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The development of telecare services in the UK has been supported by grants from the respective governments of Scotland and Wales, and by the Department of Health in England. New services are being established, sometimes to operate alongside existing community equipment services and community alarm services. Elsewhere they are embracing a wider range of services including rehabilitation, intermediate care and health services designed to reduce use of unscheduled care services. This paper discusses the difficulties in understanding the scope of telecare services, and the definitions of services that will need to be confirmed if service users are to be able to choose appropriately if offered direct payments. Two service models are offered, one of which uses telehealth as an umbrella term to cover all telecare, e‐care and m‐care, and telemedicine, where the former includes all such services offered in the service user's home, including those of a medical nature. The second model views telecare alongside assistive technologies and telemedicine as one of three technology groups designed to make people more independent, or to bring care closer to home. There is significant overlap between the three groups, which justifies the introduction of a new term ‐ ARTS (assistive and remote technology services) ‐ to describe this area of support.

The development of telecare services across the UK has been supported by grants from the respective governments of Scotland and Wales, and by the DH in England. New services are being established to sometimes operate alongside existing community equipment services and community alarm services. Elsewhere they are embracing a wider range of services including rehabilitation, intermediate care and health services designed to reduce the use of unscheduled care services. This paper discusses the difficulties in understanding the scope of telecare services, and the definitions of services that will need to be confirmed so that service users can choose appropriately if offered direct payments. Two different service models are offered, one of which uses telehealth as an umbrella term to cover all telecare, e‐care and m‐care, and telemedicine where the former includes all such services offered in the service user's home, including those of a medical nature. The second model views telecare alongside assistive technologies and telemedicine as one of three different technology groups designed to make people more independent or to bring care closer to home. There is significant overlap between the three groups, which justifies the introduction of a new term ‐ ARTS (assistive and remote technology services) ‐ to describe this area of support.

Telecare is a new form of assistive technology that has the potential to offer benefits to a wide range of stakeholders including the service user, informal carers and formal care services. It is a complex intervention, combining selected items of technology and telecommunications equipment in combination with conventional community services in order to support independent living. An overview of a robust evaluation framework is presented that will enable services to be compared from several viewpoints. It also offers a means of considering individual service elements and their integration into an effective service delivering cost benefits to the health and social care economies as well as improved quality of life to service users.

The use of telecare with appropriate domiciliary care packages may provide the means to manage many of the risks associated with the increasing number of older people who wish to continue to live independently in their own homes. Those who become especially frail or disabled can retain their independence and quality of life if their homes are made ‘smart’. This paper discusses the range of services that are available, or under development, for the prototype ‘MIDAS’ (Modular Intelligent Domiciliary Alarm System) telecare system, which enable traditional community alarm, telecare and assistive technologies to be used in an integrated and intelligent fashion. A range of services that allow autonomous operation within the home (and hence increase the perceived independence of a client by decreasing the reliance on a response centre operator) known as ‘HAMISH’ may be used. It offers a wider range of cost‐effective services of relevance to both the individual, and to society, in different types of home environment including dispersed housing and new sheltered housing schemes.

The rapid evolution of the social alarm network in the UK during the 1980s is one of the greatest success stories of the local authority housing departments which championed their growth. Yet, during the past decade, when ‘care in the community’ became a reality and the number of older people living alone in society increased significantly, the number of connections has often grown slowly and investment in new technology has been relatively low. This article describes the features of new generations of ‘telecare’ using systems with increasing potential.

Most local authorities now offer a telecare service to people who are eligible for community services under Fair Access to Care Services (FACS). Others also offer telecare in a prevention mode to people with lower levels of risk alongside traditional social (or community) alarm systems. A survey of local authorities, mainly members of the Centre for Usable Home Technologies (CUHTec), was performed to gauge the service provision options available and the charging strategies that have been adopted. Results from 39 authorities across the UK indicate significant differences between English shire counties and the unitary authorities elsewhere in the country in terms of eligibility and provision. The majority of authorities have yet to confirm a charging policy, using the principle of ‘pilot project’ to delay a decision until their Preventative Technology Grant (PTG) or telecare grants have run out. Some authorities with more mature services have chosen to make telecare free to particular groups on the grounds that they will reduce costs elsewhere in the health and/or social care economy. Most are introducing charges in the range of £5 to £10 per week indicating a generous subsidy from the council.

There is a significant body of evidence from small‐scale trials and pilot studies that show telecare services can be cost‐effective as well as popular with service users and their carers. However, the results of serious external audits and evaluations suggest that many services are inefficient and that telecare technology prescriptions are not always optimised. This appears to be the case especially when referral numbers are small and when many staff are asked to match technology to identified risk. The emerging best practice is for much greater emphasis on making professional staff and members of the public aware of the potential of the technology, and then using a small, highly‐trained and experienced team to ensure that telecare solutions are person‐centred and tailored to the individual's needs. A major gap in training for these teams has been identified.

Hospices offer people a place to die with dignity, but their numbers are so limited that most people die in hospital or in a care home. This paper describes the development of a telehospice toolbox which it is believed will help to replicate hospice care in the homes of people in the community, thus enabling many more people to be supported in the way that they want at the end of their lives. The toolbox contains a number of different technology items that can be selected on a per‐patient basis to allow a dying patient and their family the best quality of life during their most stressful experience.

Many telecare services will in the future rely on service users to subsidise their existence through a charging policy. This will reduce the level of uptake, and hence the economic efficiency, unless services are shown to offer value for money. As part of a wide audit and evaluation of telecare provision in Gwynedd, service users were asked both about the value of the service to them and to their families. The responses showed that the service was perceived to be valuable to the vast majority of services users, but even more so to their families. Most thought that telecare played a valuable role in helping them to maintain their independence. When asked about the financial value of the service, more than half felt that it was worth £4.50 per week or more without a dedicated response team. The majority would not wish to pay extra for a response team.