Policy paper

Telecare stakeholder action plan: preparations for the analogue to digital switchover

Published 5 December 2022

This was published under the 2022 to 2024 Sunak Conservative government

Applies to England

Ministerial foreword

Telecare services are a vital means of preventing, reducing or delaying the development of care and support needs, giving independence to nearly 2 million people who use telecare devices across the UK and acting as a lifeline if they need emergency help.

The UK’s telecommunications providers are currently transitioning their telephone services from analogue to digital networks. BT has said it wants to complete that transition by the end of 2025 and other telecommunications providers that also rely on traditional telephony networks plan to follow a broadly similar timescale.

Digital systems will create a basis for a next generation of telecare services that will provide a means for more personalised and early preventative interventions. Devices that can detect signs of health deterioration – such as through presence and movement sensors – have already begun to be introduced.

Yet, at the moment, many vulnerable telecare users are at risk of losing their protection the day their telephone line goes digital. That’s because telecare is still mainly provided through analogue equipment and these devices may not be digitally compatible or perform as reliably as they do now on digital networks. The need to mitigate this risk is urgent. It is vital that the telecare and telecommunications sectors work together in the best interests of people who use telecare services.

Efforts are complicated, however, by the diverse nature of the telecare sector. It comprises a great number and variety of stakeholders in the public and private sectors including telecare:

• service commissioners and providers
• alarm receiving centres (ARCs)
• equipment suppliers and manufacturers

The move to digital telecare is further complicated by the global shortage of semiconductors, which is creating delays in telecare suppliers meeting orders for digital equipment.

The telecommunications sector is also complex with the telephone lines on which telecare services currently rely being delivered by over 600 different telecommunications providers. It can, however, do much to inform and work with the telecare sector when switching over its customers who are also telecare users.

Telecare sector stakeholders will want to make sure every telecare user has a device that keeps them protected when their digital switchover takes place, and that planning is taking place for the future. Openness on the testing of existing analogue telecare devices to get a better understanding of what current equipment will work reliably in the short term on digital telephone lines is important, and will help realistic and proportionate procurement plans to be put in place to manage the switchover locally.

The government is encouraging collaboration, and has given the Department of Health and Social Care (DHSC) and its joint digital policy unit in NHS England’s Transformation Directorate a co-ordination role.

This document presents DHSC’s initial plan to guide essential co-ordinated stakeholder action across the telecare and telecommunications sectors in England. It will be updated each quarter. Much is already in progress, but the pace has to pick up: although the switchover won’t complete until the end of 2025, it has already commenced and will accelerate over the coming months.

Telecare service providers should act now with other telecare and telecommunications sector stakeholders to make sure people who use their services – our vulnerable citizens – are protected and prepared for the future. I commend this action plan to them.

– The Lord Markham CBE, Parliamentary Under Secretary of State, Department of Health and Social Care

1. Introduction and summary

BT has taken the decision to retire its public switched telephone network (PTSN) by December 2025 and this means other telecommunications providers that use BT’s network must follow the same timescale. Other companies with their own networks that also use traditional telephony, such as Virgin Media O2, plan to follow a similar timescale.

In addition, telecommunications providers are also investing in new systems and networks – for example, by upgrading old copper-based broadband lines to full fibre. They will need to switch customers away from the old PTSN at the same time as upgrading their technology.

The UK telecommunications sector’s imminent switch to digital raises risks for users of the telecare services run by local authorities, housing associations, the third sector and commercial organisations.

Telecare services provide monitoring, protection and support to people remotely, typically via a device connected to a telecommunications network. The device sets off an alarm when the user needs assistance – for instance, if they have a fall. The alarm signal travels over the telephone network to an ARC, triggering a response from the ARC or the emergency services.

An estimated 1.8 million people in the UK currently use telecare services, of whom 1.3 million use alarms in their own homes, and 0.5 million in a range of care homes, supported housing and sheltered living arrangements (see ‘Annex 2. Telecare services’ below for more detail on this).

The digital switchover means traditional telecare devices – such as telephone handsets and telecare units that are currently connected to the analogue PSTN – will need to be reconnected to the digital network, and some devices will need to be upgraded or replaced.

Telecare service users are at risk of being left unprotected unless their device:

• is already compatible with a digital network
• can and will be converted to work with a digital network
• is replaced by a new digital device

The digital switchover also creates opportunities for telecare service providers to widen and improve their services using digital technologies. Telecare service providers will wish to ensure that they make full use of the opportunities that digital technology offers to improve their care service offering.

The government – through the Department for Digital, Culture, Media and Sport (DCMS) and the independent regulator for communications Ofcom – is working with telecommunications providers to ensure consumers and businesses in every sector are prepared for the digital switchover, and protected against allied risks.

This goal is being pursued in each sector by the appropriate government department. For the telecare service sector in England, this is the DHSC, working through the Joint Digital Policy Unit in the NHS Transformation Directorate, which was formerly NHSX and is now part of NHS England.

In the telecare sector, the government’s priority is to see action taken to mitigate any risks to users of telecare services before their switchover day. Making sure these actions are taken depends on co-ordination among stakeholders. While this is a plan for England, the switchover is a UK-wide approach so there is close working with counterparts in the devolved administrations, with relevant references throughout.

The main stakeholders (there is more below on this at ‘Annex 4. Telecare service stakeholders, interest groups and government bodies’) are:

• telecare service providers, including local authorities, supported housing providers, health services, third-sector and commercial organisations
• ARCs, both public and private
• telecare equipment suppliers
• telecommunications providers

Since 2021, DHSC has been working with sector stakeholders to help identify, co-ordinate and support necessary actions. In this telecare stakeholder action plan, the DHSC is setting out for the first time in one document:

• what stakeholders are already doing
• what more they will want to consider doing to both mitigate the risks of the digital switchover for telecare users and to develop the service transformation opportunities arising from it

A full list of actions is set out in an action tracker in section 4 below. These actions are based on a report commissioned from the technology consultancy FarrPoint who was commissioned to undertake a study into the readiness of the telecare sector for the digital switchover – see ‘Annex 7. FarrPoint study’ below for more details.

An action plan focused on the needs of people who use telecare

The following 3 priority needs have been identified for people who use telecare services:

1. To understand all aspects of the digital switchover that affect them, telecommunications and telecare service providers will want to explain the consequences of the switchover to service users clearly, in consistent language, so that they or their friends and family understand exactly what is happening.
2. To experience a smooth transition of their telecare services on their digital switchover day, including where an engineer acting on behalf of the telecommunications provider is physically present to change over the telephone connection. Telecommunications service providers will also want to give telecare service providers information about planned network upgrades where they have their contact details. Telecare service providers will want to assess their telecare users’ equipment for digital compatibility, contacting their equipment supplier for the latest verifiable information, and having a plan to react if a telecare service user’s equipment does not work reliably when switched over.
3. To be able to benefit from future improvements in digital health and care services made possible by the digital switchover.

