Assisted Living UK Capabilities
and
Opportunity Report

ktn logo

Scotland

Scotland - full text version

1.0 Introduction

This case study provides an overview of the assisted living sector in Scotland and is part of a wider UK Capability Map commissioned under the KT4i Project[1]. The case study looks at the Demographics, Health Profile, Provision of Care and the Industrial and Research base within Scotland. The mapping exercise is intended to illustrate areas for potential investment, either in service or product development.

2.0 Regional Overview

The map illustrated in Figure 1 shows the 6 Scottish regions covering 32 Council areas.

  • Highlands: Argyll & Bute, Eilean Siar (Outer Hebrides), Highland, Moray, Orkney Islands and Shetland Islands
  • North East: Aberdeen City, and Aberdeenshire
  • Central & Tayside: Angus, Dundee City, Perth & Kinross and Stirling
  • West: East Dunbartonshire, East Renfrewshire, Glasgow City, Inverclyde, North Ayrshire, North Lanarkshire, Renfrewshire and West Dunbartonshire
  • South East: Clackmannanshire, East Lothian, Edinburgh City, Falkirk, Fife, Midlothian, Scottish Borders and West Lothian
  • South West: Dumfries & Galloway, East Ayrshire, South Ayrshire and South Lanarkshire

fig1

Figure 1: Scottish Regions Map

Scotland comprises of over one third of the landmass of Great Britain and covers approximately 30,414 square miles. The major conurbations include the capital city of Edinburgh with a population of 492,233 Glasgow (596,000) and Aberdeen (219,539).

2.1 Demographics

The following section describes the demographics of Scotland including the population density, urban and rural population characteristics, population age, life expectancy and population projections.

2.1.1 Population

Figure 2 below ranks Scotland 8th in relation to population size across the other UK regions.

Figure 2: UK Population by Region 2010[2]

image008

Figure 3 illustrates the population of Scotland by Female / Male age ranges. The chart shows the greatest proportion of the population sits in the 30 – 49 age range. A higher percentage of people in this age range is fairly typical to other regions of the UK. However the population figures for the 0-15 and 16-29 age groups are significantly lower by comparison than any other UK region. This illustrates a population which will over the next decade see its 65+ population account for nearly one quarter of the overall population for Scotland.

Figure 3: Population by Age Range[3]

 

image009

2.1.2 Urban and Rural Population and Population Density

Population figures published by the General Register Office for Scotland (GROS) in 2010 estimate the total population to be 5.22 million representing around 8.4% of the total population of the UK. The overall population is projected to grow by 9%[4] (463,900) by 2033. The population is widely dispersed with 18% living in rural areas and 82% living in urban areas. The GROS use the following definitions to describe the population distribution:

1) Accessible rural (12%): those with less than a 30 minute drive time to the nearest settlement with a population of 10,000 or more
2) Remote rural (6%): those with a greater than a 30 minute drive time to the nearest settlement with a population of 10,000 or more
3) The rest of Scotland (82%): includes large urban areas, other urban areas, accessible small towns and remote small towns

When related to the landmass of Scotland approximately 1 million people (18% of the population) live in rural areas which accounts for 94% of the landmass of Scotland. In contrast 4.2 million people (82% of the population) live in urban areas accounting for just 6% of the landmass.

2.1.3 Population Over 65 Years

Figures 4 and 5 illustrate the distribution of the 65+ population over the 6 Scottish regions. The map shows ranges of between 15% and 19% across the broad Scottish regions.

Figure 4: Population by Region[5]

image010


fig5

Figure 5: Age Profile Map

However the percentage of people over 65 in a number of the Highlands regions exceeds 20%. The areas of Argyll & Bute and Eilean Siar (Outer Hebrides) are at 22% while the Orkney Islands are at 20%. Areas of the South West also exceed 20%, in particular Dumfries & Galloway (22%) and South Ayrshire (21%) and the Scottish Borders in the South East (20%). The lowest percentages of the population over 65 can be found in the urban areas of Edinburgh and Glasgow, both are at 14%. These figures suggest that the rural and island communities of the Highlands have an ageing population.

