A Lack of Expertise
Both focus group participants and experts recognised the lack of expertise and knowledge regarding the range of telehealthcare devices. Even for those working in the sector it was seen as confusing, preventing expertise from developing because of fragmented services and variation in practice. For example, home-care workers were identified as knowledgeable on the needs of their clients, but lacking knowledge of devices. Training provision for such groups was a complicated issue as Local Authorities frequently contract out care provision. Thus uniformity of training across numerous private care providers was problematic. In addition, it was recognised that home care workers have “very limited time, limited resources, a high staff turnover, how do you make sure everyone’s up to speed?” (Interviewee 010).
Training was discussed by the expert sample, where it was seen as a major barrier to device uptake. Unless receiving training, health and care professionals are reliant on gaining experiential knowledge through practice. Those involved day-to-day in assessment and the prescribing of devices will develop knowledge and confidence in the products and what will meet specific needs. Without this, “they'll lose confidence and they never then go on to prescribe telecare” (Interviewee 017).
The focus group participants called for independent experts to be able to advise them, whether telehealthcare specialists, occupational therapists, social services or community nurses with sufficient expertise in the field. Many had experienced the “red tape” of navigating social services and difficulties in “finding the right person who’s going to have the knowledge” (Oxfordshire focus group participant). To this end, they recognised that there were often high street “mobility centres” providing larger assistive technology items and called for similar places to try out telehealthcare devices, offering somewhere for them to view the devices in person. This lack of independent shops to explore and test devices was also acknowledged by the expert sample, but they noted some health centres and public spaces were being used for the purpose. The expert participants called for independent web-based reviews of products. Internet forums featuring product reviews were seen as a valuable mechanism for sharing what “equipment has meant” to an individual as no one size fits all (Interviewee 012). The need for an “honest broker” that could “give people an independent source of information on the whole market” regarding “all the products that are out there” was viewed as vital (Interviewee 017). Some Internet resources were identified, however the current lack of comprehensive and freely available material accessible by both end-users and professionals was recognised. One expert identified Telehealthcare specialists as a means of addressing the lack of expertise in the area, calling for their widespread introduction to comprehensively advise clinicians within CCGs. Such specialists, once in place, could bridge the gap between clinicians and suppliers, as at present most clinicians will not agree to meet a supplier/manufacturer if approached. Furthermore, the experts also identified the need for specialists to advise commissioners in this field, particularly between the variations in services offered (Interviewees 014 and 024).