The actions aimed at meeting those needs are divided into 4 connected workstreams:

1. Co-ordination among stakeholders – so telecommunications providers can identify telecare users among their customers and they, telecare service providers, ARCs and equipment suppliers can all carry out work to smooth each telecare user’s digital switchover and ensure the continued reliability of their service.
2. Communication – including to increase awareness and understanding of the switchover among telecare users by providing information in an accessible format.
3. Best practice and guidance for all telecare sector stakeholders – on the technical and operational issues raised by the digital switchover for telecare services.
4. Business case and strategy support for local authorities – including information on the value telecare services currently deliver. This section will also be of interest to non-local authority-commissioned or provided services. Telecare manufacturer Appello and the Housing Learning and Improvement Network (LIN) have recently issued advice for housing providers. Actions in this workstream, alongside support from the Local Government Association (LGA)’s Local Government Digital Switchover Working Group, will help local authorities develop business cases for transforming their telecare services.

The action plan draws on the report The Digital Shift and its Impact on the Telecare Sector in England. This report is based on research commissioned by the DHSC in late 2021 from FarrPoint, a technology consultancy working with the telecare and telecommunications sectors – see ‘Annex 7. FarrPoint study’ below for more information.

The DHSC will provide high-level co-ordination of the actions stakeholders are taking forward. Progress will be updated on a quarterly basis with the first update published based on progress by the end of March 2023.

Examples of current work to support the workstreams are to:

• test and publish data on the reliability of analogue telecare devices when operating over a digital telephone line to assist telecare service providers develop upgrade plans
• consider establishing a helpdesk where equipment failures can be reported and investigated. A helpdesk pilot has been run by the TEC Services Association (TSA), the main industry body for technology-enabled care
• develop good practice for the telecommunications sector’s on-the-day switchover processes for telecare users

If you wish to comment on current work in the action plan or make further suggestions, email [email protected] at DHSC.

2. The digital switchover: risks and opportunities for telecare stakeholders

Work has been completed to understand the main risks to telecare users as a result of the digital switchover and these are set out in this section.

It is also important to note that the digital switchover also presents telecare service providers with significant opportunities to transform health and care services.

Risk of limited co-ordination among stakeholders

Shifting telecare services to digital networks is inherently complicated because of the sector’s fragmentation. There are over 300 telecare service providers and ARCs, each with a differing service offer, technology infrastructures and operational processes.

The main sources of risks to telecare users arising from a lack of co-ordination among telecare and telecommunications sector stakeholders are:

• telecommunications providers not knowing which of their customers are also telecare users
• telecommunications providers not giving telecare users enough notice of their switchover or communicating this in an unclear way
• telecare equipment not being assessed or updated by the telecare service provider prior to a service user’s digital telephone upgrade
• good switchover practices not being developed in time. There is currently no requirement or set process for a telecommunications engineer, if present in a vulnerable person’s property, to reconnect a telecare device to a digital telephone line, nor accepted practice across the telecommunications industry for testing the functionality of reconnected devices

Insufficient communication risks

Telecommunications providers’ customers will face different routes for their digital migration. Some customers will be:

• switched when they change their telecommunications provider or upgrade to a new contract or service with their existing provider
• selected by their telecommunications provider for managed migration to digital

The routes available will not necessarily depend on a customer’s geographical location. Each telecommunications provider will have its own plans, meaning different migration routes may be used in the same areas at the same time.

Telecare service providers and people who use telecare services need to be aware of the migration routes likely to be used, and the actions needed to ensure their telecare service continues to operate. For instance, telecare alarms may be deactivated or lose functionality with little or no notice if the telecare service user signs up to a new digital telecoms service from a telecommunications provider without that provider knowing they use a telecare service.

The main risk arising from insufficient communications among telecare and telecommunications sector stakeholders, and between them and telecare users is telecare users no longer being able to rely on their devices because:

• they are not identified as telecare users by telecommunications providers or they do not tell them, and they may be switched to a digital telephone line without consideration being given to the impact on their telecare devices
• they migrate to digital, either by changing their telecommunications provider or upgrading to a new package with their existing provider, unaware of how this will affect their telecare device
• their telecare service provider does not tell them whether or how their equipment will be upgraded because the provider has not yet made full plans for the switchover

Telecare service providers will also want to plan to identify and pre-empt potential problems for their users associated with switching to digital.

At present, telecare service providers are at different stages in their planning for the switchover and upgrading equipment. Those at an early stage of this work may not yet have fully engaged with their service users about the switchover, and explained what it means for them and the telecare equipment they use.

Similarly, more engagement between telecommunications providers and telecare service providers about switchover plans will help telecommunications providers identify telecare users among their customers and ensure a smoother switchover.

Technical risks

The main technical risks of the switchover affecting people who use telecare services concern the reliability of their telecare equipment in:

• an all-digital telecommunications environment
• the event of a power cut

The current method of communication between telecare alarm devices attached to analogue phone networks is tone-based signalling. Digital telephone networks are not designed to support this form of communication. In some cases, they distort signal tones from alarm devices meaning alarm calls fail to connect correctly to the ARC, potentially placing service users at risk.

Difficulties in using analogue equipment on digital networks

To work over a digital network, the signal from a tone-based analogue alarm needs to be converted to digital. This conversion between analogue and digital can introduce slight changes to the duration of the tones, meaning that the signal cannot be correctly interpreted by the ARC.

On the journey from a telecare user’s home to the ARC, an alarm call may travel across several telecommunications provider’s networks. Each time a network is crossed, a signal may be converted back and forth between analogue and digital signalling, with a risk of degrading of quality at each conversion.

Even where an alarm call has connected successfully in the past, it cannot be relied on to work in the future. This is because a telecare user may have changed their telephone provider or occur as a result of changes a telecommunications provider has made to their network for commercial or technical reasons.

The telecommunications industry and Ofcom recommend that all communications devices connected to telephone networks – including telecare alarms – should be digital because of the risk that signals from analogue devices could be corrupted or lost over a digital network.

The switchover has implications for the reliability and safety of analogue telecare equipment, which cannot be guaranteed to operate safely and reliably over digital telephone lines. The reality is, however, that some analogue devices will continue to be used after the switchover period ends.

Telecare equipment suppliers should be testing existing analogue telecare equipment and assessing its ability to function reliably when connected to a digital network. The results of these assessments should be published so telecare service providers can plan and prioritise the switchover of their service users.

At present, not enough testing is being done by equipment suppliers. Nor are test results being sufficiently publicised to help telecare service providers decide whether they need new devices and what devices to buy.

The main risks for telecare users arising from insufficient equipment testing are:

• telecare service providers are unsure of how reliably their analogue equipment will work when a telecare user’s phone line is moved to digital
• telecare service providers do not plan to purchase new equipment because they think their current equipment will perform to an acceptable level when switched over
• telecare users may be left with unreliable analogue equipment when their switchover takes place

Resilience for digital telephones and telecare devices in the event of a power cut

The PSTN provided sufficient electricity to power a basic wired handset during a power cut to be able to make emergency calls and to keep devices linked to the network running. Existing analogue telecare devices also provide 12 to 24 hours of operation via an internal battery in the result of a power failure.

Following the digital switchover, landline telephones will typically operate using a socket on a customer’s broadband router that relies on mains power to work. Therefore, corded landline telephones will only work in a power cut if they have a battery back-up.

Ofcom requires that telecommunications providers provide a free resilience solution for customers that are reliant on their landline to call emergency services during a power cut. This should allow these customers to call the emergency services during a power cut at their home for a period of at least one hour. To meet this requirement, telecommunications providers may provide a battery back-up of at least an hour, although some battery back-ups may last longer.

The battery back-up provided by telecommunications providers will provide enough power to allow the customer to dial the emergency services, but it is not expected to support other equipment, including telecare devices.