2.1.4 Life Expectancy

The average life expectancy at birth for Females in Scotland is 80.7[6] years and 75.7 years for Males. The Western Isles has the highest life expectancy for Females at 82.0 years but one of the lowest levels for Males at 73.5 years. Greater Glasgow and Clyde has the lowest over all life expectancy for both Females (78.9) and Males (73.1). The UK average for Females is 82.0 years and Males 77.7 years.

2.1.5 Population Projections

The 65+ population is projected to grow by 502,000 people between 2008 and 2031 from 859,000 to 1,361,000. Like all areas of the UK Scotland is subject to significant population growth in this age bracket. Figure 6 illustrates the estimated growth of the 65+ population between 2010 and 2030. The diagram shows a general upward trend in population growth for the 65+ age group.

Figure 6: Population Projections (000’s) of Older People in Scotland by Sex (2010 to 2030[7])

image016

Figure 7 illustrates the projected growth of the 65+ population for Scotland in comparison with the rest of the UK.

Figure 7: Estimated and Projected % of the Population Aged 65 and Over by Region[8]

image017

2.1.6 Old Age Support Ratio

The old age support ratio compares the number of people of working age (20-64) against the retired population (65+) of a given area. Areas with a lower ratio of working age people indicates fewer people able to support the over 65 population.

Figure 8: Old Age Support Ratios

image018

The chart shows very low support levels in the South East, West and South West of Scotland. This is due to significantly lower numbers of younger people of working age living in these regions.

2.1.7 Internet Usage

The following diagrams illustrate the internet usage of the over 55 age group. The diagrams are based on data collected by the Office for National Statistics and provide a general over view of usage across Great Britain.

Figure 9: Internet Purchases 2008 to 2011 by Age Group 2008 - 2011[9]

image019

Figure 10: Internet Purchases by Type 2008 to 2011 (AdultsAaged 55+)

image020

Figure 9 shows a gradual year on year growth of internet purchases made by people aged over 55. The largest growth is in the 55-64 and 65+ age groups.

Figure 10 illustrates the types of products and services being bought by this age group. The highest percentages of purchases related to travel arrangements (68%), books, magazines, newspapers (66%) and clothes, sports goods (63%). This indicates the 55+ age group are using the internet primarily to make leisure purchases rather than buying essential goods and services. The diagram indicates E-Learning (5%) at the lowest percentage; again this may be indicating that this age group is using the internet for leisure and entertainment purposes.

Figure 11 illustrates the uptake of mobile internet connections by age group between 2009 and 2011. The chart shows a steady increase in connections by the 55+ age group, however this is insignificant in comparison with the 16 – 34 age groups. The lower uptake may be due to fewer people in the 55+ age group using mobile devices for work based activities. The usability of mobile devices can also be prohibitive as age related physical (dexterity) and sensory (sight and hearing) degeneration can make using such devices difficult.

Figure 11: Mobile Phone Internet Connections by Age Group 2009 to 2011

image021

3.0 Regional Economic Overview

The Scottish economy was valued at £139.774[10] Billion in 2010 with a GDP per capita of £26,700. The Scottish economy shifted from manufacturing in the 1980's towards a more service orientated economy. Scotland has particular strength in the financial services sector; Edinburgh is ranked the 6th largest financial centre in Europe. The economy is further strengthened by strong Manufacturing, Tourism and Oil production industries.

3.1 Suppliers of Products and Services

Figure 12 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 12: Type and Number of Companies by Region
  image023

Scotland has only 4 companies specialising in the technology areas outlined in the chart. The chart suggests that these companies tend to locate in the English regions of the South East, North West and Midlands regions.

This may be due to a number of factors including access to technical knowhow and skills and the availability of academic institutions supporting research and development. To date Scotland appears to be an adopter rather than a developer of high tech assisted living products. However some of the developments discussed in section 6 suggest that Scotland has plans to develop the high tech healthcare sector further over the next 5 years.

More information on UK companies can be found by accessing the KT4i Assisted Living Directory see https://connect.innovateuk.org/web/assisted-living-innovation-platform-alip/assisted-living-directory

3.2 Regional Economic Infrastructure

In 2010, the UK Government developed a National Infrastructure Strategy[11] 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[12] and revised to include more regional detail in 2011[13].

In 2011, the Scottish Government published Scottish Infrastructure Investment Plan[14] – which outlined its strategy to define its approach to its social and economic infrastructure for the areas for which it has devolved responsibility.

