NHS England has sketched out the future of healthcare and it will be one using smartphones and wearable bio-sensors to monitor ourselves and alert clinicians. NHS National Medical Director Sir Bruce Keogh has written to around 250 organisations across health, social care, industry and third sector asking them to support the Technology Enabled Care Services (TECS) programme which he says will take the NHS into this new technological era.
The TECS programme, born out of the Three Million Lives (3ML) initiative (which didn’t quite go anywhere after all the song and dance, including from Prime Minister David Cameron), was reviewed last year resulting in the change of focus to “address the demand for support and practical tools to commission, procure, implement and evaluate technology enabled care services” according to Sir Bruce’s letter as reported on the NHS England website.
The TECS Stakeholder Forum‘s views and proposals now form the TECS Improvement Plan for 2014-17. This is a broader group following the failure of the 3ML Stakeholder Forum, which consisted mainly big industry organisations, to achieve anything of substance.
According to the NHS England website posting, Sir Bruce explains: “To ensure continued progress, we have brought together a TECS Implementation Group consisting of experts and leaders from across these sectors whose remit is to support the strategic development and delivery of the proposals within the Improvement Plan. In addition, we have formed the TECS Executive Steering Group which meets regularly to provide clinical, technological and strategic leadership for the programme at a director level in NHS England.”
This all sounds like a lot of bureaucracy and a drawn out attempt to rescue what remains of the 3ML programme. I started thinking of the Titanic and deck chairs.
Readers will find the very readable McKinsey survey of patient attitudes to digital health valuable in helping them determine the best way forward to develop their online services.
The survey covered patients in three very different health services – UK, Germany and Singapore. Principal findings, headlined as five busted myths, were:
Myth: People don’t want to use digital services for healthcare – actually 75% of them (more…)
Dr Stephen Hicks is a Research Fellow in neuroscience and visual prosthetics at the University of Oxford. He and his team are working on a project to develop a pair of glasses to help partially sighted people “see” what is in front of them.
BBC’s Johny Cassidy spoke to Hicks recently about the Oxford smart specs project for BBC’s In Touch programme. The project uses Augmented Reality (AR) to make objects in the field of vision sharper for partially sighted people. Hicks says the object is to “try to make a pair of glasses which look relatively normal to people in the environment and still provides a computer based object enhancement and object detection that would be able to be seen by people with very, very limited sight”.
The glasses use two cameras, a gyroscope, a compass and a GPS unit. The “lenses” are made of transparent OLED displays enabling the wearer to see through with any available sight and also allowing others to see the user’s eyes.
“The next step in terms of commercial development is to reduce the size of the glasses and the processing unit into something acceptable to people in day to day life”, says Hicks. The “take-home” versions are targeted to be built in autumn this year.
How much is it likely to cost? A stated goal of the project is to keep the costs down so that the maximum number of people as possible will have access to these glasses. So where possible off-the-shelf components are being used. Hicks says that a pair of glasses for less than £300 is possible compared to just under US$10,000 for the only other one that Johny Cassidy had been able to find. Google Glass, Epson Moverio and similar glasses are, of course, not functionally comparable.
UK Telehealthcare is again having a free-to-attend London Market Place in Kensington Town Hall, on 2nd June 2014. In case you are wondering, UK Telehealthcare is the re-branded London Telecare. The change which took place in September last year is taking the London Telecare model nationwide.
These Market Place events provide the supplier members of UK Telehealthcare the opportunity to show their telehealth and telecare products and for visitors to try them out and discuss their requirements. The Market Place is open for five hours and there is a programme of talks running in parallel. See the flyer (pdf) for other details. As the flyer says, there is no need to book but please let Doug Miles know id you are planning to attend.
The Telecare Learning and Improvement Network (LIN) newsletter for April is out now to download and read at your leisure and as usual contains a host of items from the last month.
There is a good roundup of UK care news in the face of the creation of the Clinical Commissioning Groups as well as news from further afield.
