Assisted Living UK Capabilities
and
Opportunity Report

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London

London - full text version

 1.0 Introduction

This case study provides a high-level snapshot of the Assisted Living (AL) sector in London. 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 London 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.

2.0 Overview

London is the capital of the United Kingdom and is located in the South of England, on the River Thames. It is the economic engine of the UK, and a major global centre for the financial sector, with to several multinationals choosing to locate their headquarters in London.

Greater London covers an area of about 610 square miles (approximately 1,579 sq km) and is home to around 7.8 million people. This makes it the largest urban area in the whole of Europe.In addition to the local population, approximately, three-quarters of a million people commute into the city every day, and approximately 14 million overseas tourists visit London every year[1] .

London is culturally very diverse - over 300 languages are spoken by London’s schoolchildren, and many do not use English as their first or main language at home.

2.1 Administrative Regions



There are 33 London boroughs including the City of London Corporation (see Figure 1). London boroughs are administrative areas and comprise 20 Outer London boroughs and 12 Inner London boroughs and the City of London (see Figure 2). Each borough is managed by a local council that is responsible for administering the borough, and for delivering public services such as housing, refuse collection and schools[2]. The City of London has its own local government, the London Corporation.The City of London is also known as ‘The City’ or ‘The Square Mile’ and is one of the world’s leading financial centres.

fig1


Figure 1 Map of Inner and Outer London Boroughs showing approximate County and Unitary Authority Boundaries (ONS 2011)

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

London has a relatively young population with a large annual turnover of people.London is the second largest region in the UK in terms of population (after the South East), with 12.57 per cent of the UK total (see Figure 2). There were 7.8 million residents in mid-2010, an increase from 7.3 million in 2001. The 2008-based population projections suggest the population could increase by 15.8 per cent between 2010 and 2030 to 9.0 million by 2030[3].

In 2009, the region received 154,000 international migrants, equivalent to 2 per cent of its population. Migration to London from the rest of the UK accounted for a further 178,000 new residents. About 339,000 people left London in 2009 − 216,000 went to other parts of the UK and 123,000 to other countries. This large annual turnover resulted in a small net decrease in the region’s population of 8,000.

London’s age structure also differs from other regions, the population tending to be younger than in the country as a whole. In mid-2010, 19.6% of the population were aged under 16, compared with 18.7% in England, and 43.0% were in the age group 20 to 44 compared with only 34.4% of the population of England. Only 11.5% of the population were aged 65 or over compared with 16.5% for England[4].

image002
Figure 2 UK Regional Population – mid 2010 (Source ONS)

2.2.2 Population Density

In mid-2010, the average population density of London was 5,000 people per sq km, but there were considerable differences between the boroughs. The most densely populated boroughs were Kensington and Chelsea with 14,000 people per sq km, and Islington with nearly 13,100[5].

2.2.3 Population over 65 years

The population of the UK is ageing. Between 1985 and 2010, the percentage of the population aged 65 and over increased from 15% to 17%, 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% of the population). By 2010, the numbers had more than doubled reaching 1.4 million, (2% 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% of the total population[6].
In London, people aged 65 and over in 2009 made up 11.5% of the population, compared with 19.3% for the under-16s . This compares with national averages of 16.4% and 18.7% respectively[7].

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 is highest for both in the age band 20-39, which echoes the relatively young population of London as a whole; in mid-2010, only 11.5% of the population were aged 65 or over compared with 16.5% for England[8].

The population of both males and females as a percentage of the overall population begins to decline between the ages of 40-59, where the population of both males and females is 12.7%, but drops more markedly to 6.1% for males and 7.0% for females in the age band 60-79. The male and female population of over 80s declines even more, dropping to 1.3% for males and 2.2% for females.

image003
Figure 3 Male and female population of London as a percentage of the total population (English Regions) (Source: GP data)

Figures 4 and 5 show the population aged 65 years and over across the Inner and Outer London boroughs.

image004Figure 4 Inner London Boroughs estimated population aged 65yrs and over
(Source ONS Regional trends online tables 10: Population 2011)

image005
Figure 5 Outer London Boroughs estimated population aged 65yrs and over
(Source ONS Regional trends online tables 10: Population 2011)

2.2.4 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.

Life expectancy at birth for both males (79.0 years) and females (83.3) in London was above the UK average in 2008-2010(78.2 and 82.3 years respectively). Life expectancy was highest in the borough of Kensington and Chelsea for both males and females (85.1 and 89.8 years respectively). The lowest life expectancy for males was in Islington (76.0 years) and for females it was in Lambeth (81.1 years)[9].

In London, men aged 65 in 2007–09 could expect to live another 18.4 years and women 21.2 years. This compares with 17.8 and 20.4 years in the UK as a whole[10].