In 2013, the Scottish Government published an update detailing progress since 2011.

The update comprises three separate documents:

  • A progress report[15], providing commentary on activity since the 2011 plan was published and a summary of future plans in each sector.
  • A programme pipeline[16], providing details of the 30 major investment programmes that are underway, or planned.
  • A project pipeline[17], providing details of 103 individual projects that are underway, or planned. This pipeline includes projects with a capital value in excess of £20m, as well as all of the planned school projects within the Schools for the Future Programme and all health sector hub projects with a value in excess of £5m.

In it, the Scottish Government set out four criteria for prioritising investment in the Infrastructure Investment Plan:

  • delivering sustainable economic growth; 
  • managing the transition to a low carbon economy;
  • supporting delivery of efficient and high quality public services;
  • supporting employment and opportunity across Scotland.

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[18], Figure 13 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 utilising 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 recognises 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 13: Regional Infrastructure Interrelationships and Interdependencies

fig13

3.2.1 Transport

In 2006, the Scottish Government published its National Transport Strategy (NTS)[19], which had 3 key strategic intended outcomes:
Improve journey times and connections between cities and towns and global markets to tackle congestion and provide access to key markets
Reduce emissions to tackle climate change
Improve quality, accessibility and affordability of transport, to give people the choice of public transport and real alternatives to the car

The Communications Infrastructure 2012 update reports[20] the following progress on infrastructure delivery programmes and Autumn Statement 2012 capital announcements relevant Scotland:

  • Rail, roads, local transport, water, flood and waste – devolved to the Scottish Government
  • New funding announced: Additional capital allocation of £394 million
  • Under construction: Whitelee Onshore Wind Farm – 217MW extension complete

The Scottish Infrastructure Investment Project and Pipeline Updates[21] published progress on key transport projects including:
A96 Fochabers to Mosstodloch Bypass
Paisley Corridor Improvements
Glasgow Central - Two new platforms
Forth Replacement Crossing: due to complete 2016
Edinburgh to Glasgow Rail Improvements Programme
Borders Railway
Edinburgh Trams: due to complete summer 2014.
M8 M73 M74 Motorway Improvements:
AWPR
A90 Balmedie to Tipperty
Glasgow Subway Modernisation
Glasgow’s Fastlink
A9 Dualling Perth to Inverness
A75 Hardgrove to Kinmount
A82 Pulpit Rock Scheme
A77 Symington to Bogend Toll
A75 Dunragit Bypass

Access to health care provision can depend upon the ease with which people can move around the region. If roads are congested, people may find it difficult to reach care services, and once there, they may find parking is either not available, full, or presents a costly challenge. Remote delivery of care via AL services, could be a potential solution to transport and travel issues.

  • 3.2.2 Digital Communications

In January 2012, the Scottish Government published its Digital Infrastructure Action Plan[22]. This set out a programme of action consisting of four inter-related programmes:
Step Change 2015 – to deliver a next generation digital infrastructure for between 85-90 per cent of premises across Scotland and the best possible uplift in speeds for the remaining 10-15 per cent.
World-Class 2020 – to establish a world class digital infrastructure in Scotland that builds upon the platform provided by Step Change 2015, through a sustainable partnership with industry.
Demonstrating Digital – to deliver a series of practical infrastructure projects in both urban and rural areas.
Choose Digital First - to raise demand for next generation broadband services thereby helping to improve the commercial case for investment in next generation infrastructure.

Ofcom, the independent regulator and competition authority for the UK communications industries has reported[23] 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 2012 report[24] has been published and highlights the availability and take-up of superfast broadband, the increasing use of mobile Internet services and the completion of the digital TV switchover. The report also provides regional information useful not only for local authorities developing broadband plans, but also for businesses wanting to develop and deliver services – see Figures 14, 15 and 16..

In addition to its UK Communications Infrastructure Report, Ofcom has produced the UK's first interactive map[25] showing accurate information on broadband take-up, speeds and availability, using data provided by communications providers.

Figure 14 shows the availability of broadband across the 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 percentage take-up of superfast broadband
  • the total take-up (including superfast broadband)

Figure 14: Broadband availability and take-up by Local Authority (Source Ofcom)
fig14


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 15 shows the Average modem speed (Mbit/s) by Local Authority.

