Does the digital telecom switchover threaten the lives of the most remote old and disabled? (UK, updated)

The UK’s recent preview of winter (which officially starts today), Storm Arwen followed by Storm Barra, was yet another exposure of the downside of the digital telecom switchover. As our UK Readers know, BT Openreach has been aggressively proceeding with the full conversion to VOIP by 2025 and closing the ‘broadband gap’ in rural and remote areas. Connecting them to the internet and more feature-filled VOIP service, including telecare services, has major advantages, especially where mobile service is sketchy or blank. 

Here’s the problem–power outages. According to the Energy Networks Association, 1 million homes and businesses in the northeast of England and Scotland lost power for days after Storms Arwen and Barra in late November, making it the worst storm in 15 years. Many of these homes were in rural villages and isolated areas. Power lines in these areas go down frequently in lesser storms that don’t have 100 mph winds and snow. When the power goes out, the VOIP goes out unless you have backup power. Phone lines no longer have their own power, as in the Public Switched Telephone Network (PSTN), equivalent to the US POTS (Plain Old Telephone Service or “copper”).

Add to this BT’s shortage of backup batteries. Digital phone systems in the US are usually installed with a backup battery, which isn’t cheap but sustains about 24 hours of basic voice service. Older models had special ‘brick’ batteries that you ordered from your phone provider that were around $50, newer models are powered by 12 D cell flashlight batteries that at least you can buy at the supermarket. Apparently, BT’s backup units are not only unavailable due to a global shortage, but also cost £85, a substantial charge to a pensioner–unless you live in a ‘not spot’ area without mobile service, in which case it’s free.

No power, no phone, no telecare, no PERS. But plenty of danger to thousands of older isolated adults, plus the frail, alone, and disabled. No connections to friends, carers, and emergency services for days, during a late fall snowstorm which made roads impassable. The storm may be early, but if this is a galloping start, there’s a whole winter to get through.

What about mobile service as a backup? Rural areas are, in bright sunny weather, plagued by spotty service. Supposedly nearly all areas in England have a minimum of 2G service sufficient to call 999. But when the cell phone masts go down, as they did in the storm, and the power to charge the phone is out, the backup is out of commission. One unnamed resident of Grizedale in the Lake District put a molto fino point on it. “It’s embarrassing that a supposedly world-leading country has such a shonky infrastructure. I had full 4G in the mountains of Transylvania a few years ago.”

Ofcom, the regulator, positioned the storms as exceptional. “Even in those circumstances, our rules are clear that there should be protections in place for people to call the emergency services” (999). Rules are one thing, reality another. Judge for yourself as we head into winter. BBC News Hat tip to Editor Emeritus Steve Hards.

Editor’s note for our US Readers: The situation is not that different for us. Nationally, POTS service is deteriorating and not being replaced by providers, forcing changes to VOIP. (I can personally speak to this–20 miles from NYC.) And if you believe that we’re well covered everywhere by cell phone service, you haven’t been to Lancaster County, Pennsylvania, much less further west in the area the locals call ‘Pennsyltucky’. That area also skews older–18.2% of state residents are age 65+. The US also has a wide variety of extreme weather–ice storms, blizzards, ‘snow bombs’, hurricanes, tornadoes, and tropical storms.

Call9 and an ’embedded’ approach to emergency response in nursing homes

Back in March, this Editor noted the substantial $34 million raise over the past three years by Call9. The Brooklyn-based company has pioneered an innovative approach filling a non-glamorous but badly needed gap in care–providing in-facility emergency care in SNFs and rehab facilities. Embedded in-facility first responders summoned by SNF nurses provide immediate care at a higher level than nursing home staff, married to telehealth capability that connects to remotely located emergency medicine doctors via a video cart and diagnostics.  The goal is to provide care immediately, avoid unnecessary and potentially harmful ER/ED admissions (estimated at 19 percent of ambulance transports), and generally keep SNF patients healthier while on site.

The numbers are there. Call9 reported in their studies a 50 percent reduction in ER admissions and a savings of $8M per year for a 200-bed nursing facility. Even if these numbers are high, a reduction is welcome news to SNFs, payors, Medicare, and one would think nursing home patients and families. Hospital readmissions within 30 days are also a CMS quality measure important to SNFs–the lower the better.

The Hunter College Center for Health Technology in their blog reported that one Call9 feature is special training for staff at their in-house Call9 Academy in the unique emergency care demands present in a SNF. These were initally learned first hand by the founder, Dr. Timothy Peck, who lived three months in a Long Island SNF’s conference room in order to better understand staff and patient needs.

It not only saves money, but fills other gaps in care and social determinants of health. Part of the Academy training covers the gap in palliative care with residents, and can facilitate Medical Orders for Life-Sustaining Treatment (MOLST) preparation with families. Last year, Call9 partnered with Lyft to provide transportation for family members of nursing home residents who have had a change in condition. Other partnerships serve the needs of community paramedicine services to connect with telehealth services as part of CMS’ ET3 model. The company currently covers over 3,700 beds in New York State, recently expanding to Albany, its third city.

A similar company, Third Eye Health, based in Chicago, covers about 15,000 beds but is a ‘lighter’ system that concentrates on remote care without the embedded staff and purely tablet based remote consults initiated by staff nurses. Both indicate through their growth and funding a surge in realization that both improved care and major savings to healthcare can be realized here.

Tender Alerts: Staffordshire’s £70m contract, Yorkshire and The Humber test

Susanne Woodman, our Eye on Tenders, alerts us to two tenders, the first which will definitely pique our UK Readers’ attention with its size and duration. The second is for a proposal using TECS and telemedicine as an alternative to emergency services.

  • Staffordshire: This is a huge seven-year contract to create the Support For Independent Living In Staffordshire (SILIS) Service to enable older and disabled adults to age in place in their current homes. “A key aim of the Service is to help Individuals to make changes to their home environment that will prevent the need for more costly interventions, such as admission to hospital or residential care, following life crises.” The Service will improve upon existing services in Assistive Technology (AT) including referral to telecare providers.

There are six borough and district councils involved, with the potential for use by nine more. The contract is valued at £70 million to start April 2018 with renewal points, ending in March 2025. Deadline is Wednesday 1 November at noon. Much more information (you’ll need it) on TED EU-Tenders Electronic Daily

  • NHS Greater Huddersfield & North Kirklees CCG: This tender is for the provision of a technology-assisted, rapid access service offering an alternative to hospital-based A&E services. Market test site is in Kirklees for residents of a care home. Requirements are:
    • A 24/7 clinical teleconsultation service delivered via secure video link into residential/ nursing homes, that is utilized instead of patients having to be taken to the local A&E department.
    • A service that provides clinical consultation not a logarithm based approach like 111.
    • A fully managed technical service utilizing bespoke laptops with HD cameras and with 4G SIM or broadband.

The CCG may also commission an accountable care organization (ACO) for this care in future, to which this contract would transfer. Deadline is 5pm on Friday 20 October to More information on Gov.UK.