The issue: What are the main challenges facing public bodies dealing with an ageing population and how can technology and telecommunications help to deliver innovative healthcare solutions?
While wrestling with a £30bn funding shortfall, the NHS faces ever-increasing demand from the UK’s ageing population. Longer life expectancy means more appointments, consultations and operations. A depleted public purse, meanwhile, dictates that services are being delivered on a tighter budget.
Politicians of all stripes have pencilled their solutions to a seemingly impossible equation – and the future of healthcare, like immigration, will dominate pre-election rhetoric in 2015.
But, in the meantime, new uses of technology are emerging as a powerful force in driving efficiencies and improving the care of society’s older members.
More clever thinking, invention and adoption needs to happen, however, if the challenges of the ageing population are to be truly managed by health authorities. In search of answers, BQ brought together influential public and private sector representatives from across Yorkshire for a debate at The Royal York Hotel, York. A lively and passionate discussion began with delegates putting forward their major concerns about the health sector and the challenge of the ageing population.
Frank Griffiths, chairman, Leeds and York Partnership NHS Foundation Trust, highlighted the importance of recognising that health issues are interconnected with every aspect of an individual’s life, rather than just something to be dealt with as standalone problems. Therefore, he said: “Technology needs to respond to an extremely complex landscape that is changing all the time.”
Juliette Greenwood, chief nurse at Bradford Teaching Hospitals NHS Foundation Trust, explained how technology in recent years had helped to move more patient care into the community but warned that: “We have a lot to learn. When we talk about technology as
a solution, we have to think about the patient experience and their expectations. Technology should not hinder or be adverse to good experience.”
Mark Chamberlain, regional board member, BT, underlined technology’s role in ensuring that patients are only sent to hospital when they truly need to be and, otherwise, have their care needs met adequately at home.
Andrew Radi, group CIO, Benenden Healthcare Society – a health and wellbeing mutual community – asked how technology could be used to improve early diagnosis and bring about better outcomes.
Michael Sweet, non-executive director, York Teaching Hospitals Foundation Trust, suggested that telemedicine had not yet lived up to its potential because of “resistance from large parts of the medical fraternity”.
He also said poor connectivity in rural parts of Yorkshire meant district nurses “are working with one hand tied behind their back” in serving their local communities.
Bob Gomersall, founder of Shipley based e-assessment and e-learning firm BTL, lists patient support apps and online training among his company’s healthcare interests. He drew parallels between the way the education sector has been revolutionised by “exposing large numbers of people to individual experts” via technology to the type of transformation needed in healthcare.
“The [technology] is clearly disruptive and we need to work out how to organise ourselves in getting people to accept these services,” he said.
Mark Fordyce, managing director of internet service provider and IT business York Data Services Ltd, warned: “The big problem we have going forward is being able to utilise the technology that’s there, to deliver more solutions. Enhancing what’s already there and enabling us to create better care services is the bit we have to get right.”
Cindy Fedell, director of informatics, Bradford Teaching Hospitals NHS, suggested that new healthcare service innovations must account for the fact that patients from different generations and backgrounds had varying degrees of technical knowhow.
Against the context of scarce NHS funding, Trevor Higgins, regional partnership director, BT, said: “My aim would be to see how we can get the universities to use their research
to develop products that SMEs can deliver to the market.”
This was backed up Dr Liam Sutton, head of knowledge transfer at the University of Bradford, who added: “The role of the university is to create new ways of doing things and to bring those innovations through into commercial relationships with partners for the wide scale deployment of technology. It’s also about training the next generation of the workforce and getting people with the appropriate skills to patients.”
Colin Philpott, chief executive of Bradford Breakthrough – a networking and lobbying group representing Bradford’s public and private sector organisations – suggested that technology in healthcare is not just for the sick: “What about people who haven’t necessary got an identifiable condition, but are just old and perhaps also lonely. What can technology do for them? It often seems to me that for people who have some sort of identifiable problem there is a system in place in dealing with them. But how can we help people who don’t fall into those categories?”
Colin Mellors, deputy vice chancellor, York University, explained why he believes cultural and behavioural changes are crucial in enabling technology to fulfil its role in future healthcare. He added that new innovations in healthcare should tick three important boxes.
“Does it reduce unnecessary demand? Does it make for more effective and efficient delivery? Does it improve the patient experience?”
Next Ian Williams, business lead, Leeds City Region LEP, said small businesses might play an increasingly important role in tackling the challenges of an ageing population. But, he added: “There’s a great desire amongst many large public sector organisations to work more locally, but some small businesses have great difficulty meeting public sector standards. So there is an issue around procurement.