Figure 15: Average modem speed (Mbit/s) by Local Authority (Source Ofcom)
fig15

Ofcom[26] 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 to provide an overall view of broadband in each region:
• 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 16 shows the ranking (1 = highest /fastest, 5 = lowest/slowest) within Scotland by local authority. Cities such as Aberdeen, Edinburgh, Dundee, and Glasgow have good broadband performance, but the more rural areas and the highlands and islands have below average to poor broadband performance.

The Communications Infrastructure 2012 update reports[27] 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.’ Aberdeen and Perth are two of the first ten ‘super-connected’ cities that have been successful in their bid for funding to deliver ultrafast broadband and public wireless connectivity.

Figure 16: Overall Broadband Quality by Local Authority (Source Ofcom)
fig16

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, 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.’[28]
According to the Government’s National Infrastructure Plan, 2011 ‘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.’

  • 3.2.3 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, the Government recognised 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.

See Section 6.1.1 for information about regional Centres of Expertise and Innovation.

4.0 Health and Social Care

Healthcare in Scotland is mainly provided by Scotland’s public health service, NHS Scotland, who provide healthcare to all permanent residents. Health is a matter that is devolved, and considerable differences are now developing between public healthcare systems in the different counties of the United Kingdom.

Primary and secondary care is integrated in Scotland and healthcare is provided through fourteen regional health boards. Health boards are sub divided in to Community Health Partnerships to provide local services more effectively.
NHS Scotland work across 14 regional NHS Boards, seven Special NHS Boards and one public health body

Each NHS Board is accountable to Scottish Ministers, supported by the Scottish Government Health and Social Care Directorates.

Regional NHS Boards are responsible for the protection and the improvement of their population’s health and for the delivery of frontline healthcare services. Special NHS Boards support the regional NHS Boards by providing a range of important specialist and national services.

All NHS Boards work together for the benefit of the people of Scotland. They also work closely with partners in other parts of the public sector to fulfil the Scottish Government’s Purpose and National Outcomes.
The Healthcare Quality Strategy for Scotland was launched by the Cabinet Secretary for Health, Wellbeing and Cities Strategy in May 2010. This provides the basis for the people who deliver healthcare services in Scotland to work with partners and the public towards their three Quality Ambitions and shared vision of world-leading safe, effective and person-centred healthcare.

This vision and the focus on quality healthcare is the context for all strategic and operational decision-making across NHS Scotland.

Since the launch of the Quality Strategy, the Scottish Government announced its ambitious plan for integrated health and social care and set out the 2020 Vision and Strategic Narrative for achieving sustainable quality in the delivery of health and social care across Scotland.

The 2020 Vision and the Strategic Narrative describe the challenges for health and social care for the future and provides a commonly agreed narrative about the direction they are working towards. The Quality Strategy provides the approach and the required actions to improve both quality and efficiency in order to achieve financial sustainability.

Everyone involved in the delivery of healthcare in Scotland is now asked to play their part in turning the vision into a reality.

The following section describes the health and social care landscape of Scotland. The section looks at the health of the population and the levels of provision available from statutory and private providers.

4.1 Health Overview by Long Term Conditions

Figure 17 illustrates the percentage of people suffering from the following long term conditions, Diabetes, Coronary Heart Disease, COPD, Hypertension, Epilepsy, Dementia and Stroke. The figures are based on data published by The Information Services Division (ISD) a division of NHS Scotland. The data is based on GP consultations with registered patients between 2009 and 2010. The incidence of LTC’s based on the ISD data suggests that 38.8% of the total population suffer from an LTC.

Hypertension represents the single highest condition at 1,201,000, second is Coronary Heart Disease at 365,494 and third is Diabetes at 221,000 registered patients. The high levels of Hypertension are close to those found in Northern Ireland (58%).

The data doesn’t take into consideration patients registered with co-morbidities but does give an accurate overall picture of the health of the region’s population.

Figure 17: Long Term Conditions Profile for Scotland[29]
  image024

5.0 Existing Care Provision

The following section outlines the existing care provision in Scotland and looks at the levels of support to enable older and disabled people to live at home. The section also examines the availability of residential care and NHS beds by county area. This information provides insight into where there may be lower levels of provision.