For telecare users in these circumstances, telecare service providers will want to have their own power backup or other solutions in place to mitigate the risk of users being unprotected during a power cut after their switchover. Many digital telecare alarms use the mobile telephone networks for their connectivity, meaning they can use their internal battery and continue to offer service in the event of a mains power cut.

A telecare alarm will not operate during a power cut if one or more of the following happen:

• the telecare alarm does not have an internal battery
• the telecare alarm does have a battery, but it runs out of power
• the telecare alarm is connected to a digital telephone line via a router and that router does not have a battery back-up

Digital development opportunities

The digital switchover presents telecare service providers with opportunities to improve and transform their services.

These will be multiplied by the improved connectivity gained through the government’s nationwide gigabit-broadband strategy. Improved network infrastructure and access to high-speed connectivity will enable better use of digital technology and data to support the delivery of high-quality telecare and closer integration with health services. The government is targeting a minimum of 85% gigabit-capable coverage by 2025 and investing £5 billion as part of Project Gigabit to ensure the hardest-to-reach areas in the UK receive coverage.

Telecare users risk missing out on the benefits of transformed services if telecare service providers do not make the most of these digital developments. Switching to digital telecare can offer better-quality services tailored to meet each service user’s specific needs.

Benefits include:

• allowing people to enjoy more choice and control over their lives by integrating their device with other digital products and services
• improved alarm call performance through shorter connection times and better sound quality
• automated fault checking and reporting, which is very limited with traditional analogue alarms
• faster and reduced costs of installation and maintenance
• the ability to connect alarm devices via mobile communications networks, which can provide more diverse communication routes and a more secure data connection
• more choice on where the alarm is located within the home that is not limited to being close to a phone socket

3. The stakeholder action plan: people who use telecare services take priority

The stakeholder actions in this action plan address the risks and opportunities outlined above in section ‘2. The digital switchover: risks and opportunities for telecare stakeholders’ through 4 closely connected workstreams.

The 4 workstreams aim to provide:

• co-ordination for stakeholders involved in telecare service delivery and the digital switchover, including those who are not currently members of existing interest groups
• communication, particularly to increase awareness of the digital switchover among telecare users
• best practice and guidance on the technical and operational issues raised by the digital switchover for telecare service users
• business case and strategy support specifically for local authorities, including information on the benefits telecare services currently deliver and the case for transforming services

Meeting the needs of telecare service users is the goal of all 4 workstreams.

The full list of actions and progress so far is shown in section ‘4. Action tracker’ below.

Telecare users are the priority

Across the action plan, the needs of telecare service users are the common focus. DCMS – with support from DHSC, TSA and others – has brought together stakeholders to prioritise and address issues affecting telecare users.

The priorities for ensuring successful switchovers for them are for:

• telecommunications providers and telecare service providers to communicate with all telecare users clearly, in consistent language and in an accessible format about all aspects of the digital switchover, so that telecare service users and their friends and family have a clear understanding of what is happening
• telecommunications providers to share information with telecare service providers on plans and processes for network upgrades, so those telecare service providers can plan actions to ensure a smoother digital switchover for their service users
• telecare service providers to put plans in place for all their telecare users whose equipment needs to be assessed for digital compatibility and upgraded or replaced

Co-ordination

Improved co-ordination between stakeholders will help ensure telecommunications providers can:

• identify the telecare users among their customers
• inform telecare service providers about digital switchover dates

This should help telecare service providers plan a smoother digital switchover for users. A number of actions in this workstream are underway to deliver this.

The DHSC has commissioned the TSA to collate all the ARC numbers dialled by telecare devices, which the Office of the Telecommunications Adjudicator (OTA2) will distribute among telecommunications providers. Telecommunications providers can then check customers’ call records to see if they have dialled one of the ARC numbers within the last 12 months and, in this way, identify telecare users.

BT, Virgin Media O2 and other telecommunications providers are currently using this checking process. BT is also looking at whether telecare service providers can share their service users’ telephone numbers, in line with General Data Protection Regulations, with telecommunications providers. In addition, telecare service providers could also ask their service users to inform their telephone provider that they have a telecare device.

To help ensure a smooth switchover for each user, OTA2 has set up a working group of telecommunications and telecare service providers to identify a ‘good practice’ switchover process involving telecommunications provider engineers that puts people who use telecare services at the centre of the on-the-day switchover process.

This aims to minimise the need for a user to be actively involved in checking the digital compatibility of their telecare equipment or arranging for third parties to be on-site at the same time as a telecommunications engineer.

The process will identify good practice for:

• migrating an analogue line to digital
• proving the digital connection over the new line
• reconnecting the required number of handsets
• reconnecting any telecare equipment
• facilitating a test of the telecare equipment
• what to do in the event of an issue with the telecare equipment

The DHSC has commissioned UKTelehealthcare and TECS Advisory to produce a range of information sheets to help prevent telecare alarm disconnections as part of this process.

The information sheets will go to:

• telecommunications provider personnel involved in planning, arranging and implementing the switching of telecare service users to a digital telephone service
• telecare service providers – both those that operate their own ARC and those that use a commissioned or outsourced call-handling service
• care professionals in different health and social care settings
• telecare service users and their carers, relatives or support network

The work of drafting and refining the information sheets is linked to the discussions between stakeholders on good practice for the on-the-day switchover process. Stakeholders are working through issues including:

• safeguarding telecare service users
• the boundaries between telecommunications and telecare service providers – who does what
• the consistency of approach

Among the actions suggested is the development by telecare service providers of contingency plans to be used if a telecare service user is switched to a digital telephone service and finds their telecare equipment no longer works, and the switchover process can’t be reversed.

Contingency planning could include telecare service providers having:

• global systems for mobile communications (GSM) devices in stock ready to deploy to impacted service users
• an agreement in place with a digitally enabled ARC to take over services for a short period

Communication

The communication workstream includes actions to improve awareness of the digital switchover, predominantly among telecare service users, and to ensure all telecare stakeholders are made aware of the digital switchover and support available to them. Priority actions focus on:

• standardising language
• communicating clearly
• increasing awareness of the implications of the digital switchover among telecare service users
• keeping users appropriately informed throughout their switchover

Action is progressing. In particular, telecommunications providers are working on the best ways of informing telecare users about their migration and prompting them to contact their telecare service provider about any changes to their telecommunications arrangements.

For instance, in Scotland, the Digital Office for Scottish Local Government has developed a range of materials entitled the Digital Telecare Playbook, including guidance leaflets and videos specifically aimed at service users and their families.

TEC Cymru (the national programme for technology-enabled care in Wales) is to launch a resource centre for telecare in Wales and has developed a pre-migration to digital support plan.

At a meeting in May 2022 led by DCMS on communication issues, it was agreed that TechUK would lead work to create a central repository for standardised communication guidance, and that they would discuss with the Digital Office for Scottish Local Government about using their existing documentation as the basis of a glossary of standard digital telecare terms.

Best practice and guidance on technical issues

The main focus of this workstream is on an authoritative and unbiased technical assessment of analogue equipment to understand which equipment will work reliably when connected to an all-digital network.

