Assistive technology can promote independence and improve people's lives as well as save money. What's not to like? asks Sally Gillen…

It was a simple wish. All Lorraine, Gaynor and Amanda wanted to do was to sleep under their own roof alone andsay "goodbye" rather than "goodnight" to their carer at the end ofthe day. After telecare sensors were installed, their wish was granted. 

Meanwhile Ted's problems began when it was decided a sleep-in carer was no longer needed in his supported living unit. On the first night, he got up, ate everything in the fridge, and was sick. The next night he did the same.

At first staff wondered if the way to stop his midnight binges was to lock the fridge. But once they involved the assistive technology experts, a simple solution was found that did not mean denying Ted's housemates the freedom to get themselves a drink or something to eat. The fridge now has a video on its door, programmed with Ted's carer's voice reminding him, when he goes to open the door, that he should go back to bed.

These are just a couple of examples of how assistive technology is improving the lives of people with learning disabilities. Telecare, fingerprint locks,alarms, touchscreen electrical appliances, epilepsy sensors,environmental controls such as flood sensors... the list goes on.All over the country assistive technology is being used to reducereliance on carers, boost independence and, in many cases, providecare that maximises the privacy and dignity of people with learningdisabilities.  

The potential to develop technologicalsolutions is as infinite as the number of individual needs and,while there are a number of off-the-shelf products available, manyproviders look to find a solution to fit an individual need. Forthat reason, the Home Farm Trust (Hft), a charity that supportspeople with learning disabilities, prefers the term 'personalisedtechnology'. 

In 2004, with £2.4 million from the European SocialFund, Hft worked with partners including manufacturers, local authorities and supported employment providers on Through AssistiveTechnology to Employment (TATE), a pioneering project looking athow assistive technology could be used to increase employabilityand support independent living. The project ended in 2007 but aftersecuring further funding, Hft and partners now support around 200people with technology. Project co-ordinator Emma Nichols says:"TATE really opened our eyes and made us realise how effectivetechnology could be for people with learning disabilities." 

Major manufacturer Tunstall works with the charity, as well as otherproviders around the country, and public sector policy directorKevin Alderson says that while the company had an established trackrecord in providing telecare for people with physical disabilities,in the last five years he has seen the learning disabilities market"really take off".

Its growth can be explained by a number ofdevelopments, including the increasing sophistication of thetechnology. "Ten years ago we had products where, if you had aproblem, you would press a button and then receive help. But ifsomeone has epilepsy, say, they may fall and blackout so they can'tdo that. The technology we have now means we can detect when thereis a problem," he explains. 

Another factor is the government policydrive towards increasing independence and control plus the growingpopulation of people with learning disabilities, many of whom areliving longer. With an ever-growing number of older people andindividuals with learning disabilities, social services budgets areunder pressure and assistive technology can perform taskstraditionally carried out by people at a fraction of the cost.

Assistive technology consultant Kevin Doughty says the need to makeefficiency savings is significant, adding that the more progressivecouncils took the preventative technology grant, an £80 million potof money provided by the Department of Health between 2004-2006,which had been intended for older people, and looked at howtelecare could be used to enhance the lives of other groups ofpeople such as diabetics, people with physical disabilities andindividuals with learning disabilities. 

Cheshire was among thoseforward-thinking local authorities. Jon Wilkie is project manager for assistive technology at Cheshire East Council. In 2005 he movedfrom a role as a social worker in older people's services at whatwas then Cheshire County Council to a role within the learning disabilities team and set about looking at how telecare could beused to benefit people with learning disabilities, partly as a wayto reduce out-of-county placements and to support those moving fromresidential care to supported living. The council then launched atelecare pilot in 2006, involving five houses whose residents wereprone to night time seizures and falls. 

Within a couple of years,and through expanding the work, the council made significantsavings. Figures collated in January this year showed that in2008/2009 the council invested £100,000 in assistive technology butsaved £400,000, says Wilkie. 

In April 2009, the government decidedto divide the council into two: Cheshire East and Cheshire West.Now based in Cheshire East, Wilkie says more than 100 people aresupported by some form of technology. 

"Most of the technology isfairly unobtrusive. It isn't like someone's bedroom ends up lookinglike something out of James Bond," he says. "That said, some of theproducts do need some more work. If I'm honest, the design isn'tthere with all of them but we are working with manufacturers toimprove them. Some of the devices were created for use by olderpeople and a young person with learning disabilities doesn't wantto be wearing a safety pendant around their neck that's beendesigned for a 90 year old. And the fall detectors can be a bitclunky. The more subtle the device, the more encouraged people willbe to use them."  

And most people with learning disabilitiesare keen to give them a go, he adds, especially those devices thatwill allow greater privacy. "Sensors reduce a lot of thejust-in-case checking staff do, which in turn means we don't haveto pay for as many sleep-in carers. They are cost-effective butthey also mean someone isn't continually disturbed in the privacyof their bedroom." 

A system whereby someone is monitored regularlyby a carer is not necessarily the most effective way of caring, heargues. "A carer could check someone, close the door and secondslater that person could have a fit and nobody would know until 29minutes later when the next check is done. With a sensor, theminute something goes wrong, staff are alerted," he says.

Wilkie cites the case of one man who had autism and epilepsy. He wouldfind it very irritating, partly because of his autism, to have hisspace invaded continually by staff who need to check him. He beganhitting them. There was talk of moving him to a hospital but,thanks to a telecare package, he was able to remain in thesupported living placement. 

"Traditionally, our default positionwhen someone has challenging behaviour is to add in more support,but in this case it was the support that was causing the problem. He didn't want to constantly be checked," explains Wilkie. But not all situations are so easily resolved. Problems can arise if someone in supported living does not want a device installed intheir home. Nichols recalls a case where a man with profound learning disabilities who did not want the lifeline box (a smallbox that that can dial a call centre for help) in the communal living area of his home. He had no speech but demonstrated his objection by damaging it and pulling the phone out. It was fixed and adapted so it is now silent and he no longer has a problem with it.

The ethical issues around installing assisted technology are considerable, the main one being consent, says Nichols. "You haveto be open and honest about why you are installing the technology.Is it to help staff or the people themselves? There's often a deathly hush when you bring this up because often people, such asproviders, don't consider all the outcomes of these technological additions." And those with profound or severe learningdisabilities, many of whom can benefit the most from assistivetechnology, may not always be able to give consent and the decision is left to others to decide what is in their best interests.

Assistive technology is defined by the World Health Organization Health as: "Any device or system that allows individuals to perform tasks they would otherwise be unable to door increases the ease and safety with which tasks can be performed."