5.1 Elderly Living at Home

Figure 18 shows a significant difference in the levels of home care provision across Scotland. Home care provision is a good indicator of the levels of people being supported to live at home.

The lowest levels of provision are in Argyll & Bute (Highlands) and Perth and Kinross (Central & Tayside). Less than half as many people aged over 65 are receiving home care in comparison with West Dunbartonshire (West).

Figure 18: Home Care Provision in Scotland 2008 to 2010[30]

image025

5.2 Residential and Domiciliary Care

There are a total of 1329 registered Care Homes in Scotland and 747 Domiciliary Care Providers. Figure 19 illustrates the high level of beds available in Private Care Homes (includes Voluntary providers) compared with the low level of Statutory care home beds.

Figure 19: Population Over 65 Compared to Care Home Beds[31]

image026

 
Figure 19 shows some interesting results. The lowest levels of private care provision are in Eilean Siar (Outer Hebrides), Orkney and Shetland Islands, in these areas statutory provision is at its highest. These island communities all have high percentages of older people; however the population levels may not be significantly high enough for private providers.

Figure 20 illustrates the percentage of the population over 65 compared with NHS bed provision. The diagram describes the number of Acute Medical beds (Cardiology, Endocrinology & Diabetes, Rehabilitation Medicine, Respiratory Medicine and Rheumatology), Acute Surgical (Orthopaedics) and Residential beds (Geriatric and Learning Disability) have a direct relationship to users of assisted living technology. 

Figure 20: Percentage of the Population Compared with NHS Bed Provision[32]

image027

The chart describes the percentage of beds in each speciality against the percentage of people aged over 65. Figure 20 suggests the highest level of residential bed provision is in the West of Scotland at 1.3%, second is Central and Tayside with 0.8%. Provision of both acute medical and acute surgical beds is low across the board.

6.0 Current Assisted Living Activity

The following section details some of the key assisted living activity in Scotland ranging from research activity, projects and centres of excellence.

6.1 Regional Projects in Health and Social Care

Scotland has made significant investment into Telecare and Telehealth over the last decade. Over recent years several pilots and initiatives have been deployed. Below are some examples of these:

NHS Borders. A project called Walkerburn Watch, has been funded by the Scottish Government through the £70 million Older People's Change Fund. The funding, managed locally by a partnership of NHS, council and independent sector groups, managed overall by NHS Borders (Health Living Network), has enabled a project worker to be put in place. The project will rely heavily on enabling technologies such as AT, Telecare and Telehealth, particularly as Walkerburn does not have its own health centre or pharmacy, the community is quite dispersed, and the nearest hospital/outpatients is about 16 miles away. The project will see a 'health hub' created at the village hall, and while it will look at more traditional health advice such as exercise classes, diet advice and home and personal safety, the project will also seek to use cutting-edge technology. The project is funded for a year, but it is hoped it may be able to attract other funding or sponsorship to enable the scheme to continue, and maybe even be rolled out across the Borders. Working in conjunction with NHS Borders, Walkerburn Watch will help to greatly improve the health and well-being of older residents whilst enhancing their independence, general well-being and ability to socialise.

NHS Highland and Scottish Centre for Telehealth and Telecare are running a Maternity Telehealth project. The Oban Maternity Telehealth project will study the use of Telehealth to enhance maternity services in a remote and rural setting on the west coast of Scotland. The objective of the project is to enable residents to have access to maternal health expertise and reduce midwife travel. Stakeholders Oban, Lorn and Islands Community Maternity Service, run by NHS Highland, Oban but also to the island of Mull and Iona will enable pregnant women to use video conferencing to improve multi-disciplinary communication between the health care team and pregnant women.

Scottish Centre for Telehealth and Telecare. SmartCare is a 3 year initiative which runs from March 2013 - Feb 2016. It involves 30 European Partners including Scotland. There will be two implementation 'waves' over 10 pilot regions. Scotland is in the first wave along with Italy, Denmark and Spain. In Scotland, 7 Health and Social Care Partnerships are taking part in SmartCare (East Ayrshire, North Ayrshire, South Ayrshire, East Renfrewshire, Renfrewshire, North Lanarkshire and South Lanarkshire). The focus of SmartCare is using technology to support the delivery of integrated services (across health and social care). In Scotland the focus is on best practice pathways to prevent and manage their response to falls management and prevention. In Scotland, a Programme Steering Board is in place (Clyde Valley and Ayrshire Projects Group) with robust monitoring and reporting mechanisms in place.

