TTA’s scorching week: events, tenders, app experts, diabetes telehealth, and When We’re 64!

 We enter Summer–and some scorching temps on both sides of the Atlantic. How to scorch your company during an EHR/HIT transition. A not-so-scorching diabetes telehealth study result. Events, tenders, app experts are hot, and We Sing A Song of Telemedicine When We’re 64–and still hot!

R2G’s annual mHealth App Survey is closing–and register now for The King’s Fund Digital Health meeting on July 11!

Tender Alert: Scotland Excel, Leeds, London/Manchester, Thurrock (Four from our Eye on Tenders–and most close 17 July)
Study doubts benefit of basic blood glucose self-monitoring for non-insulin T2 diabetes (Not encouraging for the Diabetes Monitoring Gold Rush)
Some London events and an opportunity to monetise your expertise (Editor Charles invites app reviewers, and three events are up)
Mismanaging a healthcare IT transition: what’s the cost? (Expensive by any metric, especially the customer and long term ones)
Singing a song–-of telemedicine (after you, McCartney!) (Congratulations to Paul on his 75th, not his 64th!, from a contributor)

June is all about change again at GE and GreatCall. A Nightingale is singing that tenders are up. Ericsson’s big study on 5G closing the gap. Telemedicine grows ever-larger and more accepted, even for bad news. Misbehaving robots and self-driving cars. And more!

Telemedicine may be appropriate for delivering ‘bad news’: study (More research needed)
UK Telehealthcare TECS MarketPlace event 4 July in Yorkshire, plus (Telehealthcare Awareness Week is end of June)
GE’s change at the top puts a healthcare head first (Many changes coming to The Blue Meatball)
Ericsson report: will 5G close the healthcare gap from hospitals into the home? (Major study from unexpected source)
Tenders closing quickly: Cornwall/Isles of Scilly, Blackpool (Blackpool is still open)
76% of health systems to adopt consumer telemedicine by 2018: Teladoc survey (But its use is changing)
The Nightingale-H2020 project for wireless acute care (UK/EU) (Major initiative, get on it before tender)
Behave, Robot! DARPA researchers teaching them some manners. (Rules for those Overrunning Robots and those Self-Driving Cars)
GreatCall’s acquisition: a big vote for older adult-centered healthcare tech (Private equity sees gold in the old)
Tech that assists those with speech impairments, telemedicine for mapping public health (Solving specific, important problems)
Wearable haptic/Braille guidance system for the visually impaired (MIT CSAIL innovation)

It’s all about change: the big EHR change at VA, change at the top at Tunstall Americas, and state telemedicine policy.

VA says goodbye to VistA, hello to Cerner for new EHR–and possible impacts (Big changes will take years)
Tunstall Americas has a new president/CEO (updated) (More details on this quiet change)
Texas gets its telemedicine on: governor signs off on full direct-to-consumer access (A change that leads the way for other states)

Previous articles of continued interest

Add hospital-acquired infections to your list, Google Ventures! (What kills 450,000 or more annually–in US alone)
DNA ‘Snapshot’ facial modeling–and predicting future Alzheimer’s risk (Out of Law & Order)
The King’s Fund Digital Health & Care Congress coming up fast! (London) (Register now for July!)

Breathe, exhale: a future bracelet that may predict asthma attacks through breath (Real research vs. the fakes)

In-home video monitoring acceptable to 90 percent of dementia carers: Age NI study (Feelings change in the Selfie Age)
Want to attract Google Ventures to your health tech? Look to these seven areas. (Won’t be easy)
Winston Churchill Memorial Trust – 2018 Travelling Fellowships (Global research grants for UK citizens)
International Conference on Rural and Elderly Health Informatics (Togo, W. Africa) (IREHI, 14-17 December–workshop papers due 25 July)

Successful Aging 2030: how far we haven’t come, how far we have to go (Over a coffee, Editor Donna’s full report from d.health Summit 2017)

The stop-start of health tech in the NHS continues (UK) (Hurry up and wait)

Thinking about a location for your health tech startup? Consider…’virtual’ Estonia! (A Baltic welcome to business–and you don’t have to leave home)

Blue Cedar releases new security for health apps, built into the app (A way around a roadblock)


 

 

Make your plans, if you have not already, to attend The King’s Fund’s annual Digital Health meeting in London. NHS England’s “Next steps on the five year forward view” outlines the plan to harness technology and innovation over the next two years. But what’s really happening on the ground? Find out in two full days of conference, networking, and exhibition. For more information and to register, click on the advert above or here


Have a job to fill? Seeking a position? Free listings available to match our Readers with the right opportunities. Email Editor Donna.


