Tony Watts, writer and chair of the SouthWest Forum on Ageing, explains the dual benefits of integrating development of digital healthcare, and action to help older people use digital technology and the internet.
An EU-funded study encompassing Italy and South West England has just demonstrated the significant health benefits of social media for older people. At the report launch in Italy, Tony Watts OBE gave one of the keynote presentations. In this précis of his presentation, Tony argues that:
Tony has now been asked to chair a Community Interest Company In the South West of England developing a “digital healthcare cluster” – made up of innovators, universities, researchers and older people themselves. From its home at the Bristol Robotics Laboratory it will “showcase solutions and make sure we plug straight in to a technology that will be the big game changer in the next few decades”.
We live in an ageing society. Not just in the UK and here in Italy, but globally. And we all know the statistics… how many more of us will have lengthy periods of our later life needing support; how many will be living with dementia, or be socially isolated. Often without families to help us.
This presents governments with huge challenges: not least how do we fund pensions and our rapidly rising health and social care bills? What I want to offer is a dual perspective:
So how can these aims best be achieved? For some time, there have been artificial barriers between two strands of digital technology: on one hand, the Internet, and with it apps such as social media and using the web for information, advice, entertainment, connecting and communicating… all of which can be a force for good in older people’s lives.
And on the other, digital healthcare: the technology to enable a person to remain living independently in their own home for longer through monitoring their condition and their environment. Both of these technologies are still “in the foothills” amongst older people and are a long, long way from fulfilling their potential. My argument is that, if you put the two together, you create an unstoppable force.
We still have huge numbers of older people who do not use the Internet, or use it very rarely, because it is seen as expensive, complicated, dangerous. They worry that they might break something or have their money stolen. Most critically, they believe that it’s irrelevant to their lives. “I don’t need the Internet” is the most common phrase I hear. Along with, “I’ve managed 70 or 80 years without it. Why should I bother now?”
For these people, the digital divide is rapidly becoming a digital gulf as more and more important services go on line. Information from public bodies. Banking. Booking hospital appointments. And that’s before all the benefits of getting cheaper holidays, buying your shopping or switching utility suppliers….
It is bad enough now. But this trend will increasingly impact upon the quality of these people’s lives as they become more and more divorced from the way the rest of us connect and communicate. How has that happened? Indeed, how has it been allowed to happen? I believe, in part, it has been a market failure which is only now being remedied.
Look at how you market any new product or service, and you come up with the criteria which will turn potential customers on: will it make my life easier? Or more enjoyable? Perhaps more fulfilling? Will it save me money… what will it do to my quality of life?
Critically, will I enjoy the experience? To me, the way that digital inclusion has been “sold” to older people has all too often been entirely wrong.
For instance, huge amounts of money were spent in our country on encouraging people to go into libraries and learn how to use Microsoft Word, on clunky personal computers that would put off any first time user. Many have been put off because they have been made to feel that they are too old, too stupid to be part of the digital world.
I speak to so many older people who tell me they “have given it a go”, but they found it complicated, even bewildering. They’ve now forgotten what they were taught, and the computer their son or daughter bought them lies unused. Or that – yes, they do have a computer, but they only go on once a day to see if they have any emails, and that’s as far as they feel able to go.
And this all comes down to how easy – or otherwise – the technology appears, and whether this is an enjoyable experience and not just a necessary one.
For someone not used to the iterative steps of digital advancement over the last few decades, or possessed with a young, plastic mind, it’s like persuading someone who has only ever ridden a horse to get into a car and drive. Not only that, the car itself is incredibly difficult to drive. And even worse, it only takes you down a road to a place you never wanted to go to anyway.
But, and it’s a very large “but”, if you stop making people think they are using a computer by giving them a tablet or smart TV to use, you instantly remove a big psychological barrier.
What’s more, this thing that isn’t a computer is easy to use… It’s intuitive, logical and actually enjoyable. And when you start showing people how to use Skype, or enjoy recordings of their favourite TV or radio programmes, you start making it relevant to their lives as well as fun.
So let’s now focus on digital healthcare: how can that be made into a major trigger for older people to be connected?
In the UK - indeed, globally - we face a mountainous challenge of enabling a rapidly growing number of people to remain independent in their own home. At the same time, our social care system is breaking down as local authorities “salami slice” spending, and ration care to those who are seriously ill.
We have to engage the wider community – families, neighbours, friends – with monitoring the wellbeing of our loved ones, as well as enable older people themselves to play a bigger part in controlling their environment and condition.
These are people often living alone, with a complex variety of conditions - including onset dementia. Often, the situation is that one elderly person with health issues is trying to care for their partner – and struggling to manage. They want to stay in their own home for as long as possible – but often are forced to go into care because their home is considered to be unsafe for them… or their condition need constant monitoring.
Digital healthcare can provide a solution for many of these situations. However, it must complement, not replace human visits and contact, and it must be done in a way that is not intrusive. It must make users themselves feel they have a level of control.
