, Adriana; Deller, Jürgen; Dulmage, Rae; Han, Tae Hwa; Hao, Qiang; Honeyman, Peter; Huber, Peter C; Linner, Thomas; Lundberg, Stefan; Nwamara, Mofoluwaso; Punpuing, Kamolpun; Schramm, Jennifer; Yamada, Hajime; Yap, Jason CHBackground: COVID-19 has a direct impact on the employment of older people. The World Health Organization has started a worldwide campaign to combat ageism and has called for more research and evidence-based strategies that have the potential to be scaled up. This study specifically aims to identify solutions to combat the adverse effects of COVID-19 on the global ageing workforce. Methods: To combat the adverse effects of COVID-19 on the global ageing workforce, Wwe present 15 case studies from different countries and report on what those countries are doing or not doing to address the issue impact of COVID-19 onfor ageing workers. • Results: We provide examples case studies of how COVID-19 influences older people’s ability to work and stay healthy, and examples of what governments, organizations or individuals can do to ensure older people can obtain work, maintain or expand their current work. Case studies come from Australia, Austria, Canada, China, Germany, Israel, Japan, Nigeria, Romania, Singapore, Sweden, South Korea, Thailand, United Kingdom (UK), and the United States (US). Across the countries, the impact of COVID-19 on older workers is shown as widening inequalities. Achieving health equity is stunted by having a large proportion of older people working in the informal sector who are often lower education and from rural areas in Nigeria, Thailand, and China. Solutions presented vary between funding support to encourage business continuity, innovative product and service developments, community action, new business models and localized, national and international actions. The case studies’ presented solutions also fit neatly within the effective strategies that have proven to work to reduce ageism: policy and law such as laws to increase benefits to workers due to lockdown (most countries); educational activities such as coaching seniorpreneurship (e,g, Australia); intergenerational contact interventions such as younger Thai people who moved back to rural areas sharing digital knowledge with older people and older people teaching the younger generation farming knowledge. Conclusion: Global sharing of this knowledge among international, national and local governments and organizations, businesses, policy makers and health and HR experts will further understanding of the issues that are faced both by society, organizations and older people. This; and will facilitate the replication or scalability of solutions as called for by the WHO to combat ageism in 2021. We suggest that policy makers, business owners, researchers and international organisations use the presented case studies and build on these by investing in evidence-based strategies to create inclusive ageing societies and workplaces. Such action will thus help to reduce ageism, inequity, improve business continuity and the quality of life of older workers.Item Open Access The Digital Network of Networks: Regulatory Risk and Policy Challenges of Vaccine Passports(Cambridge University Press, 2021-07-12) Wilford, S.; McBride, Neil; Brooks, Laurence; Eke, Damian; Akintoye, Sinmisola; Owoseni, Adebowale; Leach, Tonii; Flick, Catherine; Fisk, Malcolm; Stacey, MartinThe extensive disruption to and digital transformation of travel administration across borders largely due to COVID-19 mean that digital vaccine passports are being developed to resume international travel and kick-start the global economy. Currently, a wide range of actors are using a variety of different approaches and technologies to develop such a system. This paper considers the techno-ethical issues raised by the digital nature of vaccine passports and the application of leading-edge technologies such as blockchain in developing and deploying them. We briefly analyse four of the most advanced systems – IBM’s Digital Health Passport “Common Pass,” the International Air Transport Association’s Travel Pass, the Linux Foundation Public Health’s COVID-19 Credentials Initiative and the Vaccination Credential Initiative (Microsoft and Oracle) – and then consider the approach being taken for the EU Digital COVID Certificate. Each of these raises a range of issues, particularly relating to the General Data Protection Regulation (GDPR) and the need for standards and due diligence in the application of innovative technologies (eg blockchain) that will directly challenge policymakers when attempting to regulate within the network of networks.Item Open Access Ethical benchmarks for industry and commerce: a new landscape for responsible innovation(2021-07-01) Fisk, Malcolm; Flick, Catherine; Owoseni, AdebowaleThis paper addresses a 'new landscape' for responsible innovation. It reports on different ethical reference points for industry and