DIALOGUE: Digital care technologies for social connection, care and support of older adults.  Final Project Report.

Aims and objectives

The original aim of the DIALOGUE project was to generate timely and appropriate data about current TECS provisions to co-produce an application to the NIHR HTA Social Care Technologies Call 2024, which will select and evaluate novel digital care technologies with the potential to form an effective, sustainable part of social care for older adults with assisted living needs living in the community. To fulfil these aims, DIALOGUE has the following objectives.

O1. Identify novel digital care technologies for community-dwelling older adults with assisted living needs that have the greatest potential for inclusion in full application.

O2. Synthesize current evidence for novel digital care technologies and, using this evidence, co-produce a set of outcome measures appropriate for social care research.

O3. Co-create with older people using digital care services and social care providers an embedded, mixed-methods evaluation methodology, comprising an outcome realization toolkit and an economic assessment appropriate to social care interventions and other primary outcome measures, which can be used to assess the effectiveness of the identified novel digital care technologies in social care.

O4. Co-produce a high-quality, fundable application for the NIHR HTA Social Care Technologies Assessment Call 2024.

Methods

Employing co-production activities and working to bring together academic experts, local authority stakeholders, and older people with lived experience of using social care as equal partners, DIALOGUE worked to identify priorities for future research and delivery of TECS within social care. The project worked in two local authorities, Middlesbrough and Oxfordshire councils, and one Integrated Care Board (ICB): Bristol, North Somerset, and South Gloucestershire (BNSSG) ICB, to bring together stakeholders with an interest in the delivery and implementation of TECS for older people with assisted living needs. Further details of the local authority/ICB partners and their associated TECS services are provided below. TECS, which provided the focus for this project and informed project outcomes, were Post Hospital Discharge and Reablement Services (PHDRS). It became clear that PHDRS were a major priority for service delivery and ongoing service development, and these services quickly became a focus for the project and its associated activities. While having the same overall goal, the projects used a diverse range of technologies, delivered via different service configurations and goals, and involved different stakeholders and partners in their delivery, including the private sector.

Middlesbrough Council Hospital to Home service operates a "Discharge to Assess, Home First" approach, which emphasizes discharging patients to home as soon as they are clinically ready. Hospital Prevention liaison officers located in hospital teams facilitate discharge, while community prevention liaison officers provide post-discharge support. Technology is provided via holistic needs assessment, referring clients to prevention and reablement services, including telecare services. Service users were reviewed at 12 weeks and six months. The deployed technologies include” Just Checking’ monitoring systems, GPS trackers, and fall detectors. Plans include integrated smart care solutions using household smart devices (e.g., Amazon Alexa speakers).

Innovate Oxfordshire (Oxfordshire County Council) Home First service is a ‘discharge to assess service’ where clients are initially assessed by a Home First Multi-disciplinary team, before receiving reablement services provided by four private strategic providers. The service is provided within 72 hours of hospital discharge and then installed for six weeks before referral to long-term care if needed. Services have a range of options for assistive technology, including telecare systems, sensors, and monitoring technologies.

Bristol, North Somerset, and South Gloucestershire Integrated Care Board. BNSSG ICB supports a regionally integrated system in three LAs (North Somerset Council, South Gloucestershire Council, Bristol City Council), alongside seven NHS Trusts and a private care provider (Sirona Health and Care; henceforth Sirona). The ICB is piloting a service delivered by Sirona to centralize support for more rapid discharge from the hospital before people can be supported by LA assessments. The services provided include a monitored alarm service and assistive technologies to support the risk of falls, wandering, inactivity, medication compliance, activities of daily living, and sensory and memory impairments. The pilot project plans to expand and offer an integrated care system using smart household technologies.

Over the course of the project, we engaged with the following stakeholders:

The DIALOGUE project included five empirical work packages that sought to summarize existing evidence and collect further evidence regarding TECS delivery to identify future priorities for a social care TECS research agenda. These work packages were organized to support the identification of priorities for future research from the perspectives of different stakeholders and forms of evidence in the field.

The remainder of this paper reports the methodology and findings of each work package and its related research activities.

Ethical approvals and data sharing agreements

Ethical approval for DIALOGUE was obtained from the lead institution of the University of Stirling via two separate ethics review applications [GUEP 2024 18182 13299; GUEP 2024 18627 13566].The first ethical approval [GUEP 2024 18182 13299] covered the WP1 workshop methodology, recruitment and consent of WP1 participants including. Subsequent ethical approval was sought for activities in WP2-WP5 [GUEP 2024 18627 13566] and included consent procedures (Consent forms/information sheets) topic guides and research methodologies covering WP3 professional interviews, WP4 e-Delphi exercise and consensus workshops). Once completed, all paper-based approval forms were collected and stored centrally by the principal investigator at the host institution. Data-sharing agreements were also set up at the beginning of the project to enable the sharing of secondary data between local authorities and the project team. During ethics application processes agreement was made not to share raw qualitative and quantitative data in data repositories because of the potential for participants in the research to be identified. Research activities adhered to requirements as set out in the Declaration of Helsinki.

Informed consent

Informed consent to participate in research activities was recorded at the beginning of research activities in individual work packages, via written or e-signatures provided at the beginning of research activities (e.g. co-production workshops) or during organisation of qualitative interviews and workshops with social care service professionals. In addition to written consent provided digitally or in person, verbal consent was also given by social care professionals at the beginning of individual qualitative interviews or at the beginning of group workshops.

Patient and Public Involvement in the proposal and the research project

The primary goal of the project was to work in partnership with older people using social care services to identify their experiences of using social care services. We then used these experiences to identify priorities for development of future research regarding adoption and implementation of technologies within social care services. Hence social care service users were integral to the initial design of the research funding application, delivery of the research project, and generating the principal findings reported in this paper.

