Hft & Tunstall Healthcare – Written evidence (INQ0036)

About Hft

1. Hft is a national charity that provides specialist care and support to over 2,500 adults with learning disabilities in order to live with as much independence, choice and control as possible.

2. We were founded in 1962 by a group of families who believed that, with the right support, their relatives were capable of more than society expected of them.

Today, we still share that same vision. We support people to live independently in their homes through our Supported Living services, alongside Residential Care, and Short Break services. We empower people to make their own choices, including finding a job, building friendships and relationships and taking part in activities. We are leaders in the use of personalised assistive technology solutions to support people to live more independently and safely.

3. We operate in sites across England – from Newcastle to Newquay.

About Tunstall

4. Established in the UK in 1957, Tunstall has grown to become a global organisation, and the market-leading provider of innovation-led connected care and health solutions.

5. We now operate in 38 countries around the world and support more than 5 million end users through our technology and service offerings.

6. Our vision is for a world where people have the freedom to live life to the full in a place of their choice. In order to achieve this, we provide technology based solutions and services to improve our customers’ ability to deliver new, more efficient and effective models for health and care management in the community setting.

7. Tunstall integrates world leading smart technology with high quality monitoring and support services to give individuals increased independence, improved quality of life and wider choice in their care options.

Executive Summary

• 8. Social care support for adults with learning disabilities accounts for one-third of the total adult social care spend in England. It is also the fastest growing part of social care, as more children with learning disabilities reach adulthood and live longer, healthier lives

• 9. There is great potential for assistive technologies to increase health and lifespan. These have applications in all areas of life including personal hygiene, health, employment and lifelong learning.

• 10. Historically, though, products and services have been aimed at Older People (65 years and over) rather than working-age adults (18 – 65 years). As a result, there is still significant untapped potential for investment and innovation in the learning disability sector.

• 11. Hft and Tunstall are calling for a Sector Deal for the learning disability sector. By encouraging providers to invest in the future of services, we believe that this will release the economic potential of assistive technologies for adults with learning disabilities. This in turn will provide enhanced support for those in receipt of care, and stimulate research and innovation in the assistive technology sector.

Q4. How complete is the understanding of behavioural determinants and social determinants of health in old age, and of demographic differences?

12. In our response to the Committee’s questions, we wish to make clear that we will be focusing on working-age adults with learning disabilities and autism. It is estimated that there are 1.5million people with learning disabilities in the United Kingdom. In England, this accounts for approximately one-third of total adult social care[1]. We are also the fastest-growing sector in councils’ adult social care spend, with only six of the 151 local authorities in England spent more on care for working-age adults than they did on care for the elderly in 2005, compared to 57 in 2017[2].

13. However, the majority of our projections for demographics are still based on a 2008 study from the Centre for Disability Research (CeDR) at Lancaster University[3]. While the Emerson & Hatton study has proved to be a robust and mostly accurate piece of research, it cannot be best practise to continue to make policy decisions based on 11-year-old research. This is particularly pressing as the paper’s concluding date of 2026 approaches ever nearer.

14. As a matter of urgency, we would urge the Commission in its conclusion of this inquiry to call on the government to commission updated research into future demographic trends for the adult learning disability population beyond 2026.

Q6. What technologies will be needed to help people to live independently for longer, with better health and wellbeing? What is the current state of readiness of these technologies, and what should be done to help older people to engage with them?

15. Community alarms/warden call systems, as they are known, have a long history in the UK, being introduced in the 1960s to enable primarily older people to easily summon help in an emergency. Warden call systems, commonly found in sheltered housing, comprised of a unit on the wall connected to a phone line which enabled the user to connect the onsite warden by pressing a button on the unit or pulling a pullcord. Community alarm systems use a home unit (hub) connected to a phone line, the user wears a pendant around their neck or on their wrist and pressing the button on the pendant or the unit connects them to a specialist monitoring centre. The operator can then talk to the user via the home unit to assess their needs and respond appropriately, for example by calling a family member, key holder or the emergency services. Telecare can extend both kinds of system, using a range of sensors to automatically raise an alert if they sense an event such as a fire, flood or carbon monoxide leak. They can also monitor for falls, or people with dementia leaving home and being unable to find their way back. A variety of GPS devices are also available that enable carers to locate someone away from home.

16. The primary function of such systems remains reacting to emergencies. The next generation of digital telecare, or connected care as it is also known, not only enables care to be more person-centred, but also more proactive and ultimately predictive. Digital technology enables a wide range of devices to connect intelligently and use data analytics to provide meaningful, actionable insight. It offers objective information about patterns of behaviour to inform assessment, meaning care can be targeted where, when and how it is needed most.

17. Digital connectivity is also becoming increasingly preventative, facilitating timely support which avoids the need for more complex care. For example, discreet sensors in the home can monitor activity, managing risks but also enabling earlier, lower cost interventions e.g. increased use of the bathroom may indicate a urinary tract infection. Treating this with antibiotics at an early stage can prevent deterioration in health, improving quality of life, avoiding a possible hospital admission and the associated risk of hospital acquired infection or reduction in mobility. The next generation of systems will become more predictive, using patterns in data to anticipate possible events such as falls by identifying changes in behaviour. Family members and carers can also engage with this information, for example, viewing their loved one’s patterns of activity via an app to help them offer support where it’s required. Using digital technology to broaden the circle of support not only improves quality of life, but also reduces reliance on statutory services, and family members can play a vital role in encouraging older people to engage with technology.

18. Technology can also support mental wellbeing. For example, enabling the use of WiFi across a development to support increased contact with friends and family, reducing social isolation, and giving access to online activities and services, such as games, shopping and utilities.