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Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine and health tech, worldwide–thoughtfully and from the view of fellow professionals

Subscribe here to receive this Alert as an email on Wednesdays with occasional Weekend Updates. It’s free–and we don’t lend out or sell our list–no spam here!

Donna Cusano, Editor In Chief, donna.cusano@telecareaware.com, @deetelecare

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Behave, Robot! DARPA researchers teaching them some manners.

click to enlargeWeekend Reading While AI is hotly debated and the Drudge Report features daily the eeriest pictures of humanoid robots, the hard work on determining social norms and programming them into robots continues. DARPA-funded researchers at Brown and Tufts Universities are, in their words, working “to understand and formalize human normative systems and how they guide human behavior, so that we can set guidelines for how to design next-generation AI machines that are able to help and interact effectively with humans,” said Reza Ghanadan, DARPA program manager. ‘Normal’ people determine ‘norm violations’ quickly (they must not live in NYC), so to prevent robots from crashing into walls or behaving towards humans in an unethical manner (see Isaac Asimov’s Three Laws of Robotics), the higher levels of robots will eventually have the capacity to learn, represent, activate, and apply a large number of norms to situational behavior. Armed with Science

This directly relates to self-driving cars, which are supposed to solve all sorts of problems from road rage to traffic jams. It turns out that they cannot live up to the breathless hype of Elon Musk, Google, and their ilk, even taking the longer term. Sequencing on roadways? We don’t have the high-accuracy GPS like the Galileo system yet. Rerouting? Eminently hackable and spoofable as WAZE has been. Does it see obstacles, traffic signals, and people clearly? Can it make split-second decisions? Can it anticipate the behavior of other drivers? Can it cope with mechanical failure? No more so, and often less, at present than humans. And self-drivers will be a bonanza for trial lawyers, as added to the list will be car companies and dealers to insurers and owners. While it will give mobility to the older, vision impaired, and disabled, it could also be used to restrict freedom of movement. Why not simply incorporate many of these assistive features into cars, as some have been already? An intelligent analysis–and read the comments (click by comments at bottom to open). Problems and Pitfalls in Self-Driving Cars (American Thinker)

Thinking about a location for your health tech startup? Consider…’virtual’ Estonia!

‘Extreme digital living’ is the norm in the Baltic country of Estonia, which rebuilt itself from the ground up after the formal dissolution of the Soviet Union (and each citizen receiving a distribution of €10) to one of the most advanced online-only countries in the world, far ahead of the US, the UK, and the rest of the EU. Internet access is by law a basic human right in Estonia. Digital signatures are equal in every way to paper signatures, except for marriage and divorce (a nostalgic touch). Everyday living is paperless and programming is taught in early grades. Live in picturesque Tallinn and need a delivery? It may come to your door via Starship robot, founded by one of the former Skype team. (Did you know that former Skypers have funded much of the Estonian tech and investment boom?) They take data security seriously with the Russian Bear growling (and hacking) on the border, so they created a NATO-accredited cyberdefense center in Tallinn and a whole country backup in a Luxembourg ‘data embassy’. Blockchain is a large part of this–and the government is working on using it for mapping the genome data of its 1.3 million citizens and sell it (deidentified) to precision medicine researchers.

So if you are a US, UK, EU, or even Australian-based developer, or already have a small tech company, why is this of interest? Estonia has opened a door for foreigners that is a most attractive one–virtual residency, no matter where you live. Once you’re an e-resident, simply register your company (online of course) and pay a fee of €145. You now can do business in euros–and fully access the EU. Most companies pay monthly administrative and accounting fees in Estonia, providing the country with income. About 1,400 companies have taken advantage of e-residency. It isn’t a tax haven, but if you do have income in Estonia, their corporate taxes are low–20 percent, compared to 19 percent for the UK, 30 percent for Australia, and a shattering 39 percent for the US (at present). Trading Economics And there is that tech and digital-savvy workforce as an additional incentive. Is This Tiny European Nation a Preview of Our Tech Future? (FortuneHat tip to TTA Founder Steve Hards