commerce. In this context, responsible innovation (and Responsible Research and Innovation, RRI) can be seen as a strand of thinking and doing to be found in several ethically oriented frameworks-including those represented by the United Nations Sustainable Development Goals (SDGs) and several international standards. Exploration of the new landscape took place within the European Commission funded LIV-IN (Living Innovation) project. This focused on technologies for our lives and our homes in 2030. Published sources, consultations with experts, and workshops with a range of consumers and customers informed the project. Such project activity utilised RRI approaches to explore technological futures for the 'focal' sectors of smart homes and smart living. This was supplemented by a specific dialogue with CSR consultants about the wider potential contribution of RRI (or elements of it) to industry and commerce in the context of other ethically-oriented frameworks.Item Metadata only The ethics of using cameras in care homes(Nursing Times, 2016-03-07) Fisk, Malcolm; Florez-Revuelta, F.Exploration of the issues and pointer to ethical framework that is applicable to the use of assistive technologies (e.g. cameras) in care homes as a means of safeguarding residents and staff.Item Metadata only European Code of Practice for Telehealth Services: Developments and Uptake(International Society for Telemedicine and eHealth, 2014) Fisk, MalcolmArticle explores the developments relating to the European Code of Practice for Telehealth Services and its role in supporting quality standards.Item Embargo Gerontology(John Wiley & Sons, 2016) Fisk, Malcolm; Nash, PaulThe evolution of gerontology and its position and status as a discipline is explored and discussed. The end point (as noted in the text) as possibly being within 'cultural gerontology' - see as having 'derived from a further widening and rethinking' in relation to critical gerontology. Narrow perspectives relating to what is described as the 'dependence–independence axis' are argued as requiring to be 'set aside'.Item Open Access GPs, Patients and Health Data Commercialisation in England(Crimson, 2022-09-12) Fisk, MalcolmThe advent of Artificial Intelligence (AI) and, more specifically machine learning, brings great opportunities for healthcare. But linked with this there are unresolved issues about the safeguarding of patients’ personal (including health) data as the frameworks for their use appear to allow for their sale by or transfer from the National Health Service (NHS) to commercial organisations. The trust that most patients hold in the NHS may, as a consequence, be undermined and lead many of them to ‘opt out’ of (or choose not to ‘opt in’ to) the systems for data collection and sharing that are being configured in England by the UK government. For those AI suppliers and service providers that are seeking patients’ health data, challenges may as a consequence of ‘opt outs’ arise because of the potential inadequacy (limited size or representativeness) of the datasets that would otherwise be available. For the patients in question, there are concerns that include the ownership, privacy and confidentiality of their data, together with the seeming shortcomings of NHS and government plans for a framework that would facilitate data sharing in ways that recognise their particular circumstances and the different levels of confidentiality that might apply. There is, at the same time, some evidence of patient trust in public health services being conditional on their data being in the firm control of the NHS – with strong resistance to data being used for financial gain by commercial organisations. This brief communication offers a preliminary examination of the issues from the point of view of patients and their general practitioners (GPs) in England. And in light of limitations of the UK Government’s June 2022 Policy Paper ‘Data Saves Lives: Reshaping Health and Social Care with Data’, it calls for the urgent development and adoption of mandatory regulatory frameworks that will (a) cement the role of GPs’ as guardians of patient data; and (b) provide appropriate safeguards for patients.Item Open Access Guidelines for Responsible Research and Innovation(De Montfort University, 2016) Wilford, S.; Fisk, Malcolm; Stahl, Bernd Carsten, 1968-Guidelines for Responsible Research and InnovationItem Metadata only The health behaviour and wellbeing of older seafarers on Merseyside - indicated changes through brief interventions(Via Medica, 2017-09-27) Fisk, MalcolmBackground: There is significant evidence of the poor health of seafarers that arises both from the rigours of their trade and, for many, the associated lifestyles. Such poor health can continue in later life. The objective of the research is to report on a specific project that provided brief interventions to assist older (ex-) seafarers and to establish the effect of those