This recognises the reality that analogue equipment is likely to continue to be used for some time, given the:

• time and resources required to replace all existing equipment
• current challenges with digital telecare equipment availability due to global semiconductor shortages

This workstream is also concerned with linking to advice in section ‘2. The digital switchover : risks and opportunities for telecare stakeholders’ above on making sure telecare equipment will continue to function in the event of a power cut following the digital switchover, as well as general technical and operational guidance for telecare sector stakeholders.

Testing telecare equipment’s performance on all-digital networks

Following engagement with suppliers of telecare equipment, Openreach and other telephone network operators have made 5 testing laboratories available. Some telecare suppliers are now using these laboratories (see ‘Annex 5. Equipment testing centres in England’ below) or testing their equipment independently.

Although laboratory testing does not completely replicate the ‘real world’ end-to-end connection of analogue tone-based alarm call communication, they can be used to assess the likely reliability of specific telecare equipment. However, uptake of Openreach’s laboratory test offer has been slow and those suppliers who are testing their equipment are generally not making their test results available to telecare service providers.

Despite the telecommunications industry and Ofcom’s recommendation that all telecare devices should now be based on digital technology, telecare service providers may need to prioritise service users where equipment needs to be upgraded.

For this reason, the government would like to see much more testing of the reliability of analogue devices on digital networks and more transparent reporting of the results. Given the range of telecare equipment, signalling protocols and telecommunications providers, there are a huge number of potential test combinations and it is not the government’s intention that every manufacturer puts their equipment through each one. Rather, the aim is for a level of testing that provides sufficient evidence for the most commonly deployed combinations.

Having access to accurate and consistent test results will allow telecare service providers to prioritise their digital equipment roll-out, focusing on the telecare users and equipment with the highest risk.

There has been considerable work undertaken to support consistent testing and, in April 2022, the TSA convened a working group of network operators, telecommunications providers, and telecare service providers and suppliers to develop:

• a common test specification
• a standard test results template
• standard test environments
• a common level of oversight to conduct appropriate levels of analogue and digital telecare product-testing on digital networks from a variety of telecommunications providers

In addition, DHSC has commissioned the TSA to do some initial analysis of analogue and digital solutions across different ARC software platforms, using actual call data to identify and report on failed calls to evaluate failure rate by alarm manufacturer, and the type and age of alarm. The results should show more clearly the current experience of telecare service users and how different equipment operates. If seen as helpful, this information could be updated regularly as the switchover accelerates over the next couple of years.

A DHSC ministerial roundtable was held in September 2022 with representatives of telecare suppliers and service providers, which looked at sharing and making available the results of testing analogue telecare devices on digital telephone lines. As a result, the TSA and DHSC – with support from the LGA, Housing LIN, TEC Cymru, the Digital Office for Scottish Local Government, and Digital Health and Care Northern Ireland – have written to telecare service providers and device manufacturers to request the results of tests undertaken, and recent alarm call data history. This data will allow a better understanding of the reliability of analogue telecare devices working in the short term on digital telephone lines after being switched over. Initial data will be analysed and available by early February 2023.

The TSA is also currently consulting on suspending its Quality Standards Framework (QSF) accreditation for telecare service providers and telecare equipment suppliers that are not taking appropriate steps to mitigate the impact on telecare users of the digital switchover, until such time as they comply with TSA’s requirements. This could impact on meeting requirements for procurement exercises.

Under the TSA QSF, telecare service providers should:

• ensure that only hybrid alarms that communicate in both analogue and digital or use purely digital protocols should be procured
• work with their alarm monitoring company to monitor and analyse alarm failures with a view to replacement where the analysis identifies that these failures are excessive
• demonstrate that plans are in place to prepare for the analogue to digital migration by 2025

Under the TSA QSF, telecare equipment and solution suppliers should:

• where analogue alarm units are known to be still in service on digital telephone networks, demonstrate that these have been successfully tested against the TSA analogue to digital testing specification and the results openly published
• work with telecare service providers to monitor failure rates with analogue equipment and support a replacement programme
• ensure that digital alarms communicate using internet protocol (IP) TS 50134-9 TS50134-9: social alarm systems as the primary communication protocol. Alarms that use proprietary protocols must not be locked down to these protocols and must have the facility to switch to the European version of the protocol automatically if migrated to another platform that cannot communicate with the proprietary protocol
• ensure that only hybrid alarms that communicate in both analogue and digital or purely digital protocols shall be supplied. The TSA commissioner and buyer guidance provides detailed advice on this

Importantly, telecare equipment suppliers should only sell analogue-only devices in exceptional circumstances, such as for a property that does not have a mobile signal or a digital line.

It is also important that the longevity and call reliability of mobile network-connected telecare equipment are explained by suppliers to potential purchasers, with the 2G networks expected to be decommissioned by 2033 and some 3G networks being switched off as soon as 2023.

Telecare service providers should also consider carrying out real-world testing of new alarm units they purchase so they can resolve any issues or problems with the alarm supplier and the ARC software platform supplier prior to rolling out the service to users. This will enable them to manage the impact of the switchover within their services in a structured way.

Managing the move to digital is also important due to the global shortage of semiconductors that is creating delays for some suppliers in meeting orders for digital telecare equipment.

Service users may therefore need to be prioritised where equipment needs to be upgraded.

Telecare service providers will want to communicate their approach to service users and their families, friends and support networks.

To make sure their services continue to protect users in the event of a power cut, the issues telecare providers will want to consider include:

• reconfiguring the telecare alarm to ensure it sends a mains power failure alert to the ARC within 30 minutes – rather than the default factory setting, which is normally in the 2 hours after failure
• ensuring that an assessment of risk and operational process is completed to ensure an appropriate response is provided to a service user within defined timescales in the event of a mains power failure. This could include ensuring they are aware that their alarm is not functioning and that contingency arrangements are in place, such as the provision of a temporary GSM-connected pendant or alerting a family member of the person using the telecare equipment
• ensuring alarm call failures are regularly monitored to quickly identify issues

Technical guidance

The TSA and the Scottish Digital Office for Local Government have issued a number of publications on the digital switchover (see details in the ‘Useful resources’ box-out below).

The TSA commissioner and buyer guidance, for example, sets out the considerations for the digital switchover and includes a checklist to support planning by telecare service providers:

• linked to establishing a digital roadmap for that service
• to understand their current estate and assets
• to connect with peers to review different approaches by testing the market to ensure a supplier’s offer meets their requirements in both a technical and outcomes-driven manner

Also, when engaging with suppliers, telecare service providers will want to consider issues such as:

• how innovative and proven the solution they are being offered is
• how much they can spend, the likely lifespan of the solution and the expected timescales for deployment
• the known experience of services that have deployed similar solutions elsewhere
• the arrangements for transitioning the ARC solution they own or use from analogue to digital

Useful resources

Visit the campaigns section of the TSA website to access the following publications:

• technology-enabled care (TEC) stories across the community
• TEC stories across care homes
• TEC sector insight report (2020)
• commissioner and buyer guidance
• data and cyber security research for TEC

The Digital Office for Scottish Local Government has produced:

• the Digital Telecare Playbook
• a national briefing for Scotland on digital telecare
• case studies from across Scotland

Business case and strategy – transforming telecare services

Many telecare service providers see the digital switchover as an opportunity to review their service and how it is delivered. This can include:

• moves to more preventative and personalised services
• use of a wider range of technology and data
• closer integration with other areas of health and care

While the primary focus of the previous work streams is on the immediate need to ensure existing telecare services are reliable during the digital switchover, this workstream has a longer-term strategic focus on what’s next for local authority telecare services in an all-digital environment.