PwC: your job at risk by robots, AI by 2030?

click to enlargePwC‘s latest study on the effect of robotics and artificial intelligence on today’s and future workforce is the subject of this BBC Business article focusing on the UK workforce. 30 percent of existing jobs in the UK were potentially at a high risk of automation by the 2030s, compared with 38 percent in the US, 35 percent in Germany and 21 percent in Japan. Most at risk are jobs in manufacturing and retail, but to quote PwC’s page on their multiple studies, robotics and AI may change how we work in a different way, an “augmented and collaborative working model alongside people – what we call the ‘blended workforce’”. Or not less work, but different types of work. But some jobs, like truck (lorry) drivers, would go away or be vastly diminished.

The effect on healthcare? The categories are very broad, but the third category of employment affected is administrative and support services at 37 percent, followed by professional, scientific and technical at 26 percent, and human health and social work at 17 percent. Will it increase productivity and thus salaries, which have languished in the past decade? Will it speed innovation and care in our area? Will it help the older population to be healthy and productive? And the societal effects will roll on, but perhaps not for some. View this wonderful exchange between Jean Harlow and Marie Dressler that closes the 1933 film Dinner at Eight. Hat tip to Guy Dewsbury @dewsbury via Twitter

Technology for Aging in Place, 2017 edition preview

Industry analyst Laurie Orlov previews her annual review of ‘Technology for Aging In Place’ on LinkedIn with six insights into the changes roiling health tech in the US. We’ll start with a favorite point–terminology–and summarize/review each (in bold), not necessarily in order.

“Health Tech” replaces “Digital Health,” begins acknowledging aging. This started well before Brian Dolan’s acknowledgment in Mobihealthnews, as what was ‘digital health’ anyway? This Editor doesn’t relate it to a shift in investment money, more to the 2016 realization by companies and investors that care continuity, meaningful clinician workflow, access to key information, and predictive analytics were a lot more important–and fundable–than trying to figure out how to handle Data Generated by Gadgets.

Niche hardware will fade away – long live software and training. Purpose-built ‘senior tablets’ will likely fade away. The exception will be specialized applications in remote patient monitoring (RPM) for vital signs and in many cases, video, that require adaptation and physical security of standard tablets. These have device connectivity, HIPAA, and FDA (Class I/II) concerns. Other than those, assistive and telehealth apps on tablets, phablets and smartphones with ever-larger screens are enough to manage most needs. An impediment: cost (when will Medicare start assisting with payments for these?), two-year life, dependence on vision, and their occasionally befuddling ways.

Voice-first interfaces will dominate apps and devices. “Instead we will be experimenting with personal assistants or AI-enabled voice first technologies (Siri, Google Home, Amazon Alexa, Cortana) which can act as mini service provider interfaces – find an appointment, a ride, song, a restaurant, a hotel, an airplane seat.” In this Editor’s estimation, a Bridge Too Far for this year, maybe 2018. Considerations are cost, intrusiveness, and accuracy in interpreting voice commands. A strong whiff of the Over-Hyped pervades.

Internet of Things (IoT) replaces sensor-based categories. Sensors are part of IoT, so there’s not much of a distinction here, and this falls into ‘home controls’ which may be out of the box or require custom installation. Adoption again runs into the roadblocks of cost and intrusiveness with older people who may be quite reluctant to take on both. And of course there is the security concern, as many of these devices are insecure, eminently hackable, and has been well documented as such.

Tech-enabled home care pressures traditional homecare providers – or does it? ‘What exactly is tech-enabled care? And what will it be in the future?’ Agreed that there will be a lot of thinking in home care about what $200 million in investment in this area actually means. Is this being driven by compliance, or by uncertainty around what Medicare and state Medicaid will pay for in future?

Robotics and virtual reality will continue — as experiments. Sadly, yes, as widespread adoption means investment, and it’s not there on the senior housing level where there are other issues bubbling, such as real estate and resident safety. There are also liability issues around assistance robotics that have not yet been worked out. Exoskeletons–an assistance method this Editor has wanted to see for several years for older adults and the disabled–seems to be stalled at the functionality/expense/weight level.

