Assisted Living UK Capabilities
Opportunity Report

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East of England - full text version

1 Introduction

 This case study provides a high-level snapshot of the Assisted Living (AL) sector in the East of England. The purpose of this study is to provide key facts and information about the geographic, demographic, economic, and health factors that have an impact upon the potential for Assisted Living. This study also highlights the main regional innovations, collaborations, and industry initiatives in AL. The main aim of the study is to provide an overview of where the opportunities lie within the East of England region for the development of the Assisted Living sector.

Throughout this study, the most recent information and data have been sourced and, where possible, are presented at County/Unitary Authority (UA) level. If data is not available at this level of detail, then regional or national data is provided instead.

 2 East of England Regional Overview

The East of England is one of the larger regions in terms of area and population. It is the second largest English region after the South West with an area of approximately 19,100 square km. It is larger than Northern Ireland but smaller than Scotland and Wales. The East of England region covers 15 per cent of the total area of England and 8 per cent of the UK. The region shares its borders with London, the South East and the East Midlands. It also has an extensive coastline, 121 kilometres of which are defined as heritage coast. Large towns and cities in the region include Norwich, Cambridge, Peterborough, Stevenage, Ipswich, Colchester, Southend-on-Sea and Luton.

 2.1 Administrative Regions

 Following the administrative re-organisation in 2011[2], the administrative geography of the East of England comprises 5 counties and 6 unitary authorities (UAs).

 east of england


Figure 1: Map of the East of England including approximate County and Unitary Authority Boundaries (ONS 2011)

The East of England region, comprises the following 5 counties (see Figure 1):

  • Cambridgeshire
  • Essex
  • Hertfordshire
  • Norfolk
  • Suffolk

    And 6 unitary authorities, most of which centre on larger towns and cities in the region:

  • Bedford
  • Central Bedford
  • Luton
  • Peterborough
  • Southend-on-Sea
  • Thurrock

2.2 Demographics

The following sections describe the age demographics of the region. The population statistics quoted are from the Office of National Statistics (ONS). The age profile graphs and charts have been created from data available from the NHS Information Centre (NHSIC) and are based on patients registered with GPs in the region.

2.2.1 Population

The East of England is the fourth largest region in the UK in terms of population (see Figure 2). In mid-2009, the East had a population of 5.8 million. Between 2004 and 2009, the population of the East increased by 4.8% compared to an overall increase of 3.3% for the UK as a whole[3].
The local authorities with the largest populations were Luton UA (190,000) and Colchester in Essex (180,000). The local authorities with the smallest populations were Maldon in Essex (62,000) and Forest Heath in Suffolk (63,000). Seven other local authorities in the region have populations of 150,000 or more[4].
Between 2006 and 2007, the population of the East increased by 54,500, an increase of 1.0 per cent, compared to an increase of 0.6 percent in the population of the UK for the same period. The East was one of three regions, including Northern Ireland and the South West (both around 1 per cent) that experienced the largest percentage increase among the regions and countries of the UK.
Over a longer period, between 2002 and 2007, the population of the East of England rose by 228,000, an increase of 4.2 per cent compared with 2.8 percent in the UK as a whole. No other region’s population had a higher rate of increase in this period, and only the East Midlands had an equal rate[5].

Figure 2 UK Regional Populations – mid 2010 (Source ONS)

2.2.2 Population Density

In 2007, the population density of the East was 300 people per square km. This was above the UK average of 250 but below the England average of 390. Within the region the population density varied considerably ranging from 100 people per square kilometre in Kings Lynn and West Norfolk and Breckland in Norfolk, to 4,400 in Luton UA, which is the third most densely populated local authority outside London. For comparison, London had a population density of 4,800 people per square km, which was 16 times the density in the East of England[6].

2.2.3 Urban v Rural Populations

The ONS regional portrait reports that experimental population estimates for mid-2006 for Lower Level Super Output Areas (LSOAs) show that approximately 70 per cent of the region’s population live in areas classed as urban, over 10,000 population, and approximately 30 per cent in areas classed as towns or rural[7].

2.2.4 Population over 65 years

The population of the UK is ageing. In the period 1985 to 2010, the percentage of the population aged 65 and over increased from 15 per cent to 17 per cent, an increase of 1.7 million people. Not only is the population ageing, but there has been an increase in the number and proportion of those aged 85 and over. In 1985, there were around 690,000 people in the UK aged 85 and over (1 per cent of the population). By 2010, the numbers have more than doubled reaching 1.4 million, (2 per cent of the UK population). By 2035 the number of people aged 85 and over is projected to be 2.5 times larger than in 2010, reaching approximately 3.6 million and accounting for 5 per cent of the total population[8].
Figure 3 shows a similar number of males and females in each age category. The population of both males and females as a percentage of the overall population begins a gradual decline between the ages of 60-79, where the population of males and females is 8.9% and 9.7% respectively, but drops more markedly to 1.8% for males and 3.1% for females over the age of 80.

Figure 3 Male and female population of the East of England as a percentage of the total population (English Regions) (Source: GP data)

Figure 4 shows that within the East region, there are significant variations in age distribution, with Bedfordshire (incl Luton) with the lowest population of over 65s (75,722) and Essex (incl Southend and Thurrock) with the highest (2,682,59).

Figure 4 Population by County within the East of England region – Male and Female over 65 (Source ONS)

2.2.5 Life Expectancy

One key indicator of health in an area is life expectancy, which is an estimate of the number of years that a person can expect to live, on average, in a given population. One of the findings from an ONS study (Kyte and Wells, 2010) that explored variations in life expectancy at birth between rural and urban areas of England during the period 2001 to 2007, was that people in rural areas lived longer than those in urban areas – an additional 2.1 years for males and 1.4 years for females[9].
In 2007-2009, the East of England had a higher life expectancy than the UK average, with life expectancy at birth for females of 83.0 years and males of 79.3 years, compared to the UK average of 82.0 for females and 77.9 for males. Within the region, life expectancy at birth for males was highest for South Cambridgeshire (81.6 years) and lowest in Peterborough unitary authority (77.2 years). For females the highest life expectancy was in North Norfolk (84.6 years) and lowest in Luton UA (80.6 years)[10].

2.2.6 Population Projection

The East of England is projected to have a higher population growth than most other regions over the next 20 years with a particularly large increase in the older age group. The 2006-based population projections show that the East of England will have the second largest increase of the English regions after the East Midlands. By 2026, the population of the East of England is will reach 6.8 million, 20 per cent more than in 2006. The population of England is projected to increase by 16 per cent in the same period[11].

Figure 5 shows the population projections for males over 65 years and females over 60 years from 2010 to 2033 for the English regions and Wales.

Figure 5 Projection Population – Older People (Male 65yrs+ Female 60yrs+) (Source ONS)

The number of older people (Male 65yrs+ Female 60yrs+) in the East is expected to grow at a greater rate than the total population. The population of older people in 2010 was 1.21m, projected to rise to 1.94m in 2033, which is a projected increase of 60.3%. This is the largest increase of the English regions and Wales, followed by the East Midlands (59.6%) and the South East (58.3%) and higher than the total projected 46 per cent rise in this age group in England. This is compared to the North West, which has the lowest projected increase of 43.2%.

2.2.7 Old Age Support Ratio

The old age support ratio is a measurement of how many people of working age (20-64) there are relative to the number of retirement age (65+). The lower the ratio, the fewer younger people there are to support the over 65s.
The population of the UK is ageing. In the period 1985 to 2010, the percentage of the population aged 65 and over increased from 15 per cent in to 17 per cent, an increase of 1.7 million people. Over the same period, the percentage of the population aged under 16 decreased from 21 per cent to 19 per cent. This trend is projected to continue. By 2035, 23 per cent of the population is projected to be aged 65 and over compared to 18 per cent aged under 16.
In 2009, people aged 65 and over in the East made up 17.1 per cent of the population, compared with 18.9 per cent for the under-16s[12]. Figure 6 shows the support ratio for the counties and UAs in the East of England for 2009 and what this support ratio is projected to be in 2033. The chart shows that the ratio of working-age people to elderly is declining in throughout the East region, which means that there will be an increasing number of elderly people being supported by fewer people of working age. The average support ratio for the East region in 2009 is 3.1, decreasing to 2.7 in 2033.