Some of the focus will also be relevant for telecare service providers who are not local authority-based.

Where next for digital local authority services?

Technology in social care services accelerated significantly during the coronavirus (COVID-19) pandemic, and there is the potential to develop innovative care tech services that further support:

• the monitoring of activities of daily living
• location tracking
• increased use of personalised, preventative and proactive services

This will make care more accessible and improve its quality, and this was identified in the white papers People at the Heart of Care: adult social care reform white paper and Health and social care integration: joining up care for people, places and populations.

Local authorities have been among the first to pioneer innovative digital solutions to protect the most vulnerable.

When technology is embedded seamlessly into care and support services, it can be transformative, supporting people to live happy and fulfilled lives in their homes and communities. This allows an individual’s own health and care data to provide greater insights into their health and care needs, and to support them to live independently for longer. The government’s work to improve connectivity, digital skills and cyber security across the adult social care sector will support the adoption of these technologies.

There are significant benefits to be gained from the ability to distil meaningful information from digital data, and use it to design more personalised services and achieve greater efficiency, better outcomes and closer integration between telecare and telehealth applications. The information generated can be used, subject to appropriate safeguards for using data, to create more preventative services, and make the most of local digital infrastructure and the potential of internet of things (IoT) and 5G technologies, among others.

Actions in this workstream are focused on developing the opportunities offered by the switchover. They include, for example, the LGA’s support for the transformation of local authority services through a Local Government Digital Switchover Working Group. This group has a primary focus on promoting telecare best practice, guidelines and case studies that showcase the opportunities of digital transformation.

The working group – a partnership of public sector organisations that is also attended by DCMS and DHSC – will develop support for local authorities to innovate and seek to improve their digital telecare services.

The LGA has developed a switchover self-assessment for commissioners so councils can consider transformation opportunities and manage risks effectively, and DHSC plans to support the production of further advice.

Typical planning stages for digital switchover transformation are listed at ‘Annex 6. Transformation planning stages’ below.

The work of the group will also help commissioners of telecare services to demonstrate potential outcomes so they can secure funding from local authorities and integrated care systems (ICSs). Much can be gained from:

• sharing learning on new initiatives
• making the most of savings generated from moving away from old-style provision
• using products that have been designed alongside service users

Partnership and collaborative working will be key in this respect across the public and commercial sectors. ICSs will help co-ordinate services across an area by forming partnerships between the organisations that meet health and care needs, and creating stronger integration.

Digital telecare systems with peripherals can also trigger pre-emptive interventions, delaying the need for and costs of care home provision, hospital admissions, ambulance call-outs and home care visits.

Along with potential savings, moving to digital telecare will incur new costs – an issue also covered in this workstream.

Digital telecare services and equipment will cost more than analogue versions. The additional costs come from the digital services and devices themselves, and the ongoing costs of digital connection, such as payments for SIM cards, maintenance and upgrades. While SIM costs may be new, the equipment cost should not all be new spend if it is assumed that historically a telecare alarm has been replaced every 5 or 7 years and these costs budgeted for.

More varied and accessible digitally connected services will also present new security challenges. Telecare service providers will need to consider cyber protection, data control and storage, and consent and transparency of information use about service users, all of which have associated costs.

Case study: Wirral Council

Some local authorities have already started to improve their connectivity infrastructure and transform their telecare services, making the most of the opportunities available to them.

An innovative new programme by Wirral Council will see a significant investment to transform telecare service for thousands of their residents over the next few years.

Currently, more than 3,500 Wirral residents are assessed as eligible for the borough’s telecare offer. The new scheme will see Wirral Council introduce a next-generation telecare service, shifting the focus from reacting to events (such as falls, early signs of infection or increased frailty) to preventing or minimising their impact. The project will be delivered in partnership with Wirral Council’s commissioned community equipment and telecare service provider, Medequip, using some of the latest technology available.

Wirral Council is one of the first local authorities to transfer residents from analogue telecare systems to new next-generation services at this scale. The digital system will create opportunities for early preventative interventions and reduce hospital admissions. New devices that can detect signs of health deterioration – such as presence and movement sensors – have already begun to be introduced with very positive initial results.

Contact [email protected] for more information.

4. Action tracker

This action tracker is based on the support identified as required by the FarrPoint study report. It outlines initial action that has already been taken or will be taken forward, and this will be added to as other work is undertaken.

Updates will be provided on a quarterly basis with the first update to be based on progress by the end of March 2023.

Co-ordination

This section outlines actions by government and organisations that will benefit the telecare sector, with some actions also supporting telecommunications providers.

FarrPoint report action requirement 1

Provide a single point of contact that represents telecare services in England.

This could be a new approach or one that builds on existing arrangements.

Status

Ongoing.

The DHSC to provide high-level co-ordination of the workstreams delivering the support identified in this action tracker.

The TSA provides a common point of contact for many industry stakeholders from commissioners to service providers, manufacturers and ARCs. Access to resources is not TSA membership dependent and can be accessed via telephone or email.

FarrPoint report action requirement 2

Provide a link between telecare and telecommunications providers to:

• highlight and resolve common issues relating to telecare services because of the digital switchover
• improve and monitor telecommunications providers’ processes for identifying and upgrading telecare users’ telephone lines
• ensure that the process for flagging telecare users as vulnerable customers is understood and is implemented
• allow plans for the migration of service users to be communicated

Status

To be completed by the end of March 2023.

The TSA – with DHSC support – is piloting a digital switchover helpdesk to provide additional help. Stakeholders can contact the helpdesk via 01625 520 320 or [email protected].

The DHSC is going to consider how it could support a helpdesk to be provided for the switchover period.

The DHSC has commissioned the TSA to collate ARC telephone numbers, which the OTA2 has distributed among telecommunications providers to allow them to identify telecare users prior to their switchover. BT, Virgin Media O2 and other telecommunications providers are currently using this data.

BT is establishing if and how telecare service providers could share details of users’ telephone numbers with telecommunications providers to help the latter identify those who are their customers. However, there are potential data protection and commercial confidentiality issues that would need to be addressed.

The DHSC has commissioned UKTelehealthcare and TEC Advisory to produce a range of information sheets targeted at different stakeholders to prevent unwanted telecare alarm disconnections during switchovers. This work is linked to the development of good practice for the on-the-day switchover process.

OTA2 has set up a working group of telecommunications and telecare service providers to identify best practice that puts the telecare user at the centre of the on-the-day switchover process. This aims to minimise, as far as possible, the need for a customer to be actively involved in checking the compatibility of their telecare equipment or arranging third parties being on-site with the telecommunications engineer.

The best practice aims to identify how to:

• migrate a telecare user’s analogue line to digital
• improve the digital voice connection over the new line
• reconnect the required number of handsets
• reconnect any telecare equipment
• facilitate a test of the telecare equipment
• react in the event of an issue with the telecare equipment

The TSA has established a special interest group with representation from telecare stakeholders and major telecommunications providers. This will continue and act as a forum to discuss and consider issues, and oversee the actions assigned to these stakeholders in this action plan.

FarrPoint report action requirement 3

Facilitate a multi-agency approach and collaboration with other areas of government or other public bodies.