Living It Up, as part of the dallas initiative, £10 million funding has been successfully secured as part of the UK-wide TSB dallas competition. The Living It Up Project aims to provide improvements in health, wellbeing and lifestyles for over 55,000 people (10,000 with long term health and care issues) living in five geographic areas across Scotland over a three year period, and to support economic benefits. The Living It Up project in Forth Valley, Moray, Highland, Lothian and Western Isles is using co-production to shape the way that new technologies facilitate services, products, and information to support people to manage their Long Term Conditions and wellbeing. Community engagement work, led by Glasgow School of Art, the Health and Social Care Alliance and Carers Scotland brings together all partners to 'co-design' solutions by sharing their expertise, skills and different perspectives. Partners include individuals, carers, local communities, third sector organisations, industry, enterprise and health, housing and care practitioners. This is all part of an 'at scale' initiative funded jointly by the Scottish Government and the Technology Strategy Board.

6.1.1 Regional Centres of Excellence

Scotland has a number of centres of excellence including the following organisations.

6.1.2 Support Organisations

The Scottish Joint Improvement Team:

The Scottish Joint Improvement Team was established in 2004 to support partnership working across health and social care in order to design, develop and deliver personal services for those requiring support and assistance to optimise their independence and happiness. In 2006 the JIT launched a national programme to support the development and enhancement of Telecare across Scotland. This was underpinned by a £20M fund to support partnerships in health and social care to develop Telecare services. The JIT’s role also includes supporting learning and the dissemination of best practice through a dedicated learning network. The learning network provides a comprehensive resource covering both Telecare and Telehealth, this can be accessed via the following link www.jitscotland.org.uk/action-areas/telecare-in-scotland/learning-network


Scottish Centre for Telehealth:

The Scottish Centre for Telehealth (SCT) was established in 2006 to support and guide the development of Telehealth for clinical, managerial and educational purposes across Scotland. The centre has now been integrated into NHS 24 in order to be part of the major delivery organisation for Telehealth across Scotland. SCT works across Social Care, the NHS, Industry and Academia to support collaborative working and to evaluate new technology.

The centre’s main activity includes disseminating best practice, providing technical support, project evaluation, service redesign and the development of standards. The centre has a range of online learning resources covering all aspects of Telehealth, for more information please go to http://www.sctt.scot.nhs.uk/resources.html

Highlands and Islands Enterprise:

Highlands and Islands Enterprise (HIE) aims to support the development of businesses in some of the UK’s most remote communities. HIE also invests in transformational projects across the region to make the Highlands and Islands a more competitive and attractive place to live, work, study and grow. HIE has been a key supporter of P4 Digital Healthcare, an over arching term used to describe the ambitions of the growing digital healthcare sector. The 4 P’s stand for Predictive, Preventative, Personalised and Participatory. The initiative was born out of the desire to build on the capability of Scotland to support the development of this growing sector. The initiative recognises the capability the region has developed in Telehealthcare through the combined efforts of academics, industry and healthcare professionals. The focal point for P4 Healthcare will be the new Inverness Campus which is intended to attract high tech industry keen to exploit the intellectual capital of the region. For more information on P4 Healthcare and Highlands and Islands Enterprise please go to www.hie.co.uk

6.1.3 Universities

The majority of Scotland’s 18 universities are actively involved in Telecare and Telehealth related research. Below are a couple of examples.