2.2.5 Population Projection

The 2008-based population projections suggest the population of London could reach 9 million by 2030, 15.8%more than in 2010.[11]

Figure 6 shows the population projections for males over 65 years and females over 60 years from 2010 to 2033 for the English regions and Wales. The number of older people (Male 65yrs+ Female 60yrs+) in London is expected to grow at a slower rate than the total population. The population of older people in 2010 was 1.06m, projected to rise to 1.5m in 2033, which is a projected increase of 42.7%, lower than the total projected 46% rise in this age group in England. This is the smallest increase of the English regions and Wales. The East of England has the largest increase (60.3%) followed by the East Midlands (59.6%) and the South East (58.3%).

image006

Figure 6 Projection Population – Older People (Male 65yrs+ Female 60yrs+)(Source ONS)

2.2.6 Old Age Support Ratio

The old age support ratio (OASR) 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. Between 1985 and 2010, the percentage of the population aged 65 and over increased from 15% in to 17%, an increase of 1.7 million people. Over the same period, the percentage of the population aged under 16 decreased from 21% to 19%. This trend is projected to continue. By 2035, 23% of the population is projected to be aged 65 and over compared to 18% aged under 16.

In 2009, people aged 65 and over in London made up 11.5% of the population, compared with 19.3% for the under-16s. This compares with averages of 16.4% and 18.7% respectively[12].

Figures 7and 8 show the support ratios for the Inner and Outer London boroughs for 2009 and what this support ratio is projected to be in 2033. The average support ratio for London as a whole in 2009 is 5.2; by 2033, the ratio is projected to be 5.7, which indicates that there will be an increase (9.6%) in the numbers of younger people supporting the over 65s. The national average was 3.2 in 2009 and is projected to be 2.8 by 2033.

For the Inner London boroughs, Figure 7 shows that the ratio of working-age people to elderly is increasing in throughout all boroughs except for Kensington and Chelsea where the ratio drops by 10% from 4.0 in 2009 to 3.6 in 2033. The boroughs with the largest increase in the old age support ratio, and therefore, potentially more people of working age to support the over 65s, are Tower Hamlets (37.1%), Wandsworth (25.8%) and Islington (25.7%).

image007

Figure 7 Old Age Support Ratios for Inner London Boroughs 2009-2033 (Source ONS[13]

In the Outer London boroughs, the OASR (Figure 8) is declining in 7 boroughs, which suggests that there will be fewer people of working age to support those over 65:
• Barnet (5.1%)
• Brent (4.6%)
• Croydon (7.3%)
• Enfield (2.5%)
• Harrow (2.6%)
• Hillingdon (2.4%)
• Sutton (2.6%)

The OASR remains unchanged for Bexley and Richmond upon Thames. The remaining boroughs all see an increase in the OASR which suggests there will be more people of working age to support those over 65. The boroughs with the largest increase in the old age support ratio are Barking and Dagenham (28.3%), Greenwich (10.2%) and Merton (10.2%).

image008Figure 8 Old Age Support Ratios for Outer London Boroughs 2009-2033 (Source ONS[14])

2.2.7 Households and Housing

In 2008, there were an estimated 3.24 million households in London, which is 14.9% of the number of households in England. The number of households in London is projected to be around 4.15 million households by 2033, which is an increase of 28.09% from 2008. This is higher than the projected increase for England of 26.7% for the same period[15].

London has the highest proportion of socially rented housing in England. In 2010, 24% of homes in London were rented from local authorities and social landlords, compared with the UK average of 18%. Over a quarter (26%) of homes were privately rented, above the UK average of 17%. London had the highest proportion of households with one person (30%), two or more unrelated adults (6.5%) and lone parent households with dependent children (9.0%) in 2010[16].

In 2009, the median house price in London was £250,000, the highest in England. The lowest median price at borough level was in Barking (£160,000).

The London Economic Development Strategy recognizes that the projected growth in the population of London will put strain in the housing stock in the area. To counteract this, the Mayor has made a commitmentto work with private and public sector investors and the London boroughs to help deliver the quality and quantity of homes required. The policies related to long-term housing needs are set out in the London Plan[17] and the London Housing Strategy[18].
Table 1 is based on statistics from the ONS and shows that older women are more likely than older men to live alone, and the percentage increases with advancing age. The percentage of older people households living in rented accommodation increases with age. More older people live in social rented housing than in private rented housing.
Table 1 Households in London aged 65yrs and over[19]


Age band

Men living alone

Women living alone

Owner Occupiers

Living in social rented housing

Living in private rented housing

65-74

22%

32%

76%

19%

5%

75 yrs +

36%

60%

65%

26%

8%
           

 

2.2.8 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[20], 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[21]. 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.

2.2.8.1 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% to 71% over the previous 12 months, there have been notable increases across all age groups (see Figure 9).

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% of Internet users to 39% in 2011.Mobile Internet use via a laptop, tablet or other portable computer also proved popular in 2011, with 38% of Internet users using these mobile devices away from the home or workplace.[22] 

image009Figure 9 Mobile phone Internet connections by age group (Source ONS 2011)

2.2.8.2 Confidence in using the Internet

Another of Ofcom’s key findings is that older people are increasingly confident using the Internet, although one in ten of over-65s saying they are not confident, compared to only one in 50 of under-34s. Most Internet users claim to be confident in using the Internet and are becoming increasingly so.

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[23].

2.2.8.3 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[24].