interventions on their knowledge, behaviours, health and wellbeing. Materials and methods: Older seafarers were recruited to the project. Brief interventions were provided by which the knowledge of a number of older seafarers with health needs was raised about the options available to them; and the implications for their lifestyles and behaviours were addressed. Initial and final interviews were undertaken to determine any changes in self-reported health and wellbeing using both EQ5D and the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) measures. Post project interviews took place with a sample of the older seafarers. Results: A good level of understanding was found among the older seafarers regarding their own health. This meant that a precondition was in place, for many, by which changes in behaviours and lifestyles could take place. An important outcome was the indicated benefits of the brief interventions for self-reported wellbeing, though not statistically significant at the 95% level of confidence. Conclusions: Endeavours within the project to reach some of those who could benefit from the brief interventions were successful. Just over half changed their behaviours or were thinking of so doing. Wellbeing gains arising were indicated.Item Embargo The History of Telemedicine in the UK(International Society of Telemedicine and eHealth (online), 2021) Fisk, MalcolmIntroduction The United Kingdom (UK) is located on the north-west extremity of the continent of Europe. In 2018 it had a population of 66.4 million people [3]. The UK is an island nation comprising Great Britain and Northern Ireland. Great Britain is made up of the three countries of England, Scotland and Wales. Northern Ireland is part of the island of Ireland to the west of Great Britain. The UK was the world’s first highly industrialised country. This industrialisation largely took place in the eighteenth and nineteenth centuries and was characterised by scientific advances in agriculture, manufacturing, shipping and other sectors. Relating to these was the occupation (or colonisation) of various territories across the world and the position of the UK as a major player in international trade. The ‘British Empire’ brought considerable wealth to the UK as well as political and cultural influence. The UK has subsequently experienced significant decline. However, links with many of the occupied territories remain within a grouping, established in 1931, known as the Commonwealth. These territories have been the source of much inmigration to the UK and have increased the UK’s ethnic and cultural diversity. The Commonwealth is described as a ‘voluntary association of 53 independent and equal sovereign states’. This is the context within which the UK is re-defining its place in the world. Its industrial, political and cultural prowess has diminished, leaving a legacy that includes both wealth and relative poverty - with the latter often co-existent with social problems, poor housing and health inequalities [4]. Aspects of this legacy may be exacerbated by the UK having left the European Union [5]. And whilst the scourge of some earlier poverty-related health challenges in the UK (such as tuberculosis and scarlet fever) have been largely overcome, for many people today there are health challenges that relate to relative poverty, low incomes, poor housing and unhealthy lifestyles; and some illnesses, long-term conditions and disabilities that are associated with what has, until recently, been steadily increasing longevity. But despite the extent of inequality and the persistence of relative poverty within the UK, its economy in 2017 (in terms of Gross Domestic Product, GDP) was the 6th largest in the world. With regard to government expenditure on health and well-being, this comprised 9.8% of the UK’s GDP in 2018. The UK’s National Health Service (NHS) consumed the largest portion of this spending. Coming specifically to telemedicine in the UK, its history and its impact are interweaved with the country’s industrial development and decline, together with (since 1948) both the enthusiasm and the angst associated with the advent, progression and role of the NHS. The history can be described as fitting within five phases, the fifth (associated with and triggered by the COVID-19 pandemic) having already been mentioned (see Figure below). The phases bear testimony to a ‘stop-start’ development of telemedicine that took place over a period of more than a century. A number of themes become apparent in the phases of telemedicine’s development. Two are highlighted here. The first is the ‘fact’ of telemedicine facilitating a decentralisation or ‘devolution’ of services. During the earlier phases, this decentralisation was instrumental in bringing greater service accessibility throughout the UK. Such decentralisation is seen as an ongoing process which necessarily created (and creates) stresses and strains for pre-existing