The LIN comes from the Health Tech and Medicines Knowledge Transfer Network which was, until April, one of the many KTNs funded by the UK Technology Strategy Board (TSB). There has now been a major reorganisation of KTNs at the TSB and the various KTNs have been consolidated into one KTN with communities within this KTN specialising in different areas. There is no mention of what impact, if any, this will have on ALIP and the the Telecare LIN – perhaps something for next month?
Telehealth and telecare applications can often depend on the willingness of the users to use the internet and that is not to be taken for granted with older users. On the other hand it is indeed the older people who can most benefit from these technologies. Recent research in the UK shows encouraging results in this respect.
Ofcom, the UK telecoms regulator, has a duty to promote media literacy and to carry out research to measure the usage of all forms media. The results of the most recent surveys commissioned by Ofcom were published on Tuesday. Adults’ Media Use and Attitudes Report 2014 is an encouraging report showing that the use of the internet by over-65s has increased by over a quarter over the past 12 months.
“The proportion of people aged over 65 that are accessing the web reached 42% in 2013, up nine percentage points from 33% in 2012. One reason found for this is an increase in the use of tablet computers by older people aged 65-74 to go online, up from 5% in 2012 to 17% in 2013. This has helped to drive overall internet use up from 79% of all adults in 2012 to 83% in 2013” say Ofcom.
“However, older people spend significantly less time surfing the web than younger people (16-24 year olds), who on average spend more than a whole day (24 hours 12 minutes) each week online. This compares to an average 9 hours 12 minutes online per week among adults over 65.”
Although these results are for the UK, they probably broadly represent the trends in most developed countries.
The Government of Wales has announced that it is to develop a new eHealth and care strategy in conjunction with health boards, NHS trusts and local authorities in Wales. The strategy will focus on using technology such as video conferencing, remote monitoring and better use of health records.
In a written statement issued last week while the Welsh Assembly is on its break, the minister for health and social services states that consultation will take place with health and social care professionals and users and the strategy will be in place by the end of the year.
“This will help us achieve our aim of ensuring there are more services, care and support available for patients in their homes or in their local communities” says the statement from Mark Drakeford.
“Technology has a key role to play. This could include the use of video conferencing to allow patients and health professionals to talk to each other; to aid diagnosis and decision making and remote monitoring for people with particular health conditions. Technology can also help improve access to services by bringing them closer to people’s homes, for example by providing mobile services in rural areas.
“With an increasing ageing population it is essential we enable people to live independently for as long as possible. Without this, the health and well-being of individuals will be adversely affected.
“We will expect our information to be accessible to professionals where and when it is needed whether in health or in social care. We already have the Individual Health Record, with appropriate security and governance in place. Any potential wider access to people’s data would only be with their consent.”
The full statement is available on the Welsh Government website here.
The number of people requiring care in the UK is expected to outstrip the number of adult children and family members able to provide that care sometime in 2017 according to a new report released today.
“Generation Strain: collective solutions to care in an aging society” is the result of research by the respected Institute of Public Policy Research. The authors note that most care for older people in the UK is provided by family at a value estimated to be £55 billion. But with the changing demographics the number of adult children able to care for aging parents is diminishing and is expected to reach a break point in the UK in three years, meaning more dependency on already stretched state and private agencies and more people, specially women, having to give up work to look after their parents.
The central message of the report is the need to transform the understanding of what social care is in order to help people live decent lives in their old age. With insufficient adult children to provide care for parents and more older people themselves becoming carers, the needs of the carers needs to be taken very seriously – social isolation and loneliness, need for transport and shopping, for example.
The report proposes new neighbourhood networks to help people stay active and healthy and help busy families balance work and care.
These are social problems which can be mitigated, if not solved, by some of the trendy new technologies that we use daily with hardly a second thought but are often not seen as a high priority for the well being of the older person.
Other recommendations are replacement of the current case management process provided by local council adult social services, giving the older people, their families and carers direct access to some of the budget and changing employment rights so more people can continue to work and care.
A highly recommended read. The full report can be downloaded as a pdf from the link above.