The University of Edinburgh through its Centre for Population Health Studies has been actively involved in developing the Tele Scot project. The Tele Scot project is a collaboration between the University of Edinburgh, NHS Lothian, Edinburgh City Council, The Scottish JIT and Scottish Centre for Telehealth. The project is a programme of academic research investigating telemetric supported self monitoring of long term health conditions. The research uses quantitative and qualitative methods to assess the potential of telemetric systems as a basis for early intervention, investigating clinical outcomes, cost efficiency and user experience. For more information please go to www.telescot.org

Aberdeen University and University of the Highlands and Islands have collaborated to create the Centre for Rural Health (CRH). The CRH is actively involved in a major European project entitled Implementing Transnational Telemedicine Solutions (ITTS). The project is a collaboration between the 6 northern countries of Scotland, Norway, Finland, Sweden, Republic of Ireland and Northern Ireland. The project aims to implement telemedicine solutions at scale across the participating countries. The participating countries share many of the same population and geographical challenges which make the delivery of healthcare in remote communities difficult. The project will develop ten demonstrators covering the areas of video-consultation, mobile self management and home-based health services. For more information please go to www.abdn.ac.uk

Sterling University is at the forefront of research into Dementia with a focus on the design of care homes. The Dementia Services Development Centre is housed in the Iris Murdoch Building which has been designed as a model of best practice in Dementia building design. The research team work closely with care home planners and developers to create safe and stimulating environments for residents. The centre looks at the integration of technology into the living space to support independent living and carers. The centre also plays a key role in showcasing design and technology to care providers. For more information please go to dementia.stir.ac.uk

The University also has a second facility in Northern Ireland, for more information please go to www.dementiacentreni.org

7.0 Summary: Regional Opportunities for Assisted Living

The ageing population will be the key driver for the development of the assisted living sector in Scotland. The country has a rapidly ageing population with areas like the South East, West and South West of Scotland having significantly lower numbers of younger people of working age in comparison with the 65+ population. Scotland’s 65+ population is projected to grow by 58% by 2030 with the steepest growth in the Female population post 2020. Unusually the Male population is following a similar trend, whereas most other areas of the UK see a significant drop prior to 2020.

The health profile indicates that 38% of the total population currently suffer from one or more long term conditions (LTC’s) with 60% of those registered suffering from Hypertension. Hypertension increases the risk of stroke, heart attack, heart failure, aortic aneurysm and is a major cause of chronic kidney disease. Therefore closer management of patients is required to reduce the risk of further health complications.

The prevalence of LTC’s will grow in line with the ageing population and put increasing pressures on services. The lowest levels of private care provision are in Eilean Siar (Outer Hebrides), Orkney and Shetland Islands, in these areas statutory provision is at the highest level. These island communities have some of the highest percentages of people aged 65+. This is further compounded by the fact that just 19% of the population live in rural areas which account for 94% of the total land mass of Scotland. This indicates that to meet demand major investment in Telecare and Telehealth needs to take place in order to bridge the gap in provision.

Section 6.0 of this report illustrates some of the development work the region has been undertaking in Telecare and Telehealth. Despite the strong evidence produced by these initiatives the move to mainstream Telecare and Telehealth to all who require them has been slow. This is in part due to the need for organisational change to enable these initiatives to embed within services and operate at scale.

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

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.

image007

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: http://connect.innovateuk.org/web/dallas

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.

http://www.england.nhs.uk/wp-content/uploads/2014/04/ppf-1415-1617-wa.pdf

 References

 [1] Knowledge Transfer for Implementation - KT4i is a knowledge transfer programme underpinning the dissemination of outcomes from the Technology Strategy Board's Assisted Living Innovation Programme. KT4i is managed by the HealthTech and Medicines KTN. For more information please go to www.alip-healthktn.org

[2] Office for National Statistics (2010) Population estimates: United Kingdom estimated residential population for constituent countries and regions

[3] General Register Office for Scotland, (2010) Population Projections for Scottish Areas (2010-based)

[4] Office for National Statistics (2011), Principal projection - Scotland population in age groups (2010-based)

[5] General Register Office for Scotland,(2010) Population Projections for Scottish Areas (2010-based)

[6] Office for National Statistics (2011) Life expectancy at birth and at age 65 for health areas in the United Kingdom 2007-09

[7] Office for National Statistics (2011), Principal projection - Scotland population in age groups (2010-based)

[8] Office for National Statistics, (2008) 2008-based sub national population projections by broad age groups for Regions and Local Authorities in England & Office for National Statistics (2011), Principal projection - Wales population in age groups (2010-based) & Office for National Statistics (2011), Principal projection - Scotland population in age groups (2010-based) & Office for National Statistics (2011), Principal projection - Northern Ireland population in age groups (2010-based)

