Digital Switchover Business Case

The transition to digital telecare for councils is currently being driven at pace by the switch from the public switched telephone network (PSTN) to a Voice over Internet Protocol technology (VoIP) by 2025. This transition provides both a range of benefits and risks to councils. For wider details on the switchover please see the information on our main page, our resources such as the switchover FAQs, glossary and checklist also provide further background information.

The shift from analogue to digital telephone lines provides an opportunity to transform how we deliver digital health and care services and how we can support people to live their lives. Digital telecare introduces efficiencies that can optimise how we use our resources, enabling councils to do more with limited resources. Some of these efficiencies include automated processes, real time data, and remote monitoring capacity which can enhance service delivery and have potential long term cost savings. Improved outcomes and proactive care can be realised through streamlined services which are essential to provide efficient and sustainable services, meaning people can have better outcomes. There are also significant risks such as poor service, service failure and risk to life so the move to digital telecare is a key infrastructure decision for all councils to consider. As with any investment in digital infrastructure there is a cost attached to move to digital telecare, which comes at a time when councils are already financially stretched. It is therefore important that councils make decisions based on their own needs and circumstances which best meet the needs of their residents.

This document has been created, with the input from councils, to support you to develop your own business case for the migration of telecare services from analogue to digital within your council. This guide provides a framework to help your council in its decision making process. It encourages you to think about risks, benefits and costs that can occur during the shift from analogue to digital telephone lines.

To help you build your business case we have suggested the following basic structure. This may need to be adapted based on your own councils’ policies and procedures.

• Summary: A concise overview of the business case, outlining the purpose, benefits and financial considerations.
• Introduction: Introduce the need for digital telecare, highlighting the current challenges faced by the council in delivering services and the risk of the switchover.
• Objectives: Clearly define the objectives of implementing digital telecare emphasising how it aligns with strategy, policy and service enhancement
• Background and context: Offer a comprehensive understanding of the current system, limitations, and necessity for digital transformation.
• Benefits and outcomes: Articulate the benefits of digital telecare including outcomes on services and people.
• Risks and mitigation: Identify the potential risks associated with not doing anything during the switchover, relying on adapters, and risks associated with your preferred option.
• Financial analysis: Produce cost-benefit analysis covering initial costs, ongoing costs, and savings over short, medium and long term.
• Implementation plan: Outline a clear timeline and road map of the transition from analogue to digital telecare including resources required.
• Stakeholder engagement: Explain involvement of all stakeholders including leadership, political, and co-production with people with lived experience or use your services.
• Regulatory compliance: Address how the proposed solutions comply with all relevant legislation including the Care Act 2014 and Data Protection Act 2018.
• Alternative options: Explore and compare other alternative options including use of adapters, the risks of these and testing information from existing providers and suppliers.
• Conclusion: Summarise key points and reinforce the importance and urgency of the digital switchover. 

To begin to build your business case we would recommend looking at 10 key steps to consider when moving to a digital telecare solution.  These considerations cover various aspects including community needs, cost, benefits, and risk management. By looking into these areas, you can get a clear understanding of what is involved with the switchover and what you may need to consider for inclusion within your business case.