frameworks – raising important questions about the role of the main institutions of healthcare, most notably hospitals. Telemedicine is disruptive. It joins, therefore, other disruptive aspects of health and medicine such as that which relates to workforce change as pointed to in the work of Christensen et al [6]. But Lynch and Fisk [7] noted their work as failing ‘to extend the logic of their argument to points of care that were beyond the local clinic’. In other words, decentralisation was seen by Lynch and Fisk as needing, facilitated through telemedicine, to go further – with the process ending with individuals. Us. The second theme is concerned with the ways in which we are empowered through telemedicine and, emboldened by greater self-awareness and health knowledge, are able to take a bigger role in our healthcare. With empowerment comes changing relationships between Fig: Phases of Telemedicine Development in the UK health professionals, practitioners and ‘their’ patients. Here, the word ‘their’ is used reluctantly (and is, in fact, superfluous) because part of the change in relationships is one where empowerment means that the transactions between patients and their service providers will, in the future, need to be recognised as one of greater equity. Is ‘empowerment’, in any case, the most apt of themes? Morley and Floridi argued instead for ‘enablement’ and suggested that ‘promoting digitally enhanced, empowered health care as a techno-utopia is misleading’ [8]. But this chapter suggests that enablement is not enough. Empowerment is considered to give us something more. Empowerment speaks to the way in which we must configure our health services (and a lot more in terms of public education) in order to help build people’s health literacy and motivate us all in relation to the adoption and maintaining of appropriate lifestyles. This chapter calls, therefore, for telemedicine to take a recognised and meritorious place within the range of the UK’s health services, part of which requires a further shift in the balance between, what Morley and Floridi refer to as ‘agency and patiency in (the) doctor-patient relationship’ [8]. Finally in this introduction, it is very worthy of note that the two main themes identified for telemedicine echo two of the United Nations sustainable development goals (SDGs) - Goal 3 (Target 8) which focuses on ‘access to quality health-care services … for all’; and Goal 10 (Target 2) which seeks a reduction in inequalities and to ‘by 2020, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or any economic or other status’. It can be noted, at the same time, that NHS Digital (a branch of the NHS) is concerned to ‘empower the person’ through ‘improved digital access to health and care information and transactions’ and by ‘developing digital technologies that put people in charge of their own health and care’ with apps and ‘personal health records’ part of their focus. The Five Phases The first phase of telemedicine’s development in the UK extends from a starting point around the 1840s to the outbreak of the First World War in 1914. It was, in large part, a period of rapid industrial development with (for industrial entrepreneurs, engineers and technologists) innovation taking place in multiple sectors – from textiles to transport. But the period, whilst bringing wealth to the UK, was accompanied by the twin scourges of poverty and ill health. Hence it would be surprising if some element of the entrepreneurship and industrial endeavour did not address (poor) health and consider the means of its amelioration. The stimulus for endeavours in this direction were not, however, just philanthropic and/or commercial. They were also self-serving. Many diseases were not respecters of geographical boundaries. The wealthier and generally more educated classes (amongst whom were most of the entrepreneurs) were not immune to having some contact with the poorest, nor to the foul miasma (perceived as carrying infections) that might drift into their neighbourhoods from squalid areas nearby. The second phase extended from the end of the First World War (1919) to around 1970. It covers the whole of the interwar period (including the period of the ‘Great Depression’) and the main period of economic recovery after the Second World War. After the First World War it was still the case that much of the UK population lived in insanitary housing – whether in urban or rural areas. It was with the promotion of better health in mind, therefore, that the then Prime Minister, Lloyd George, called (in reference to the returning soldiers) for ‘habitations fit for heroes’. This heralded a municipally-led house-building programme with accompanying attention to ridding the country from at least some of its slums. But for telemedicine, the inter-war years in the UK (from 1919 to 1939) can be regarded as ‘fallow’. There was little or nothing that might be viewed as a stimulus for