Involvement in proposal development

During the proposal writing phase and application for funding, we built relationships with three organisations supporting older people using social care services. In South West England we worked with Age UK Bristol. In Central England we worked with an existing service user lived experience advisory panel working on existing social care research projects organised by one of the project co-investigators (JL) at the University of Hertfordshire and the charity 'Shaping Our Lives'. In North East England we worked with Rekindle, who support co-produced research projects in social care in conjunction with Middlesbrough council. Ten people across the three organisations provided feedback on the proposal design in a combination of email exchanges and an online development workshop. During this process RM, an older person with lived experience of social care services was also invited to join the project team as a Co-Investigator, acting as PPI lead with support from the project team. During the proposal writing stage the participating older people were provided with early drafts of the project outline and proposed co-production activities and were given the opportunity to contribute their perspectives on planned project activities via video call or via written feedback. Feedback was provided regarding the plan and order of specific project work packages, the overall scope of the project, identifying target groups of older people with lived experience of social care who are likely to be priorities for the project, including likely technologies that will be targeted within the project. Specific technologies listed as potential targets included consumer smart technologies which may be deployed by social care, and technologies that promote social connectedness. The older people provided specific feedback on the initial project design, including appropriate design of co-production activities in WP1, the type, scope, and questions in the literature review in WP2, the scope and role of the WP3 process evaluation and choice of e-Delphi survey and associated consensus workshops in WP4. These elements were then fed into subsequent iterations of the project plan. Detailed feedback was also provided to ensure the plain English summary centred the perspectives of those older people with lived experience.

Involvement in project delivery

Service user involvement was built around the creation of three co-production partnerships, in which older people using social care services worked with the project team to identify key priorities for future technology research which can inform future research questions and future applications for research projects. Three project partner organisations (Age UK Bristol, Rekindle and Shaping our Lives) supported the research team to identify a diverse sample of 18 older people who were in receipt of social care services were recruited to take part in a series of three co-production partnerships in the three study areas. Further details of the sample of older people who took part in the project are detailed in Table 1. The original ten people invited to contribute to the proposal were also invited as part of the 18 people who joined the workshops. The PPI lead (RM) worked with the WP1 work package lead (HRM) to design co-production workshops, and to provide resources to support the organisation of these workshops. The co production workshops engaged in analysing data in all project work packages. Initial co-production workshops generated information regarding priorities for technology deployment and for ongoing and future service development, experiences of using social care technologies and the identification of outcomes for the evaluation for such technologies and services, such client wellbeing and quality of life. During later co-production workshops, the older people using services were provided with interim results from activities in WP2, WP3 and WP4, and given the opportunity to contribute to analysis of WP3 and WP4 data. Co production workshop members also contributed to checking of project data, and plans for dissemination of results through their own personal networks, and through the host organisations listed above. The final co production workshop concerned the generation of dissemination of the research via executive summaries, presentations, and targeted conference presentations.

The co production workshops, alongside wider project activities across all project work packages identified the priority of supporting early discharge from, and reducing re-admissions into hospital via technology enabled care services delivered in social care as a core focus for subsequent project development. This focus was further developed in a project application to NIHR’s Research Programme for Social Care, for research funding to evaluate outcomes and factors influencing deployment and implementation of technology enabled post hospital discharge and reablement services delivered within social care. At the time of publication this funding was awarded, with the project due to start in Spring 2026. An earlier application to NIHR’s HTA programme was made in early 2024 to conduct a randomised controlled trial of social care delivered post hospital discharge services, which did not progress past stage one. Participants in the co-production workshops supported identifying these priorities and provided advice and feedback on the development of both project applications through initial focused discussion of priorities in earlier workshops, and by giving feedback on proposed research designs, on early application drafts.

Research methodology

Co-production was employed in WP1, together with older people using social care, to understand the challenges, concerns, and enablers of using technology in the community. Workshops at two of the three sites (Bristol and Middlesbrough) were conducted in person with residents in each area. The third co-production group, based in Hertfordshire, was convened and held online, with participants geographically spread across England. Five participants were invited to join the co-production workshops in Middlesbrough and Hertfordshire. Eight participants were recruited for the Bristol group. Anonymised participants’ details are summarized in Table 1.

Workshops were delivered with the support of three third-sector organizations. In Bristol, workshops were facilitated with the assistance of Age UK Bristol. Age UK Bristol organizes information and awareness-raising campaigns and runs day centres, reminiscence services, befriending groups, and local exercise classes for older people. In Middlesbrough, Rekindle, a participatory practice and co-production forum that fed into the development of social care services within the Middlesbrough council assisted in co-production workshops. An online co-production workshop was convened at the University of Hertfordshire with the assistance of Shaping Our Lives. Shaping Our Lives is a non-profit, user-led organization that works to promote the inclusive involvement of disabled people and those from other marginalized communities in activities that help shape policies and services. All three groups facilitated co-production activities by providing venues for the workshops, promoting the project, identifying, and recruiting older social care service users, and coordinating local travel arrangements for participants.

The objectives of the workshops were to identify what is important to older adults regarding care and how digital care services could be more effective in assisting them. During the co-production workshops, we aimed to understand how older people use digital care services, what types of challenges, barriers, and enablers they or their friends and neighbours have experienced through using technology in their daily lives, together with social care provision. It was anticipated that by involving older people in all parts of the project and through co-production workshops, they would be able to describe what is important to them in terms of digital care, and whether current services assist them in their daily lives.

Four workshops were conducted between April and December 2024. Each workshop had a specific theme and set of activities – workshop one introduced the project and collected information about experiences of engaging with technology in general and social care technologies specifically. Workshop two identified special priorities for social care service delivery and specific technologies that met these priorities. The third workshop explored key outcomes, facilitators, and barriers for technologies and reported service priorities for local authorities, identified in WP4. The final workshops identified key priorities for future research applications in the project and summarized the ongoing involvement in future research applications. Each participant received £75.00 per half-day workshop for their contribution and attendance alongside reimbursement for travel expenses, and where necessary, costs of any support required for an individual to participate in workshops (e.g., translation support, or presence of a support worker).