Figure 6 East of England Old Age Support Ratios (Source ONS)

2.2.8 Households and Housing

In 2006, the East of England had an estimated 2.37 million households, which is 11 per cent of the number of households in England. The average household size was estimated at 2.33 people, compared to the England average of 2.32.

According to the ONS, Portrait of the East of England, by 2026, the number of households in the East is projected to reach around 3.06 million, an increase of 29 per cent from 2006, which is greater than the projected increase for England of 24 per cent. This is a faster rate than the projected population increase; consequently, the average household size in is expected to decrease to 2.17 people. This change is due to the projected increase in one-person households (58 per cent between 2006-2026), which will result in the number of one-person households equalling the number of married-couple households with is not projected to change. The increase in one-person households is partly the result of a continuation of past trends in household composition and partly related to the projected change in age distribution of the population. For example, an increase in the proportion of elderly people in the region by 2026 could contribute to an increase in the number of people living alone[13].
In September 2011, the Older People’s Day Statistical Bulletin reported that:
‘Older women are more likely than older men to live alone and the percentage increases with advancing age.
In 2009 in Great Britain, 32 per cent of women aged 65-74 lived alone compared to 22 per cent of men in this age group;
For those aged 75 and over the proportion living alone increases to 60 per cent for women compared to 36 per cent for men.
In 2009, 73 per cent of older people households in the UK (where the household reference person was someone aged 65 or over) were owner occupied and of these the vast majority owned their homes outright, with only 6 per cent overall being bought with a mortgage or loan.
Within the 65 and over age group, there is a decrease in owner occupation with age: 76 per cent of those aged 65 to 74 owned their own homes compared to 65 per cent of those aged 85 and over.
The percentage of older people households living in rented accommodation increases with age.
In 2009, 19 per cent for those aged 65–74 were in social rented accommodation compared to 26 per cent for those aged 85 and over.
Relatively small proportions of people aged 65 and over live in privately rented accommodation; however, this also increases with age, from 5 per cent for those aged 65-74 to 8 per cent for those aged 85 and over’[14].
In the East of England, the median dwelling price in 2009 was £175,000, the joint third highest of the English regions after London and the South East[15].

2.2.9 Older People and the Internet

The demographic information relating to Internet access and usage in this section is sourced from the ONS and Ofcom (the independent regulator and competition authority for the UK communications industries). At present, it has not been possible to obtain useful county/UA level demographic data on how older people access and use the Internet, so national data has been used to identify information and trends that could be seen as relevant at a regional level.
Ofcom produces an annual Communications Market report[16], which provides data and analysis on broadcast television and radio, the Internet and on fixed and mobile telephony, and provides some useful demographic information on broadband take-up and Internet usage in the UK. It also offers insights into how people are using mobile technology to access audio-visual and online content.
The last 10 years has seen rapid change in the communications market with the fast emergence and take-up of digital technology. New communications devices and services have been adopted by consumers across all age groups.
Ofcom’s key finding relating to the demographics of Internet access is that older people and those in lower socio-economic groups are less likely to have Internet access. Despite this, take-up for older people is increasing: 55% of 65-64s and 26% of over-75s have home Internet access. Of those over 65s that don’t have Internet access, the main reasons are:
31% lack of interest – no need for the internet
24% age - too old to use the internet
17% need - did not want a computer
15% training - did not know how to use the internet / a computer
3% cost - it was too expensive

Television has proved a resilient audio visual broadcast medium, and has evolved to encompass digital technology, with smart TVs starting to provide Internet access. Consumption of TV increases with age - the over 65s spend on average 5.7 hours a day watching television compared to an average of 4 hours for the typical viewer in 2010[17]. With access to the Internet via TV becoming more widely available, this may be relevant to the delivery of AL services for the older demographic. Mobile Internet connections

The ONS has noted a significant growth in the adoption of mobile Internet technology over the previous 12 months. Six million more people reported using their mobile phone to access the Internet in 2011 than in 2010. Although this growth is fastest among those aged 16-24, with Internet use over a mobile phone increasing from 44 per cent to 71 per cent over the previous 12 months, there have been notable increases across all age groups (see Figure 7).
Since 2009, when the measurement of mobile phone Internet use in this survey began, the number of women using mobile phones to access the Internet has more than doubled, from 18 per cent of Internet users to 39 per cent in 2011. Mobile Internet use via a laptop, tablet or other portable computer also proved popular in 2011, with 38 per cent of Internet users using these mobile devices away from the home or workplace.[18]

Figure 7 Mobile phone Internet connections by age group (Source ONS 2011) Confidence in using the Internet

Another of Ofcom’s key findings is that older people are increasingly confident using the Internet. Most Internet users claim to be confident in using the Internet and are becoming increasingly so. However, older people are least likely to be confident in using the Internet. One in ten of over-65s saying they are not confident, compared to only one in 50 of under-34s.
However, the biggest increases in confidence was in the 45-54s and 55-64s, age groups, with a ten percentage point rise in both age groups; more than 90% now claim to be confident.
Men are still marginally more likely to be confident in using the Internet than women (97% to 94%), but the gap has been closing[19]. Internet activities

In 2011, the ONS reported just over one in five (21%) Internet users made telephone or video calls online. This activity is not dominated by a specific age group; older age groups show similar patterns of use to the younger age groups. Of those aged 65 and over, 17% used this technology, compared to 22% of those under 24[20].
Figure 8 shows that older people are using the Internet increasingly to make purchases. Whilst there has been an increase in purchases made by both those over 55s and over 65s year on year since 2008, there has been a significant increase in the percentage of those aged 55 purchasing online. Fifty nine percent of over 55s compared to 27% of over 65s making purchases in 2011. This pre-disposition to purchase goods and services online in the over-55s may be of relevance to the AL market[21].

Figure 8 Internet purchases by over 55s (Source: ONS 2011)

Figure 9 shows the type of goods and services purchased online by those aged 55 and over as reported to the ONS in 2011. The most popular purchases were holiday accommodation (10%), other travel arrangements (11%), which includes flights, car hire and other transport tickets; books magazines and newspapers (11%); clothing and sports goods (10%) and household goods (10%).

Figure 9 Internet purchase by type by over 65s (Source ONS 2011)

3 Regional Economy

3.1 Economic Overview of the East of England

The East of England is one of the largest regions in terms of its share of jobs and has a high level of labour productivity. The region has managed to sustain a comparatively high level of employment and low unemployment rates. The East also has the highest expenditure on research and development by businesses in the UK (see Section 8).

In 2007, the East of England economy generated £106.8 billion of gross value added (GVA) on a workplace basis (8.8 per cent of the UK total). Although this is below the average GVA per head of £18,900 per resident, the East is the fourth highest in the UK, after London, the South East and Scotland[22].

3.1.1 Older People’s Income

In 2008-2009, the average gross weekly household income in the East was the fourth highest of the English regions and countries of the UK at £722 per week and just over the UK average of £703[23].

For the UK as whole, the Older People’s Day Statistical Bulletin reports that in 2009-2010,
‘Pensioner couples received an average gross income of £607 per week, single male pensioners received £320 per week and single female pensioners £274.
The largest source of income for pensioners is 'benefit income', which includes state pension income and benefits.
Occupational pensions are also a significant source of income. Average incomes conceal considerable variations between poorer and richer pensioners.
On average, older pensioners have lower incomes than younger pensioners and male pensioners have higher incomes than female pensioners.
Couples where the household head was aged 75 or over had an average gross income of £491 a week compared with £653 for those with a household head aged under 75;
Single male pensioners aged 75 and over had an average gross income of £315 per week compared to £325 per week for single male pensioners aged under 75;
Single female pensioners aged 75 and over had an average gross income of £255 per week compared to £297 per week for single female pensioners aged under 75.
Despite increases in pensioner incomes over the last fifteen years, in 2009/10, the incomes of an estimated 1.8 million pensioners in the UK (16 percent) fell below the most commonly used official measure of relative poverty (less than 60 per cent of equivalised8 contemporary median income after housing costs). Two-thirds of these pensioners were women’[24].