The task would require existing and potential new collaboration and good practice to be identified or developed and shared with telecare stakeholders. For example, health and care integration, or potentially linking with fire services to identify vulnerable people and install smoke detectors.

Status

To be completed by the end of June 2023.

The DHSC will scope and define this work.

The TSA already has existing links to the National Fire Chiefs’ Council and Association of Ambulance Chief Executives, and are working with all emergency services stakeholder groups to develop operational guidance for interaction between ARCs and emergency services.

FarrPoint report action requirement 4

Link to the other programmes of work that are looking to address the digital switchover more widely.

Examples include the existing DCMS and LGA digital switchover programmes, and the work completed by some housing providers to identify systems (other than telecare) that are impacted by the digital switchover – for example, retrofitting their stock, digital inclusion in their new housing to Technology for our Ageing Population: Panel for Innovation (TAPPI) design principles, and digital application in construction, manufacturing processes and building management systems, including energy performance.

Status

Ongoing.

The TSA and Housing LIN are collaborating on the production of the TAPPI principles to develop a benchmark for design and architecture of technology within new housing stock. TAPPI will be co-produced with users of services, tested out and independently evaluated across 4 localities and different housing settings in the UK with the resultant findings due by 2024.

The Housing LIN also has a range of existing documentation and guidance on smart housing and technology.

FarrPoint report action requirement 5

Liaise with telecare service providers to understand progress and plans for the digital switchover, and to use this to provide an updated national picture.

The update frequency for the national picture will be determined by the pace of the response to the digital switchover – however, we anticipate that, given the 2025 deadline, at the minimum an annual update is required, but ideally quarterly updates.

Status

Ongoing.

Information on telecare providers’ digital switchover progress will be co-ordinated by the DHSC and be collated from a range of sources.

The TSA is planning a member survey requesting updates on digital switchover progress to get an update on the total number of UK connections, and the number that are analogue and digital. This follows a similar study completed in 2021.

The TSA is working with Housing LIN within the TAPPI programme to support a survey across their housing providers’ community of practice.

The LGA have recently undertaken a survey to understand awareness of and readiness for the switchover among local authorities.

FarrPoint report action requirement 6

Highlight funding opportunities available to telecare service providers and, potentially, suppliers.

Status

Ongoing.

The DHSC will work with the LGA to develop plans to support good practice in telecare and highlight funding opportunities.

Organisations are requested to communicate funding opportunities to the DHSC for wider sharing with stakeholders.

FarrPoint report action requirement 7

Agree consistent terminology for telecare and the digital switchover that is then used by all stakeholders.

Status

To be completed by the end of March 2023.

TechUK will lead work to create a central repository for standardised terminology, communications and guidance.

The TSA published a glossary of terms in November 2021. The glossary is part of the analogue to digital commissioner and buyer guidance.

FarrPoint report action requirement 8

Increase awareness of the digital switchover among telecare service users and the public.

Status

Initial work by the end of March 2023.

DCMS, with the support of Ofcom if appropriate, will co-ordinate telecommunications providers sharing outlines of their current plans for engaging with vulnerable customers, especially telecare users, where possible. This could help clarify where standard language and other good practices could be adopted to improve understanding among telecare users.

Linked to work under action 2, the DHSC has commissioned UKTelehealthcare to produce a range of information sheets targeted at different stakeholders to prevent unwanted telecare alarm disconnections during switchovers. This includes an element of awareness raising.

The LGA Local Government Digital Switchover Working Group will consider communication issues as a priority as part of its work programme.

The Digital Office for Scottish Local Government has developed a range of Digital Telecare Playbook materials, including guidance leaflets and videos specifically aimed at service users and their families.

The TSA, in collaboration with Delta Wellbeing, has produced a customer awareness letter template for service providers to use to communicate information about the digital switchover to people who use telecare services.

FarrPoint report action requirement 9

Identify telecare service providers and contacts.

This will provide a more complete list of telecare providers in England, allowing a more comprehensive baseline of readiness for the digital switchover to be produced, and offer a route for providing advice and support to all telecare service providers.

Status

To be completed by the end of January 2023.

The TSA holds the most comprehensive list of telecare service providers and contacts. A publicly available directory provides contact information for all telecare service providers that are TSA members. This covers the whole of the UK.

The LGA is increasing awareness of the switchover among telecare providers and identifying up-to-date contacts among its local authority members.

FarrPoint report action requirement 10

Provide a glossary of digital telecare terms.

Status

To be completed by the end of January 2023.

Tech UK will discuss with the Digital Office for Scottish Local Government whether their existing documentation can be used as a basis for creating a more comprehensive glossary of digital telecare terms.

The TSA has an existing glossary of terms – see action 7.

On a more technical basis, the UK and EU standard TS 50134-9: social alarm systems IP communications protocol contains a glossary of digital telecare-related technical terms.

Good practice and guidance on technical issues

This section is focused on supporting telecare equipment suppliers, ARCs and telecare service providers.

FarrPoint report action requirement 11

Provide authoritative and unbiased technical and operational guidance.

Examples of required guidance are as follows:

1. Whether analogue adaptors are an appropriate long-term solution for telecare services.
2. Whether it is appropriate to continue purchasing or installing analogue alarm devices.
3. Describing the risks associated with not adapting telecare services to the digital switchover, including guidance for senior management.
4. Providing risk assessment tools to allow telecare service providers to understand and quantify the risks associated with the options available.
5. Providing advice on contingency planning or risk mitigation for telecare service providers that are unable to complete the switchover prior to 2025.
6. The operational impact of digital telecare services, including the impact on call volumes, and how providers should monitor and respond to the additional information on system health provided by digital solutions.
7. Details of the common challenges faced during the switchover to digital and how to evaluate or address them.
8. Cyber security and data protection advice.
9. Procurement or commissioning advice and templates.
10. Digital telecare readiness assessment tools.
11. A ‘fact checking’ service allowing providers to validate information offered to them.
12. Training materials for staff.

Status

Ongoing but with an update by the end of March 2023.

A lot of the initial documentation and guidance across a variety of technical topics has been produced by the TSA.

The analogue to digital commissioner and buyer guidance addresses the following issues:

• the continued purchase of new analogue-only technology (2)
• risk matrices associated with the switchover (3, 4)
• lessons learned from the digital switchover, including how to mitigate failure rates and best practice procurement (6, 7)
• the TSA’s initial testing results on the continued use of analogue over digital reference the fact that all the routers tested have an in-built analogue telephone adapter (1)
• cyber security guidance (8)
• fact-checking digital surgeries on a quarterly basis – available to TSA service provider and commissioner members but slides are publicly available through TSA Virtual Surgeries (11)
• digital switchover training provided by the TSA Academy (12)

See also section ‘3. The stakeholder action plan: people who use telecare services take priority’ above for more examples of existing guidelines.

The DHSC has commissioned the TSA to analyse analogue and digital solutions across different ARC software platforms, using alarm failure data against equipment type to evaluate failure rate by manufacturer, type and age of alarm. This will help provide clearer evidence on how equipment will work going forward. Updates could take place on a regular basis as the switchover accelerates over the next couple of years.

The TSA will collect test results from telecare suppliers and service providers, and publish data on the reliability of analogue telecare devices when operating over a digital telephone line to help telecare service providers develop upgrade plans.