[9] Office for National Statistics (2011), Internet access, households and individuals

[10] Scottish National Accounts Project. Gross Domestic Product in Current Prices for Scotland, 2010 Q4

[11] HM Treasury, "Strategy for National Infrastructure," 2010 1-March, www.direct.gov.uk/prod_consum_dg/groups/dg_digitalassets/@dg/@en/documents/digitalasset/dg_186451.pdf

[12] HM Treasury, "www.hm-treasury.gov.uk/ppp_national_infrastructure_plan.htm," 2010 1-March

[13] HM Treasury, "http://cdn.hm-treasury.gov.uk/national_infrastructure_plan291111.pdf," 2011 1-November

[14] Scottish Government, Infrastructure Investment Plan 2011, December 2011 http://www.scotland.gov.uk/Resource/Doc/364225/0123778.pdf

[15] Scottish Government Infrastructure Investment Plan 2011 – Progress Report (2012) http://www.scotland.gov.uk/Resource/0041/00413690.pdf

[16] Scottish Government Infrastructure Investment Plan 2011 - programme pipeline update (January 2013) http://www.scotland.gov.uk/Resource/0041/00413696.pdf

[17] Scottish Government Infrastructure Investment Plan 2011 - project pipeline update (January 2013) http://www.scotland.gov.uk/Topics/Government/Finance/18232/IIP/ProjectPipelineSep2013

[18] HM Treasury, "www.direct.gov.uk/prod_consum_dg/groups/dg_digitalassets/@dg/@en/documents/digitalasset/dg_186451.pdf," 1 March 2010

[19] Scottish Government National Transport Strategy http://www.transportscotland.gov.uk/strategy-and-research/nts; http://www.scotland.gov.uk/Resource/Doc/157751/0042649.pdf

[20] Ofcom, "Communications-infrastructure-report 2012 update," 20 December 2012, www.ofcom.org.uk http://stakeholders.ofcom.org.uk/binaries/research/telecoms-research/infrastructure-report/Infrastructure-report2012.pdf

[21] Scottish Government Infrastructure Investment Plan 2011 – Progress Report (2012) http://www.scotland.gov.uk/Resource/0041/00413690.pdf

[21] Scottish Government Infrastructure Investment Plan 2011 - programme pipeline update (January 2013) http://www.scotland.gov.uk/Resource/0041/00413696.pdf

[21] Scottish Government Infrastructure Investment Plan 2011 - project pipeline update (January 2013) http://www.scotland.gov.uk/Topics/Government/Finance/18232/IIP/ProjectPipelineSep2013

[22] Scottish Government Digital Infrastructure Action Plan, January 2012, http://www.scotland.gov.uk/Publications/2012/01/1487/1

[23] Ofcom, The Communications Market 2011, 4 August 2011, http://stakeholders.ofcom.org.uk/market-data-research/market-data/communications-market-reports/cmr11/?a=0

[24] Ofcom, "Communications-infrastructure-report 2012 update," 20 December 2012, www.ofcom.org.uk http://stakeholders.ofcom.org.uk/binaries/research/telecoms-research/infrastructure-report/Infrastructure-report2012.pdf

[25] Ofcom Broadband Speeds Map, http://maps.ofcom.org.uk/broadband/

[26] Ofcom, "Communications-infrastructure-report 2011," 6 July 2011, www.ofcom.org.uk

[27] Ofcom, "Communications-infrastructure-report 2012 update," 20 December 2012, www.ofcom.org.uk http://stakeholders.ofcom.org.uk/binaries/research/telecoms-research/infrastructure-report/Infrastructure-report2012.pdf

[28] HM Treasury, "http://cdn.hm-treasury.gov.uk/national_infrastructure_plan291111.pdf," 2011 1-November, www.hm-treasury.gov.uk

[29] Information Services Division Scotland (2011) General Practice - Practice Team Information (PTI) Specific Conditions

[30] Graph source: The Poverty Site (2011) Help from social services Scotland

[31] Care Home Census 2011 tables and charts March 2003, IDS Scotland March 2011

[32] Quarterly Trends by NHS Board of Treatment, Inpatient Facilities by NHS Board and Specialty 2011, IDS Scotland

end faq

 

Back to top