3.2 Regional Economic Infrastructure

In 2010, the UK Government developed a National Infrastructure Strategy[25] as a first step towards providing a more integrated approach to infrastructure development across the five sectors and networks that directly contribute to economic growth (energy, transport, water, waste and communications). This strategy has distilled into a National Infrastructure Plan, first issued in 2010[26] and revised to include more regional detail in 2011[27], and updated in 2012[28] to report progress against the plan.
A region’s economic infrastructure can have a significant impact upon the ease with which technology innovations can be deployed to meet social objectives such as healthcare. The sectors and networks that are of most relevance to AL are energy, transport, and digital communications and surrounding them all is the region’s ability to generate intellectual capital. Given the recent nature of the strategy and plan, there are few statistics at the moment to support the development of the economic infrastructure at regional level. Instead, regional initiatives and projects have been used to illustrate activities in the relevant areas.
Based on the framework in the National Infrastructure Plan[29], Figure 10 shows the interrelationships and inter-dependencies between the care network and the regional economic infrastructure. For example, a poor transport infrastructure can offer opportunities for AL services, whereas a poor digital communications network would be a constraint.
All the elements within this infrastructure depend on utilizing the Intellectual Capital within a region, and it in turn depends on these networks to facilitate the take-up of science and technology innovations. The 2011 Infrastructure Plan recognizes the importance of good transport and digital communication links in facilitating the development of innovation hubs, science parks and clusters, which will all benefit from investment in world-class research facilities. Co-location of these innovation clusters with universities will also foster knowledge transfer and expertise exchange.

figure 10 
Figure 10 Regional Infrastructure Interrelationships (Source UK Strategy for Nat Infrastructure)

3.2.1 Transport

Three major motorways pass through the region: the M1, the M11 and the A1(M), all of which are used to access London from the north of England and the Midlands. Part of the M25, which surrounds London, also passes through the south of the region.
The Insight East Sustainability Report[30] highlights significant problems with the road system in parts of the region, in particular, the road network suffers severe congestion on key strategic networks and as such average speeds are lower than the English Average. The East of England's road network suffers the greatest congestion on strategic links around London (M25) and on the strategic network around the London Arc and Thames Gateway/South Essex. Other key 'hot-spots' are on much of the A12, the A120 and A1 (M) and on key routes around Cambridge. Average speeds on the regions strategic road network are amongst the lowest of the English regions.
The ONS Regional Trends report on the East of England reports that in 2007, the average daily vehicle flow on the region’s motorways was 88,200, which was above the England average of 82,500 and the Great Britain average of 77,500. This is the fourth highest motorway flow below London, the South East and the East Midlands. The above average traffic flow could be attributed to the roads being used to access London. However the average daily flow for all roads is one of the lowest at 3,900, below the England average of 4,000 but slightly above the average for Great Britain of 3,500[31].
According to the Insight East Sustainability Report[32] the availability of public transport in the East of England is poor compared to the English average. People in the region make less use of and spend the least on public transport than the rest of England. The region has consistently had the lowest yearly total number of journeys and number of journeys per person of all the English regions.
Many towns have a direct train link to Central London and large numbers of workers commute to the city on a daily basis.
Two of the five international London airports are in East of England, at Luton and Stansted. London Stansted is the third largest UK airport in terms of passengers after London Heathrow and London Gatwick. Southend Airport aims to become a fully-functioning regional airport by 2012. There are plans to build a new terminal, control tower, railway station and hotel, as well as an extension to the airport’s runway. The plans could see passenger numbers increase up to two million a year by 2010.
Cambridge Airport aims to become a leading aviation hub for the East of England. The airport hopes to expand its regional airline routes, refurbish the passenger terminal and develop the horse transport market, particularly between Newmarket and the Middle East[33].
The region also has two major sea ports, Felixstowe and Harwich. Nearly 30 million tonnes of freight were handled through these ports in 2007.

The Communications Infrastructure 2012 update reports [34] the following progress on infrastructure delivery programmes and Autumn Statement 2012 capital announcements relevant to the East of England region:

  • Under construction: East Coast Mainline Enhancements – Hitchin flyover
  • Starting soon: A11 Fiveways to Thetford – 2013
  • Under construction: M1 J10-13 Improvements
  • New funding announced: A5-M1 new link road (£127 million)
  • New funding announced: J30 M25 improvement works (£150 million)

3.2.2 Digital Communications

Ofcom, the independent regulator and competition authority for the UK communications industries, has reported[35] that during the last 10 years, the UK’s communications market has been totally transformed. Digital technology has developed extremely quickly, and has changed the way that communications services work for consumers. It has also had a major impact on businesses and networks. For AL to take advantage of these rapid developments, a region must have an adequate digital communications infrastructure. Ofcom is now tasked with reporting on broadband take-up, speeds and availability, using data provided by communications providers.
The connectivity of a region has a direct impact upon the implementation and take-up of AL products and services. The UK Government aims to have the best superfast broadband network in Europe by 2015 by providing all homes and businesses in the UK with access to at least 2Mbit/s broadband and that superfast broadband should be available to 90 per cent of people in each local authority area. There will be a particular focus on making sure that people in remote, as well as urban areas, get good online access.
The most recent information on broadband in the UK has been compiled by Ofcom. The Digital Economy Act 2010 requires Ofcom to report on the state of the UK’s communications infrastructure every three years. The Communications Infrastructure 2011 report[36] has been published and provides some useful regional information not only for local authorities developing broadband plans, but also for businesses wanting to develop and deliver services – see Figures 11 and 12.
In addition to its first UK Communications Infrastructure Report, Ofcom has produced the UK's first interactive map showing accurate information on broadband take-up, speeds and availability, using data provided by communications providers.
Figure 11 shows the availability of broadband across the East of England region based on:

  • the percentage of homes with broadband currently not achieving 2Mbit/s speeds
  • the percentage of addresses which are within the coverage area of superfast (over 24Mbit/s) broadband networks
  • the number of existing broadband connections as a proportion of premises (including superfast broadband connections)
  • the percentage take-up of superfast braodband

As part of the government’s commitment to connecting rural areas, Norfolk in the East of England will receive £15m funding for superfast broadband[37], part of the £530m fund earmarked to support the roll-out of superfast broadband to areas that the market alone will not reach. Suffolk has also been identified as a priority area for superfast broadband, with funding still to be confirmed.

broadband 2012
Figure 11 Broadband availability by East of England Administrative Authority (Source Ofcom)

The Communications Infrastructure 2012 update reports [38] that the Government has 'established a framework agreement for Local Authorities to use to deliver rural broadband projects and secured state aid clearance to enable investment to proceed.' Norfolk, and Suffolk are expected to have completed procurement by December 2012. Cambridge is one of the first ten 'super-connected' cities that has been successful in its bid for funding to deliver ultrafast broadband and public wireless connectivity.

Ofcom has also collected data on the average maximum speeds of existing broadband connections, although notes that speeds achieved in the home will be slower. Figure 12 shows the Average modem speed (Mbit/s) by Local Authority.

sync speed graph
Figure 12 Average modem speed (Mbit/s) by Local Authority (Source Ofcom)

 Ofcom[39] has ranked each area on a scale of 1 to 5, with 1 the highest or fastest, and 5 the lowest or slowest on how they score on four broadband metrics:

• Average modem sync speed (Mbit/s): The average maximum speeds of existing broadband connections. Speeds achieved in the home will be slower.
• Percentage receiving less than 2Mbit/s: The percentage of homes with broadband currently not achieving 2Mbit/s speeds.
• Superfast availability: The percentage of addresses, which are within the coverage area of superfast (over 24Mbit/s) broadband networks.
• Average take-up:The number of existing broadband connections as a proportion of premises, excluding superfast broadband connections.