Study release TBD

Robot-assisted ‘smart homes’ and AI: the boundary between supportive and intrusive?

click to enlargeSomething that has been bothersome to Deep Thinkers (and Not Such Deep Thinkers like this Editor) is the almost-forced loss of control inherent in discussion of AI-powered technology. There is a elitist Wagging of Fingers that generally accompanies the Inevitable Questions and Qualms.

  • If you don’t think 100 percent self-driving cars are an Unalloyed Wonder, like Elon Musk and Google tells you, you’re a Luddite
  • If you have concerns about nanny tech or smart homes which can spy on you, you’re paranoid
  • If you are concerned that robots will take the ‘social’ out of ‘social care’, likely replace human carers for people, or lose your neighbor their job, you are not with the program

I have likely led with the reason why: loss of control. Control does not motivate just Control Freaks. Think about the decisions you like versus the ones you don’t. Think about how helpless you felt as a child or teenager when big decisions were made without any of your input. It goes that deep.

In the smart home, robotic/AI world then, who has the control? Someone unknown, faceless, well meaning but with their own rationale? (Yes, those metrics–quality, cost, savings) Recall ‘Uninvited Guests’, the video which demonstrated that Dad Ain’t Gonna Take Nannying and is good at sabotage.

Let’s stop and consider: what are we doing? Where are we going? What fills the need for assistance and care, yet retains that person’s human autonomy and that old term…dignity? Maybe they might even like it? For your consideration:

How a robot could be grandma’s new carer (plastic dogs to the contrary in The Guardian)

AI Is Not out to Get Us (Scientific American)

Hat tip on both to reader Malcolm Fisk, Senior Research Fellow (CCSR) at De Montfort University via LinkedIn

Touch and feeling through a bionic prosthetic arm (DARPA-Univ. Pittsburgh)

click to enlargeA robotic arm with a neural interface that allows the user to experience touch has been developed by the University of Pittsburgh and University of Pittsburgh Medical Center, funded by the Defense Advanced Research Projects Agency (DARPA).  The Revolutionizing Prosthetics program since 2006 has been developing advanced upper-limb prosthetics. Their first was the Gen-3 Arm System by DEKA Integrated Solutions Corporation, submitted for 510(k) in 2012. The subject for the test of the touch interface, Nathan, has been a quadriplegic from the chest down since 2004. He permitted four microelectrode arrays, each about half the size of a shirt button, to be placed in his brain: two in the motor cortex and two in the sensory cortex regions that correspond to feeling in his fingers and palm. Wires run from the arrays to the robotic arm, which has torque sensors that detect when pressure is applied to its fingers. These physical “sensations” are converted into electrical signals back to the arrays in Nathan’s brain so that he has the sensation of feeling and touch.  The sensation of touch in the bionic arm is near 100 percent natural and accurate. This research has great potential both for prosthetics and for other neurological conditions. Armed With Science.  Video

Artificial intelligence with IBM Watson, robotics pondered on 60 Minutes

click to enlargeThis Sunday, the long-running TV magazine show 60 Minutes (CBS) had a long Charlie Rose-led segment on artificial intelligence. It concentrated mainly on the good with a little bit of ugly thrown in. The longest part of it was on IBM Watson massively crunching and applying oncology and genomics to diagnosis. In a study of 1,000 cancer patients reviewed by the University of North Carolina at Chapel Hill’s molecular tumor board, while 99 percent of the doctor diagnoses were confirmed by Watson as accurate, Watson found ‘something new’ in 30 percent. As a tool, it is still considered to be in adolescence. Watson and data analytics technology has been a $15 billion investment for IBM, which can afford it, but by licensing it and through various partnerships, IBM has been starting to recoup it. The ‘children of Watson’ are also starting to grow. Over at Carnegie Mellon, robotics is king and Google Glass is reading visual data to give clues on speeding up reaction time. At Imperial College, Maja Pantic is taking the early steps into artificial emotional intelligence with a huge database of facial expressions and interpretations. In Hong Kong, Hanson Robotics is developing humanoid robots, and that may be part of the ‘ugly’ along with the fears that AI may outsmart humans in the not-so-distant future. 60 Minutes video and transcript

Speaking of recouping, IBM Watson Health‘s latest partnership is with Siemens Healthineers to develop population health technology and services to help providers operate in value-based care. Neil Versel at MedCityNews looks at that as well as 60 Minutes. Added bonus: a few chuckles about the rebranded Siemens Healthcare’s Disney-lite rebranding.