telemedicine development. Rather it is the reverse. The health focus was on regularising the roles of doctors and nurses; and establishing and embedding service norms that we see to this day around hospital and GP services. Meeting the needs of patients, furthermore, revolved around the ways that people interacted with the services rather than how the services reached out to them. Besides, telephony networks were poorly developed and telemedicine, if it were to have been considered, could have only involved communication from clinician to clinician or with those patients able to pay for services. The Second World War meant, of course, that attention to public health issues were put ‘on hold’. But the years that followed the war (from 1945) were very important from a health perspective. They were characterised by an optimism that brought the UK, not just its now iconic NHS, but also other welfare reforms including a national insurance scheme and planning reforms that underpinned the development of ‘new towns’. Such reforms were associated with a sincere and urgent belief among politicians that the people of the UK, after the deprivations of the war, deserved to be able to live better lives and, importantly, access better health services. The impact of the NHS, from the date of its foundation in 1948, cannot easily be overstated. It brought access to health services for all. Its establishment opened a relatively ‘settled’ period for health services where even the most enlightened entrepreneur and innovator might have seen little merit in devoting energy on developing technologies that resembled what we now recognise as telemedicine. The focus of health practitioners was on the establishment and operation of new administrative arrangements in a context of benefit for families and individuals, rich and poor alike. Hospitals became focal resources in every city and GPs became integral to life in every community - with the latter especially being romanticised or immortalised in literature and film. The third phase starts around 1970. Significant from the health perspective was the fact that along with expanded telephone networks, telephony based warden-call ‘systems’ (later more generally known as social alarms, then featuring a part of telecare) were becoming a feature in schemes of municipal housing for older people. These enabled wardens (supervisors and ‘good neighbours’) to be alerted, normally through the pull of a cord, in urgent situations – e.g. after a fall [9]. The image of the ‘fallen’ woman was commonplace at this time in the literature of the companies who marketed such systems (see Plate 1). In this phase, with the ensuing advent of ‘carephones’ (that could be installed in any home with a telephone line), older people could link, with Plate 1: The ‘Fallen Woman’ Brochure promoting the private Aid Call service, Moreton Hampstead. the pull of a cord or the push of a radio trigger, to monitoring (call) centres. Systems that had operated within housing schemes became more community-oriented ‘services’. The number community (or social) alarm services increased quickly in the public sector with 301 operating in the UK by 1990. These were driven mostly by the need to give ‘out of hours’ cover for wardens [10]. There were just a handful of services in the private sector. The more recent evolution of such services (see Phase 4) started to bring such services into the wider world of telemedicine. Commencement of the fourth phase can be pinpointed to 1998 – with the publication of the NHS strategy report for England and Wales, ‘Information for Health’ [11] and both the ‘Information Management and Technology’ report and the ‘Acute Services Review Scotland’ [12]. These key reports heralded the greater use of information technology (IT) within the NHS – including promoting the taking of initial steps to develop electronic health records; facilitating the transferability of images and data between hospitals; and the overcoming of what were referred to as ‘data islands’ (i.e. silos). The reports also presaged the establishment of NHS Direct (from 1999), NHS Direct Wales (from 2001) and NHS24 (from 2001) in Scotland. The date of 1998 happened, in addition, to be the fiftieth anniversary of the foundation of the NHS. The public telephone network was, by this time, extensive - though it was several years before the Internet begun to make its mark on businesses, let alone being accessed by large numbers of people from their homes. It is, nevertheless the time at which there were new, and strong, stirrings around telemedicine. The transfer of images was, for instance, an aspect of telemedicine that was increasingly in use, albeit that this novel aspect of telemedicine was not in ‘real-time’ and did not involve access by patients. NHS Direct (and its variants in the UK) was, by contrast, a new ‘real-time’ telemedicine service - though perhaps not widely recognised as such. It directly