The TSA has established a QSF to accredit manufacturers and telecare service providers in the provision of telecare services. QSF certification is available to all organisations within the TEC sector, regardless of TSA membership. There are several analogue to digital-related additions to the QSF that are currently going through a consultation stage. If adopted, the impact of failure to comply would result in suspension from the QSF.

The LGA is supporting the transformation of local authority services through a Local Government Digital Switchover Working Group (3, 4, 5, 9 and 10). This includes the development of a switch-over self-assessment toolkit for commissioners of telecare services – see action 16.

FarrPoint report action requirement 12

Support development of definitions and standards for telecare. Examples include:

• definition of a reliable telecare connection, how this should be tested and the evidence that should be provided to customers
• standards to improve interoperability between telecare devices or systems, including peripherals and device management platforms
• data standards to improve system interoperability, including with other health and social care systems, and to promote better use of telecare data

Status

To be completed by the end of June 2023.

The TSA is aiming to have further discussions with telecare equipment manufacturers about developing an interoperable peripheral protocol to allow peripherals from different manufacturers to work across multiple alarms.

The TSA has developed application guidance for TS 50134-9 digital-dispersed alarms (to support the technical integration of multiple dispersed digital devices with digital ARC platforms).

The TSA is to develop application guidance for BS 8521-2 scheme equipment (to support the technical integration of multiple digital scheme-based equipment with digital ARC platforms) equipment.

DHSC has work underway to develop data and reporting standards in social care, beginning with a process to consolidate existing social care terminology standards by March 2023.

FarrPoint report action requirement 13

Use a collective voice to influence telecare suppliers to resolve issues telecare service providers are experiencing, including:

• maturity of the market and digital processes
• solutions and equipment not operating as advertised
• interoperability issues
• supplier lock-in
• cost
• equipment availability and lead-in times

Status

Ongoing.

The TSA leads a series of special interest groups with contributions from TEC commissioners, suppliers and service providers, reporting into a Quality Improvement Programme Board, with representation from TEC Cymru and the Digital Office for Scottish Local Government. Alongside the interoperability and resilience elements, there are also active special interest groups, including on proactive and preventative services, emergency services, infection control, and TEC sector risk management.

The TSA special interest group on the digital switchover will be expanded and, with DHSC support, will react to issues and oversee the actions in this action plan.

The TSA holds digital surgeries on a quarterly basis for TSA service provider and commissioner members, and slides are publicly available through TSA Virtual Surgeries.

The TSA also holds analogue to digital-focused webinars that are publicly available and allow all attendees to pose questions. These webinars are recorded.

FarrPoint report action requirement 14

Identify and share good practice. Stakeholder interviews completed for the FarrPoint study highlighted some initial good practice that can be used to support this activity.

Status

To be completed by the end of March 2023.

The LGA is supporting the transformation of local authority services through a Local Government Digital Switchover Working Group with a key focus on telecare good practice, guidance and case studies that showcase the opportunities of digital transformation. The working group will consider its priorities in this area.

Business case and strategy – transforming telecare services

This section supports local authority telecare service providers to transform their services.

FarrPoint report action requirement 15

Emphasise the opportunities associated with the digital switchover.

Status

Ongoing.

The LGA is supporting the transformation of local authority services through a Local Government Digital Switchover Working Group with a key focus on telecare good practice, guidance and case studies that showcase the opportunities of digital transformation. The working group will consider its priorities in this area.

FarrPoint report action requirement 16

Develop business case templates for the move to digital telecare.

Templates are required for a like-for-like transition to digital and for a wider service transformation, with both ensuring that the impact telecare has – or could have – on reducing pressure on other elements of health and care are considered and quantified.

These business cases will assist telecare service providers in securing funding internally or from integration partners.

Status

To be completed by the end of March 2023.

The LGA has developed a switchover self-assessment toolkit for commissioners so councils can effectively manage risk and consider transformation opportunities. This is aligned around case studies, good practice, programme plans, commissioner advice, communication plans and business cases.

Consideration will be given to what future materials can be produced with DHSC support.

FarrPoint report action requirement 17

Promote service transformation and develop strategy.

Stakeholders highlighted the need for a champion for service transformation to:

• demonstrate the benefits of transforming telecare services, including a move towards proactive, preventative and personalised care
• demonstrate how wider use of technology – including consumer technology – can improve telecare services
• demonstrate how better use of data can improve telecare services
• promote closer working between telecare and other areas of health and social care
• collect, collate and quantify the benefits that service transformation offers to service users, service providers, the wider health and care system, and society

Status

To be completed by the end of June 2023.

The DHSC is going to address this in its policy role for health and social care digital integration.

The LGA is supporting the transformation of local authority services through a Local Government Digital Switchover Working Group with a key focus on telecare good practice guidance and case studies that showcase the opportunities of digital transformation. The working group will consider its priorities in this area.

The Digital Office for Scottish Local Government is developing a resource on the benefits and socioeconomic impact of telecare.

FarrPoint report action requirement 18

Provide cost models to support providers planning the move to digital, including wider service transformation.

Status

To be completed by the end of June 2023.

The LGA is supporting the transformation of local authority services through a Local Government Digital Switchover Working Group with a key focus on telecare good practice, guidance and case studies that showcase the opportunities of digital transformation. The LGA, with DHSC, will consider approaches in this area.

FarrPoint report action requirement 19

Promote telecare more broadly.

Telecare service providers highlighted that the profile of telecare services can be relatively low, meaning that potential service users and other health and care professionals are not aware of the benefits that services can offer.

Status

To be completed by the end of June 2023.

The DHSC is going to address this in its policy role for health and social care digital integration.

Annexes

Annex 1. Background to the digital switchover

The PSTN is a privately owned copper wire-based telecommunications network delivering telephony services and the decision to upgrade it has been taken by the telecommunications industry.

Fixed-line operators such as BT and Virgin Media O2 will replace analogue telephone services with voice over internet protocol (VoIP) technology, which carries voice calls as data using internet protocols and technology over a broadband connection.

The analogue phone network is fast approaching its end of life. It is decades old and the ageing infrastructure will soon no longer be able to be maintained easily. The upgrade will be delivered by fixed-line telecommunications operators with a PTSN in a phased approach over the next 3 years.

Openreach provides the wholesale services that support the provision of BT’s PSTN and the traditional telephony services of many other telephone providers. It plans to have completely stopped selling new provisions of these wholesale connections by September 2023 and entirely withdraw those traditional services by December 2025. Virgin Media O2 is following a broadly similar timescale for its network.

In parallel, telecommunications providers (of which there are around 600) are upgrading their broadband services to fibre to the premises (FTTP), an unbroken fibre connection from an exchange directly to a property. Only digital telephone services can be delivered over FTTP. Therefore, other providers of telephone services that may not be affected by the PSTN switch-off are progressively migrating customers to FTTP, as it becomes increasingly available, and will at the same time migrate customers to digital.

The migration to digital telephone services has already started and will happen at different times for telephone customers depending on their providers and their own situation – for instance, BT has said it will not migrate some categories of vulnerable customers until later in its migration programme.

Annex 2. Telecare services

Telecare is the use of technology to enable people to live independently where they otherwise might not be able to do so.

Telecare equipment is bought directly from suppliers – either by the customer or by a telecare service provider, such as a local authority or a housing association – and installed in a person’s home or specialist accommodation.

While much of this technology comprises a simple alarm system, installations increasingly include a wider range of remote monitoring technology such as temperature, fall or flood detectors.

