Anyone following Scotland’s technology-enabled care debate will have noticed how far it has already moved. The argument that care technology should be proactive rather than reactive, preventative rather than crisis-driven, is no longer a fringe position.
Scottish Care has made it plainly, pointing out that the real obstacle is not the technology but commissioning frameworks built around time-and-task care. Voices in the housing sector have gone further, calling the old personal-alarm model of telecare outdated and arguing that funding should shift from reactive response to models that keep people independent.
Even the Scottish Government’s own telecare guidance now describes the ambition as a more integrated, proactive and intelligence-informed approach to care. The direction of travel is set, and the sector deserves credit for setting it.
When people in Scotland talk about proactive technology, they tend to mean smart sensors, lifestyle monitoring, video calling and remote health checks, which are all valuable. But there is a distinct category that sits alongside these and does something different again: technology designed to help someone with a learning disability, autism, dementia or an acquired brain injury structure their day in the first place.
That translates into real-world digital interventions such as visual schedules, step-by-step prompts, and reminders that arrive at the right moment. Interfaces such as these are simple enough to be used independently and are known within the care sector as ‘cognitive support technology’. Such tools, however, do not wait for a crisis and don’t only watch for one – they help make the ordinary day navigable, which is often how the pressure on a day is eased before it builds.
MEMOplanner, a medical-device-regulated planning device widely used across the Nordics, the UK and Europe, is a visual calendar and clock designed to give someone the prompts, structure, and timings they can rely on without another person in the room to provide them. It’s designed to look like it belongs in someone’s home rather than a clinic, which is rather the point. The change it’s designed to support is for a person who needed prompting through every transition in their day to begin leading themselves.
This is not a tangent from Scotland’s stated goals, it runs straight through them. The Health and Social Care Service Renewal Framework’s “People Principle”, care designed around the person rather than the system, is exactly what proactive cognitive support is for.
Its prevention principle is the logic of helping someone manage their own routine before support needs escalate. Self-directed support, in place in Scotland for over a decade, assumes people can exercise choice and control over their own lives, and that the right technology often makes that assumption real for someone who would otherwise depend on another person to tell them what happens next. The same is true of the community living agenda and the ambition to bring people home from inappropriate placements. Independence at home is far easier to sustain when the day itself is navigable.
The track record for this category is longer than its low UK profile suggests. Abilia, the company behind MEMOplanner, has roots dating back more than 50 years in communication technology and has specialised in cognitive support for around three decades, much of that as a market leader in Sweden and Norway, where the category is part of mainstream care provision, backed by national evidence.
The scale is real rather than pilot, with tens of thousands of devices in daily use and more than 130,000 accounts on its supporting platform. The early UK findings point in the same direction as the Nordic evidence, towards reduced support intensity, greater independence and measurable cost avoidance. What is still thin is the Scottish evidence base, because the category has rarely been commissioned and studied here as a thing in its own right. That gap is the opportunity, not the obstacle.
There are, however, some positive developments in Scotland. In Lanarkshire, the same region chosen to pilot MyCare.scot, North Lanarkshire Council has been working with Abilia’s Komp Pro, a cognitive support solution with virtual care capabilities, built around a daily orientation clock, an on-screen schedule and timed reminders.
The service recorded measurable cost avoidance running into tens of thousands of pounds a year, alongside the outcome that matters more: people supported well, at home, with dignity. When technology helps a person do more for themselves, the system regains capacity, and the person regains their independence. Those are the same outcomes described from two ends.
Which brings us back to the barrier we face in Scotland, which is that although the ambition is to deliver more proactive and preventative forms of care, the money still moves through reactive budgetary cycles. A category like cognitive support struggles in that model, because its value shows up as a day that goes better and a support need that doesn’t grow, not as an alarm answered. If Scotland is serious about preventative care, the commissioning route has to recognise the value of technology that prevents quietly, not just those that respond loudly.
So, that’s why I think now is a good time to renew our focus on what good care actually looks like, and how to get there. Scotland is rebuilding its care technology architecture right now, with open standards, shared platforms, an interoperable approach to data through the Telecare Information Framework, and a single front door taking shape in MyCare.scot.
The design decisions made now will determine what is possible over the next decade, and care technologies – like any other – are easier to design alongside such national platforms than left to be retrofitted later on. If the rails are being relaid anyway, it is worth deciding now what we want them to carry.
None of this is a challenge to the work already underway, but an offer to widen it. Scotland has made the case for proactive care technology more clearly than most of the UK. Having spent three decades in this particular category, Abilia would rather help name it and help build the Scottish evidence for it than watch it stay at the edge of a conversation it belongs in the middle of.