Informed consent was obtained from all participants at the beginning of each workshop. With participant consent, workshops were recorded to support analysis and interpretation, and extensive notes were taken. Discussions in each workshop were initially analysed by site leads (ML, JF, HRM) and then synthesized by the WP team. Notes and transcripts were analysed following Braun and Clarke’s (2022) thematic analysis approach. A summary of the headline findings from each workshop is provided below:

Findings

Workshop 1 – experiences of using technologies in social care

Our participants reported varying levels of confidence and familiarity with technology. Some felt comfortable and capable, whereas others felt uncertain and anxious about using it. Although our participants felt that technology could help support aging in place, especially for older people living alone, experiencing mobility loss, or living with dementia, they raised concerns about the potential negative and unintended consequences of our increasing reliance on technology. For example, the move towards a cashless society and the growing dependence on online platforms for accessing services were highlighted as barriers. Our participants also discussed their concerns regarding data protection and the risk of scams. Whether these risks are real or perceived can significantly discourage older adults from engaging with digital technology, with associated effects on people’s confidence and willingness to engage with social care technologies. Finally, while technology was seen as a useful tool for maintaining social connections with family and friends, there was a clear preference for it to complement, rather than replace, personal care, especially when it comes to technology-enabled health and social care.

Workshop 2 – Priorities for technology enabled social care delivery

In workshop two, our participants across sites emphasized that while technology can support older people, it is important that this is secondary to meaningful human care and connection. Technology must be simple, accessible, and reliable for acceptance and use. Whether discussing a need for reassurance, complex medication needs, care following a fall, or the broader issue of digital inclusion, all our participants shared their concern that technology alone cannot ensure safety, dignity, or well-being. Our participants shared the belief that informal, relational ways of checking, such as noticing small changes in routine, remain essential and often more meaningful than digital monitoring.

Key issues with technology include the usability of devices (especially for those with cognitive or physical impairments), importance of personal choice and privacy, and critical role of social networks in facilitating technology use. There must also not be over-reliance on family members; care responsibilities need to be more equitably shared and supported by community and statutory services. Technologies such as voice-activated assistants, medication carousels, fall detectors, and simple tablets were cautiously welcomed, but they needed to be in conjunction with trusted, ongoing human care and support. Participants also called for better access to information, support for digital literacy, and broader public awareness, underscoring the need for integrated care systems that balance technological innovation with the irreplaceable value of human connections.

Workshop 3 – Key outcomes, facilitators, and barriers

During the discussions, participants shared practical and ethical concerns about the use of technology for care, focusing on devices such as the Buddi GPS monitoring clip, medication dispensers, and remote monitoring systems. The Buddi GPS Clip in Middlesborough was viewed positively for its simplicity and GPS features, but our participants raised concerns about how someone would go about setting it up, particularly if the person had poor digital literacy skills. Hertfordshire highlighted the need for telecare systems or wider technologies provided via social care to be reliable, accessible, sensitive, and which service users can easily be trained to use. Participants in Bristol were concerned with the ease of use of technologies provided by local authorities and proposed a “borrow bank” that would allow people to trial devices to decide whether they would be right for them. Overall, all our participants recognized the potential benefits of technology, but they also discussed ethical issues, including data privacy, affordability, and the need for human care.

When discussing medication dispensers, the participants expressed concerns about their complexity and reliability, especially for individuals with cognitive or physical impairments. Simpler manual systems such as dosette boxes were preferred by some, and there was strong emphasis on human support in medication management. Issues such as trust, digital literacy, and access to pharmacies were raised, with scepticism about technology fully replacing traditional systems without additional support. When discussing remote monitoring systems, our participants were open to using them but emphasized that these technologies should be introduced with clear communication, support, and respect for privacy. A significant theme and concern that has emerged from many of our discussions, across workshops and sites, is that technology should not replace human care. Rather, it should complement it with involvement from family and caregivers to ensure that the needs and preferences of the individual are prioritized.

Workshop 4 – Consensus priorities

The final workshops identified shared priorities among older adults in relation to the TECS. Across all three sites, participants consistently highlighted the need for clear signposting and accessibility of information, training, and ongoing support, and building trust in technology and services. In Middlesbrough, participants emphasized the need for clear and accessible information and highlighted the importance of trusted organizations, such as social services, in endorsing or recommending products to help older adults feel confident when using technology.

Our participants were concerned about scams, unreliable services, and a lack of data privacy. Our participants stressed the need for complementing, rather than replacing, human care with technology. Trust in local authorities or NHS-endorsed services was stronger than that in commercial offerings. Middlesbrough participants also raised concerns about high upfront costs, outdated technology, the need for personalized, ongoing training, and fragmented services. Hertfordshire participants all ranked the theme of signposting and information accessibility as the most important priority, with training, trust, and cost falling into mid-range priorities, and infrastructure considered the least important. In Bristol, although individual rankings varied, training and support were identified as the top priorities, followed by cost and access to information.

Participants raised several concerns and aspirations regarding how technology-enabled care services should be organized in the future. First, they wanted fewer devices that combined the functionality of all the devices currently on the market. Second, they wanted a ‘trusted entity’ to assess or rate the devices available to allow older people as future technology users/consumers to make informed decisions about how they spent their money on digital care and support. Finally, they highlighted that what they needed from the system was increased responsiveness, a characteristic that many were dubious that could be provided from more technology.

Limitations reported by studies (publication level)

Twenty of the 30 examined publications reported limitations, affecting and restricting the reliability, scope, or generalization of study findings. Several of the studies were exploratory or pilot studies, which may explain why 12 had a small sample size or cohort (Arthanat et al., 2024; Ault et al., 2020; Berridge et al., 2019; Bults et al., 2024; Curnow et al., 2021; Kerssens et al., 2015; König et al., 2022; Malmgren Fänge et al., 2020; Megges et al., 2018; Rose et al., 2018; Rossetto et al., 2023; Turner & Berridge, 2023) and four had a convenience cohort or clustering (Arthanat et al., 2024; Berridge et al., 2019; Howard et al., 2021; Puaschitz et al., 2021). While small numbers usually do not allow for wider generalization, Borg et al. (2022) stated that their large sample size might have affected the statistical analysis and significance, and König et al. (2022) felt that the heterogeneity among participants in their study was a limitation.