Figure 13 shows the ranking (1 = highest /fastest, 5 = lowest/slowest) within the East region by administrative authority. All areas except Norfolk and Suffolk have a ranking of 1 or 2. Norfolk and Suffolk, two of the largest counties by area, have the lowest ranking (3) within the region. However, procurement of rural broadband projects is under way, so the quality of broadband in these regions should improve.

Figure 13  Overall Broadband Performance by East of England Administrative Authority (Source Ofcom)

3.2.3 Energy

With smart meters being considered as a potential important opportunity for the delivery of AL, the roll-out of smart meters represents a significant milestone. As part of its National Infrastructure plan[40], the UK Government aims to make every home and every business an intelligent part of an electricity network, to help moderate demand at peak times and to preserve supply and demand balance despite increased amounts of intermittent, renewable electricity generation. The aim is also to ensure greater energy interconnection with continental Europe and Ireland.
Currently, there is no regional data available, but by 2019, the Government will ‘complete the rollout of smart meters, so that electricity customers can participate actively in helping reduce carbon intensity (by consuming less energy) and maintain security of supply (by smoothing their consumption over time). Development of the communications and data infrastructure required to support smart meters is expected to commence by 2014.’[41]
According to the Government’s National Infrastructure Plan ‘widespread use of smart meters can be accommodated within the current digital communication network infrastructure, but potential future developments of smart energy grids might require further innovation and investment in communications infrastructure.’[42]

3.2.4 Intellectual Capital

Intellectual capital is vital for attracting inward investment, stimulating innovation and allowing the UK and its regions to be competitive in the global knowledge economy. In its Infrastructure Plan 2010[43], the Government recognized the important role that Intellectual Capital plays in the UK’s economic infrastructure and is committed to providing funding to develop the UK’s Intellectual Capital, for example:
enabling investment in science, research and innovation through provision of research facilities and equipment in universities.
supporting (including by way of capital investment) the work of the Research Councils and investing in innovative technologies in and for infrastructure.
supporting the Technology Strategy Board to incentivise business led technology innovation;
establishing a network of Technology and Innovation Centres.
Intellectual Capital, if measured by spending on R&D (see Section 8), is concentrated within the region, particularly around institutions – such as Cambridge and Cranfield Universities, the Genome Campus at Hinxton, and the research facilities at Norwich Research Park and University of East Anglia – which all act as key drivers of knowledge-based economic development.

See Section 7 for information about regional Centres of Expertise and Innovation.

4 Health and Social Care

This section aims to provide an overview of the health of over 65s in the region compared to the provision of services, in particular, NHS hospitals, residential care homes, domiciliary care, and care provision by the Third Sector.

Currently, the Department of Health (DH) has a duty to provide a comprehensive health service in England. The health departments of the devolved assemblies of Scotland, Wales and Northern Ireland have similar duties.

The new health and care system for England become fully operational from 1 April 2013 when NHS England, Public Health England, the NHS Trust Development Authority and Health Education England took on their full range of responsibilities[44] . Nationally, NHS England commissions specialised services, primary care, offender healthcare and some services for the armed forces[45] . It has 27 area teams but is one single organisation operating to a common model with one board.

Locally, clinical commissioning groups (CCGs) will buy services for patients[46] . These are groups of general practices which have come together in each area to commission the best services for their patients and population. Most of the NHS commissioning budget is now managed by 211 clinical commissioning groups commissioning care for an average of 226,000 people each.

The CCGs are supported by commissioning support units (CSUs) As at June 2013 there were 19 CSUs and they will be hosted by NHS England until the end of 2016[47]. They will support clinical commissioning groups by providing business intelligence, health and clinical procurement services, as well as back-office administrative functions, including contract management.

Commissioning of public health services is undertaken by Public Health England (PHE)[48] and local authorities, although NHS England commissions, on behalf of PHE, many of the public health services delivered by the NHS.

Each top tier and unitary authority has its own health and wellbeing board promoting public health[49]. Board members will collaborate to understand their local community's needs, agree priorities and encourage commissioners to work in a more joined up way. As a result, patients and the public should experience more joined-up services from the NHS and local councils.

Healthwatch, the independent consumer champion for health and social care in England, ( will provide a powerful voice for patients and local communities.

A common pathway for an individual with an illness is to self refer themselves to a GP, for the GP to get them admitted to a hospital, for them to recover from their acute episode and be discharged to a community hospital to recover as much of their pre-event capacity as possible and then to return home where they may need social care. Social care (such as providing help with bathing and dressing) is provided by the local authorities and is means tested. Private sector and third sector bodies (for example, charities and not-for-profit organisations) are available to provide social care should public sector provision not be available to the individual.

4.1 Health in the East of England – Long Term Conditions

Long Term Conditions (LTCs), are conditions such as diabetes, asthma and arthritis, that cannot currently be cured, but whose progress can be managed and influenced by medication and other therapies.
The incidence of LTCs in the East of England is 1,583,660 out of a regional patient population of 5,564,345. This implies that 28.5% of the East of England patient population suffers from an LTC, but this assumption does not allow for occurrence of co-morbidities, so the actual percentage in the population will be lower. However, individuals with co-morbidities tend to be greater users of statutory health and care services and, therefore, 28.5% may be a reasonable ballpark figure to use in order to estimate the percentage of the East of England patient population needing to access products and services for LTCs.
The balance of specific LTCs within the East of England patient population is shown in Figure 13, broken down into nine specific conditions:
Heart Failure
Coronary Heart Disease
Chronic Obstructive Pulmonary Disease (COPD)
Learning Disability

The LTC profile shows Hypertension (52%) as the single largest condition being monitored by GPs in the region. Patients with Hypertension are at an increased risk of COPD (5%) and Stroke (6%). The second largest condition is Diabetes (16%), which also has strong links to Coronary Heart Disease, which has the third largest (13%) patient numbers.

Figure 14 East of England - Specific conditions as a percentage of all incidences of LTCs July 2010 data)

Figures 15 and 16 show patients with long-term conditions in the East of England in each Primary Care Trust (PCT). Figure 14 shows the number of people with LTCs registered with their GP. The data does not take into account patients registered with co-morbidities. Figure 16 shows the number of patients with LTCs as a percentage of the total patient population for that PCT.
Although Hertfordshire (279,929) and Norfolk (224,762) PCTs have highest number of patients with LTCs this actually accounts for 7% and 8% of all patients within each PCT respectively. Peterborough PCT has the lowest number of patients (43,724) with LTCs, which accounts for 4% of their total patient population.
South West Essex (12%) and South East Essex (11%) have the highest percentage of patients with LTCs.

Figure 15 East of England – Patients with LTCs by PCT (GP data)

Figure 16 East of England – Percentage of patients with LTCs in each PCT, July 2011 (GP data)

5 Existing Care Provision

In 2010, a new system for registering and regulating health care and adult social care in England came into effect, as a result of the Health and Social Care Act 2008. The changes in recording data about health care provision has made collecting relevant data difficult, either because the way the data is collected has changed or the data is not yet available. Because of changes in the legal requirements for registration, it is not possible to make direct comparisons with figures about provision and capacity from previous years.
A variety of sources have been used to collect the data in this section, including the NHS Information Centre (NHSIC), the Care Quality Commission (CQC) and the Office of National Statistics (ONS).
Each year, the CQC, which is the independent regulator of health care and adult social, care services in England reports on the state of health and adult social care in England. The latest report[50] was published on 15 September, 2011. The findings of this report show that:

  • the bed capacity in NHS hospitals across England has progressively reduced in recent years
  • the increase in day treatment in the NHS has reduced the length of time people spend in hospital and increased overall treatment capacity
  • the adult social care sector continues to evolve as new types of provision develop to enable people to live at home for longer
  • the number of residential care services fell by 10% between 2004 and 2010, whilst the number of domiciliary care agencies increased by over a third during a similar period.