• Identify the need: Clearly outline the community needs for telecare services, emphasizing the potential benefits such as improved healthcare accessibility and enhanced emergency response.
• Regulatory compliance: Address legal and regulatory requirements to ensure that the proposed digital telecare solution aligns with privacy and data protection standards. This may include the Care Act 2014 and Care and Support (Charging and Assessment of Resources) Regulations 2014.
• Risk management: Identify potential risks and propose mitigation strategies, ensuring a resilient and secure telecare system. Further details on the risks should telecare fail are below.
• Technology assessment: Evaluate available digital telecare technologies, highlighting their capabilities, scalability, and compatibility with existing systems. Using ATA adapters for analogue telecare may introduce compatibility issues or quality degradation. Additionally, consider consulting with the system providers for testing results.
• Stakeholder engagement: Involve key stakeholders, including healthcare professionals, emergency services, and the community, to gather diverse perspectives and ensure comprehensive support. Understand the interests of stakeholders and determine the best channels for communication which may include multiple options. Ensure feedback is captured and consider how you can co-produce any solutions with people using support.
• Training and support: Outline plans for training both staff and people who use care and support to maximize the effectiveness and adoption of your digital telecare solution. 
• Measurable outcomes: Define key performance indicators (KPIs) to measure the success and impact of the digital telecare implementation over time.
• Cost-benefit analysis: Conduct a thorough cost-benefit analysis, considering initial implementation costs versus long-term savings in social care, healthcare and emergency services. Upgrading to digital telecare can offer advantages such as enhanced communication features, data integration and improved reliability. There may be additional initial costs for new equipment and training however the long-term benefits may include more efficient monitoring and potential cost savings over time which may outweigh the initial investment. You may find our financial checklist resource useful to identify some of the costs.
• Sustainability: Demonstrate how the proposed telecare solution aligns with long-term sustainability goals, including environmental considerations and ongoing maintenance. This may include a digital ready solution and not reliant on analogue or hybrid adapters.
• Public awareness: Consider your communications to raise public awareness about the benefits of digital telecare, fostering community support and participation. The LGA have created a communications toolkit to help raise awareness of the digital switchover more broadly.

When developing a business case for a shift to digital telecare, councils should be aware of the benefits digital telecare has on services. From improved connectivity and real-time intelligence to greater prevention and improved patient outcomes, this section supports councils to understanding the benefits of embracing digital telecare and strengthen business cases for funding.

• An improved experience for service users: Digital telecare provides better quality, tailored services supporting independence and personal outcomes through custom technology offers. With faster connection speeds, improved call quality, and reliability, it creates more meaningful contact with health and care services. Additionally, it offers the potential for self-installation, reduced waiting times, and the flexibility to use own devices.
• Increased resilience: Users benefit from a heightened sense of safety with a real-time overview of device statuses, leading to fewer instances of failed calls and live monitoring for swift fault detection. The flexibility of SIMs to move between networks, the option to install dual SIMs, and the inclusion of battery backup collectively mitigate the impact of power cuts.
• Greater flexibility: Calls can be efficiently routed, offering increased options for remote work and enabling service providers to support each other during high call volumes, such as during adverse weather events. This flexibility is enhanced by the fact that call takers do not need to be physically located in the same building as the ARC equipment.
• Improved device management: Eliminating the need for an analogue phone line expedited setup, and digital systems provide efficient processes for updates and configuration. This includes swift deployment of digital devices, simplified setup processes allowing citizens to potentially self-install alarm units (plug and go), and the ability to update/reconfigure devices remotely.
• More efficient delivery models: Automating routine administrative tasks not only frees up care staff, enabling a shift to more proactive services and increasing overall service capacity and increasing overall service capacity but also allows a greater focus on user-facing tasks. This time efficiency further enables staff to dedicate time to outbound calls for welfare, health, well-being support or engaging in activities, ultimately contributing to improved job satisfaction.
• Consumer technology: Integrating digital devices and wearables offers the potential for rapid up-scaling and more responsive services, savings on installation time, reduced device expenditure, and the possibility of eliminating installation visits. This approach also makes telecare alarms a more attractive option for users, alleviating some of the associated stigma.
• Integration and prevention: Leveraging open data, shared platforms, and predictive analytics holds the potential for enhanced service integration and proactive approaches. The instant sharing of user information among health and care services strengthens partnership working, while the ability to predict health risks and implement preventative measures through digital systems contributed to reducing hospital admissions. In addition, the ample bandwidth of digital systems allows for seamless incorporation of video, facilitating integration with other NHS remote clinical support.

The risk of not moving to digital telecare is that once the PSTN is switched off the previous analogue telecare may fail. If telecare fails it can have significant impact on the services people rely on. This section provides 10 key effects that could happen if you are not prepared for the switchover. These disruptions include increase in hospital admissions, increase in burdens to carers, or loss of life due to lack of ability to call for help. 