responded to patients with an almost infinite variety of concerns. It was proving a success. This fourth phase steadily became characterised by many, many more telemedicine pilots and initiatives in the UK. These related to a range of different health conditions. A key focus was on services specifically responding to the needs of older people - seen as those for whom interventions might give the biggest ‘wins’ in terms of time and cost savings. And while attention, in the evaluations of such pilots and initiatives, was given to the financial ‘gains’ arising from e.g. fewer hospital visits and admissions, shorter ‘bed days’ in hospitals and sometimes reduced death rates; less attention was given to broader well-being gains and/or the greater convenience for patients through the reduced need for them to travel or for them or others (e.g. carers) not needing to take time off work. In addition, but with notable exceptions - see, for instance, Wootton et al [13], little or no attention was given to the potential environmental benefits though reduced travel. Telemedicine pilots and initiatives did not, however, take place without opposition. The oppositional positions of some clinicians and other health service professionals and practitioners were not to be easily changed. What had been little less than a magnificent contribution of the NHS in the foregoing five decades went, after all, hand in hand with bureaucracies and associated mindsets that were unaccustomed, resistant to, or fearful of change. Telemedicine was a threat to the established order. The NHS was, generally speaking, not ready to consider this threat. Besides, established NHS practices, even with their manifold inefficiencies, carried substantial public support. The fifth phase started with the COVID-19 pandemic. The shape of the NHS and of telemedicine within (or outside of) the NHS is still in large part, therefore, to be determined. Crucial will be the manner in which UK health services, the NHS in particular, responds not only to the numbers of infections (and the death toll) but also to the ongoing repercussions for many of those who have struggled to recover from the virus (i.e. relating to ‘long-COVID’). Herein lies, not so much an opportunity to be grasped by those who favour telemedicine’s further development, but rather a context in which there is growing realisation of it offering another, complementary way forward – linking with public health imperatives that have necessitated a reduction in the extent of personal contact with patients. What is certain is that we are at the early stage of a transition that will represent the biggest and most profound since the establishment of the NHS. Old affiliations and loyalties will be tested. Some will be broken. New ways of working that hold onto some of the caring and personal nature of our traditional health services, albeit mediated through IT, will be found. Finally, with the NHS facing a time of dramatic change, it can be anticipated that the ‘balance of power’, as health services are further decentralised, will shift away from clinicians. New service norms, that hold on to what is good in the NHS and which include telemedicine, will become established. In the meantime, this chapter attempts to do justice to the multi-faceted nature of telemedicine’s emergence … from its technological roots through the embedded nature of the UK’s health services, to an uncertain future that may be very different to that which has been previously envisaged.Item Open Access Knowledge and Skills Sets for Telecare Service Staff in the Context of Digital Health(Deggendorf Institute of Technology, 2021-12) Fisk, Malcolm; Woolham, John; Steils, NicoleTelecare services have an established place within the United Kingdom. Through employing online technologies to help mostly older people to remain at home, they are increasingly recognised as having a support role for health as well as social care. This positions telecare services within the broader realm of ‘digital health’. But as that position becomes more embedded, it poses questions about the nature of tasks that are (or should be) undertaken by telecare staff, and regarding new skills that are required. A convergence of telecare and telehealth services is indicated together with the need for some kind of accommodation. This paper summarises the United Kingdom policy context; references the technologies that are provided by telecare services or can be linked to them; notes briefly the impact of the COVID-19 pandemic; and proposes six knowledge and skills sets. Outcomes of the UTOPIA study undertaken in England from 2016 to 2017 are drawn upon: this study provided important information from over 100 ‘adult social care’ service providers.Item Open Access Knowledge and Skills Sets for Telecare Service Staff in the Context of Digital Health(International Society for Telemedicine and eHealth, 2020-12-21) Fisk, Malcolm; Woolham, John; Steils, NicoleTelecare