The latest data for England from the CQC report[51] shows that in July 2011 the following care provision:

  • 5,894 registered home care agencies
  • 4,608 registered care homes with nursing
  • 13,475 registered care homes without nursing
  • 208,546 beds in registered care homes with nursing
  • 261,262 beds in registered care homes without nursing

Note that some care homes may be registered as both ‘with nursing’ and ‘without nursing’, so numbers are not mutually exclusive.

Figure 16 provides an overview of the care provision in England (NHS and independent hospitals, care homes and domiciliary care agencies) compared to the population of older people. Please note that in Figure 16, the population figures are indicative only for the purposes of providing a comparison with care provision. To obtain actual population figures, multiply the figures shown in the table by a thousand.

In general, social care provision echoes the size of the elderly population within a region. NHS hospitals and Independent hospitals and clinics also follow this general trend, although it must be noted that NHS and Independent hospitals also serve the wider population, so a direct comparison can not be made. Figure 20 shows the proportion of both older people and the general population compared to NHS hospital and independent hospitals in the East of England region.

Figure 17 shows that the East of England has the third largest population of older people (male 65 years and female 60 years) (1,209,000) served by care provision comprising 90 NHS hospitals, 200 Independent hospitals/clinics, 364 care homes with nursing, 1514 care homes without nursing and 627 domiciliary care agencies. The South East has the largest population of older people (male 65 years and female 60 years) and greatest number of domiciliary care agencies and care homes both with and without nursing. The North East has the smallest population of older people and the fewest domiciliary care agencies and care homes both with and without nursing.

All regions apart from the North East and the South West have at least twice the number of Independent hospitals and clinics as NHS hospitals.

Figure 17 Care Provision across English Regions (Source: CQC 2011)

5.1 Adult social care provision in England

Social care is defined by the Department of Health as: ‘The wide range of services designed to support people to maintain their independence, enable them to play a fuller part in society, protect them in vulnerable situations and manage complex relationships.’ (Department of Health 2006)

Care services can be provided in a variety of ways:
Care homes, including residential homes and nursing homes
Care in own home, usually referred to as domiciliary care or home care
Community venues, such as day care centres and drop-in centres.

There are also different types of social care available:
Personal care, such as help with washing, toileting, dressing, and eating, etc
Practical help, such as help with shopping, cleaning, etc
Nursing care, which is any service provided by a registered nurse in any setting

The different types of care are not necessarily dependent on the care setting; for example, domiciliary care can include both practical help and personal care.

Over the past few years, the adult social care sector has been evolving in response to the development of new types of provision aimed at helping more people to live at home for longer. The 2011 CQC report into adult social care provision noted that extended stays in hospital are being replaced by new or expanded models of provision, such as Extra Care Housing/Housing with Care, and short-term nursing care in homes. CQC registration data shows that there are 564 such Extra Care housing locations across England.[52].

The charity, the Elderly Accommodation Council (EAC) defines Housing with Care as: ‘all forms of specialist housing for older people where care services are provided or facilitated. This includes extra care housing, assisted living, very sheltered housing, close care and continuing care environments, and care villages’[53].

5.1.1 Access to social care

If people are finding it difficult to cope with daily living without assistance, they can self-refer by contacting their local authority’s social services department and ask for an assessment. People can also be referred by a hospital, primary health service or relative of friend. The CQC reports the following statistics for 2009-2010:

councils with adult social care responsibilities received 2.12 million new contacts from potential service users of services - a 4% increase from 2008/09 and an 8% increase from 2005/06
26% (540,000) were self-referrals
22% (474,000) were referred from secondary health sources, such as hospital wards or hospices
13% (272,000) were referred from primary or community health services
14% (304,000) were referred by family, friends or neighbours
34% (699,000) First assessments were completed for new people
52% of new contacts resulted in a further assessment or commissioning of ongoing services.

5.1.2 Eligibility criteria

Local councils (unitary and county councils) with responsibilities for adult social care must use national criteria[54] to assess people requesting social care and categorize their level of need. Need is categorized as low, moderate, substantial or critical. Each council can determine what category of need they will fund, and sets its own needs eligibility threshold for people o receive state-funded social care, for example, some councils will fund moderate needs, others only critical.

In their 2009/10 report, the CQC reported that 3 councils set their eligibility threshold at ‘critical’ and 107 set thresholds at ‘substantial’. The 2011 CQC report notes that there is evidence that local councils are changing the needs categories that they will fund as a consequence of budget cuts and demographic pressures. Based on a survey in May 2011, by the Association of Directors of Adult Social Services, the CQC reports:

‘of the 148 (98%) councils responding to the survey: 19 councils (13% of those responding) were changing their eligibility criteria for 2011/12, including 15 that were moving the threshold from “moderate” to “substantial” need. Six councils (4%) have set the threshold at “critical” and 116 (78%) at “substantial” – an increase from 70% in 2010/11. Twenty-two councils (15%) set their threshold at “moderate” and four (3%) at “low”.[55]

If such changes to eligibility thresholds continue, an increasing number of people will be move out of state-funded social care and into self-funded care. This may create a growing market for AL services.

5.1.3 Paying for Care

The social care system in England is currently under review, in particular how social care is funded. At present, in contrast to the way NHS services are funded, social care is funded in a much more localized way with much of the spending being controlled by local councils. Consequently, there are wide geographical variations in the way social care is funded. The King’s Fund Briefing on Adult Social Care 2009[56], summarises how social care in England is funded at present:

In England, social care is funded through the following

  • central government funds allocated to the local council
  • council tax revenues
  • individuals’ contributions to their council care package, and/or
  • individuals’ contributions to services arranged independently.

The voluntary or third sector also provides and subsidises a range of care services.

It is the responsibility of councils (unitary and county councils) with social services responsibilities to commission social care services for the local community.

If an individual needs social care, the local council will carry out an assessment of need to determine the level and type of disability and dependency. The council uses the national criteria[57] to categorize an individual’s level of need as low, moderate, substantial or critical.

Each local council has its own budget for adult social care and decides which of these four needs bands it will fund (some councils fund moderate needs, others cover only the critical band). Anyone below their council’s needs eligibility threshold must pay for their own care. In England, an adult who is eligible to receive social care is means-tested to determine what their contribution to the cost of their care will be.

The CQC reports that ‘an estimated 45% of care home places in England are occupied by people who are self-funding, meaning their costs are met privately rather than by the state. In addition, some people funded by local authorities have their care home fees ‘topped up’ by relatives or other third parties, to bridge the gap between what their council will pay and what the care home charges. Across England, around a quarter of local authority care home placements may be co-funded in this way. It is estimated that 168,700 older people pay privately for care in their own homes, and this increases to over 271,500 if widened to include those who pay for support with things like housework and shopping’.

5.2 Domiciliary Care (Home Care)

Domiciliary care is care delivered in a person’s own home and can be either personal care, such as help with washing, toileting, dressing, and eating, etc, or practical help, such as help with shopping, washing and ironing, cleaning, etc or a combination of both. Domiciliary care services can be provided by either the local authority or an independent care agency.

According to the CQC report[58], there were 5,894 home care agencies in England in July 2011. The South East has the highest number, with 1079 agencies, followed by the North West and London with 795 and 745 agencies respectively. The North East has the lowest number of domiciliary agencies, with 263. Agencies vary in size and the number of people they serve. A single agency will usually be registered to provide care for more than one type of person.

Data is not currently available for individuals receiving home care at a national or regional level; however, some data is available based on households receiving home care.

Figure 18 shows the number of households receiving intensive home care based on data from the NHS Information Centre (NHSIC)[59]. Intensive Homecare is defined as the number of households receiving more than 10 contact hours and 6 or more visits during the week. Households receiving home care purchased with a direct payment are excluded. The total number of households receiving home help/home care excludes double counting of households receiving care from more than one sector.