Figure 10 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 and over 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[25].

image010Figure 10 Internet purchases by over 55s (Source:ONS 2011)

Figure 11 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%).

image011Figure 11 Internet purchase by type by over 65s (Source ONS 2011)

3.0 Regional Economy

3.1 Economic Overview of London

According to the London Economic Development Strategy[26], London’s economy is bigger than that of Sweden or Austria, and larger than Denmark’s and Portugal’s combined. The economy is very diverse, but for the last two decades, high-value added business services have been the driver of London’s economic growth. In addition to financial services and tourism, London has significant clusters of world-class businesses in other sectors. These include the creative industries, life sciences, legal and accountancy services, and higher education. Several of the largest sectors such as health and social work, retail, education and public administration are located in the outer London boroughs and are a major source of employment.

The London Economic Development Strategy reports that ‘a substantial part of London’s economy provides services to its residents (7.8 million in mid-2010), such as healthcare, schools, or consumer services, such as shopping and leisure activities. These services account for about half the jobs in London and are especially important in the economy of Outer London, where 60% of the population lives.

London is home to businesses large and small, from multinationals to micro, small and medium sized companies, often providing key services to larger corporations. There are also over 600,000 self-employed people in London. Business start-up rates have been higher than any other region in the UK. Successful innovation is strongly identified with high productivity, which has been considerably higher in London than any other region.

3.1.1 Older People’s Income


In 2008-2009, the average gross weekly household income in London was £882 per week, above the UK average of £703[27].

In the three-year period 2007/08 to 2009/10, 28% of people (2.1 million) were in households in London with incomes below the poverty threshold. However, in London there is a much wider range of incomes relative to other regions. The median weekly household income after housing costs in London was £371, one of the highest of all English regions[28].

In 2007-2008, the mean household income for pensioners (male 65+, female 60+) was £24,772, above the UK average of £19,730[29].

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 equivalised contemporary median income after housing costs). Two-thirds of these pensioners were women’[30].

3.2 Regional Economic Infrastructure

In 2010, the UK Government developed a National Infrastructure Strategy[31] 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[32] and revised to include more regional detail in 2011[33].

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[34], Figure 12 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.

London’s economic infrastructure and social development plans are contained in three key documents: the Economic Development Strategy[35], the London Plan[36] and the Mayor’s Transport Strategy[37]. Given the complexity of London, it is not possible to go into the detail of London’s infrastructure plans; instead, a few key initiatives of relevance to AL have been included in the relevant sections.

image012Figure 12 Regional Infrastructure Interrelationships (Source UK Strategy for Nat Infrastructure)

3.2.1 Transport

In addition to the local population, travelling around London, approximately, three-quarters of a million people commute into the city every day, and each year, approximately 14 million overseas tourists visit London[38], all of whom rely on London’s transport infrastructure. The Mayor’s Transport Strategy[39] (MTS) contains proposals to strengthen London’s strategic transport network. These include transforming the Tube, National Rail enhancements, smoothing traffic flow and enhancing the quality and role of bus services, London Overground, DLR, Tramlink and river services. Challenges that the strategy aims to address include improvements in access to services, and improved traffic flow (managing delay, improving journey time reliability and resilience). A key outcome of relevance to AL is ‘Balancing capacity and demand for travel through increasing public transport capacity and/or reducing the need to travel’.

The Communications Infrastructure 2012 update reports[40] the following progress on infrastructure delivery programmes and Autumn Statement 2012 capital announcements relevant to London:
• Completed: Thameslink – Blackfriars station upgrade now reopened
• Completed: Underground Investment – Jubilee, Victoria and Metropolitan line upgrades
• Under construction: Crossrail – 1,300m tunnelling from Royal Oak
• New funding announced: Northern Line Extension to Battersea – providing a UK Guarantee to support the £1 billion investment to extend the Northern Line

3.2.2 Digital Communications

Ofcom, the independent regulator and competition authority for the UK communications industries, has reported[41] 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% 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[42] 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 13, 14 and 15.

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 13 shows the availability of broadband across London 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 broadband.

fig13
Figure 13 Broadband availability – London (Source Ofcom)

Figures 14 and 15 show the percentage of homes with broadband in Inner and Outer London boroughs that are not achieving 2Mbit/s speeds as of 15 March 2012.

lon-fig14Figure 14 Inner London Boroughs – Percentage not receiving broadband speed of 2Mbit/s (Source Ofcom) 

fig15Figure 15 Outer London Boroughs – Percentage not receiving broadband speed of 2Mbit/s (Source Ofcom)

Ofcom[43] 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.

The overall ranking for the whole of London is 1, indicating that London has the highest average score.

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 little 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.’[44]

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.’[45]

In November 2011, the London smart meter trial was launched. The smart meter trials led by EDF Energy, are part of Low Carbon London[46], a consortium of partners led by UK Power Networks funded by £24.9million from Ofgem’s Low Carbon Networks Fund, plus £4.6million from the electricity network operator.As part of the ‘Low Carbon London’ project, 5,000 smart meters are to be installed in homes and businesses across London.