Several studies have reported limitations in data collection and analysis. While Warner and Tipping (2022) noted that inconsistent data management hampered the evaluation, two studies (Ault et al., 2020; Rose et al., 2018) reported data loss due to technical issues, and another three (Arthanat et al., 2024; Howard et al., 2021; Kerssens et al., 2015) reported missing data at the follow-up data collection point. Not collecting data on technology use experience at baseline was reported as a limitation in two studies and three publications (Bults et al., 2024; Puaschitz et al., 2021; Puaschitz et al., 2023). The participants’ use of medication may have affected the study by Rose et al. (2018). Malmgren Fänge et al. (2020) found that interviewing older adults and caregivers together might have limited the disclosure of sensitive experiences. Bults et al. (2024) used care professionals as interpreters, potentially adding a bias to their study. Similarly, in Berridge et al. (2019), it was the data from social workers’ reports rather than from older people or caregivers who informed the study.

Methodology

This work package involved a pilot process evaluation to explore the current processes and practices of the PHDRS across the three study sites. The process evaluation was provided by the Medical Research Council’s guidance for the process evaluations of complex interventions (Moore et al., 2015) and its revised recommendations with the National Institute of Health and Care Research (Skivington et al., 2021). These frameworks represent an agreed-upon framework to inform the evaluation of complex interventions for applied health and care research in the UK. PHDRS are complex interventions for several reasons. First, the technology works across multiple integrated care boards, including hospital trusts, local authorities with adult social care responsibilities, and, at times, technology providers and call centres as part of this wider ecosystem. The deployment of PHDRS requires coordination, communication, and accountability by all actors involved in the delivery of PHDRS rather than a single provider organization. Previous studies have argued that all digital care technologies are necessarily complex, as they intervene in both the social, material, and care dimensions of a person’s life (Hamblin & Lariviere, 2023) based on the installation and space technology occupies, habituated use of the technology changing routines, and changes to care relationships and practices of caring (Lariviere et al., 2021).

Rather than a full-scale process evaluation, this work package sought to ‘map’ the different interventions on offer and processes of delivery than attempt a normative evaluation of the different service models. To identify the interventions and processes, the work package team conducted semi-structured interviews with strategic leads within the partner sites (N=12) and appraised the data collected from the pilot projects within the Bristol region and Middlesbrough.

Semi-structured interviews were conducted online by the WP lead (ML) and recorded via MS Teams. Automatic transcripts were generated via native Teams software functionality and checked for quality by reading them with the audio of the recording. Transcripts were analysed via qualitative framework analysis (Goldsmith, 2021; Klingberg et al., 2024). Framework analysis was selected as the deductive analytical requirement based on a narrow focus on how PHDRS were delivered in local contexts rather than an inductive inquiry to explore unanticipated phenomena within the topic area. The data matrix was informed by the Non-adoption, Abandonment, Scale, Spread and Sustainability (NASSS) framework (Greenhalgh et al., 2017), our in-depth findings are published elsewhere (forthcoming). For this NIHR Open Research Report, the team provided an overview of the work package’s findings.

Overview of findings

This section provides a concise summary of the findings from the pilot process evaluation, notably the mapping of different service models and technologies of PHDRS within Bristol, Oxfordshire, and Middlesbrough. Two distinct service models were identified at three study sites. In Bristol, the PHDRS was coordinated at the regional level by the BNSSG ICB. The ICB includes three regional local authorities (the Bristol City Council, North Somerset Council, and South Gloucestershire Council), all hospital trusts, local charities, and industry partners. One industry partner, Sirona Health and Care, has historically provided telecare services in the region alongside localized provisions offered by the three local authorities’ technology-enabled care (TEC) teams. For the ongoing piloting of the PHDRS in the region, Sirona was contracted to work directly with hospitals to provide technology as part of care packages for older people being discharged following a professional needs assessment conducted by a health professional in the hospital wards. Sirona would ensure that the technology was installed with the person when they arrived at the hospital and would maintain free access to the technology for eight weeks. After the initial eight-week period, the older person could continue to use the technology with Sirona (for a fee), be transferred to their local authority’s TEC team, or request that the technology be withdrawn from their care package.

In Oxfordshire and Middlesbrough, the local authority TEC teams were the sole organizations responsible for providing PHDRS for older people in their respective areas. Local authority TEC teams would work with hospital staff to identify how digital technology could be meaningfully included in the older person’s care package to support their timely discharge from hospital back to their home or other care settings. The TEC teams similarly offered PHDRS technology for free for an eight-week period. After the initial eight-weeks had elapsed, the older person could decide to continue to pay for the technology or request its removal.

The differences in service models were informed by the people in the different localities perceived as localized issues. For the Bristol region, the hospitals in the area were concerned about time delays in waiting for one of the three local authorities to match a person to relevant technologies and have them installed before discharge could be processed. They were also concerned that each local authority had its own ‘menu’ of technology rather than a harmonized set of technologies shared within the region, leading to concerns that people may not have the ‘right’ technology available to them if there was not a contract with the relevant technology provider in place in that local authority catchment area. By working with Sirona Health and Care, they could ensure that all older people would receive access to the same range of technologies, whether they lived in Bristol, South Gloucestershire, or North Somerset. Conversely, in Oxfordshire and Middlesbrough, the local authority TEC teams felt it was important to have local ownership of PHDRS, as technology-enabled care is one of the few services that makes money for resource-constrained local authorities providing social care services. Many local authorities have sustained partnerships with hospital trust and other health authorities for several years. These TEC teams have learned how to demonstrate their value and work alongside their health colleagues in multi-disciplinary teams, with TEC teams enabling their PHDRS to be managed by these public actors instead of a private partnership.