Figure 18 shows that the East of England has the fourth highest number of households in receipt of home care (37,720), the South East has the largest number of households in receipt of home care (49,985), followed closely by the North West with 48,210 households and London with 44,380. The North East (21,425) has the lowest number of households receiving home care.

Figure 18 People aged 65 and receiving Home Help and Home Care by Region (Source: NHSIC Community Care Statistics 2008, Home Care Services for adults, England 26 Mar 2009)

Data on the number of households over 65 yrs receiving home care was not available from the NHS Information Centre, however, the NHSIC did provide demographic statistics for those aged 65 and over as a percentage of households in receipt of homecare in a council area, based on the oldest person in the household. This data has been used to create Figure 19 which shows the proportion of households aged 65 and over as a percentage of all those provided with intensive home care by local council with responsibility for social services responsibility.

Figure 19 Households aged 65 and over as a percentage of all households in a council area receiving intensive homecare (Source: NHSIC Community Care Statistics 2008, Home Care Services for adults, England 26 Mar 2009)

Hertfordshire (39%) has the lowest percentage of households over 65 in receipt of intensive home care. For four councils, at least 80% of the homecare they provide is for those aged 65 and over: Norfolk (80%), Southend (82%), Suffolk (85%), and Thurrock (87%).

5.3 Residential Care

Care homes fall into two categories, those that provide nursing care and those that do not. Some care homes may be registered as both ‘with nursing’ and ‘without nursing’. When collecting data about care homes, it is not always possible to distinguish between the different types, so numbers are not mutually exclusive. Care homes are usually registered to care for more than one type of person. According to the CQC for care homes with nursing, the most common type of provision is for older people and those with dementia. For care homes without nursing, the most common type of provision is for older people and those with a learning disability or autistic spectrum disorder (ASD).

In July 2011 in England there were 4,608 registered care homes with nursing and 13,475 registered care homes without nursing. Figure 16 shows the regional variations in the number of care homes with nursing, care homes without nursing, and domiciliary care agencies. The estimated population of older people (M65+/F60+) in the East of England in 2010 was 1,209,000[60]. In July 2011, in the East there were 32,450 beds in care homes without nursing and 18,042 beds in nursing homes with nursing.

Figure 20 shows the proportion of care homes with nursing, care homes without nursing, and domiciliary care agencies in the East of England compared to the proportion of older people (males over 65 and females over 60) in the region.

Total regional figures for residential homes and domiciliary care agencies are given in Figure 20.

Figure 20 Population of older people compared to social care provision in the East of England (Source: CQC)

Figure 21 shows the proportion of both older people and the general population compared to NHS hospital and independent hospitals in the East of England region.

Figure 21 East of England Population compared to care provision in the East of England (Source: CQC)

5.4 NHS and Independent Hospital Care

In England there are 378 registered NHS provider trusts, which are responsible for delivering health care in 891 NHS hospitals across England.
It has not been possible to source data on the number of geriatric beds available because in 2010/11 the NHSIC changed the way they collected information on bed numbers. Previously statistics on the number of beds were collected by ward classification; now they are collected according to consultant-led beds by a consultant’s main specialty. It is not possible to make direct comparisons with figures from previous years, so data on beds for older people has not been included in this study.

However, the CQC has reported that ‘the number of NHS ‘geriatric’ beds had fallen further in 2009/10, despite the rapidly increasing proportion of very elderly people with health and social care needs in the population. As figures for ‘geriatric’ beds are no longer collected, we are unable to report on this for 2010/11. However, it is likely that the trend of many years – for a diminishing proportion of long-term care for older people to be provided directly by the NHS, and a rising proportion to be provided in care homes and community settings – is continuing’[61].

5.5 Local Authority Expenditure on AL in Health and Social Care

Over the past few years, interest in telecare has been growing, as has investment in these areas, both by solutions providers and care commissioners. Telecare is defined as ‘the delivery of social care services to an individual using a combination of information and communication technologies and sensor technologies’.

Local authorities are beginning to recognize the role telecare can play in easing the demands on a health and social care system that is suffering from budget restrictions and increasing demographic challenges. Figure 22 shows expenditure on telecare between 2006 and 2009 in each local authority in the East of England. The chart shows how much was spent per person aged 65 yrs and over in 2008/2009, and how much they expected to spend per person in 2009-2010. Due to boundary changes, comparative data is not available for Bedford, Central Bedfordshire and Bedfordshire.

Thurrock spent the most per person (£21.83) in 2008-09 and is projected to spend the most per person (£31.09) in 2009-10. Hertfordshire spent the least per person (£1.70) in 2008-09 rising to an estimated spend of £2.03 per person in 2009-10.

Figure 22 East of England Local Authority Expenditure on Telecare per person over 65 yrs 2008-2010

5.6 Third Sector Provision for the Elderly

Third Sector Organisations (TSOs) include small local community and voluntary groups, large and small registered charities, foundations, trusts, social enterprises and co-operatives. They are also referred to as Voluntary, Community and Social Enterprise (VCSE) sector organisations.

The government recognises that these organisations have a critical and integral role in health and social care as providers of services, advocates, and in representing the voice of service users, patients and carers. The sector makes a substantial contribution to the delivery of high quality health and social care services. The government also acknowledges that these organisations have a strong track-record of designing services based on insight into clients’ needs, and are often well placed to respond flexibly to those needs.

In 2007, the Department of Health commissioned research to examine the potential contribution that third sector organisations could make to the delivery of health and social care. The research involved surveys of third sector organisations and local authorities. The resulting ‘Third Sector Market Mapping’ report[62] found that:

approximately 35,000 TSOs provide health and/or social care in England
a further 1600 plan to do so in the next three to five years.
62% of TSOs provide social care
23% provide both health and social care services
62% are local providers
26% are regional providers
3% provide services across England
10% are UK-wide
2% are international as well as national
In 2006/07 total funding for these services was £12bn. The government’s budget for health and social care in England in 2005/06 was £87bn.
Just over half of the organisations’ funding comes from the public sector, although the public sector’s share is higher for social care (62%) than health care (36%)
52% of funding for third sector-provided health care is from fees paid by service users
63% of TSOs provide social care services for those 65 years and over
67% of TSOs provide health(DH) care services for those 65 years and over.
Most common social care needs: physical disabilities/sensory impairment (32%), mental health issues (24%) and learning disabilities (23%).
The two most common social care services: advice / counselling (42%) and education (25%), which account for 45% of the sector’s expenditure on social care.
Organisations providing transportation services are most likely to be recipients of public sector funding (84%), whereas those providing advice/counselling are least likely to do so (5%)
Most common client health care groups: those with mental health issues (31%) and those with a physical disability/sensory impairment (29%)

The East of England has 80 third sector organisations involved in providing services for the elderly, with the largest number of these in Norfolk (23). Bedfordshire and Hertfordshire both have 7 TSOs operating in each of their regions. The total income across the East of England of the top 5 organisations in each county is £31,341,256 with total expenditure of the top 5 of £30,790,350. The largest (in terms of income) TSOs operating in the East of England are shown in Table 1.

Table 1 Largest Third Sector Organisations (by income) in the East of England (Source: Guidestar)

Third Sector Care Organization

£ Income (all counties)

Age UK


All Hallows Healthcare Trust Limited


Carers in Hertfordshire


The Southend on Sea Darby and Joan Organisation Limited


Colchester United Community Sports Trust


Table 2 shows the number of third sector organisations (including income and expenditure) that provide services for the elderly in the East of England.

Table 2 Distribution of Third Sector provision for the elderly across the East of England (Source: Guidestar)

table 2

6 Current Assisted Living Activity

6.1 Suppliers of Products and Services

Figure 23 below illustrates private companies selling products and services into the Assisted Living market. The chart includes companies whose primary area of business is manufacturing and / or selling the following products and services:

1. Telecare: Telecare products and services only, includes devices and managed services
2. Telehealth: Telehealth products and services only, includes devices and managed services
3. Telecare & Telehealth: Combined Telecare & Telehealth products and services, includes devices and managed services
4. Environmental Control: Home automation and Environmental Control solutions
5. Communication aids: Including Video Conferencing solutions and products and services for people with Dementia, Learning Disabilities and Sensory loss.
6. Care Technology: Devices and services to support care workers delivering assisted living services in the community

Statutory Telecare and Telehealth providers are excluded from these figures unless they provide a privately managed service option.

