Established users and the making of telecare work in long term condition management: implications for health policy.

Increasingly policy for long term condition management is focussing on new technologies. Telecare is viewed as a means of making services more responsive, equitable, cost and clinically-effective and able to play a central part in mediating between service users, professionals, and service providers. It has also been identified as helping to establish patient self-management for long term conditions. In this paper we consider the social practices of the work of telecare integration and incorporation for patients, their interactions with professionals and the synergy or otherwise with policy makers' expectations for how patients approach, use and interact with services. The research took place in England and in Wales and involved qualitative interviews with 31 individuals. Our research suggests that, telecare services provide both an adequate substitution for traditional services and additional benefits such as minimising the need to travel and the added reassurance of regular external surveillance. However, the nature of patient work involved is 'low level' rather than requiring higher level interpretation of readings and decision making commensurate with realising a policy vision of more independent and responsible self -managers. Indeed a paradox of the reliance and acceptance of telecare is the creation of new relationships and dependencies rather than the diminution of reliance envisaged by policy. The illumination of practices around telecare provides evidence for policy makers and others to adjust the predictions and presumptions about how telecare might enable and promote more effective long term condition management.