Technologies provided

For the PHDRS, the technology provided as part of the service includes a broad range of analogue and digital devices. The participants described the following technologies as part of the service: motion sensor lights, digital pendant alarms, memory clocks, fall detectors, chairs and bed sensors, and passive IR activity monitoring systems. These technologies were offered at all the three regional sites. Bristol and Oxfordshire also began to evaluate novel digital technologies, including acoustic monitoring for people discharged into care homes (Bristol region) and voice-activated computer assistant technologies, such as Alexa (Oxfordshire), to expand their offers beyond traditional telecare service models. All technologies offered for the PHDRS were the same technologies already embedded within the local authority TEC teams and Sirona’s routine TEC provision. No technologies were specifically identified or adapted to support the PHDRS. Instead, the three sites attempted to repurpose technologies routinely offered by their TEC teams in this new context (post hospital discharge and reablement) to bridge the gap between health and social care services.

Survey one: foundational knowledge

Table 4 presents the results of the first survey. For TEC offered by LAs, 100% (N=12) provided telecare and GPS monitoring services, 92% (N=11) provided community pendant and monitoring services, and 83% (N=10) provided fall detection and prevention services and general household aids/adaptations for activities of daily living (e.g., kettle tippers and household appliances). The main users of these TEC were people aged 75–84 (92%, N=11), living with dementia (92%, N=11), aged 65–74 (83%, N=10), with frailty (75%, N=9), and aged 85+ (58%, N=7). Those who benefit the most from digital technologies are generally the same as those who use them, although some differences emerge. People living with dementia were most frequently identified as beneficiaries (92%, N=11), followed by individuals aged 65–74 years (83%, N=10), those with frailty (75%, N=9), and those aged 85+ years (58%, N=7). Notably, while 92% of the respondents identify people aged 75–84 as users, only 75% see them as beneficiaries. This suggests that one of the highest user groups might not always benefit from digital technology offered by social care services. The comments offered by respondents explained this as follows.

The priorities for TECS among TECS staff were to increase the independence (92%, N=11), quality of life (75%, N=9), and delaying/reducing the need for care (75%, N=9) of older people. Second, reducing the costs and increasing efficiencies in care delivery (75%, N=9) and relieving the pressure on family caregivers (58%, N=7) and social care services (50%, N=6). TEC is embedded primarily in these services: reablement or short-term support (100%, N=12), activity monitoring to assess independence (92%, N=11), fall intervention (83%, N=10), support following hospital discharge (83%, N=10), and telemonitoring/telehealth (42%, N=5). TEC is available to individuals eligible for and funded by the LA or adult social care (100%, N=12) as part of a short-term offer, such as to support reablement (92%, N=11), and to those who self-fund their care (83%, N=10).

The main indicators of TEC success were enhancing the quality of life of older people (92%, N=11), creating a safer home environment (75%, N=9), improving independence (67%, N=8), enhancing the quality of life for family caregivers (67%, N=8), and improving or stabilizing the health of older people (58%, N=7). When asked what TEC is the most effective, the respondents indicated that more traditional technology, such as telecare, is essential for enabling vulnerable adults to live safely and independently at home, thus forming a key part of care planning. For example, fall detectors linked to telecare and emergency response services have been successfully integrated into routine care, reducing risks, such as long lies after a fall. Simpler devices such as emergency buttons are praised for their ease of use, especially for individuals with memory or dexterity issues. However, most responses indicate that newer technology (e.g., commercial technology, medication optimization systems, GPS trackers, and activity monitoring devices) has the potential to generate more benefits and success as long as devices are used regularly (and not forgotten about).

The main barriers to TEC adoption highlighted in the e-Delphi survey were lack of knowledge or skill among LA staff (75%, N=9), older people's awareness of the technology (67%, N=8), support for clients (67%, N=8), resources to scale-up technology (67%, N=8), and personnel to install the technology effectively (42%, N=5). Respondents mostly agreed that TEC offers value for money by reducing care needs and improving system efficiency, especially when it is well supported and implemented effectively. However, concerns have been raised about obsolete technology, unreliable providers, and difficulty measuring impact due to limited trial data and anecdotal evidence. Additional comments emphasized the importance of bespoke support teams, cultural acceptance of technologies in care, and the need for careful monitoring to avoid unintended negative outcomes for service users.

Survey two: reaching consensus

TEC offerings

All respondents (100%) agreed that the TEC options selected in the first survey aligned well with their products, services, or current offers. They also aligned well with what they hoped to provide in the future, which suggests that respondents agreed on the topic. Consequently, Telecare, GPS, community pendant monitoring, fall detection and protection, and general household aids are the main TEC offered by LAs; however, some LAs also offer additional TEC on a smaller scale. The qualitative comments indicate that ‘Digital Inclusion with one-to-one support is a prominent element of support which is not reflected above’ (Participant 4, female, age 39, Middlesbrough Council). Furthermore, a respondent commented that "commercial devices have been offered in the past through specifically funded projects but are not a core part of our delivery”’ (Participant 6, male, age 50, Middlesbrough Council).

When asked how TEC, especially emerging technologies, alter the fundamentals of care work, none selected ‘not at all,’ 13% (N=1) selected ‘only a little,’ 38% (N=3) selected ‘to some extent’ and ‘rather a lot,’ and 13% (N=1) selected ‘very much. ’The comments on this question highlight the potential of technology to enhance social care by supporting independence, improving safety, and reducing care workloads when implemented effectively. However, challenges include improper deployment, lack of integration, and missed opportunities for social workers, which undermine its benefits. Respondents emphasized that technology should complement safety and cost-effectiveness rather than replace hands-on care. Emerging technologies, such as AI, wearable devices, and telehealth, promise to improve outcomes, enable preventive care, and empower users through autonomy and data-driven decision making. However, barriers, such as late adoption, stigma, and financial concerns, limit their uptake. Better understanding, training, and integration could maximize the potential of these tools, shifting care from reactive to preventive, and creating space for social aspects of care to be prioritized.

