Professor Debbie Holley and Dr Vanessa Heaslip, Bournemouth University – Written evidence (INQ0045)
Written evidence submitted by Debbie Holley and Vanessa Heaslip on behalf of Bournemouth University, to the Science and Technology Committee call for evidence on Ageing: Science, Technology and Healthy Living Inquiry. The submission covers ‘Technologies’.
Debbie Holley is the Professor of Learning Innovation in the Faculty of Health and Social Sciences at Bournemouth University; she is a digital expert with research interests in innovation and the cross-overs between health and education.
Vanessa Heaslip is the Associate Professor of Nursing at Bournemouth University, and has research interests in marginalised and vulnerable communities.
Holley and Heaslip have an interdisciplinary focus and work closely with NHS partners across Dorset.
Technologies to provide a solution for loneliness (e.g. the virtual tea party) and virtual health care can provide efficiencies for the NHS as well as improved access for marginalised communities. However, key barriers are the spread and access to technology (especially rural communities) the skill set (and costs) necessary for the ageing population to engage with this technology, alongside the upskilling of the current NHS workforce to work virtually need careful consideration. Some barriers can be directly addressed by Government 5G and NHS workforce priorities; there is a clear role for charities; other barriers will need universities and industry to work together to engage with agile and rapid prototyping and testing. The methods of procurement need to be revisited, currently excellent SMEs are filtered out – working across with the Department of Business could provide ways of supporting innovation. Further work with experts is needed to invest in effective scaling solutions across the sector, and learning from examples/solutions/suggestions are contained in the text below. More of the same is not going enable the huge changes that demographic pressures are bringing to bear on an already stretched NHS; and work of effective data capture is needed to identify and bring the policy makers lens onto those belonging to marginalised groups.
TECHNOLOGIES – response covers questions 5, 6, 7, and 8 as set out in the call for evidence document
- Technology can start to address many long-term health issues, especially when supported by powerful health algorithms enabling health professionals to provide evidence-based screening, promoting self-management as well as navigating individuals to the most appropriate service at the most appropriate time. This includes the identification and management of those most in need. This type of ‘exception management’ can help set key priorities, however there is a need to ensure that all individuals have the capabilities, skills and knowledge to manage to navigate these new forms of technology otherwise this may perpetuate health disparities.
- Theoretically, technology could be utilised to address many current health and wellbeing challenges for older people and marginalised communities. However the implementation of this is currently challenging. A robust debate is needed to position the strategic use of technology, exploring the budget required for life-long learning, to educate those for whom the technological age has passed by. There is a wealth of evidence highlighting there are communities and age groups currently unable to participate in the digital world, and whilst OFCOM surveys are useful in identifying groups by age they currently do not provide information on ethnic minority groups, social class and gender. This information is essential in ensuring that strategic plans can be put into place to address any technological health illiteracy.
- For health, access to GPs is a key area of concern as they remain the primary access point to health care as well as the gatekeepers to specialist and secondary care services. However, there have been public concerns regarding current waiting times to access GPs. In the UK, there is an overall GP shortage and little has changed despite the Governmental/ BMA work launched in 2014 on series of initiatives to create more flexible and attractive pathways into General Practice. In addition to a lack of GPs, there is an international shortage of nurses which challenge current system of care provision. Technology could be utilised to provide virtual face to face communication with your GP where access to services are difficult however this requires a secure internet connection. There is existing good work underway in Dorset; 5G Rural Dorset is one of the Councils applying for the current Governmental call for 5G pilots, and user groups, public engagement and a robust strategy are in place. Personalisation in the future could, one group proposed, look like ‘my hologram GP beamed into me’ ‘my chatbot GP’ and ‘virtual GP’ putting on an OCULUS quest type headset and attending the ‘real’ doctors surgery. These kinds of technological solutions have a human dimension, although require careful planning to ensure the building of trust in utilising this service. Scenario development offering genuine feelings of ‘presence’ are already emerging practices within industry and lessons could be shared across sectors.
- It is really important that we work collaboratively with older people in order to identify which technologies work best to enable them to stay within their own homes. Input at the design and specification of new house building will need to anticipate health needs of the future, including excellent design in terms of form and function. High quality broadband and continuous energy will be required for the more sophisticated and lifesaving equipment that can be brought to support the individual in their own home. As such there is a need to ensure that all areas including remote and rural communities have access to this high quality broadband.
