The role of combinatorial health technologies in supporting older people with long-term conditions: Responsibilisation or co-management of healthcare?

Sandra Elaine Varey; Mandy Dixon; Alejandra Hernandez; Ceu Mateus; Tom M Palmer; Christine Milligan

doi:10.1016/j.socscimed.2020.113545

The role of combinatorial health technologies in supporting older people with long-term conditions: Responsibilisation or co-management of healthcare?

Sandra Elaine Varey^*, Mandy Dixon^*, Alejandra Hernandez^*, Ceu Mateus^*, Tom M Palmer^*, Christine Milligan^*

^*Corresponding author for this work

Bristol Medical School (PHS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

9 Citations (Scopus)

42 Downloads (Pure)

Abstract

Neoliberalism, austerity and health responsibilisation are increasingly informing policies and practices designed to encourage older patients to take responsibility for the management of their own healthcare. Combined with an ageing population, novel ways to address the increasing healthcare needs of older people have become a priority, with the emergence in recent years of new models of integrated care enhanced by combinatorial health technologies (CHTs). This paper presents qualitative findings from the evaluation of one programme, the Lancashire and Cumbria Innovation Alliance (LCIA) Test Bed, a programme funded by NHS England and conducted in England between 2016 and 2018.

Drawing on data from patients, family carers, and staff members involved in the programme, this paper explores the extent to which CHTs, as part of the LCIA Test Bed programme, contributed to health responsibilisation amongst older people with complex health conditions. Through this programme, we find that relationships between patients, family carers and healthcare professionals combined to create a sense of reassurance and shared responsibility for all parties. Our findings suggest the need for a more nuanced approach to responsibilisation and self-management for older people living with complex health conditions. By focusing on co-management – and recognising the potential of CHTs to facilitate this approach – there is potential to increase patient confidence in managing their health condition, reduce carer burden, and enhance clinician satisfaction in their work roles. While neoliberal agendas are focused on self-management and self-responsibility of one's own health care, with technology as a facilitator of this, our findings suggest that the successful use of CHTs for older people with complex health conditions may instead be rooted in co-management. This paper argues that co-management may be a more successful model of care for patients, carers and clinicians.

Original language	English
Article number	113545
Number of pages	11
Journal	Social Science and Medicine
Volume	269
Early online date	24 Nov 2020
DOIs	https://doi.org/10.1016/j.socscimed.2020.113545
Publication status	Published - 1 Jan 2021

Bibliographical note

Funding Information:
Within a landscape of neoliberalism, austerity and an ageing population, the responsibilisation agenda is continuing to strengthen, with ?the responsibility for the prevention and management of health shift[ing] increasingly onto patients (as consumers) and to technological systems? (Rich et al., 2019, p.34). In the UK, for example, one of the aims of the ?Personalised Health and Care 2020? strategy (NHS Digital, 2020a) is to ?to help people better manage their health and care? and ?take greater control of their health? (NHS Digital, 2020b). Ways to address the increasing healthcare needs of older people have also become a priority, with a focus on facilitating older people's ability to better self-manage their health care needs at home. One strategy developed by NHS England has been a focus on the potential of health technologies to support the provision of new models of care (NHS England, 2020). The NHS England Test Bed programme has been designed to encourage the trialling of combinatorial health technologies (CHTs), in which new models of care are supported by digital health technologies across a number of areas in the UK. This paper presents findings from the qualitative evaluation of one such programme, the Lancashire and Cumbria Innovation Alliance (LCIA) Test Bed (hereafter referred to as ?the programme?). Drawing on data from patients, family carers, and staff members, this paper explores the extent to which CHTs, as part of the programme, contributed to health responsibilisation amongst older people with complex health conditions. In doing so, this work contributes to the conversation regarding the responsibilisation agenda within healthcare and suggests the need for a more nuanced approach to responsibilisation and self-management for older people living with complex health conditions.This evaluation was funded by NHS England. The authors wish to thank all patients, family carers and staff members who took part in and supported the study. Thank you to members of the Evaluation Advisory Group who provided invaluable advice and guidance throughout the LCIA Test Bed programme. Special thanks are due to Professor Maggie Mort, with whom a conversation about co-monitoring marked the beginnings of this paper.

Funding Information:
This evaluation was funded by NHS England. The authors wish to thank all patients, family carers and staff members who took part in and supported the study.