The Beneficiaries of TEC

There was a 75% (N=6) agreement on who benefits most from TEC (those aged 75 to 84, people with dementia, those aged 65 to 74, people with frailty, and those aged 85+). While older people are widely recognized as significant beneficiaries, 25% (N=2) of respondents were concerned that those with sensory impairments, such as sight and hearing loss, should be included. Technology’s potential to empower people with sensory impairments through tools such as screen readers, smart navigation, and magnification is seen as substantial, but underrepresented in the results.

The qualitative responses suggest that people living with dementia benefit the most from TEC because of the extensive range of technology specifically developed to meet their unique and varied needs. The slow progression of the condition often motivates individuals and caregivers to use these tools to extend their independence. Memory clocks, medication reminders, and cognitive stimulation applications can address daily challenges and reduce isolation. Furthermore, because there are “more services supporting dementia, people are less likely to 'slip through the net,'” (Participant 4, female, age 39, Middlesbrough Council). There is also greater accessibility and representation in care provisions for this group, enhancing TEC's effectiveness.

Respondents reported that family caregivers do not benefit as much from TEC due to several factors, including “limited tech offered to this cohort, and it is also not clear how they can request or access it’ (Participant 9, female, age 38, Oxfordshire County Council). While caregivers feel more secure knowing that their loved ones are supported, the primary benefits are directed toward the care recipient, with caregivers experiencing only secondary benefits. Managing the setup, maintenance, and potential technical issues can add stress and hidden costs such as batteries or billing errors. Additionally, technology may generate data requiring caregiver intervention, which can be overwhelming rather than supportive. Caregivers might also be unaware of the available technology or misconceive that TEC is only applicable to older people. Moreover, TEC cannot replace the need for hands-on care that many caregivers still provide.

To improve the benefits to family caregivers, all respondents agreed and reached a consensus on the following: understanding their needs (100%, N=8), offering training and support (100%, N=8), ensuring the privacy and security of the device and data (100%, N=8), improving the affordability and accessibility of the TEC (100%, N=8), and involvement of family caregivers in decision-making (e.g., inclusive design and PPI groups; 100%, N=8).

Main priorities of TEC services

There is an 88% (N=8) agreement that the priorities of TEC reported in survey one represents the priorities of LAs, and they are ranked as follows:

The responses highlight that meeting the priorities of TEC involves a person-centred approach, where individual assessments and regular reviews are key to ensuring that TEC effectively supports users. LAs, such as Middlesbrough, prioritize promoting independence, enhancing safety, and delaying the need for more intensive care by offering tailored solutions, such as pendants, memory aids, and assistive technology. However, challenges arise when people are reluctant to engage with services early, which can lead to crises that complicate the implementation. Success is monitored through feedback from users and family members as well as by tracking key performance indicators, such as cost savings and improved outcomes. Financial pressure sometimes limits the scope of TEC, but efforts to reduce care packages and provide family caregivers with respite through TEC are underway. Additionally, education, training, and exploration of emerging technologies such as AI-driven analytics are important for improving service delivery and understanding the impact of TEC.

Barriers to TECS

Most respondents (88%, N=7) agreed that barriers to TECS identified in the survey aligned well with the challenges faced in their LAs: 1) lack of skill among LA staff, 2) older people’s awareness of the technology, 3) lack of technical support for older people, and 4) lack of money and resources to scale up the technology. Other barriers that are not reflected include resistance to adopting TEC among older people, older people’s poor understanding of TEC's practical benefits, and the cultural shift required among staff to prioritize TEC in service delivery. Further issues include poor rural connectivity and technological limitations in areas with inadequate Wi-Fi networks. Additionally, issues such as fragmented systems, where devices require different dashboards, are considered obstacles to seamless integration.

When asked how to upskill the LA workforce, respondents' preference was to give LA staff members hands-on experience (75%), embed digital skills into their induction process (75%), and provide face-to-face training (50%; see Table 5). The qualitative comments mentioned that some LAs already provide training, including early and effective intervention, emphasizing the importance of integrating training into formal processes such as induction, supervision, and performance reviews to ensure accountability. While various training modalities are offered, including face-to-face, online learning, and hands-on demonstrations, the overarching aim is to address the social care teams’ lack of awareness" (Participant 6, male, age 50, Middlesbrough Council) regarding available technology and its potential to shift from reactive to proactive care. Initiatives include peer-to-peer support, practical sessions displaying technology during assessments, and creating TEC demo sites and eLearning modules, which are now part of the induction process.

To raise awareness of TEC, information, and referrals from primary care providers (e.g., GPs: 75%) and third-sector organizations (50%) are the best way (see Table 5). Comments relating to this question suggest that some LAs already offer printed materials, an online presence, and established services, such as Hospital to Home, with solid connections to local hospitals. Others have suggested that support for older people could be enhanced by meeting them in community settings where they feel comfortable. Community engagement is therefore critical, as older people often rely on word-of-mouth rather than digital tools, and direct discussions can uncover needs beyond simple referrals. Standardizing support across LA boundaries and ensuring that trusted, familiar organizations share information and make referrals enhance trust and accessibility. Practical solutions, such as showrooms or living labs where individuals can test technology, would help build confidence.

To provide technical support, the LAs agree that the best solution is to employ dedicated TEC support staff (75%) and incorporate technical support for TEC users among the existing staff (63%; see Table 5). The qualitative comments mentioned that ensuring effective aftercare is vital for supporting older people with technology as it evolves. One respondent mentions that "older people need to feel they do not have the sole burden of resolving issues" (Participant 4, female, age 39, Middlesbrough Council). Reliable infrastructure, like a stable Internet, reduces problems, as "sometimes the problem is not the tech but the infrastructure underneath" (Participant 10, female, age 39, Oxfordshire County Council). There must be dedicated TEC technicians who provide installation, training, and ongoing help until users feel confident. A multilevel approach is essential, with specialist staff to support advanced technical issues, upskilled frontline workers, informed carers offering natural support, and technology mentors. Accessible resources, including downloadable guides and online repositories, can support staff and residents in adapting and using new technologies.