By the end of February 2012, the first 500 meters had been installed by EDF Energy in customers’ homes in the pilot zones of Lewisham, Perry Vale, Canning Town, Archway, Barking, Muswell Hill and Peckham. In 2013, the trial will be extended to EDF Energy customers in the Green Enterprise District (covering six London boroughs of Hackney, Tower Hamlets, Newham, Waltham Forest, Barking and Dagenham and Havering) and in ten low carbon zones (Low Carbon London):
1. Muswell Hill, (Haringey)
2. Archway, (Islington)
3. Queen’s Park (Westminster)
4. Barking (Barking & Dagenham)
5. Ham and Petersham (Richmond)
6. Wandle Valley (Merton)
7. Hackbridge (Sutton)
8. Brixton (Lambeth)
9. Peckham (Southwark)
10. Lewisham (Lewisham)

It is anticipated that the roll-out of 5000 meters will be completed by the end of August 2013.

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, 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.

The London Economic Development Strategy[47] recognizes the importance that innovation plays in London’s global competitiveness and high productivity. However, the Strategy notes that London’s performance lags behind that of the highest global performers in terms of innovation and knowledge economy competitiveness. Consequently, the Mayor is committed to ‘further developing London’s strengths in innovation, by encouraging collaboration across sectors, promoting more productive links between business and academia, providing support for innovative activities, fostering entrepreneurial skills, and helping in accessing funding’. In particular, there is a commitment to supporting innovation in London’s businesses by stimulating and encouraging an environment within which collaboration, enterprise and creativity can flourish.

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

4.0 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, the availability of NHS beds, beds in residential care homes, domiciliary care, and care provision by the Third Sector.

Currently, the Department of Health 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[48]. Nationally, NHS England commissions specialised services, primary care, offender healthcare and some services for the armed forces[49] . 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[50] . 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[51]. 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)[52] 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[53]. 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, (www.healthwatch.co.uk) 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 London – 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 Londonis 1,862,573 out of a regional patient population of 7,710,330. This implies that 24.2% of London’spatient 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, 24.2% may be a reasonable ballpark figure to use in order to estimate the percentage of London’s patient population needing to access products and services for LTCs.

The balance of specific LTCs within London’s patient population is shown in Figure 16, broken down into nine specific conditions:
• Diabetes
• Heart Failure
• Coronary Heart Disease
• Chronic Obstructive Pulmonary Disease (COPD)
• Hypertension
• Epilepsy
• Learning Disability
• Dementia
• Stroke

The LTC profile shows Hypertension (51%) 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 (5%). The second largest condition is Diabetes (22%), which also has strong links to Coronary Heart Disease, which has the third largest (10%) patient numbers.

image016
Figure 16 London: Specific conditions as a percentage of all incidences of LTCs July 2010 (GP Data) 

Figures 17 and 18 show patients with long-term conditions in each LondonPrimary Care Trust (PCT). Figure 17 shows the number of people with LTCs registered with their GP. The data does not take into account patients registered with co-morbidities. Figure 18 shows the number of patients with LTCs as a percentage of the total patient population for that PCT.

Although Ealing (87,824),Barnet (86,269), Croydon (85,442), Sutton and Merton (85,213), and Southwark (84,752) PCTs have the highest number of patients with LTCs, this actually accounts for 3% of all patients within Ealing, Barnet, Croydon, and Sutton and Merton PCTsand 4% of all patients within Southwark PTC. Kensington and Chelsea PCT has the lowest number of patients (32,129) with LTCs, 2% of their total patient population, slightly below Hammersmith and Fulham PCT (33,453) with 3% of patients with LTCs.Redbridge with 65,347 patients with LTCs has the highest percentage (7%) of patients with LTCs.

image017
Figure 17 London: Patients with LTCs by PCT(GP data)

image018Figure 18 London: Percentage of patients with LTCs as a percentage of total patients in each PCT, July 2011 (GP data)

5.0 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[54] 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[55] 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 19 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 19, 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 19 shows that London has the fifth largest population of older people (male 65 years and female 60 years) (1.06m) served by care provision comprising 115 NHS hospitals, 730 Independent hospitals/clinics, 436 care homes with nursing, 1473 care homes without nursing and 745 domiciliary care agencies.

The South East has the largest population of older people (male 65 yrs and female 60 yrs) and greatest number of domiciliary care agencies and care homes both with and without nursing. London has the greatest number of Independent hospitals/clinics. 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.

image019
Figure 19 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.[56].

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’[57].

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[58] to assess people requesting social care and categorize their level of need. Need is categorized as either 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”.[59]

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[60], summarised 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[61] 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 toover 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[62], 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 20 shows the number of households receiving intensive home care based on data from the NHS Information Centre (NHSIC)[63]. 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 20 shows that London has the third highest number of households in receipt of home care (44,380), 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.

image020Figure 20 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 Figures 21and 22, which show the proportion of households aged 65 and over as a percentage of all those provided with intensive home care by Inner and Outer London borough with responsibility for social services responsibility.

image021
Figure 21 Households aged 65 and over as a percentage of all households in an Inner London Borough receiving intensive homecare
(Source: NHSIC Community Care Statistics 2008, Home Care Services for adults, England 26 Mar 2009)

image022
Figure 22 Households aged 65 and over as a percentage of all households in an Outer London Borough receiving intensive homecare
(Source: NHSIC Community Care Statistics 2008, Home Care Services for adults, England 26 Mar 2009)

In Inner London, Lewisham (66%) has the lowest percentage of households over 65 in receipt of intensive home care. For half of Inner London boroughs, at least 80% of the homecare they provide is for those aged 65 and over. Barking and Dagenham borough (91%) has the highest percentage of households over 65 in receipt of intensive home care.
Note: data was unavailable for Redbridge borough.