19. Connected Health is a model for the delivery of healthcare that includes technology in pathways to help make more efficient use of resources, by enabling healthcare to be provided in the community and empowering patients to take an active role in managing their own health. Connected Health enables the remote capture of vital signs and symptoms by patients in their own home utilising technology including apps and mobile devices. Results out of the parameters set for that patient will raise an alert on the system, and information is reviewed remotely by clinicians, reducing the number of face-to-face interactions required and providing valuable insight into trends over time. Exacerbations can be detected at an earlier stage, avoiding more complex interventions and reducing the need for home visits, GP appointments and hospital admissions. This aids caseload management and helps care to be targeted where it is needed most, reducing cost, improving outcomes and enhancing the patient experience.

20. These technologies are all at market, but further investment is needed to expand their use. For example, austerity has resulted in many local authorities reducing the provision of community alarm services. Investment in this kind of low-level support helps people remain at home and independent for longer. Investment will also increase adoption and therefore technology will become more acceptable and mainstream.

Q8. What are the barriers to the development and implementation of these various technologies?

21. While the Committee has made clear social care funding that is beyond the remit of this inquiry, it is pertinent to note that the way in which social care is currently funded is, in and of itself, a barrier to the development and implementation of these technologies.

22. The sector is often described as “the classic definition of a monopsony – a market with one buyer and many sellers”[4], with local authorities being the predominant commissioner of care packages within a locality. The pressure of social care funding on local authority budgets is well documented[5]. As a result, local authorities are reducing the rate at which they commission social care.

23. This means that providers are made to do more with less. Hft’s own research has shown that, in order to cope with increasing financial pressures, 92% are making internal efficiencies and 45% are stemming investment in the future of their services[6], with 73% saying they envisage needed to curb investing in the future of services within the next couple of years[7]. With local authorities and social care providers reducing future investment for short-term financial stability, we believe that this is severely hindering the development and implementation of more innovative and efficient technologies.

24. In addition, the transition of the UK’s communications network from analogue to digital, which is set to complete by 2025, is leading to confusion over what assistive technology equipment (specifically community alarm/telecare home units) will work in future, leading to delayed purchasing decisions.

(a) What is needed to help overcome these barriers?

25. We believe that the current social care model has perverse incentives. Local authorities are incentivised to reduce costs in the short term, and providers are incentivised to adhere to costly hours-intensive care packages, rather than truly deliver improved outcomes and increased independence. Technology is often seen as a way of achieving this. In January 2017, when the government launched its green paper on a potential Industrial Strategy, Hft submitted evidence calling for a Sector Deal for the learning disability sector[8]. In July 2019, we were delighted to partner with Tunstall to launch Improving Outcomes, Enhancing Care: Assistive technologies and the case for a Sector Deal for the learning disability sector, which put forward a detailed proposal for why a Sector Deal is needed, and the potential benefits it could bring[9].

26. Hft and Tunstall believe that a Sector Deal for the learning disability sector will help incentivise local authorities and commissioners to invest in the future of the sector. This will release the untapped potential of the learning disability sector for innovative technologies. For people supported by the sector, this will mean improved health outcomes and increased independence. This in turn will not only upskill staff, but also free them up to deliver more meaningful and personalised care and support.

27. Greater clarity is required from communications providers regarding the digital transition, its timings and impact. Government should also consider whether there is a need to support local authorities and providers which need to replace vast amounts of equipment supporting vulnerable people which will no longer operate on the new network.

Q9. What opportunities are there for the industry in the development of new technologies to help increase health span? In which areas of medical research and technology development does the UK excel?

28. It is our belief that products aimed at increasing health span have historically been aimed at older people and the Elderly Care market[10]. Looking at telecare alone, figures by

the TSA show that, of the 1.7 million people in the UK, only 1.7% are adults with learning disabilities – or 28,900 of the 1.5 million people in the UK with a learning disability[11]. Clearly, then, there is significant untapped potential amongst working age adults with learning disability for assistive technologies that increase health span.

29. Recent UK government schemes such as the Preventative Technology Grant and the Housing and Technology Fund for People with Learning Disabilities have demonstrated the positive benefits assistive technologies can bring to working age adults with a learning disability[12]. Seed-funding for successful pilots and a rigorous analysis of the outcomes of these funding streams should be a priority for both local authorities and the Department for Business, Energy and Industrial Strategy.

30. As well as an underdeveloped domestic market, there are substantial foreign markets for assistive technologies including the USA ($55bn), China ($100bn), Australia ($44bn) and Europe (€30bn)[13]. Japan and Norway have received significant attention for policies that are set to turbocharge the research into, and adaption of, assistive technologies in health and social care settings[14]. With former International Development Secretaries Pritti Patel[15] and Penny Mordant[16] placing “Disability” at the forefront of the UK’s overseas aid policy, and urging it to be a wider part o of our foreign policy, we believe the UK is well placed to be a leading incubator and exporter of such assistive technologies.

Q10. What more is required for the UK to benefit from commercialisation of its discoveries and inventions relating to healthy ageing, as envisioned by the Government’s Industrial Strategy?

31. As stated in our response to Questions 8a and Question 9, we believe that the government needs to grant a Sector Deal to the learning disability sector.

32. We have outlined briefly in our response to these questions the positive impact such a deal could have on both improving healthy living for people with learning disabilities, and unlock the economic potential of an underdeveloped market. These arguments are elaborated upon in our report Improving Outcomes, Enhancing Care: Assistive technologies and the case for a Sector Deal for the learning disability sector. We have submitted a full copy of this report alongside our submission to the Committee’s inquiry. We invite the Committee to read the report in full and welcome any further questions they may have about our proposals.

19 September 2019