A new report analysing the telehealth development in the UK and proposing improvements has been produced by Inside Commissioning. The report Tackling Telehealth – how CCGs can commission successful telehealth services is written by a panel of authors led by Dr Ruth Chambers who co-chairs NHS England’s Task and Finish group for commissioning skills and capability for the delivery of Technology Enabled Care Services (TECS).
The UK has been experimenting with telehealth as much as any country in the world and has notably carried out the largest clinical trial of telehealth anywhere, the Whole System Demonstrator (WSD). WSD produced some valuable results with regard to telehealth benefits, including reduced mortality, and was instrumental in the launching of the key government telehealth programme, 3 Million Lives (3ML) in 2011.
Last year the GP magazine had carried out a major survey of telehealth implementation in the UK by making information requests from all 176 Clinical Commissioning Groups (or CCGs, a new administrative unit introduced by the current government) under the Freedom of Information Act (a common technique to gather official data). A comprehensive analysis of the returned data (108 out of the 176 had responded) forms a major part of the Tackling Telehealth report.
The research results reported are mixed. Some of the results make painful reading. The 3ML target of 100,000 telehealth users in seven pioneering “pathfinder” areas by end of last year was dismally missed with the actual figure being below 3,000. In one pioneer area the local council had withdrawn a telehealth tender due to lack of a supplier able to meet the requirements. Another 3ML pioneer area had decided to decommission its telehealth services. Meanwhile other CCG areas have reported more than 1,000 telehealth users each and one had budgeted £1M for services this financial year.
The report looks at what needs to change for telehealth to be successful and follows this up with a case study.
This is a very well written and professionally presented report. I do have one reservation though. The case study deals with the selection of a supplier for telehealth products in Nottinghamshire and quite blatantly that selected supplier is noted as a co-producer of the report. I think this does bring the independence of the report into question and somewhat spoils the authority which it may otherwise have had.
The report is free to download so long as you register on the Inside Commissioning website here.
Vodafone has signed a global partnership with AstraZeneca in order to develop m-health services to improve the outcome for patients with cardiovascular conditions. The collaboration will create new mobile and internet-based services to support patients through their treatment journey, improving medication adherence and giving patients confidence to manage their condition more effectively, according to the press release.
AstraZeneca’s Intelligent Pharmaceutical Group will lead the project with Vodafone charged with providing the technology, infrastructure and expertise for the new services.
The UK-based operator said it will also look to capture data from a variety of sources to improve overall engagement between patients and healthcare professionals. All the new services will be designed to work across geographies.
“Bringing together the best in connectivity with the best in treatment and education will create powerful and compelling outcomes for patients,” according to a comment attributed to Vodafone M2M Director Erik Brennais. But there is little in the way of details of what the two companies may develop or the timescales.
“Care in Crisis 2014“, the third edition of their Care in Crisis report was published by Age UK last week. This is the first update since the 2012 report and and contains the details of funding for social care in the UK.
Age UK say that the Care Bill which is currently progressing though Parliament and has just completed all its stages in the House of Commons, has addressed some of the concerns about the framework for care and support for older people. Also, the government’s commitment to transfer £3.8 billion from the NHS (Better Care Fund) for joint NHS and local council decisions about funding for health and care services from 2015 is seen as a positive move.
However this funding can only mitigate and not solve the huge reduction in the availability of services caused by a combination of the recent real term cuts in spending and the increase in demand due to demographics. Between 2005/6 and 2010/11 public funding for older people’s social care stagnated and from 2010/11 to 2013/14 public funding for older people’s social care (including transfers from the NHS to councils) decreased by 10 per cent in real terms according to the government’s Health and Social Care Information Centre. This reduction in spending in the face of increasing demand has meant that more and more councils are only providing care for those in substantial or critical need.
Without substantial growth in the overall funding envelope, says Age UK, the Government’s aspirations to “transform the social care system to focus on prevention and the needs and goals of people requiring care” cannot be achieved.
This well researched report has some excellent data and an analysis of future funding requirements which would be invaluable for anyone trying to understand the current state of the UK care scene.