• Increased emergency calls: Without effective telecare, individuals may resort to traditional emergency services, leading to a surge in emergency calls and potentially overwhelming response systems. 
• Delayed or failed response times: Emergency response times may be prolonged as the absence of telecare hampers the ability to quickly assess, prioritise and address urgent situations.
• Hospital admissions: The lack of timely telecare interventions could contribute to a higher number of hospital admissions, placing additional strain on hospital facilities.
• Decreased efficiency: Telecare is designed to enhance efficiency in health and social care delivery. Its failure may result in a less streamlined and more resource-intensive process. This may include staff making proactive outbound calls to people or increase in-person home visits.
• Impact on health: Telecare often plays a crucial role in managing chronic conditions remotely. Failure could lead to a decline in proactive management, potentially exacerbating health issues for people.
• Impact on carers: Family or friend carers heavily reliant on telecare for support may experience increased stress and strain as they lose a valuable tool in managing the care of their loved ones.
• Resource reallocation: Without the support of telecare, resources may need to be reallocated to handle increased demands on traditional reactive health care, social care and emergency services.
• Communication breakdowns: Telecare often facilitates effective communication between care providers, service users, and emergency services. Its failure could result in communication breakdowns, leading to misunderstandings, inefficiencies and issues delivering good quality care.
• Loss of preventive care: Telecare is instrumental in providing preventive and proactive care. Its failure may result in a reduction of preventive measures, increase in reactive care, contributing to a decline in overall community health.
• Impact on wellbeing and mental health: A sudden failure of telecare services can disrupt the routine and confidence of individuals who rely on these services, potentially leading to increased anxiety and a loss of independence for people.

When telecare systems fail it is not just an impact on services that occur, there are financial pressures that need to be considered when building a business case to support the shift to digital. This section serves as a guide to help councils understand some of the financial considerations for failing to have a robust reliable telecare system. This section will detail 10 direct or indirect financial pressures that could happen if a council is not prepared for the switchover. These pressures not only affect councils but also wider health and social care as well as people and the community.

• Emergency service utilisation costs: Without effective telecare, individuals may resort to emergency services (Accident & Emergency) more frequently, leading to increased costs related to emergency call responses, ambulance services, and hospital admissions.
• Health and social care resource overutilisation: The absence of telecare could result in the overutilisation of health and social care resources, such as increased visits to care facilities and higher demand for medical interventions including primary health care or voluntary community sector.
• Hospitalisation expenses: Telecare often helps in preventing hospitalisations through proactive monitoring. Failure could lead to higher rates of hospital admissions, contributing to increased costs to NHS. Increased hospitalisation often results in increased care needs following discharge which contributes to increased costs for council social services.
• Long-term care costs: Inadequate telecare support may necessitate increased reliance on long-term care facilities, driving up the costs associated with residential or nursing placements.
• Complications and readmission costs: Telecare helps in managing chronic conditions and preventing complications. Failure could lead to increased complications and subsequent hospital readmissions, incurring additional costs to services.
• Loss of productivity: The impact of telecare failure on friends and families health may result in decreased productivity due to increased sick days, benefit claims/allowances, and carer respite as they provide more proactive visits.
• Reactive care costs: Telecare is designed to facilitate proactive and preventive care. Failure may shift the focus to reactive care, which tends to be more costly and resource intensive on services.
• Legal expenses: In cases where telecare failure contributes to loss of life, there may be legal implications, resulting in monetary or time costs for care providers and local authorities.
• Care system strain: Increased reliance on traditional reactive care services may strain the overall care system, leading to higher operational costs, longer wait times, and decreased overall efficiency.
• Impact on public health programmes: Telecare often supports public health initiatives. Its failure may disrupt these programs, leading to increased costs associated with managing public health challenges such as falls prevention.

We have also produced a financial checklist for local authorities to use alongside this guide and our telecare checklist. This checklist will assist you in identifying some of the potential costs you may incur and need to consider.

Digital switchover business case - financial checklist

• LGA Digital Switchover Hub
• LGA Scams Guidance
• LGA Telecare Checklist
• LGA Commissioners Toolkit