All sensors or monitors are connected to an alarm device, either wirelessly or wired in group schemes (such as in sheltered housing). The alarm device is connected to the phone network, most often using a connection to an analogue telephone line, but mobile telephone networks can also be used. When an alert is sent to an ARC, this triggers a response from the ARC or emergency services.

Telecare services can often include other support for service users, including location tracking, preventative services and telehealth applications.

How analogue telecare alarm calls currently connect to ARCs

Traditional analogue alarm devices rely on sending and receiving audible tones (similar sounds to the ones heard when pressing numbers on a telephone keypad) to communicate with an ARC.

When an alert is triggered, the alarm device in the person’s home makes a telephone call to the ARC.

When the call connects, the alarm device and the ARC exchange tone-based messages – this tells the ARC system which alarm device is making the connection and how the alert was triggered. Once the message has been correctly received by the ARC, the call can be passed to a call handler and a voice connection is made to the individual raising the alarm.

Typically, the process of establishing the connection between the alarm device and ARC will take about 40 to 50 seconds. If there is any disruption to the message tones – meaning the ARC cannot correctly interpret them – the alarm device will disconnect and try to connect again. It is not unusual for this process to occur 2 or 3 times before an alarm correctly connects. ARC solutions can monitor and report on the number of failed connection attempts.

The equipment will continue to operate in the event of a mains power failure. The telephone analogue phone line in the home receives its power from the telephone exchange and the alarm device contains an internal battery that allows the device to operate if its mains power connection fails – often for a period of up to 1 to 2 days.

Annex 3. Telecare service providers in England

Telecare services are provided by a range of organisations in England including:

• local authorities – at metropolitan, unitary, county, district or borough levels, where responsibility can sit with social care, housing or customer service teams
• housing providers – that cover a range of housing types, including sheltered or retirement housing, assisted living or extra care housing, and supported housing facilities
• health services – where NHS trusts can offer or support telecare services, often to assist with timely discharge. Going forward, this will include ICSs involving collaborations between health, local government and adult social care
• the third sector – with voluntary sector organisations offering or promoting telecare services
• commercial providers – that offer telecare services on a privately funded basis

In England, telecare service providers can use a range of approaches for delivering services, including in-house provision, a commissioned service or by partnering with another organisation.

ARCs are a mix of commissioned commercial services or those provided by local authorities, and they will also have to plan for how they will upgrade for the digital switchover.

Annex 4. Telecare service stakeholders, interest groups and government bodies

During the switchover, DCMS is working with the communications regulator Ofcom to mitigate the impact on vulnerable customers, and is aligning with work in this action plan as appropriate.

This action plan is primarily for organisations in England. However, the digital switchover is UK wide, and changes to processes led by the telecommunications sector will have implications for Scotland, Wales and Northern Ireland. The Digital Office for Scottish Local Government, TEC Cymru and Digital Health and Care Northern Ireland are therefore among organisations linking into actions.

The TSA has a special interest group focusing on the digital switchover. The group will be expanded and, alongside DHSC, will act as a forum to discuss and consider issues in the action plan.

The LGA is supporting the transformation of local authority services through a Local Government Digital Switchover Working Group with a key focus on telecare good practice, guidance and case studies that showcase the opportunities of digital transformation.

Ofcom, as the independent regulator for telecommunications, has a statutory duty to further and protect the interest of consumers, and this includes ensuring that those who are elderly or vulnerable are not discriminated against.

Ofcom has asked telecommunications providers to take steps to identify at-risk customers and engage in effective communication with them. Ofcom issued a policy positioning statement in 2019 setting out its expectations of how telecommunications providers should support and protect customers, particularly those who are vulnerable. Expectations of telecommunications providers include:

• clear and timely notice of service changes
• clear information about the potential impact on equipment that uses the PSTN, such as telecare alarms
• assessment of customers’ needs, offering extra help if needed

Ofcom has set General Conditions of Entitlement that include an obligation (General Condition C5.2) on telecommunications providers to establish, publish and comply with clear and effective policies and procedures for the fair and appropriate treatment of vulnerable customers. Ofcom has also published a guide to treating vulnerable customers fairly, and giving them the help, support and services they need.

Other organisations involved in taking forward actions in this action plan include Openreach, the Digital Office for Scottish Local Government, Tech UK, UKTelehealthcare, OTA2 and BT.

Annex 5. Equipment testing centres in England

There are currently 5 standard test laboratories that have been provided by various network operators and telecommunications providers to test the compatibility of equipment and services with digital telephone lines as outlined below.

Openreach

Networks available: BT Consumer, BT Enterprise, Sky, Talk Talk, Vodafone, Zen

Learn more about the Openreach Digital Services Test Lab.

To book, complete the Openreach Digital Services Test Lab enquiry form.

Address:

Kelvin House
123 Judd Street
London
WC1H 9NP

Virgin Media

Learn more about IP Voice Lab.

To book, email [email protected]

Address:

Building 300
Wharfedale Road
Winnersh Triangle
Wokingham
RG41 5TZ

BT

Networks available: BT Consumer, BT Enterprise

Learn more about BT’s special services.

To book, email [email protected].

Address:

BT Labs
Barrack Square
Martlesham Heath
Martlesham
Ipswich
IP5 3RE

KCOM

To book, email [email protected].

Address:

KCOM
37 Carr Lane
Hull
HU1 3RE

Talk Talk

To book, complete the TalkTalk Test Lab booking form.

Address:

Talk Talk
Brinell House
Brinell Drive
Irlam
Manchester
M44 5BL

Annex 6. Transformation planning stages

Telecare service providers or commissioners may find it helpful to consider the following key stages when planning and completing the switchover to digital.

Some of the suggested materials have already been provided as part of the LGA-developed switchover self-assessment toolkit for commissioners. It is planned to identify and publicise further resources.

Planning

• business case template
• risk template
• option appraisal template
• outline cost modelling
• best practice examples

Procurement and implementation

• data protection template
• technical guides
• market information
• gathering and sharing technical issues and solutions

Operationalisation

• details of the impact of digital on telecare services processes
• device management platforms monitoring and good practice
• technology service management good practice
• staff training materials

Transformation

• business case for widening service scope and/or eligibility
• economic benefit models for current and future services
• integration benefits

Risk mitigation

• details of short-term risk mitigation options
• sharing known issues and risks
• details of the digital switch roll-out including timescales and processes
• template for service user communication

Annex 7. FarrPoint study

What is now DHSC’s joint digital policy unit in NHS England’s Transformation Directorate (but was at the time NHSX) commissioned the technology consultancy FarrPoint, in the autumn of 2021, to conduct a study into the readiness of telecare services for the digital switchover – The Digital Shift and its Impact on the Telecare Sector in England.

The study found that there was a high level of awareness of the digital switchover among the telecare sector, but low levels of awareness among telecare service users.

Low levels of engagement with individuals by telecare service and telecommunications providers was also highlighted.

The study report forms the basis of the actions that stakeholders are taking forward in this action plan to deliver support to:

• identify and safeguard vulnerable service users, and mitigate risks to them when they are switched over
• follow good practice for a more consistent approach across telecommunications providers to switching over telecare users
• assess what equipment will work after switchover, taking into account differing digital levels of technology resilience
• assist telecare service providers with the transition to digital so that they can take up the opportunities digital technology offers to improve and transform telecare services