services have an established place within the United Kingdom. Through employing online technologies to help mostly older people to remain at home, they are increasingly recognised as having a support role for health as well as social care. This positions telecare services within the broader realm of ‘digital health’. As that position becomes more embedded, it poses questions about the nature of tasks that are (or should be) undertaken by telecare staff, and regarding new knowledge and skills that are required. This paper briefly sets out the United Kingdom policy context; references the technologies that are provided by telecare services or can be linked to them; briefly notes the impact of the COVID-19 pandemic; and proposes six knowledge and skills sets. Outcomes of the UTOPIA study undertaken in England from 2016 to 2017 are drawn upon: this study provided important information from over 100 local authority telecare managers.Item Open Access Making Use of Evidence in Commissioning Practice: Insights into the Understanding of a Telecare Study’s Findings(Policy Press, 2019-12-16) Steils, Nicole; Porteus, Jeremy; Fisk, Malcolm; Forsyth, Kirsty; Woolham, JohnIn less than a generation, telecare has become a significant new resource for local authority (LA) Adult Social Care Departments (ASCDs) in England and other European countries to offer to people eligible for social care and support. All English ASCDs either have directly managed, or commissioned, telecare services, and telecare is often used as a 'first line' service (that is, before other forms of intervention). The Whole Systems Demonstrator Project (WSD), a very large clinical trial funded by the English Department of Health (DH) concluded that it does not deliver better outcomes. Despite this, and in the context of unprecedented reductions in adult social care expenditure over the last decade (Innes and Tetlow, 2015), investment in telecare has continued in the UK. This article explores the extent and nature of the evidence used in LAs to support investment in telecare.Item Open Access Outcomes for Older Telecare Recipients: The Importance of Assessments(Sage, 2019-10-30) Woolham, John; Steils, Nicole; Fisk, Malcolm; Porteus, Jeremy; Forsyth, KirstySummary This article explores the role of telecare assessment, review and staff training in meeting the needs of older people living at home. Using original empirical data obtained from an online survey of English local authorities it reveals considerable variation in assessment and review practice and in training given to social work and other staff who assess and review, which may impact on outcomes for telecare users. The study findings are situated within an English policy context and earlier findings from a large, government funded randomised controlled trial. This trial concluded that telecare did not lead to better outcomes for users. Findings Our survey findings suggest that it may be the way in which telecare is used, rather than telecare itself that shapes outcomes for people who use it, and that ‘sub-optimal’ outcomes from telecare may be linked to how telecare is adopted, adapted and used; and that this is influenced by staff training, telecare availability and a failure to regard telecare as a complex intervention. Application The findings may help to reconcile evidence which suggests that telecare does not deliver better outcomes and local authority responses to this which either discount or contest its value. The article suggests that to use telecare to achieve optimal outcomes for older people, social workers, care managers and other professionals involved in assessing for telecare will need to be given enhanced training opportunities, and their employers will need to perceive telecare as a complex intervention rather than simply a ‘plug and play’ solution.Item Metadata only A Practical Guide to Improving Lighting in Existing Homes(Thomas Pocklington Trust, 2015) Fisk, Malcolm; Raynham, P.Better lighting at home can make a dramatic difference to people’s lives. This Good Practice Guide explains how to improve lighting to meet the needs of people with sight loss. It is useful to anyone supporting others to live independently in their own homes, such as housing and support staff, home improvement agencies, rehabilitation workers for people with visual impairment (ROVIs) and occupational therapists (OTs).Item Metadata only Principles to Underpin the Use of Cameras and Other Surveillance Technologies in Care Settings(International Society for Telemedicine and eHealth, 2015) Fisk, MalcolmItem Metadata only Skills and Knowledge Sets for Health and Social Care Staff in the Context of Telehealth(International Society for Telemedicine and eHealth, 2014) Fisk, MalcolmArticle explores the skills and knowledge needs, notably in relation to digital literacy, of (health and social care) staff in the context of developments in telehealth.