The Scottish Health Secretary, Alex Neil, has announced the investment of an additional £10 million (about US $ 15 million) to support home health monitoring solutions across Scotland, the BBC has reported. This additional funding for the NHS Boards will enable people to use technology such as tablet computers and smartphones to monitor conditions such as diabetes, heart problems and lung problems at home, the report added.
In 2011, Nicola Sturgeon MSP, Cabinet Secretary for Health, Wellbeing and Cities Strategy in Scotland set out her strategic vision for achieving sustainable quality in the delivery of healthcare services across Scotland, in the face of the significant challenges of Scotland’s public health record, changing demography and the economic environment. The Scottish Government’s 2020 Vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting and, that Scotland will have a healthcare system where, amongst other goals, there will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.
Mr Neil’s announcement was made during a debate in the Scottish Parliament entitled ‘Update on Delivering the 2020 Vision in NHS Scotland’. Mr Neil claims past efforts in telecare and telemedicine have meant that £2.8 million has been “ploughed back” into Scottish frontline services and reduced emergency admissions to hospital by 70 per cent.
Health apps are often in the news these days. Ofcom, the UK telecommunications regulator, commissioned Kantar Media to carry out qualitative research on attitudes and behaviours of apps users when using devices such as smart phones and tablets. The resulting report, Apps Environment, published today by Ofcom makes interesting reading.
Although the report was commissioned by the UK regulator, I think the findings are applicable to any country. What’s more, the generic nature of the conclusions make them relevant to health apps as much as to any others.
The report says that “among app users, several perceptions were found to be influencing behaviours, attitudes and the low level of concern in the app environment. These perceptions were:
• official app stores monitor and vet the apps they make available;
• well-known brands provide a safe, secure and reliable user experience, and;
• apps are safer than browsers due to their more limited and contained nature compared to browser-based internet use.”
Another finding was that many app users said they paid very little attention to permissions requested by apps – nothing new there then. How many times have you ticked that “I Agree” box to the terms and conditions without reading them?
Very few participants in the research are reported to have raised spontaneous concerns about apps. The researchers say that when prompted, in-app purchasing and advertising were of greatest concern to parents, and at most, a frustration or annoyance to others.
This shows that when it comes to more critical apps such as health apps or those that are designed to provide a safety net in a care environment a stronger regulation may be needed as well as a pro-active educational effort to emphasise the need to be aware of issues such as data privacy.
Responsive holograms that change colour in the presence of certain compounds are being developed into portable medical tests and devices, which could be used to monitor conditions such as diabetes, cardiac function, infections, electrolyte or hormone imbalance easily and inexpensively, according to the University of Cambridge. It is claimed that the technique can be used to test blood, breath, urine, saliva or tears for glucose, alcohol, drugs, bacteria or hormones. Clinical trials are said to be underway to test glucose and urinary tract infections (UTI) in diabetics at Addenbrooke’s Hospital.
It is estimated that the reusable sensors could cost as little as UK £ 0.1 (about US 15 cents) to produce, making them affordable for use in developing countries. A prototype smartphone-based test suitable for both clinical and home testing of diabetes and clinically relevant conditions is under development.
If this is a commercial success this could form the basis of a multi-purpose portable tester suitable for telehealth use.
A research paper, Light-Directed Writing of Chemically Tunable Narrow-Band Holographic Sensors, has been published in Advanced Optical Materials.
The January 2014 newletter from the Telecare Learning and Improvement Network was published two days ago and has the usual rich collection of news and links to news and articles. This month there is a lot on dementia. Always a good read to catch up with any news you may have missed and for pointers to some events.
Here’s a selection of articles if you have a few idle minutes this coffee break in which to soak up some interesting views.
Emerging Niche: Telehealth from the American Occupational Therapy Association tells the story of what Jana Cason did when she took over an OT caseload which involved a 4-hour round trip.
Telecare handling 100,000 calls every six months from the Times of Malta gives a brief insight into telecare growth in Malta.
Telehealth trend rings in changes to care in The Tennessean debates the pros and cons of telehealth in pediatric care in the US
Do we know enough about telehealth to know it’ll work? from Total Politics is a fascinating debate by two British MPs and a Research Fellow from Nuffield Trust