In Outer London, the boroughs of Hounslow (61%) and Enfield (64%) have the lowest percentage of households over 65 in receipt of intensive home care. For 10 of the 13 Inner London boroughs, at least 80% of the homecare they provide is for those aged 65 and over. Wandsworth (87%) has the highest percentage of households over 65 in receipt of intensive home care.

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 19 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 London in 2010 was slightly above 1.06m[64]. In July 2011, in London, there were a similar number of beds in care homes without nursing (19937) and beds in nursing homes with nursing (20427).

Figure 23 shows the proportion of care homes with nursing, care homes without nursing, and domiciliary care agencies in London 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 19.

image023
Figure 23 Population of older people compared to social care provision in London (Source: CQC)

Figure 24 shows the proportion of both older people and the general population compared to NHS hospital and independent hospitals in London.

image024
Figure 24 East of England Population compared to care provision London (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’[65].

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 25 shows expenditure on telecare between 2006 and 2009 in each London Borough. 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.

Haringeyborough spent the most per person aged over 65 (£77.62) in 2008-09 and is projected to spend the most per person aged over 65 (£80.67) in 2009-10.Newham borough, spent the second most per person aged over 65 (£64.19) in 2008-2009, and is projected to spend £73 per person aged 65 and over on 2009-10. Bexley borough spent the least per person (£0.68) in 2008-09 and estimates to spend the same (£0.68) per person aged 65 and over in 2009-10.

image025
Figure 25 Expenditure on Telecare per person over 65 yrs 2008-2010 by London Borough (Source: King’s Fund)

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[66] 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%)

London has 189TSOs involved in providing services for the elderly. The total income of the top 5 organisations operating in London is £585,149,000with total expenditure of the top 5 of£543,722,000. The largest TSOs (in terms of income) operating in London are shown in Table 2.

Table 2 Top 5 Third Sector Organisations (by income) in London (Source: Guidestar)


Third Sector Care Organization

£ Income

Anchor Trust

273,969,000

Peabody Trust

130,634,000

Sue Ryder Care

76,228,000

The Congregation of the Daughters of the Cross Liege

62,318,000

Bridge House Estates

42,000,000
   

Table 3 shows the income and expenditure of the top 5 TSOs providing assistance to the elderly in London.

Table 3 Income and Expenditure of Top 5 of Third Sector organisations in London (Source: Guidestar)

 
Anchor Trust

Peabody Trust

Sue Ryder Care

The Congregation of the Daughters of the Cross Liege

Bridge House Estates

Total/average
             

Income top 5 organisations

273,969,000

130,634,000

76,228,000

62,318,000

42,000,000

585,149,000

% income of top 5 organisations

46.8

22.3

13.0

10.6

7.2

100.0

Average income (£) top 5 organisations
         
117,029,800
             

Total expenditure top 5 organisations

276,511,000

96,393,000

75,546,000

59,372,000

35,900,000

543,722,000

% total expenditure

50.9

17.7

13.9

10.9

6.6

100.0

Average expenditure (£) top 5 organisations
         
1,203,545
             
             

 

6.0 Current Assisted Living Activity

6.1 Suppliers of Products and Services

Figure 26 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.

image026
Figure 26 Type and number of companies by region (Source: Medilink UK)

There is little data available for companies operating solely in the Assisted Living sector in London. Figure 26 shows evidence of 10 companies involved in AL solutions.

The Technology Strategy Board’s Assisted Living Innovation Platform (ALIP) has a directory[67] 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.

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

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.

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

 

ENGLISH REGIONS ONLY

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.

6.2.3.1 Designated Academic Health Science Networks

The designated AHSNs are:

• East Midlands
• Eastern
• Greater Manchester
• North East and North Cumbria
• North West Coastal
• Imperial College Health Partners
• Oxford
• South London
• South West Peninsula
• Kent, Surrey and Sussex
• UCL Partners
• Wessex
• 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 11 planned in London by local councils and NHS PCTs.An overview of these telecare and telehealth projects and services in London and the rest of England can be found at the following Google map links (last updated spring 2011)

Telecare Services Map:
http://maps.google.co.uk/maps/ms‌?hl=en&ie=UTF8&msa=0&msid=100406857045032193451.0004540c223f16f2d1c9d&ll=52.842595,-1.867676&spn=8.339986,18.676758&z=6

Telehealth in England Map:
http://maps.google.co.uk/maps/ms‌?hl=en&ie=UTF8&msa=0&msid=100406857045032193451.00047bfad6341183c8523&ll=54.329338,-1.604004&spn=8.052625,18.676758&z=6

6.3.2 Newham PCT Whole System Demonstrator

The Whole System Demonstrator (WSD) programme is the largest randomised control trial of telehealth and telecare in the world, involving 6191 patients, 238 GP practices across three sites, Newham, Kent and Cornwall. WSD was set up to look at cost effectiveness, clinical effectiveness, organisational issues, effect on carers and workforce issues. It focused on three conditions, diabetes, COPD and coronary heart disease. The programme will provide a clear evidence base to support important investment decisions and show how technology supports people to live independently, take control and be responsible for their own health and care.