To resolve resource-related issues, respondents think that the best solutions are to provide greater evidence about the effectiveness of TEC (88%), have greater commissioning guidance related to TEC (75%), ringfenced increases in TEC service budgets (63%), and new iterations of technologies that are more cost-effective (63%; see Table 5). The comments outline that the affordability and effectiveness of TEC remain significant challenges, especially for people on state pensions or with limited incomes. One respondent noted, "TEC is expensive and new and is risky to invest in" (Participant 7, female, age 27, North Somerset Council), particularly given limited budgets and the risk of investing in companies that may fail. Evidence-based research on TEC’s long-term impact of TEC, such as its preventative benefits and cost savings for health and social care, could guide better procurement and implementation. However, such studies must be concise and digestible. Private sector solutions such as Alexa or Google Home offer potential, but often bundle unnecessary features, raising costs. Over time, as smart home technology becomes more standard and costs decrease, it may become easier to integrate health-oriented services or develop lower-cost leasing models for users, thus enabling broader access.

Introduction

WP5 brought project activities together via consensus workshops with the three co-production groups, a consensus workshop with local authority and ICB staff members, and a consensus workshop exploring factors influencing the economic evaluation and assessment of social care TECS. This section summarizes the findings of the consensus activities undertaken in the project, before summarizing the main outputs from the project, in the form of two applications to NIHR HTA and RPSC funding competitions, which have arisen from the project. The section concludes with a brief discussion of the overall findings, recommendations, and limitations of the project.

Consensus workshops

Two consensus workshops were held, each of which took the form of an online focus group. One group was held with TECS staff participating in LA, and a second focus group with experts in health economic assessment to identify an appropriate evaluation framework for TECS. We set out to explore what might constitute the key research and economic questions related to the research priorities that had been identified in previous co-production workshops and consensus groups, and to consider appropriate methods of addressing these questions.

We aimed to recruit up to six health economists working in UK universities who were interested in technology-enabled social care research. We sent an invitation to researchers on the mailing list of the Social Care Economics Network (SCENE) via the network coordinator and distributed the email via DIALOGUE co-investigators’ networks, asking interested researchers to contact the leads. In both focus groups, PowerPoint slides were presented to participants, which summarized results from previous work packages, and used these topics to provide a focused discussion.

The focus groups lasted between 1 h and 1 h 45 minutes and were held online using the Teams platform. The groups were recorded and transcribed. A thank-you payment voucher of £25 was offered to participants. Using a framework approach, transcripts were first coded by topic area and methodological approaches were suggested. The themes were narratively summarized.

A focus group with LA TEC teams was included in the initial ethical review of the project at the University of Stirling [GUEP 2024 18182 13299]. A further review of the economic evaluation consensus workshops was conducted by the LSE Ethics Committee and approved 9^th January 9, 2025.

Six TECS staff members across four local authorities participated in the LA focus group in January 2025. Four health economists working in UK universities participated in the economic evaluation focus group held in early February 2025.

Consensus workshop results

Discussions in consensus workshops ranged widely. The participants described their previous research and practice experiences working on their respective TEC services. Not all topic areas elicited comments; the focus of discussions was mostly on costs of technology, trust in TECS, and digital inclusion and exclusion, and to a lesser extent everyday technologies and consumer markets and infrastructure, design, and environment. In the LA/ICB consensus workshop, themes that emerged included factors influencing the implementation and integration of services across sectors (ICB, NHS trusts, and LAs), barriers to the uptake of technologies among both professionals and older people, evaluating and demonstrating evidence of impact, commissioning and procurement challenges, and strategic and organizational challenges to technology adoption. In the economic consensus workshop, themes emerged that crosscut the topic areas: time horizons and time frames of evaluations, evaluation perspective, relevance of evaluation aims and outcomes, data collection challenges, application of economic theory, and reflecting complexity in evaluations.

Participants in both workshops argued for employing methods that went beyond standard trial-based approaches to evaluate the costs of TECS and examine issues of digital inclusion and exclusion. Economists believe that economic theory could be used to understand the issues of trust and consumer markets for technologies. Discrete Choice Experiments and contingent valuation approaches were suggested as a means of evaluating TECS from the consumer perspective, participants attaching importance to affordability and willingness to pay for these technologies, and preferences for specific aspects of technologies. Equally, the economic evaluation group was concerned with social care commissioners’ perspectives and identified ways in which these decision-makers’ priorities differed from their healthcare counterparts. These findings were also evident from accounts from LA staff members, who highlighted similar tensions between enhancing clients’ independence and quality of life, and meeting financial imperatives for services. For instance, commissioners might focus on the immediate affordability of making TECS investments, or where cost savings are accrued, rather than long-term or whole-system changes.

Consensus workshops have identified key gaps that pose structural or practical barriers to ongoing TECS development. A lack of confidence and skills on the part of both clients, but also wider LA staff, was identified as an ongoing barrier to the effective use of TECS. Knowledge and information gaps, specifically on the availability of technologies and services, were felt to hamper decision-making in terms of service delivery and future service development. The evidence base for TECS was partial, limited to small-scale pilot projects, and a lack of clear evidence generated through evaluation was noted. Building tools for the evaluation of LA TECS was highlighted as a need for both consensus workshops. A lack of standardized evaluation tools that would support LAs in conducting local evaluations of their services or enable cross-service comparisons across LA providers was noted as a gap in the LA workshop, which would enhance future development and scaling up of the TECS. It was striking that participants saw mixed methods, particularly Discrete Choice Experiment approaches, as appropriate for evaluating the costs and outcomes of the TECS interventions. They suggested qualitative methods for investigating the complex production of TECS, namely participatory research with staff delivering the intervention and realist evaluation approaches. Another route for evaluating TECS is through quasi-experimental designs using routine data collected through digital records and apps.