Figure 23 Type and number of companies by region (Source: Medilink UK)

There is little data available for companies operating solely in the Assisted Living sector, with evidence of 11 companies involved in AL solutions.

The Technology Strategy Board’s Assisted Living Innovation Platform (ALIP) has a directory [63] of technology suppliers ranging from traditional Telecare and Telemedicine through to Environmental control and Memory support and Prompting devices, that can be searched on by region.

6.2 National AL Projects and Initiatives

At the time of writing 2 major initiatives are looking to support and underpin the mainstreaming of Telecare and Telehealth.

6.2.1 Delivery Assisted Living Lifestyles at Scale (dallas)

Dallas is an initiative backed by the Technology Strategy Board, The UK’s innovation agency; it kicked off in 2012 and currently is supporting four delivery partner organisations around the UK.

living it up logo

Living it Up (LiU), a digitally-enabled community that supports better health, wellbeing and active lifestyles in Scotland. LiU provides personalised experiences to keep people connected with one another and with their health and wellbeing.

ifocus logo

i-focus collaborates with health organisations on interoperability and best practice to transform health and care by providing better service delivery through digital comms and technology. Part of i-focus, Warm Neighbourhoods helps families stay connected by using simple sensor technology. It provides support and reassurance for families with vulnerable members who live alone.

mi logo

Mi (More Independent), a Liverpool-based scheme designed to enable people to take charge of their health, wellbeing and lifestyle through technology. Mi allows people to live more independently in their own homes, offering peace of mind both to them and their family, whilst reducing the amount of time spent on appointments by supporting people to manage better at home.


Year Zero is creating a suite of innovative digital products based on personal health records (PHRs) to allow people to take greater control of their own health and wellbeing, while transforming the relationship between patients and health care professionals. Products developed to date include the online personal care planning tool A Better Plan, digital care and support network Good Neighbours, a diabetes goal-tracking app uMotifand a digital version of the Personal Child Health Record (also known as the Redbook) eRedbook.

With an investment of £37.3million dallas aims is to improve health, wellness and quality of life through innovation, technology and digital services.

For more information see:

6.2.2 TECS Technology Enabled Care Services (3 Million Lives)

 NHS England Integrated Care for 3millionlives :
(Delivering Improved Heath and Wellbeing through Technology Enabled Care Services (TECS))

Launched in December 2011 3millionlives is underpinned by the idea of service integration to improve patient care and outcomes. When different services and sectors work together, towards shared goals, patients get far more flexible, better, and more appropriate care. To achieve true service integration, NHS England recognise that 3millionlives needs to be delivered through a genuine partnership across NHS England facilitating collaboration between clinicians, and empowering patients to better self manage their conditions, with the use of technology. They also recognise this cannot be achieved through technology alone the key will be to deliver service transformation through realising the potential of that technology to support clinicians, patients and carers.

It is known that there is a growing elderly population, a growing number of people with Long Term Conditions (LTCs), and growing numbers of people with multiple LTCs. This is putting an increasing strain on already stretched NHS resources. One in three people are living with at least one chronic condition, such as asthma, heart and lung disease, arthritis, hypertension and diabetes and half of people over the age of 60 have one. One in three of the population in England amounts to just over 15 million people with an LTC and its estimated that by 2025 this will rise to 18 million. People with LTCs are the biggest users of the NHS, accounting for around 50 per cent of GP appointments, 64 per cent of inpatient appointments and 70 per cent of inpatient hospital beds meaning 30 per cent of the population accounts for 70 per cent of the spend. If care is continue to be managed in the same way as it is now then NHS can expect to see an estimated of additional cost in five years. In the new NHS and social care landscape, we need to find new approaches and service delivery models that will deliver more efficient and effective care. There is a need for better health outcomes and innovations that support people to live more independently, and the NHS know that technology enabled care services can transform peoples lives. The challenge now faced is integrating these technologies into the NHS and wider health and social care services, so they become a mainstream service, not a side-line proposition. And this is where the 3millionlives programme, delivered in the right way, can really make a significant difference

NHS England took action on implementing the delivery programme from April 1st 2013, a rapid review of 3millionlives implementation to date was conducted, as there was a significant risk the programme as previously delivered would not hit the interim ambition of 100,000 new users in 2013. The review resulted in a need for a significant shift in strategic direction for the 3millionlives programme, including a redefined vision, mission and objectives for delivery, and bringing on board strong clinical and technological advocacy and a reframed partnership with Industry.

An early outcome from the review was an agreed change in governance arrangements, so that 3millionlives will be delivered going forward through a matrix approach of clinical advocacy, service improvement and technology strategy making it a true partnership and synergy within NHS England.

There is now tri-partite accountability for the successful delivery of the programme at Director level, with co-ordination for delivery and implementation of the programme residing with the Collaboration for Excellence Team.

Under a redefined vision for the programme, the Collaboration for Excellence Team intend to engage with, work with, and enable the 3millionlives brand to be associated with a much broader range of technology solutions and organisations. Its therefore essential to ensure that industry is working with NHS England as a true strategic partner in the delivery of 3millionlives. NHS England has now convened a much wider 'Integrated Care for 3millionlives Stakeholder Forum', bringing together Industry including all of the original members of the Industry Group commissioners, providers, colleagues from Social Care, the Third sector, and Local Government and housing, to form a collaborative group to collectively debate and resolve key system-wide issues around the delivery and implementation of the programme.

Now all of the different stakeholder groups with an interest in delivery of 3millionlives have been brought together to look at issues collaboratively and The Forum met for the first time in October 2013. The programme will also now look much more widely across the system, to harness where the energy lies locally for delivery of 3millionlives.

The programme is closely aligned with both the integrated care and technology strategy agendas, and has been repositioned as Integrated Care for 3millionlives It will be delivered as a unique collaboration between the NHS, Social Care and Industry to support integrated care, management of Long Term Conditions, and the enablement of 7 day services.

The team established four rapid Task and Finish Groups, one to progress each priority area and the findings and recommendations of these Task and Finish Groups informed the publication of a 3millionlives NHS England Delivery Plan for 2014-17.


Innovation is recognised as an essential part of the future of the NHS. The development of Academic Health Science Networks (AHSNs) across England resulted from the 2011 report Innovation Health and Wealth: accelerating adoption and diffusion in the NHS.

6.2.3 Academic Health Science Networks

NHS England has confirmed the designation of 15 new Academic Health Science Networks (AHSNs). AHSNs have the potential to transform health and healthcare by putting innovation at the heart of the NHS. This will improve patient outcomes as well as contributing to economic growth.

AHSNs present a unique opportunity to pull together the adoption and innovation with clinical research and trials, informatics, education and healthcare delivery. They will develop solutions to healthcare problems and get existing solutions spread more quickly by building strong relationships with their regional scientific and academic communities and industry.