The Whole system demonstrator programme: Headline findings – December 2011 is now available. They show that, if delivered properly, telehealth can substantially reduce mortality, reduce the need for admissions to hospital, lower the number of bed days spent in hospital and reduce the time spent in A&E.For more information on the findings see:www.dh.gov.uk/health/2011/12/wsd-headline-findings

7.0 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: http://www.telecarelin.org.uk/

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:http://www.kingsfund.org.uk/topics/technology_and_telecare/index.html

7.2 Regional

7.2.1 NHS Innovations London

NHS Innovations London Ltd (NHSIL) aims to aid the financial health of London NHS Trusts, the physical and emotional health of patients and the prosperity of innovation driven economies. They achieve this by leveraging their expertise in innovation management, unique partnership with the NHS and understanding of how healthcare works in real life.NHSIL fast-tracks NHS innovations to market; helps commercial and public organisations innovate more effectively; and enables industry and healthcare providers to better understand the market they seek to serve. NHSIL bridges the gap between the NHS, commerce, governments and public bodies, uniting these diverse groups in a common purpose: to make healthcare better through innovation.
Xcelerate™ Health Outcomes (XHO) is a specialist business unit of NHS Innovations London (NHSIL) that utilises its well established access, expertise and insight to open up access to NHS clinical pathways and anonymised patient data by acting as a bridge between NHS Trusts and industry.
For more information see: www.nhsinnovationslondon.com

7.2.2 Academic Health Science Centres (AHSCs)

London has three Academic Health Science Centres (AHSCs), partnerships between top medical schools and NHS organisations focusing on innovation.

AHSCs bring healthcare services, research and education together under a single leadership, to allow cutting-edge medical discoveries to be quickly translated into new techniques and introduced faster into London's hospitals. AHSC status has been awarded to five partnerships in the UK who have demonstrated international excellence in biomedical research, education and patient care, including three in London: Imperial College, King's Health Partners and UCL Partners.

7.2.3 Science Parks and Business Incubators

A Science Park 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 London’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 5science parks are in the region. For more information see the UK Science Park Association: http://www.ukspa.org.uk/

7.2.4 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: http://www.ukbi.co.uk

8.0 Research and Education

Figure 27 shows the expenditure on research and development (R&D) in London for 2008 and 2009 as reported by the ONS (8 June 2011)[71].

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.

London had the fourth highest total spend on R&D in 2008 (£3,049m), and third highest in 2009 (£2,975m) behind the South East, which had the highest R&D expenditure (£5,323m) and the East of England (£4,896m).

London’s HEIs had the highest R&D spend in England and the devolved countries in 2008 (£1,643m) and 2009 (£1,732m). In 2009, Businesses spent £926m on R&D, the third highest spend after the East of England (£3,898m) and the South East (£3,598m). Government R&D spend in London in 2009, was the fourth highest (£317m) after the South East (£709m), the South West (£384), and the East of England (£381m). In comparison, in 2009, the North East spent the least on Business R&D (£313m), Government R&D (£1m) and HEI R&D (£242m).

image027
Figure 27 Expenditure on Research and Development in London2008-2009 (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 London in the period 2007 to 2013 is 33 with a value of just over £78.53million. The universities receiving funding for AL associated projects are:

• Arts London and Westminster
• Brunel
• City
• Goldsmiths
• Imperial
• Institute of Education
• Kings
• London South Bank
• London School of Economics (LSE)
• Middlesex
• Queen Mary and Hertfordshire
• The London School of Medicine and Dentistry
• University College London (UCL)
• UCL and Imperial
• Westminster

There is a wide range of funding sources including the European FP7 programme and Engineering and Physical Sciences Research Council (EPSRC), and Technology Strategy Board ALIP programme.

There is little, if any, university-based training provision specific to AL, but the following universities all have courses or modules in clinical or technical subject areas with potential relevance for AL:

• Brunel University
• City University London
• Imperial College London
• Kingston University
• London Metropolitan University
• London South Bank University
• Queen Mary, University of London
• University College London
• University College London
• University of Greenwich
• University of West London
• University of Westminster

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.

9.0 Regional Opportunities for Assisted Living

London is the largest conurbation in Europe. For administrative purposes it is divided into boroughs. Those who call London “home” live either in inner London boroughs or in outer London boroughs . The population of London is predicted to grow but the average age of the population is lower than other UK regions. The population of London is increased enormously by people who commute to work in London and by tourists.

With its high population density and regional economic impact, London is the focus for innovative projects such as the roll out of super fast broadband, trials of smart metering and whole system demonstrator. The conditions for the implementation of AL are right although the slightly better access to care in Inner London because of the number of hospitals (and teaching hospitals) and the road network might mitigate against its widescale adoption. It can be assumed that in Outer London 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.