- Thought for the carers and families should be considered as part of overall specification. However, marginalised communities with chaotic and non-stable lifestyles need to be part of the wider plan – how to reach, for example, the homeless? Street screens, along the lines of Sugata Mitra ‘Hole in the Wall Project’ may offer insights as to taking this work forward.
How can technology be used to improve mental health and reduce loneliness for older people? (Question 7)
- Technologies are already available to improve mental health and reduce loneliness – this question is problematic as it is converging two very different sets of issues. There are numerous mental health ‘apps’, resources from charities, policies and good practices for enhancing mental health and wellbeing. The issue is the lack of confidence in utilising technologies as part of an integrated solution. Cross disciplinary and sector collaborations are needed between those developing the technologies, the medical experts prescribing and a potential new role for mediating between stakeholders and the individuals seeking support is envisaged. ‘Living lab’ design methodologies are effective and user led to enable the co-creation of the knowledge needed to take forward successful innovation.
- Loneliness – there are numerous technologies to assist communication. Mobile phones, iPads and Chatbots all facilitate links to communication channels, and offer different ways of accessing for those who may be hearing impaired, housebound or with limited mobility. However we need to explore why such technologies are not being utilised fully and from this we can develop strategies to support the implementation of technology.
- A potential example could be a ‘virtual ’teaparty’.
Technologies such as the OCULUS Quest have the ability to give the ‘feel’ of being in a totally different space, and can be designed with customised and personalised scenarios. Using well established practices such as ‘Dementia life story work’, scenarios can be designed to support those living with memory loss. They can offer tactile spaces for the person to interact with ‘bots’ programmed to look, and speak, designed as personnas from the individuals’ past. Similarly, technology can enable ‘hook-ups’ of isolated individuals to have tea and conversations with others. Situated in a shared virtual room, the individual genuinely feels they are in a different space, alongside their friends or relatives yet without leaving their own home. This supports the most frail living alone at home to increase their social interaction reducing loneliness associated risks.
What are the barriers to the development and implementation of these various technologies (considered in questions 5-7)?
- A whole category of debate and policy discussion is required for the ‘worried well’. An education (possibly more of marketing of key messages about where to seek help – the NHS call lines, but also alternative providers (for example, the excellent partnerships being developed with pharmacists and GP surgeries). Further roll out models could include the ‘virtual surgery’ based within supermarkets with trained pharmacists, the travel clinic model, and for rural and isolated communities, the virtual ‘bus’ – a kind of travelling library replacement). A co-creation project to scope these areas would be useful, to design for the user. They will have ideas that those running the focus groups would never imagined.
- Digital access to healthcare could enhance access from marginalised communities; however this relies on these communities being able to access and navigate these systems which can be difficult and a barrier. Furthermore, as digital health care is delivered at a distance there is a need to ensure that the information provided considers those with limited health literacy. Key to ensuring this is working with individuals from these communities in the development of such services.
- Scaling from pilot to full implementations and robust evaluation – is the sector equipped with the skills for this? Systematic literature reviews of the NHS and technological innovation indicate issues with these key areas and lessons need to be learnt from this evidence in avoiding replicating these challenges moving forwards. Specific development programmes, from different sets of partners would assist this – for example the Leadership Foundation, JISC (the technical experts), Universities, NHS experts from different disciplines, and the outstanding international experts.
- Ethics and data collection – who is monitoring, using the data, and are those supplying the data being recompensed? With the monetisation of health ‘hidden’ agenda – is it ethical for the public sector to fund private companies, who will collect and hold data, and in all likelihood sell the datasets back to the sector? The individual and their consent is lost in the transactional analysis. Sharing of data across health and social care organisations could lead to a wealth of information regarding population health leading to clear strategic evidence-based public health plena. However, this will only be effective if the data collected is robust. For example, current UK healthcare services do not collect ethnic minority data on Gypsy Roma Travellers. A set of inclusive principles regarding types of data that needs to be collated needs to be generated, and then implemented consistently across NHS areas. In addition, there has to be a co-ordinated shared technological infra structure between health and social care services, this would enable joined up thinking regarding integrated care provision which is fundamental for older people and those living with chronic illness. This shared data base would enable systematic examination of local health needs enabling evidenced-based public health strategies to be developed and implemented.
