There is no avoiding it: we are all getting older. By 2017 the UK will have almost two million more people aged between 65 and 84 than it did in 2004. And by 2025 the number of over 85s will have gone up by two-thirds.

Financially, that means tricky pension arrangements and changes to the retirement age. But it is not just about money. Longer life means higher incidences of chronic complaints, such as heart disease, and more elderly people requiring care. In the context of weakening family structures and changing roles, particularly for women, the pressure on hospitals and care homes looks unsustainable.

Clearly there is no simple solution. But a good start is to find ways to help people stay out of institutional care.

This is where technology comes in. Telecare is an umbrella term for a range of networked systems to monitor safety and health at home. Examples include environmental and movement sensors, and specific clinical measurements such as heart rate or blood pressure.

Used effectively, telecare has the potential to change the structure of health and social care – helping the chronically ill stay out of hospital and allowing the elderly to live for longer in their own homes.

The financial arguments look promising. Whitehall’s Social Exclusion Unit estimated last year that reducing institutionalisation by just a single per cent could save £3.8bn.

Even more hopefully, preventative technology chimes with Labour’s wider choice agenda plans to shift healthcare away from district hospitals to community organisations.

So far, so good. But those initiatives that already exist are patchy and small scale. And while central government is starting to take an interest – with £80m-worth of Preventative Technology Grants and nascent plans for larger-scale trials – telecare is still very much on the fringes.

A report last week from the government’s national director for older people, specifically looking at how to ‘bring care closer to home’, makes no mention of technology at all.

Even the most successful schemes say the biggest challenge is proving that they make a real difference and do save money. In the public sector’s increasingly straitened budgetary climate, only a business case with clear return on investment stands much chance of securing funding.

Establishing the potential for telecare and how best to exploit it needs clarity and commitment from central government. There is no time to lose – the clock is ticking...

Last autumn the NHS IT programme was under particular pressure. The itimetable for implementation was sliding further than ever, iSoft was hitting the headlines for all the wrong reasons and Accenture was so convinced against success it walked away from its £2bn-worth of deals. There were questions as to whether the programme would even survive.

The appointment of a new NHS chief executive - David Nicholson - in July, to replace acting head Ian Curruthers, was talked of as a key moment. Nicholson, said the rumours, would be the new broom to sweep away the discredited remnants of an unworkable, unpopular, unsustainable programme.

The key to its survival would be top-level support, said insiders. But whether such support would be forthcoming was a whole other question.

Nicholson's conference speech last week, which repudiated calls for an independent review, included just such strong support.

In the short term at least, and notwithstanding the conclusions of the internal review commissioned by Nicholson himself, the programme still has the support it needs.

All that is needed now is for Nicholson to undertake the considerable challenge of getting NHS staff to share his belief in the benefits of the National Programme.

The news that the British Medical Association (BMA) is urging doctors to discuss with their patients the electronic record at the core of the £6bn National Programme for NHS IT is a considerable step forward.

Relations between doctors' groups and Connecting for Health (CfH), which runs the National Programme, have been fractious since the start - clinicians claiming the programme is mis-designed because they were not sufficiently consulted, CfH hinting that the doctors are simply defending their status quo.

The BMA is recommending doctors educate themselves about  electronic records, in order to begin the process of educating patients. Such proposals, in advance of the major advertising campaign to be launched by CfH, suggests that calls for fundamental changes to the programme, from the BMA at least, may now be at an end.

The point where major stakeholder groups begin to accept a common route forward, and to work together in that regard, is a significant milestone in the monumental changes to be ushered in by the National Programme.

After weeks of speculation, Accenture, one of four prime contractors for the £6bn National Programme for NHS IT (NPfIT), has walked away from its £2bn contracts for two of the scheme’s five regions.

The next few months – until the handover to CSC is completed in January – will be vital in ensuring that the programme is not allowed to be derailed.

The official line is that CSC, already responsible for NPfIT’s North West and West Midlands area, will apply its formula to get the lagging ex-Accenture regions back on track.

Though Accenture managed 827 deployments in its regions, they were almost exclusively smaller-scale GP and community care systems. CSC has done well delivering the large, complex patient administration systems (Pas) at the core of the programme, and, so the theory goes, can now do the same in the East and North East.

The main differentiator between the Accenture and CSC approaches was in their work with iSoft, the second-tier Pas provider that the two prime contractors shared. For the handover strategy to work, much will hinge on iSoft.

Since NPfIT’s first delays, NHS IT director general Richard Granger has emphasised the immaturity of the healthcare software market.

If the programme was buying accounting software it would have a range of options with well-resourced and experienced implementation and support teams, he says. But the programme is breaking new ground, and the systems contracted are still in development.

To some extent, NPfIT cannot win. NHS IT directors are baffled that Granger bought software that is still being built. But, equally, long-term government programmes are often criticised for being obsolete by the time they deliver.

Regardless of rights and wrongs, the relationship between the prime contracto r and the software supplier is of unusual importance. And where CSC took the iSoft situation in hand, Accenture walked away from it.

But even for CSC it is not all roses. Because development of iSoft’s next-generation software is slow, the systems it is installing now will have to be upgraded, and such a strategy will cause more upset along the way.

What happens next will depend on CSC’s continuing work with iSoft; how the latter’s financial issues play out; and the implications of Granger’s decision to create a catalogue of suppliers offering additional capacity.

Accenture’s departure has, so far, been managed as well as can be expected. But it is not over yet.