Summary of key findings

As a project development grant, the primary goal of DIALOGUE was to identify the scope for future research related to the delivery of TECS in social care, in order to lay the groundwork for future applications for research funding. The goal of DIALOGUE is to start the process of developing a wider research agenda assisting the generation of real-world and practical and usable evidence in relation to TECS, which can support social care services in commissioning, delivering, and evaluating future TECS services. DIALOGUE collected evidence from the literature and from participating local authorities regarding current practices in the delivery of TECS and key gaps. The project summarized much of the current knowledge regarding factors influencing current TECS services from across service users and, using co-production with older social care service users, highlights key priorities for consideration in future research within the TECS field.

The project highlighted several intractable issues that continue to play a role in influence the development of TECS in social care. Many of the issues highlighted across the stakeholder groups engaged in DIALOGUE (older social care service users, carers, LA staff and commissioners, and academic experts in the sector) appear to be perennial issues within TECS research. From the perspective of service users, these included building awareness of TECS and deployed technologies and their potential, engendering a sense of trust in technologies and services being delivered, and providing clear information and signposting pathways through which older people can access technologies, which can support older people to use technologies in person-centred ways appropriate to their own life circumstances. For LA providers, issues arising in the project included the need for guidance and support for the commissioning of TECS, providing an evidence base that reflects the local circumstances in which TECS may be provided by an LA but also allows for meaningful cross-service comparisons. In addition, ensuring adequate training in TECS, ranging from practical knowledge about what technologies are available to how to assess and provide technologies in person-centred ways that will enhance ongoing adoption and usage, are highlighted as ongoing areas for knowledge exchange and development. Given the importance of efficiency and cost effectiveness associated drivers within social care policy and commissioning, providing technologies in person-centred ways may lead to services achieving expected cost savings and efficiency improvements; however, modes of delivery and evaluation models need to be sensitive to such service models. Building opportunities for greater flexibility within services to support the delivery of technologies in person-centred ways should be considered in any future research agenda for TECS.

Our review of the literature pertaining to the delivery of TECS, specifically within social care contexts, highlighted similar findings. Preconditions for successful TECS adoption in social care relied on several well-recognized factors in relation to technology and its design (e.g., being intuitive to use, adaptable, and personalisable according to changing needs within and across social care clients). Assessment and delivery of TECS should be comprehensive and person-centred, for example, including ongoing follow-up and adaptation as service user needs change. Considering TECS as an ongoing project requiring personalization and adaptation, rather than being ‘dropped in’ as a one size fits all solution has been long recognized within the research literature, and among staff delivering such services, but continues to be under-considered within commissioning policy, or decision making about technology adoption and deployment. There are several examples of good practices in terms of delivering personalisable TEC solutions in social care. Many of the continuing gaps highlighted in this research, such as signposting to technologies for service users and training in person-centred approaches to technology deployment, suggest that this approach is not yet recognized at the core of ongoing policy making and practice ethos in relation to TECS.

Limitations

This study had several limitations. As a project development grant, the primary goal and outcome of the project was to generate an NIHR HTA funding application, rather than specifically to generate new knowledge regarding TECS service delivery. As a time-limited application development grant, our findings are based on relatively small-scale engagement with services over a shorter period when compared to a larger empirical research project, including greater engagement with a wider range of stakeholders. This means that the findings should be approached with caution and should be validated in a larger study.

A further limitation related to the timing of the funding application for this project development grant was required for submission. The stage one application call was introduced after only a brief period of initial funding (four months after project onset). This meant that project activities that were originally planned to be conducted during the earlier stages of the project were postponed until later in the project to allow for grant development activities. This had the effect of limiting work with partners that could be conducted to generate the stage 1 funding application. Specifically, DIALOGUE was limited in the preparatory work that could be undertaken to ascertain and design an effective randomized controlled trial.

Project outputs & future work

The primary output from this project was a stage 1 Application to NIHR HTA Social Care technologies call in June 2024. A Stage 1 application was submitted, which proposed a pilot randomized controlled trial of post hospital discharge and reablement services using digital technologies within social care. The proposed RCT would scope the feasibility of conducting a large-scale RCT across multiple local authority sites, given the differences in the range of settings, service models, and deployed technologies within services. The RCT also included a nested process evaluation, with the goal of exploring factors influencing the implementation, adoption, scale-up, spread, and sustainability of post hospital discharge services delivered within social care. This application did not proceed beyond Stage 1, with peer review feedback highlighting issues with differences between the proposed services to be included in the pilot trial. The process of submitting this application demonstrated the difficulty of applying traditional health-related RCT methods to assess complex, highly variable service models, such as those delivered within social care. Ongoing work within the team will look again at the possibility of developing a pilot RCT, given the subsequent project activities undertaken since the original submission.

A further submission to NIHR was made to Stage 1 of the NIHR Research Programme for Social Care’s Highlight Notice programme in October 2024. This project further developed the process evaluation adopted in the above application to explore in greater detail the factors that influenced the commissioning, implementation, adoption, scale-up, spread, and sustainability of digital post hospital discharge services delivered in social care. This project application proposes to use the NASSS (non-adoption, abandonment, scale-up, spread, and sustainability) framework (Greenhalgh et al., 2017; Greenhalgh et al., 2018) to conduct a four-year evaluation for the deployment and subsequent development of three different post hospital discharge services located in social care and using digital technologies to identify what works to support ongoing service development and delivery across social care. At the time of publication, this application was successful, and the project will begin in April 2026.

Further planned outputs from this project include academic papers reporting findings focusing on the following work packages: WP1 findings from the co-production groups; WP2, rapid review of evidence for TECS delivery in social care; WP3-WP5 process evaluation, e-Delphi exercise, and consensus workshops. The papers will be written and submitted for publication in 2025. Further outputs will include supporting information and resources to support local authorities in implementing TECS to be published on the DIALOGUE project website (www.dialogue-project.org).