A brief history of robotics, including Turing and Asimov (weekend reading)

click to enlargeTechWorld gives us a short narrative on robotics history dating back to Asimov’s Three Rules of Robotics (1942), Turing’s Imitation Game (1950) and the pioneering work of several inventors in the late 1940s. There’s a brief tribute to Star Wars’ R2-D2 (Kenny Baker RIP) and C-3PO.  It finishes up with AI-driven IBM Watson and Deep Mind’s AlphaGo. Breezy but informative beach reading! Hat tip to Editor Emeritus and TTA founder Steve Hards; also read his acerbic comment on Dell and Intel’s involvement in Thailand’s Saensuk Smart City

The healthcare future according to Britons before London Technology Week

click to enlargeMore robots than people, VR visits to the GP and 3D printed human organs were among the predictions in a survey of over 2,000 British adults. Also in their collective vision in the next 20 years (2036) were communications devices being embedded inside the human body (37 percent), a cloned human born by that year (50 percent), clothing connected to the internet (50 percent) and more driverless cars than conventional models. The study was conducted by SMG Insight and YouGov, commissioned by London & Partners, the Mayor of London’s promotional company, in the runup to London Technology Week through 26 June, highlighting London as a global technology hub. According to their release, an EY report ranked London as second only to Silicon Valley as the most likely place to produce the world’s next tech giant. The event also promotes Imperial College London’s Foresight team and their Tech Foresight 2036 on 24 June.  Also ITPro.

Robot greeter on the job at Ostend, Belgium hospital–and those killer robots

click to enlargeThis humanoid (but not Terminator-like, its developers are careful to say!) robot is currently on the job as a receptionist at Ostend, Belgium hospital AZ Damiaan. Equipped with healthcare-oriented software developed by local company Zora Robotics, the Aldebaran/SoftBank Robotics’ demure Pepper robot stands 1.2 meters (just under 4 feet), speaks 19 languages and works for about 20 hours on a single charge. Pepper communicates via its tablet interface but also is responsive to actions and emotions in what SoftBank calls a natural and intuitive way. The Pepper robot was first deployed in the hospital’s maternity area. The video has an awwwww…. illustration of a newborn grasping Pepper’s fingers. Previously, the toddler sized Nao robot worked with patients at AZ Damiaan for physical therapy. (Nao robots have also been featured in modern dance and as greeters at Japanese hotels and banks.) Reuters (video 1:51)

click to enlargeThis is a far more benign take on robots than the Daily Mail‘s recent screamer that “Killer robots are ‘quickly moving toward reality’ and humanity only has a YEAR to ban them” which conflates drone weaponry (human guided) with ground robots (human guided). As of now, They’re Still Puppets (more…)

Your weekly robot fix: ingestible robot fetches swallowed button batteries, more

click to enlargeA research team drawn from MIT, the University of Sheffield and the Tokyo Institute of Technology has developed an ‘origami’ robot to aid in the location and fetching the result of a common and potentially fatal incident–swallowed button batteries or other foreign objects. The robot is swallowed in a capsule which dissolves. It then unfolds its dried pig intestine appendages and is directed by external magnetic fields towards the battery, attaches to it and safely moves through the digestive system. Another potential use is to patch wounds or deliver medicine to a specific location. Unlike other robots, it is untethered and moves freely, propelling itself through a ‘stick-slip’ motion, and is resistant to acidic gastric fluids. Next steps for the team are to equip it with sensors and to perform animal and human in vivo testing. ZDNet

Nosocomial hospital infections may also get a good zapping by disinfecting robots. In an 18 month test at Lowell (Massachusetts) General Hospital, robots with pulsing xenon high-dose ultraviolet light from Xenex Disinfection Services disinfected the Lowell Hospital ORs nightly in addition to routine chemical disinfection. The study estimated that they avoided an estimated 23 infections at a cost savings of one life and $478,000. MedCityNews.

Robotics in healthcare will also be part of the five tracks centered on informatics available to attendees of HEALTHINFO 2016, August 21 – 25, 2016 in Rome’s H10 ROMA CITTA,  organized by IARIA (International Academy, Research, and Industry Association). More information here.