The AHSNs provide an important mechanism for achieving step-change in the way the NHS translates research, innovation and best practice in to effective and cost-effective treatments and services for patients. They will help to develop better technology and make better use of the skills of NHS staff. Designated Academic Health Science Networks

The designated AHSNs are:
East Midlands
Greater Manchester
North East and North Cumbria
North West Coastal
Imperial College Health Partners
South London
South West Peninsula
Kent, Surrey and Sussex
UCL Partners
West Midlands
West of England
Yorkshire and Humber

6.3 Regional AL Projects/Initiatives in Health and Social Care

6.3.1 Local Councils and NHS PCTs

There are approximately 5 AL projects being undertaken with a further 3 planned in the East region by local councils and NHS PCTs. An overview of these telecare and telehealth projects and services in the East and the rest of England can be found at the following Google map links (last updated spring 2011)

Telecare Services Map:,-1.867676&spn=8.339986,18.676758&z=6

Telehealth in England Map:,-1.604004&spn=8.052625,18.676758&z=6

7 Centres of Excellence

7.1 National

7.1.1 The Telecare Learning and Improvement Network

The Telecare Learning and Improvement Network (LIN) is the national network supporting local service redesign through the application of telecare and telehealth to aid the delivery of housing, health, social care and support services for older and vulnerable people. For more information see the Telecare LIN website:

7.1.2 The Kings Fund

The King’s Fund is a charity that aims to understand how the health care system in England can be improved with the intention of helping to shape policy, transform services and bring about behavioural change. Telecare and Telehealth is one of the topic areas that the Fund covers in detail. In particular, the Telehealth Evidence Database is a free resource for anyone looking for information on telecare, telehealth and the management of long-term conditions. The database is updated weekly and holds 1,000 records of publications, journal articles and web resources. For more information see the King’s Fund website:

7.2 Regional

 7.2.1 NHS Innovations

Health Enterprise East Limited (HEE) is one of eight regional Innovations hub set up from 2004 to champion the cause of healthcare innovation and to identify, develop and commercialise innovations and intellectual property created by NHS staff. Operating within the NHS, HEE also provides consultancy services to technology-based companies looking to access the UK market. HEE committed to improving healthcare through supporting the development of innovative new products and services that meet the needs of the NHS. HEE provides a broad range of services to NHS organisations, providing expert advice, funding and support to NHS innovators to translate their ideas into practice. HEE works with clinical key opinion leaders and senior NHS managerial, commissioning and procurement staff on a daily basis. HEE’s NHS market assessments provide vital information for companies to ensure that their products are well targeted to the technical and business needs of the NHS, speeding up adoption of new technology by the NHS. Health Enterprise East is based at Papworth Hospital Cambridge, one of the leading UK Cardio/Respiratory Research and Treatment Centres. For more information see:

7.2.4 Health Innovation and Education Clusters (HIEC)

East of England has three HIECs. Norfolk and Waveney focuses on independent living for older people, while the Cambridge University Health partnerships follows the NHS East of England vision Towards the best, together. North East London and Essex look at maternity care, chronic pulmonary disease and cardiac conditions. Norfolk’s large ageing population poses particular challenges for health and social care, which is why the Norfolk and Waveney HIEC’s focus on maintaining independent living in old age is so important. The number of people in the county over the age of 85 is predicted to rise sharply during the next five to 10 years. According to Hadrian Ball, Medical Director of Norfolk and Waveney Mental Health NHS Foundation Trust, a co-ordinated response is needed to tackle the challenges arising from this.

Further information on the HIECs can be found at: http://
For further information on Norfolk and Waveney HIEC contact Hadrian Ball, Medical Director of Norfolk and Waveney Mental Health NHS Foundation Trust.

Tel:01603 421421,e-mail This email address is being protected from spambots. You need JavaScript enabled to view it.

7.2.5 University of East Anglia Faculty of Medicine and Health Sciences

The faculty covers all aspects of the UK Clinical Research Collaboration pipeline from underpinning research to health services policies and systems by conducting biological, psychological and economic research, complex clinical trials and economic evaluations in complex interventions for acute conditions and in the rehabilitation and management of long-term conditions. In particular, it undertakes health economics and public health studies and evaluations for a wide range of private and public sector clients; a wide range of clinical trials in a number of areas including healthy ageing and respiratory infection; and offers a consultancy focused on helping to increase the effectiveness or profitability of businesses and organisations by improving the wellbeing, lifestyle and musculoskeletal health of their employees.
Further information can be found at;

7.2.6 University of Cambridge

The Department of Public Health and Primary Care (DPHPC) is one of Europe’s leading academic departments of population health sciences. Several of its research themes are relevant to AL particularly ageing and neuroepidemiology, which investigates normal and abnormal cognitive ageing and the prevention of chronic disease through behavioural change.
Further information can be found at:

7.2.7 Cambridge City over-75s Cohort Study

The Cambridge City over-75s Cohort Study (CC75C) is a long-term follow-up study of a representative population-based sample of older people which started in 1985 from a survey of over 2,600 men and women aged 75 and above. The older people who have taken part – and those still taking part – in this study make up a unique group: the Cambridge City over-75s Cohort (CC75C). Through a series of interviews and assessments spanning over 20 years they have contributed to one of the largest and longest-running longitudinal observational studies of ageing into older old age.

7.2.8 Science Parks and Business Incubators

A Science Parks is a business support and technology transfer initiative. It provides a links between the knowledge base and businesses to facilitate the exchange of expertise and ideas and collaborations. Innovation, science and technology are critical to East of England’s prosperity. Underpinning this success is the region’s network of science parks and incubation centres, providing the environment to support the growth of innovative and enterprising individuals and companies. There are 14 science parks are in the region. For more information see the UK Science Park Association:

7.2.9 Business Incubators

Business incubators provide start-up businesses with low-cost facilities and support during the critical early stages of their growth. Incubators enable businesses to take advantage of a range of support and facilities, and access to advice expertise. Incubators can be public of private organizations. They are sometimes based within or near to a region’s universities. See the UK Business Incubation (UKBI) website for business incubators in the region:

8 Research and Education

Figure 24 shows the expenditure on research and development (R&D) in the East of England region for 2008 and 2009 as reported by the ONS (8 June 2011)[66].

Note: The figures for government include estimates of NHS and local authorities' research and development and estimates for those areas in central government not available from the Government Survey and local authorities. Due to the unavailability of regional data, the total for all R&D sectors does not include expenditure on the private non-profit (PNP) sector.

In 2008, the East of England had the highest R&D expenditure in the UK (£5162m) slightly ahead of the South East (£5083). In 2009 these positions were reversed, with the East of England spending (£4896m) on R&D behind the South East, which had the highest R&D expenditure (£5,323m).

Figure 24 Expenditure on Research and Development in the East of England 2008-2009 (Source: ONS 2011)

8.1 Universities and Higher Education Institutions

The region is home to seven universities, including the University of Cambridge, and several other higher education establishments.

The number of projects focused on Assisted Living involving Universities in East in the period 2007 to 2013 is 13 with a value of just over £24.8million. The universities receiving funding for AL associated projects are Cambridge (just over £13.383), Hertfordshire (£3.693m), Bedfordshire (£2.904m), East Anglia (£2.69m) and Essex (£1.13m). The main sources of funding are the European FP7 programme and Engineering and Physical Sciences Research Council (EPSRC).

There is little, if any, university-based training provision specific to AL, but the universities of Essex, Hertfordshire and Cambridge all have courses or modules in clinical or technical subject areas with potential relevance for AL. Specific AL training is fragmented, varies in its subject coverage and content, and is generally offered by individual service providers or local adult social care departments.

9 Regional Opportunities for Assisted Living

The East of England was not awarded a Whole System Demonstrator site so there is no local experience of implementing AL other than at pilot trial scale. However, there is considerable expertise in the region with three HEICs, one of which is focused on independent living for older people. In addition, Health Enterprise East has been involved in a Small Business Research Initiative (SBRI) in LTCs and is becoming involved in a medicines management SBRI.

The demographics of the region show that the elderly population will grow over the next decade but that many people live in rural communities. With arguably one of the poorest road networks and public transport networks of any region this will make accessing care difficult. The Government has however, targeted parts of the region for broadband rollout. The conditions in the region are therefore appropriate for the implementation of AL to help reduce inequalities to care access.

As a consequence, it can be assumed that in the East of England the markets for AL products and services delivered by the statutory sector (prescribed) and for AL products and services marketed directly to the individuals (elective) are both going to grow. The market for prescribed services will grow because the statutory services will increasingly come to depend on such services, either provided by themselves or by Any Qualified Provider (AQP), to meet the predicted growth in demand. The market for elective services will grow because it addresses the preventative and self-care agenda, which have long-term benefits for the individual and the statutory sector alike.

10 Bibliography

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