- The existing infrastructure does not currently facilitate the sharing of data from different health and social care organisations. Investing in data econometrics experts, expert ‘big data’ visualizers and co-creating safe and secure systems with the cyber-security expert in Universities in partnership with CCGs, and sharing the practice would enable a set of starting specifications. Partnership working is crucial.
What is needed to help overcome these barriers?
- Supporting digital education of the aging is a barrier – a potential solution is ‘jobs we have not yet imagined’ such as a technological ambassador supporting the development of digital skills. Topol (2019) outlines some possibilities; roles such as digital health professionals, with increasing investment in health data experts and health economists is essential to capitalise on the affordances of managing, interpreting and implementing policy based on large data sets.
- We need a strategy to revise how we educate a workforce of health care professionals enabling them to work in a more digital way; work to map and support digital lifelong learning is crucial across the whole of formal education and beyond. Moving this forward, we need to identify clear pilot sites where universities and clinical commissioning groups work in partnership to develop models of working which can then be implemented nationally.
To what extent do socio-economic factors affect access to, and acceptance of, scientific advice and use of technology by older people and those who care for them?
- The establishment of a national expert group to direct the strategic efforts of charities and social enterprises, to set objectives and timelines and commissioning evidence where necessary would set in place the structures to support proactive public health prevention strategies. Top priority areas have already been established - loneliness and mental health. Key to successful roll-out to this is the engagement with older people. Ideas such as a virtual tea party can easily be generated, but identifying new roles and re-training from existing provision would be critical in the support, will organisation, running and management on the one hand; as well as exploring the training requirements for older people to feel confident in the safety of using this technology. Charities could be strategic partners in assisting to capitalise on confident ‘silver surfers; there are many older people that regularly use technology and as such are ideally placed to act as peer mediators and supporters. We envisage a mix of trained staff and volunteers to ensure that key areas such as safeguarding and GDPR are adhered to. Universities can certainly be tasked with developing degree pathways/alternative local CPD provision to scale up effectively.
- Recommendations for policy action:
- Speed roll-out of 5G to enable nation-wide coverage to enhance, promote and ensure inclusion for rural and vulnerable/marginalised communities and individuals. A set of inclusive principles needs to be generated, and then implemented consistently across NHS areas.
- Review and mapping of digital/lifelong learning to include the needs of the aging; feed into workforce reviews.
- Further work on successful scaling of innovation, EU partners have already developed mechanisms and methodologies for scaling in health, for example the EU learning layers Scaling up Technologies for Informal Learning in SME Clusters
- Implement technological pilots that are co-designed and evaluated with user groups.
- Begin to develop strategies for collaborative working across the digital industries, third sector organisations and health professionals with a focus on how technology can be used to support healthy ageing through social prescribing schemes.
- Develop technological public patient involvement groups to ensure health literacy requirements of innovations.
- Ensure that health and social care professionals of the future have the skills and education to work in an increasingly digital world. Universities already operate effectively in this arena, and the modern apprenticeships may create suitable education pathways to scale and deliver mixed workforce we envisage.
20 September 2019
- BMA and GP shortages https://www.bma.org.uk/news/2014/october/government-seeks-answers-on-gp-shortage
- Dementia Story Work https://www.dementiauk.org/for-professionals/free-resources/life-story-work/
- Jesse Stommel (2019) keynote ‘Revolutionising feedback for student success’ Association of Learning Technology[digital ethics] https://altc.alt.ac.uk/2019/sessions/altc-keynote-jesse-stommel/#gref
- Junghee Kim, You Lim Kim, Hyoeun Jang, Mikyeong Cho, Mikyung Lee, Jonggun Kim, Hyeonkyeong Lee, Living labs for health: an integrative literature review, European Journal of Public Health, , ckz105, https://doi.org/10.1093/eurpub/ckz105
- OFCOM https://www.ofcom.org.uk/research-and-data/multi-sector-research/cmr/cmr-2019
- 5G Rural Dorset https://news.dorsetforyou.gov.uk/digital-first/2019/
- Sugata Mitra (2012) The Hole in the Wall Project and the Power of Self-Organized Learning https://www.edutopia.org/blog/self-organized-learning-sugata-mitra
- The Topal Review Preparing the healthcare workforce to deliver a digital future https://topol.hee.nhs.uk/wp-content/uploads/HEE-Topol-Review-2019.pdf
- EU Learning Layers: Scaling up Technologies for Informal Learning in SME Clusters http://results.learning-layers.eu/