Above all, the solutions have to be centred on the person. It’s all about the user experience, not the technology behind it. If you “shoehorn” people into a solution they never asked for and don’t understand, it will never work.
And back to the point I made earlier, they need to see the value it brings to their life – it makes it easier, more enjoyable, more fulfilling.
But the technology commonly made available to older people is “yesterday’s technology” – it is very basic, only covers a few conditions and, because it is supplied by one or two companies who dominate the market, it relies on proprietary software.
This means that no one else’s equipment will work with it. It’s the “any colour as long as it’s black” approach.
The pattern of hospitals and local government is not to try out new things but to go for safe, “tried and tested” technology. This is holding us back and stifling innovation.
Moreover, we need solutions that help the carers as well as those being cared for: in the UK alone we have several million people who need to work as well as care for someone: often their lives are made impossible because of the conflicting need to earn a living and be there for a loved one. All too often they have to give up work, and suffer financial hardship.
Keeping carers connected to their loved ones through digital healthcare can enable them to work with peace of mind. As part of the quantum shift we need to develop digital healthcare that truly enables independence and wellbeing, and as part of that solution is to break down the artificial barrier between digital inclusion and digital healthcare.
My vision, and that shared by a rapidly growing number of people, is to equip every older person’s home that requires it with a piece of equipment – a tablet or smart TV – that enables them to connect with their doctor or health visitor through Skype.
Moreover, this equipment is fed by sensors that enable their vital signs… blood sugar or oxygen level, heart rate, temperature… constantly monitored, with any alerts being sent to a network of carers… family and neighbours possibly as well as their hospital or doctor.
Their whole living environment could also be monitored – the room temperature, whether or not they had remembered to turn off the oven, whether they have gone out of the home, or got out of bed, opened the fridge that morning to get food…
As their needs change, or technology advances, new apps can be loaded. It evolves with THEIR needs.
Subtly, unintrusively, cost effectively, their condition can be constantly monitored and interventions rapidly organized. Monitoring also has to be possible outside of the home in the form of wearable technology – otherwise we simply become prisoners in our own homes.
Just as importantly, the dual technology can be used to encourage and enable older people to actively monitor their own wellbeing… and do something about it.
In the South West of England where I live and work, we have developed a “digital healthcare cluster” – made up of innovators, universities, researchers and older people themselves. Our home is at the Bristol Robotics Laboratory where we can showcase our solutions and make sure we plug straight in to a technology that will be the big game changer in the next few decades.
We are now creating a CIC to act as a conduit between the members, commissioning bodies, end users and funders – and I have now been asked to chair that.
We are working to ensure that the technologies speak to each other – above all, that there is an “open platform” approach, with standards that could be applied internationally, so you can precisely tailor the right equipment and technology around the individual’s needs and aspirations.
So how can we justify the expenditure needed to make this vision of connecting older people with a tablet or smart TV pre-loaded with apps that can be added to at any time as new apps come along or the person’s needs change?
One is that the cost benefits to the public purse make it a social investment: it will reduce home care and healthcare costs, as well as enable earlier discharges from hospital. It will reduce isolation and loneliness – which we know is as bad for one’s health as smoking – by enabling people to remain connected to the outside world when they are not able to go outdoors.
It will enable health and social care to be delivered far more comprehensively and cost effectively. In the UK, local authorities currently spend over £20 billion a year on adult social care.
In 2011, one local authority in London produced what it called “the graph of doom” showing that, that within 20 years, unless things change dramatically, the council will be unable to provide any services except adult social care and children's services. No libraries, parks, leisure centres or even bin collections.
This approach is possibly the best possible hope we have for bringing that spending back under some sort of control.
I also believe there is a huge potential for residents in care homes to have their health and environment monitored – not by intrusive CCTV but by unobtrusive equipment sending data to their families as well as the care home staff.
Technically, you would be able to know when your loved one had last been changed, washed, clothed, turned or fed – and was not stressed or in pain. One way, in fact, to root out the uncaring carers. And the connection between the two technologies?
Having free teleheath equipment installed in their homes will encourage more and more people to go beyond Skypeing or monitoring their health to try other aspects of going online – to try out Youtube, read the daily news, shop, track down old friends, research their family history, pursue hobbies and interests… in short, be on the right side of the digital divide.
So what are the wider implications of this approach?
Within the South West Cluster, our ambition is to develop joined up solutions that will have uses not just in our own country but overseas too… in countries like China, where there are massive problems looming for the “single child” generations.
We have the support of our local enterprise partnership, which is funded by central Government, and hope to access sources of funding to take our concepts further.
So what next? Well I for one feel that this is a global problem, and to tackle it we need the best minds and best thinking… regardless of where they are. Indeed, we should all be working more closely… sharing our ideas and knowledge on ways forward.
If anyone reading this would like to help us take the cause forward of delivering joined up digital solutions for older people, we would welcome them aboard!