The large itinerant population made up of workers and tourists represents another, different opportunity for AL. People with LTCs who commute into London will want the same AL support services as they receive at home. This number will increase as the pension age rises over the next decades. Meeting this need will probably require the greater convergence of AL and other means of delivering health and social care such as through the mobile phone (referred to as m-health), though.

10.0 Bibliography

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Dept for Culture Media and Sport. Superfast Broadband Press Releasewww.culture.gov.uk/news/media_releases/8167.aspx . 2011 27-May. www.culture.gov.uk

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Department of Health“Third Sector Market Mapping.” 2007 13-February. www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_065403.pdf

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Department of Health, The health and Care System Explained, 26 March 2013, https://www.gov.uk/government/publications/the-health-and-care-system-explained/the-health-and-care-system-explained

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[2] London.gov, 31 March 2012, www.london.gov.uk

[3] ONS, "Summary: Regional Profiles - Summary - London," 2011 8-June www.ons.gov.uk/ons/rel/regional-trends/regional-trends/no--43--2011-edition/regional-profiles---summary---london.html

[4] ONS, Regional Profiles - Population and Migration - London, 28 October 2011, www.ons.gov.uk/ons/rel/regional-trends/region-and-country-profiles/population-and-migration/population-and-migration---london.html

[5] ONS, Regional Profiles - Population and Migration - London, 28 October 2011, www.ons.gov.uk/ons/rel/regional-trends/region-and-country-profiles/population-and-migration/population-and-migration---london.html

[6] ONS, "Older Peoples Day 2011," 29 September 2011, www.ons.gov.uk/ons/dcp171778_235000.pdf

[7] ONS, "Summary: Regional Profiles - Summary - London," 2011 8-June, www.ons.gov.uk/ons/rel/regional-trends/regional-trends/no--43--2011-edition/regional-profiles---summary---london.html

[8] ONS, Regional Profiles - Population and Migration - London, 28 October 2011, www.ons.gov.uk/ons/rel/regional-trends/region-and-country-profiles/population-and-migration/population-and-migration---london.html

[9] ONS, Regional Trends 43 Regional Profiles - Social Indicators - London, 2012 29-February www.ons.gov.uk/ons/rel/regional-trends/region-and-country-profiles/social-indicators/social-indicators---london.html

[10] ONS, "Summary: Regional Profiles - Summary - London," 2011 8-June, www.ons.gov.uk/ons/rel/regional-trends/regional-trends/no--43--2011-edition/regional-profiles---summary---london.html

[11] ONS, Regional Profiles - Population and Migration - London, 28 October 2011, www.ons.gov.uk/ons/rel/regional-trends/region-and-country-profiles/population-and-migration/population-and-migration---london.html

[12] ONS, Regional Trends 43 2011 Region and Country Profiles, 8 June 2011, www.ons.gov.uk/ons/rel/regional-trends/regional-trends/no--43--2011-edition/index.html

[13] ONS, "Ageing in the UK Datasets Table 12," 28 September 2011, www.ons.gov.uk/ons/publications/re-reference-tables.html‌edition=tcm%3A77-248402

[14] ONS, "Ageing in the UK Datasets Table 12," 28 Sept 2011, www.ons.gov.uk/ons/publications/re-reference-tables.html‌edition=tcm%3A77-248402

[15] ONS, "Regional Trends Online Tables 10 Population and Migration, tab 10.15" 11 June 2011, www.ons.gov.uk/ons/publications/re-reference-tables.html‌edition=tcm%3A77-254270

[16] ONS, Regional Trends 43 Regional Profiles - Social Indicators - London, 2012 29-February, www.ons.gov.uk/ons/rel/regional-trends/region-and-country-profiles/social-indicators/social-indicators---london.html

[17] GLA, "The London Plan," 1 July 2011, london.gov.uk, www.london.gov.uk/priorities/planning/londonplan

[18] GLA, "London Housing Strategy," 1 December 2011, london.gov.uk, www.london.gov.uk/publication/revised-london-housing-strategy-public-consultation

[19] ONS, "Older Peoples Day 2011," 29 September 2011, www.ons.gov.uk/ons/dcp171778_235000.pdf

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

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

[22] ONS, Internet Access - Households and Individuals 2011, 31 August 2011, www.ons.gov.uk/ons/rel/rdit2/internet-access---households-and-individuals/2011/stb-internet-access-2011.html#tab-Key-points

[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] ONS, Internet Access - Households and Individuals 2011, 31 August 2011, www.ons.gov.uk/ons/rel/rdit2/internet-access---households-and-individuals/2011/stb-internet-access-2011.html#tab-Key-points

[25] ONS, Internet Access - Households and Individuals 2011, 31 August 2011, www.ons.gov.uk/ons/rel/rdit2/internet-access---households-and-individuals/2011/stb-internet-access-2011.html#tab-Key-points

[26] GLA, "London Economic Development Strategy," 1 May 2010, London.gov.uk, www.london.gov.uk/sites/default/files/Economic-Development-Strategy.pdf