Meanwhile Professor Clive Kay, chief executive, Bradford Teaching Hospitals Foundation Trust, predicted that the NHS in future would be a “total network of care” and less disjointed than currently. But he warned: “We will be providing a single system network and it’s up to the IT community to make sure that there is no waste. Currently we are haemorrhaging money out the system because none of it is joined up.”
BT’s director of strategic operations David Furniss, whose role covers BT’s global government and health division which delivers services to the public sector, underlined further barriers preventing technology from driving change in healthcare. He warned that devices dependent on being self-managed by patients failed to service certain factions, including people with dementia. He also suggested that fear of failure, an overreliance on pilot projects and a lack of joined up thinking between institutions was hindering meaningful innovation in the health sector.
“There seems to be risk aversion stemming from the search for conclusive evidence,” he said, before asking: “How do we adapt funding models so commissioners are able to invest in these things and drive benefits down the track?”
He also highlighted the need for councils and the NHS to work more collaboratively in tackling health and social care issues. “If we work in isolation we are not going to be capturing the problem,” he said.
Furniss also explained that implementation of new technologies and methods would have to run in parallel with the existing system, since “10% of the population will remain digitally excluded in perpetuity for a variety of reasons”.
But Bob Gomersall was more optimistic about the universal take-up of health-related technologies and applications. He also disagreed that there are too many pilot projects within the NHS. “I think the trend is very much towards easy adoption by everybody. If you look at the vast numbers of people who started using tablets who didn’t use PCs before as an example and the fact that the next generation [of devices] will be so intuitive.”
“[Innovation] tends to evolve rather than be centrally planned. It’s impossible to plan from the top because you don’t really know what’s going to happen, you just have to let it evolve. So I think there will be a lot of more experiments and pilots and some will succeed and a pathway will be found.”
Returning to the crucial issue of funding, Mark Fordyce said: “I think the problem that arises around large-scale projects for the NHS is that we tend to lose momentum when large amounts of funding are involved. It becomes less about the project and more about spending the funding. But private enterprise just happens and doesn’t need governments to help. Enterprise will just go on and get it done. Yes there are a lot of failures, but that’s the nature of enterprise.
“When we go down the funding route, it’s under the glare of everybody. So therefore failure becomes something to talk about.”
Frank Griffiths: “The assumption is that NHS organisations around this table will over the next five years contract financially by 4% per annum. I don’t know where in the private sector you have organisations doing that and not only surviving but also being successful in that period. On one hand I want to support and encourage local innovation and empower our hospital clinicians to try these things and see if they make the quality of experience better. But this is against a background of an unparalleled resource squeeze.”
Mark Fordyce: “But don’t pressures and budgets actually force change and force us
to develop innovation?”
Clive Kay: “What I think has been missing is how we can learn from local delivery systems that are different around the country quickly and seamlessly. Taking several years to learn from the best is not sustainable. There must be an IT solution that allows us to learn from the best.”
Juliette Greenwood suggested that the “voice and power of citizens” could fuel such a speeding up of the best innovations being adopted nationally.
“I’ve seen how the use of technology in the home, joined up technology within primary and acute care, can take somebody from having an admission every month, to maybe one a year. That might be aspirational but it is happening in places. The passion of that individual telling me how they were self-managing themselves using technology is something that we somehow need to harness.”
Tom Keeney: “I think there’s always a fear of change but for some of these ideas to stick they can’t just be perceived by the public as being about cost. They’ve got to be about something better that can replace what’s there at the moment. There’s an education process and an engagement process that we need to go through and creating a vision making it compelling is important.”
In bringing innovations and technology for the aged into healthcare, Andrew Radi said his firm had found success by keeping processes slick and simple. But, looking to the longer term, he admitted that engaging younger people in tech-driven areas like self-diagnosis was proving a major challenge.
“How can we get technology working with young people to actually save problems further down the line and get them interacting with self-diagnostics?”
Colin Mellors: “To change behaviours you need two things – to demonstrate self-interest and to make it easy. It’s about introducing a technological interest which is clearly going to make something more effective, rather than it just being imposed on people”.
In terms of specific innovations that might improve healthcare, Liam Sutton pointed to a more integrated delivery of different kinds of health provision. “The idea is that the patient has a consultation, perhaps through some sort of telehealth contact, and gets advice on several issues all at once, whether they are a medical, social or lifestyle related”.