And if you wonder if humans will be able to find work when robots take over everything (maybe we just go to conferences and have a guaranteed income?), take comfort (or not) in this interview with one of the two authors of Only Humans Need Apply: Winners and Losers in the Age of Smart Machines, a new book by Thomas Hayes Davenport and Julia Kirby. “One is to work alongside smart machines, and complement their activity. The other is to dip into what smart machines are unlikely to be able to do any time soon.” The emphasis on STEM education may be misplaced as many of these jobs will be replaced by AI. In healthcare, they predict that automation will displace specialists and empower GPs, leaving room for ultra specialization in combinations not thought of today. Robots beware: Humans will still be bosses of machines (TechRepublic)

Drone ‘bots’ to help older adults in future

click to enlargeA Saturday Robot Fix! Short article in yesterday’s NY Times about development of tiny household drones to fetch medications and do other simple tasks around the house (like cleaning). These ‘Bibiddi Bobbidi Bots’ are under development at the University of Illinois. This Editor will take several to go clean. But do they do laundry? I’d rather take the new iteration of a 4′ Robby the Robot under development in Seattle by an ex-Microsofter who founded Hoaloha Robotics. Practical? Perhaps not, says Laurie Orlov of Age in Place Technology, who’s been up and down a few hype curves. And will it help older people stay connected, even though help around the house is always appreciated? The withering comment on the Jibo robot from a 91 year old at the end of the article does put a damper on it. Still, Robby could make me a dress of sapphires any old time (as did his namesake in Forbidden Planet). As Aging Population Grows, So Do Robotic Health Aides 

Is ‘pure’ robotic telesurgery nearing reality?

click to enlargeMoving beyond robot-assisted surgery (e.g. the well-accepted use of the daVinci system with prostate surgery), controlled by a surgeon present in the operating room, is telesurgery, where a remote surgeon uses a robot to fully perform surgery at a distant location. The Nicholson Center at Florida Hospital in Celebration, Florida, which specializes in training surgeons and technicians in leading (bleeding?-Ed.) edge techniques, is studying how internet latency (lag time to the non-techie) affects surgical effectiveness. Latency is defined in this case as “the amount of delay a surgeon can experience between the moment they perform an action to the moment video of the action being carried out at the surgery site reaches their eyes.” Their testing so far is that internet latency for surgery between hospitals has a threshold of 200-500 milliseconds before dexterity drops off dramatically (not desirable)–and that given the current state of the internet, it is achievable even at a mid-range distance tested (Florida to Texas). Making this a reality is highly desirable to military services worldwide, where expertise may be in, for example, Germany, and the casualty is in Afghanistan. It would also be a boon for organizations such as the Veterans Health Administration (VA) where resources are stretched thin, rural health and for relief agencies’ disaster recovery. ZDNet

Your Friday robot fix: the final DARPA Robotics Challenge

click to enlargeThey’re Still Puppets! The final DARPA Robotics Challenge took place last week at the Fairplex racetrack in Pomona, California. 10,000 spectators viewed 24 teams’ robots going through their disaster-response paces to win a share of $3.5 million in prize money in this final stage of the DARPA three-year program. Many of the robots were custom, but several teams fielded adaptations of the Boston Dynamics Atlas robot as a common platform. The engineering teams were sequestered in a ‘garage’ offsite and linked to their robot charges by a deliberately degraded communication system (to simulate field conditions). The robots had no cords (unlike 2013) and were given eight tasks: driving a car down a dirt road, getting out of the car, opening a door and entering a building, turning a valve, cutting a hole in a wall with a drill, completing a surprise task (flipping a switch or unplugging a tube and plugging it into another hole), navigating a pile of rubble, (more…)

10th Anniversary Article 1: The Next Ten Years of Telecare

This year, on the 10th Anniversary of Telehealth and Telecare Aware, we have invited industry leaders nominated by our readers to reflect on the past ten years and, if they wish, to speculate about the next ten. Here is the first article, with a UK focus, by Dr Kevin Doughty.

Many of us are frustrated at how little progress there has been in the deployment and acceptability of telecare during the past decade. Yet, despite warnings that an ageing population was about to bankrupt the NHS (and health insurance schemes elsewhere in the world), and that access to social care for older people was being withdrawn at such a rate that it could only be afforded by the wealthiest in society, our health and social care systems have just about survived.

But this can’t go on, and in England over the past 12 months: (more…)