[27] ONS, Regional Trends 43 Regional Profiles - Social Indicators - East of England, 8 December 2010, www.ons.gov.uk/ons/rel/regional-trends/regional-trends/no--43--2011-edition/regional-profiles---social-indicators---east-of-england---dec-2010.html

[28] ONS, Regional Trends 43 Regional Profiles Social Indicators London, 2012 29-Feb www.ons.gov.uk/ons/rel/regional-trends/region-and-country-profiles/social-indicators/social-indicators---london.html

[29] HMRC "Income and tax for individuals of pension age 2007-08" 1 Feb 2010 ww.hmrc.gov.uk/stats/income_distribution/table-3-12-feb2010.xls

[30] ONS, "Older Peoples Day 2011," 29 September 2011, www.ons.gov.uk/ons/dcp171778_235000.pdf

[31] 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

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

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

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

[35] GLA, "London Economic Development Strategy," 1 May 2010, www.london.gov.uk/sites/default/files/Economic-Development-Strategy.pdf

[36] GLA, "The London Plan," 1 July 2011, www.london.gov.uk/priorities/planning/londonplan

[37] GLA, "Mayor's Transport Strategy," 1 May 2010, www.london.gov.uk/publication/mayors-transport-strategy

[38] GLA, "London Economic Development Strategy," 1 May 2010, London.gov.uk, www.london.gov.uk/sites/default/files/Economic-Development-Strategy.pdf

[39] GLA, "Mayor's Transport Strategy," 1 May 2010, www.london.gov.uk/publication/mayors-transport-strategy

[40] 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

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

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

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

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

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

[46] Low Carbon London, 24 February 2012, .

[47] GLA, "London Economic Development Strategy," 1 May 2010, London.gov.uk, www.london.gov.uk/sites/default/files/Economic-Development-Strategy.pdf

[48] DH, The health and Care System Explained, 26 March 2013, https://www.gov.uk/government/publications/the-health-and-care-system-explained/the-health-and-care-system-explained

[49] NHS England, Sept 2013, http://www.england.nhs.uk/ourwork/com-dev/

[50] NHS Choices, 'Clinical Commissioning Groups (CCG) and how they perform' http://www.nhs.uk/NHSEngland/thenhs/about/Pages/ccg-outcomes.aspx

[51] NHS England, 'Towards commissioning excellence: Developing a strategy for commissioning support services', 12 June 2013 http://www.england.nhs.uk/wp-content/uploads/2013/06/towa-commis-exc.pdf

[52] Public Health England, https://www.gov.uk/government/organisations/public-health-england

[53] DH, A short guide to health and wellbeing boards, 28 February, 2012, http://healthandcare.dh.gov.uk/hwb-guide/

[54] CQC, "The state of health care and adult social care in England," 15 September 2011, www.cqc.org.uk/sites/default/files/media/documents/state_of_care_2010_11.pdf

[55] CQC, "The state of health care and adult social care in England," 15 September 2011, www.cqc.org.uk/sites/default/files/media/documents/state_of_care_2010_11.pdf

[56] CQC, "The state of health care and adult social care in England," 15 September 2011, www.cqc.org.uk/sites/default/files/media/documents/state_of_care_2010_11.pdf

[57] EAC, Extra Care Housing.org.uk, 1 March 2010, www.extracarehousing.org.uk/

[58] Department of Health, "Fair Access to Care Services: Guidance on eligibility criteria for adult social care," 25 February 2010, www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_113155.pdf.

[59] CQC, "The state of health care and adult social care in England," 15 September 2011, www.cqc.org.uk/sites/default/files/media/documents/state_of_care_2010_11.pdf

[60] The King's Fund, 1 March 2009, www.kingsfund.org.uk/publications/briefings/funding_adult_social.html

[61] Department of Health, "Fair Access to Care Services: Guidance on eligibility criteria for adult social care," 25 February 2010, www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_113155.pdf

[62] CQC, "The state of health care and adult social care in England," 15 September 2011, www.cqc.org.uk/sites/default/files/media/documents/state_of_care_2010_11.pdf

[63] NHS Information Centre, Community Care Statistics 2008, Home Care Services for adults, England 26 Mar 2009

[64] ONS, 2008-based Subnational Population Projections (2008 1-January).

[65] CQC, "The state of health care and adult social care in England," 15 September 2011, www.cqc.org.uk/sites/default/files/media/documents/state_of_care_2010_11.pdf

[66] Department of Health, "Third Sector Market Mapping," 13 February 2007, www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_065403.pdf

[67] Technology Strategy Board Assisted Living Directory, https://connect.innovateuk.org/web/assisted-living-innovation-platform-alip/assisted-living-directory

[68] More Independent website, http://www.moreindependent.co.uk/life-enhancements/smarthouse/

[69] Department of Health The Mandate A mandate from the Government to the NHS Commissioning Board http://mandate.dh.gov.uk/

[70] E-Health Insider, Lis Evenstad, http://www.ehi.co.uk/news/EHI/8375/pathfinders-losing-their-way) 11 February 2013

[71] ONS, "Regional Trends Online Tables: 03 Economy," 8 June 2011, www.ons.gov.uk/ons/publications/re-reference-tables.html‌edition=tcm%3A77-254270

 

end faq

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