Colin Mellors agreed, explaining that “the elderly can be treated brilliantly for discrete things but the problem is that they often feel they are not been looked after generally.”
Next, Colin Philpott suggested that, while technology is a part of the solution to the NHS’s budgetary challenges, a more simplified healthcare landscape would also help. “I think the real answer is that we’ve got too many organisations involved in the sector,” he said.
Then Frank Griffiths and Mark Fordyce both suggested inspiration from digital trends, particularly among younger people, could also improve the use of technology in healthcare. Fordyce added: “When the internet was born many years ago, it started off as just being a network, then we had two networks and then it became an internetwork. Initially we would pay each other to share our traffic but then one day we realised it was mutually beneficial to not charge each other, because my customers would see your content and vice versa. If we could adapt even a quarter of that essence to deliver similar solutions, we could solve our problems overnight. Technology is not the problem, people and governments are the problem. This is why we need to come up with a way of maybe localising it to spot the best way forward. When it’s just one huge entity, it becomes an almost impossible task and it is set up to fail.”
Cindy Fedell: “But I think healthcare by its very nature is risk averse and controlled. We manage people’s health and nobody is willing to let that go. Technology is on the other side and until we are willing to let healthcare be a free market – I don’t mean privatisation but complete freedom - the two are never going to drive properly. We are always going to be trying to manage our own technology.”
At this point Trevor Higgins reminded delegates that not all transformational use of technology in healthcare and wellbeing needs to be complicated. “It just has to be used right to make things better for people,” he said, citing the example of a project launched recently which simply encourages volunteers to have regular phone correspondence with elderly people who live alone.
The issue of greater devolution to Yorkshire and other northern areas looms large over most sectors and, as mentioned by David Furniss, healthcare is no exception. One positive result that might come out of the fallout of regional clustering, might be better sharing of data between health and social care-related bodies, he said.
Michael Sweet then addressed what he sees a major failing of the current use of new technologies in healthcare. “The type of things we’re talking about today are for the wealthy well, who are the people we don’t need to worry about so much. So how are we going to actually get these things down to the grass roots? I believe we do require national strategy to make people aware of their own health.”
Juliette Greenwood: “There is a really interesting drive towards personalisation and people taking responsibility for themselves and in healthcare we have to adapt to that.”
But overall there seems a lack of strategy in terms of dealing with the challenges of the ageing population, according to Ian Williams. “I’m hearing about all the things we can deliver, but what is the end game? What is the goal?”
Mark Fordyce: “I think the aim should be to share knowledge [and] then we can capitalise on it. We tend to work in silos in this country and often don’t see what the person over the fence is doing. But they could be reinventing the exact solution we’re after.”
Cindy Fedell: “I don’t think we should define the endgame because it will always evolve and you can’t predict what is going to happen.”
Perhaps not a single goal then, but a series of major ‘to do’ items is required. Among them, suggested Colin Mellors, is to find a way of making sure “people are not simply recipients of the health service but are participants in the health service”.
He added: “Can we use technology to address the other side of the problem not just the scarcity of resources and get people to take responsibility for themselves?”
Certainly Liam Sutton believes this is possible, given the increased demand for people to take ownership of their own data: “People want to own their data, and morally they should do, and people are becoming more savvy about this. None of us can predict the future but sure it’s going to have an influence on whether technology can get things right.”
Tom Keeney: “There are definitely examples of this emerging. A few years ago you wouldn’t have tracked how many steps you took in a day or your blood pressure but
these things are becoming the norm for the younger generation through apps and wearable devices.
Juliette Greenwood: “Social media, apps and games are influencing people to change their habits and I think we’ve got to look at how we can capitalise on things like that.”
David Furniss explained how this is also influencing consumer facing businesses to respond to the increased amount of data they have about their customers. For example, he said, supermarkets are using online shopping data to develop recipes which are lower in
salt to market their own brands.
As the debate neared conclusion, it was agreed around the table that many other uses of technology to improve the wellbeing of the ageing population would continue to spread throughout Yorkshire and the UK in the coming years.
Some are simple – such as the screening of archive films to help people with dementia as championed by Colin Philpott – and others more complex, involving data, telepresence and diagnostic technology.
However, what also emerged from the debate was, in the face of tight budgets, the need for more collaboration between organisations within and beyond the healthcare sector and spanning regional borders.
But Tom Keeney ended on an upbeat note, saying: “15 years ago we were talking about online banking and shopping as things we weren’t sure about. Hopefully in 15 years we’ll talking about cracking something else with technology because we’ve managed to fix healthcare’s issues.”