ORCID

Abstract

The Urgent Need for a Shift from Crisis Intervention to Prevention. As highlighted by the Chief Medical Officer, demographic ageing—particularly acute in coastal areas like Cornwall—necessitates a fundamental shift in care models to allow individuals to live as independently as possible. Currently, the potential of digital technologies to support this aim is not being realised. To maintain wellbeing and reduce demand on statutory services, the system must pivot from reactive crisis management to a greater focus on prevention. While technology can play a pivotal role, it will only succeed if integrated into interoperable, data-driven systems that facilitate early intervention and holistic assessment.The Current Landscape. Despite the clear value proposition, most Local Authorities remain in the "foothills" of digital transformation. The sector is dominated by first-generation telecare (alarms) and second-generation sensors that support crisis response rather than hospital avoidance. Advanced "third generation" solutions and remote monitoring (RM) are primarily accessed via the private market by self-funders. This introduces socio-economic inequality and ensures that valuable data regarding atypical behaviours are lost to the integrated system. A "fourth generation" solution—fully integrated systems underpinned by predictive analytics—remains the ambition but is rarely achieved in practice.A Changing Policy Context. Acceleration in the digitalisation of adult social care has been necessitated by the ‘digital switchover’, impacting telecare devices that have only analogue capabilities. Several key policy documents are also positioning digital transformation as central to the future of delivery of social care and offered practical guidance about how to accelerate digital adoption. These include the Department of Health and Social Care What Good Looks Like (WGLL) guidance for digital working in adult social care (ASC) and a practical blueprint for planning, implementing and scaling up proactive and preventative care services issued by ADASS and the TEC Services Association. In addition, the publication of the NHS 10-Year Plan offers indications of how ASC departments might leverage funding for digital innovation. Technologies and Evidence. A vast array of technologies exists, from smartphone apps and wearables to multi-sensor platforms (e.g., MiiCare, Whzan Guardian) that offer "smart insights" into health and wellbeing. However, the formal evidence base is limited, often relying on grey literature and small pilots. Consequently, comparative assessments of value are difficult, and commissioners risk becoming locked into procurement relationships withproviders whose products may soon be superseded. Barriers to Adoption The slow uptake of technology-enabled social care is driven by complexsystemic, organisational, and individual barriers:• The Separation of Health and Social Care: Institutional divisions mean that while the NHS stands to benefit most from reduced admissions, the responsibility for prevention often falls to financially constrained Local Authorities.• Organisational Complexity: There is ambiguity regarding who responds to alerts generated by remote monitoring—whether NHS, social care, or VCSE providers—and how data orchestration is managed.• Procurement and "Articulation Work": There is a failure to capture the full costs of digital technologies, specifically the hidden "articulation work" required for installation, maintenance, and managing the "emotional labour" with service users Workforce Anxiety and Digital Exclusion: Staff often lack digital confidence and fear the "Alexification" of care will erode human relationships, while digital exclusion threatens to leave older and vulnerable populations behind.Enablers and Policy Opportunities A changing policy context, including the NHS 10-Year Plan and the What Good Looks Like framework, positions digital transformation as central to the future delivery of social care. Case studies from innovators such as Hampshire and Sunderland demonstrate that success requires moving beyond "pilotitis" to embed systemlevel change. Recommendations To harness the potential of technology-enabled care, the review suggests:1. Leveraging a key role in Integrated Neighbourhood Teams (INTs): Local Authorities are uniquely placed to lead on primary and tertiary prevention within INTs, challenging medical dominance to ensure a focus on the wider determinants of health.2. Addressing "Hidden Work": Commissioners must account for the articulation work required to sustain technology, potentially deploying digital inclusion officers to support onboarding and maintenance.3. Adopting a "Test and Learn" Approach: Rather than seeking static procurement, Councils should utilise "Living Labs" (such as the Plymouth Living Lab) to co-design and prototype solutions with industry, de-risking investment and ensuring system fit.4. Workforce Culture Change: Training must move beyond functional skills to experiential learning (e.g., training bungalows) that builds confidence in the role of technology in relationship-based practice.Conclusion There is an urgent need to shift the balance of care from expensive, reactive crisis intervention to prevention. By understanding the barriers to adoption and leveraging new policy opportunities for integration, commissioners can harness technology to support ageingwell at home.

Publication Date

2026-01-01

Publication Title

Health Determinants Research Collaboration Cornwall

First Page

1

Last Page

63

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