Publisher Copyright:
© 2020 Elsevier Ltd

Keywords

Ageing
Co-management
Healthcare
Health technologies
Neoliberalism
Responsibilisation
Self-management

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10.1016/j.socscimed.2020.113545

Full-text PDF (author’s accepted manuscript)
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Dr Tom M Palmer
- tom.palmerbristol.acuk
- eptmpbristol.acuk
- Bristol Medical School (PHS) - Senior Lecturer in Biostatistics Applied to Genetics
Person: Academic

Cite this

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title = "The role of combinatorial health technologies in supporting older people with long-term conditions: Responsibilisation or co-management of healthcare?",

abstract = "Neoliberalism, austerity and health responsibilisation are increasingly informing policies and practices designed to encourage older patients to take responsibility for the management of their own healthcare. Combined with an ageing population, novel ways to address the increasing healthcare needs of older people have become a priority, with the emergence in recent years of new models of integrated care enhanced by combinatorial health technologies (CHTs). This paper presents qualitative findings from the evaluation of one programme, the Lancashire and Cumbria Innovation Alliance (LCIA) Test Bed, a programme funded by NHS England and conducted in England between 2016 and 2018.Drawing on data from patients, family carers, and staff members involved in the programme, this paper explores the extent to which CHTs, as part of the LCIA Test Bed programme, contributed to health responsibilisation amongst older people with complex health conditions. Through this programme, we find that relationships between patients, family carers and healthcare professionals combined to create a sense of reassurance and shared responsibility for all parties. Our findings suggest the need for a more nuanced approach to responsibilisation and self-management for older people living with complex health conditions. By focusing on co-management – and recognising the potential of CHTs to facilitate this approach – there is potential to increase patient confidence in managing their health condition, reduce carer burden, and enhance clinician satisfaction in their work roles. While neoliberal agendas are focused on self-management and self-responsibility of one's own health care, with technology as a facilitator of this, our findings suggest that the successful use of CHTs for older people with complex health conditions may instead be rooted in co-management. This paper argues that co-management may be a more successful model of care for patients, carers and clinicians.",

keywords = "Ageing, Co-management, Healthcare, Health technologies, Neoliberalism, Responsibilisation, Self-management",

author = "Varey, {Sandra Elaine} and Mandy Dixon and Alejandra Hernandez and Ceu Mateus and Palmer, {Tom M} and Christine Milligan",

note = "Funding Information: Within a landscape of neoliberalism, austerity and an ageing population, the responsibilisation agenda is continuing to strengthen, with ?the responsibility for the prevention and management of health shift[ing] increasingly onto patients (as consumers) and to technological systems? (Rich et al., 2019, p.34). In the UK, for example, one of the aims of the ?Personalised Health and Care 2020? strategy (NHS Digital, 2020a) is to ?to help people better manage their health and care? and ?take greater control of their health? (NHS Digital, 2020b). Ways to address the increasing healthcare needs of older people have also become a priority, with a focus on facilitating older people's ability to better self-manage their health care needs at home. One strategy developed by NHS England has been a focus on the potential of health technologies to support the provision of new models of care (NHS England, 2020). The NHS England Test Bed programme has been designed to encourage the trialling of combinatorial health technologies (CHTs), in which new models of care are supported by digital health technologies across a number of areas in the UK. This paper presents findings from the qualitative evaluation of one such programme, the Lancashire and Cumbria Innovation Alliance (LCIA) Test Bed (hereafter referred to as ?the programme?). Drawing on data from patients, family carers, and staff members, this paper explores the extent to which CHTs, as part of the programme, contributed to health responsibilisation amongst older people with complex health conditions. In doing so, this work contributes to the conversation regarding the responsibilisation agenda within healthcare and suggests the need for a more nuanced approach to responsibilisation and self-management for older people living with complex health conditions.This evaluation was funded by NHS England. The authors wish to thank all patients, family carers and staff members who took part in and supported the study. Thank you to members of the Evaluation Advisory Group who provided invaluable advice and guidance throughout the LCIA Test Bed programme. Special thanks are due to Professor Maggie Mort, with whom a conversation about co-monitoring marked the beginnings of this paper. Funding Information: This evaluation was funded by NHS England. The authors wish to thank all patients, family carers and staff members who took part in and supported the study. Publisher Copyright: {\textcopyright} 2020 Elsevier Ltd",

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doi = "10.1016/j.socscimed.2020.113545",

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