Assisted Living UK Capabilities
Opportunity Report

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South West England

South West England - full text version

Assisted Living Capability - South West England

This study was updated in September 2013 to include changes to the NHS and public procurement of health services, and to provide updated information on regional broadband availability and take-up.

1.0 Introduction

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

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

2.0 South West Regional Overview

The South West region is the largest in England with the longest coastline of any English region. It has the largest area (18%) of the 9 English regions - larger than Wales and Northern Ireland - with the lowest population density (10% of the English regions)[1]. The South West region has a very diverse landscape and contains 2 national parks, Dartmoor and Exmoor, and almost 1000 sites of special scientific interest. Two thirds of the population live in rural areas.

2.1 Administrative Regions

Following the administrative re-organisation in 2009[2], the South West Region comprises the following 4 counties that contain 25 (mostly rural) districts (see Figure 1):

  • Devon
  • Dorset
  • Gloucestershire
  • Somerset

And 12 unitary authorities, (including Cornwall and Wiltshire created in 2009 from former counties):

  • Isles of Scilly
  • Cornwall
  • Plymouth
  • Torbay
  • Poole
  • Bournemouth
  • North Somerset
  • Bath and North East Somerset
  • City of Bristol
  • South Gloucestershire
  • Swindon
  • Wiltshire

Figure 1 Map of the South West showing approximate County and Unitary Authority Boundaries (as of 2011) (Source: ONS)

2.2 Demographics

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

2.2.1 Population

The South West is the seventh largest region in the UK in terms of population (see Figure 2). In mid-2009, the population of the South West was 5.2 million, which is 8.47% of the population of the UK. The population is increasing in line with that of the rest of the UK: between 2004 and 2009, the population of the region increased by 3.8% compared to an overall increase of 3.3% for the UK as a whole.[3]

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

2.2.2 Population Density

Despite being the largest region in England in terms of area, the South West is one of the least densely populated regions in England, although it is more densely populated than Scotland, Northern Ireland and Wales. The South West's population density in 2008 was 219 people per sq km, compared with the UK and England densities of 253 and 395, respectively.

Among South West counties and unitary authorities, the population density ranges from 115 per sq km in Devon to 3,830 in Bristol. The former has the seventh lowest population density in England but there are 34 English unitary authorities that are more densely populated than Bristol[4].

2.2.3 Urban v Rural Populations

In mid-2008, 33% of the South West's population (1.7 million) lived in rural settlements, the largest proportion among the nine English regions. This includes almost 20% who lived in villages, hamlets or isolated dwellings, again the highest percentage in England. The largest conurbations in the region are Bristol, Bournemouth/Poole and Plymouth, which have estimated populations, respectively, of over 600,000, 350,000 and 250,000.

The five 'Large Urban' districts (Bristol, South Gloucestershire, Bournemouth, Poole and Christchurch) contained about 20% of the region's population; 19% lived within the seven authorities classified as 'Other Urban' (Cheltenham, Exeter, Gloucester, Plymouth, Swindon, Torbay, and Weymouth and Portland). The remaining 61% of people in the South West lived in Rural or Significant Rural authorities; the largest proportion of any English region.[5]

2.2.4 Population over 65 years

The South West has the highest proportion of people of state pension age and above among the nine English regions. Almost 1.2 million people were in this age group in 2008, the third highest regional total. The proportions of children and working- age people (18 and 60 per cent respectively) were the lowest of any English region, but the latter figure hides the fact that the South West had the second highest proportion of people aged 50 to retirement age (after the North East) in 2008[6]. In 2009, people aged 65 and over made up 19.3% of the population, compared with 17.6% for the under-16s. This compares with averages for the UK of 16.4 and 18.7 per cent respectively.

Figure 3 shows a similar number of males and females in each age category. The population of both males and females as a percentage of the overall population begins a gradual decline between the ages of 60-79, where the population of males and females is 7.45% and 8.11% respectively, but drops more markedly to 1.60% for males and 2.78% for females over the age of 80.


Figure 3 Population of the South West as a percentage of the total SW population (English Regions) (Source: GP data)

image004Figure 4 Population by County within the SW region - Male and Female over 65 (Source ONS)

Figure 4 shows that within the SW region, there are significant variations in age distribution, from Bristol at 12.3% over 65s in 2011 to Christchurch (30.3%) and West Somerset (30.5%). Over the next twenty years, the Bristol ratio is projected to reach 13.1% with West Somerset at 42% and West Dorset (39.7%)[7].

2.2.5 Life Expectancy

People in the South West have among the highest life expectancies. Life expectancy at birth in the South West in 2007-2009 was among the highest of the UK at 83.3 years for females and 79.2 years for males. Within the region, life expectancy at birth was highest in East Dorset for both males and females (81.4 and 85.4 years respectively). The lowest for both males and females was in Bristol unitary authority (77.2 and 81.9 years respectively). In the South West men aged 65 in 2007-09 could expect to live another 18.6 years and women 21.3 years. This compares with 17.8 and 20.4 years in the UK as a whole.

2.2.6 Population Projection

Although it has one of the smallest total populations, over the past 20 years, the South West has seen the fastest rate of population growth, of all of the English regions. This trend is predicted to continue[8].

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

Figure 5 shows the population projections for males over 65 years and females over 60 years. Population projections suggest that, based on trends and incorporating planned changes to the state pension age, the working-age population in the region in 2026 will have grown by almost 610,000 or 20 per cent. The number of children will be 130,000 or 14 per cent higher and there will be 280,000 more people of pension age and above, a rise of 25 per cent[9].

2.2.7 Old Age Support Ratio

The old age support ratio is a measurement of how many people of working age (20-64) there are relative to the number of retirement age (65+). The lower the ratio, the fewer younger people there are to support the over 65s. Figure 6 shows the support ratio in 2009 and what this support ratio is projected to be in 2033.

The South West has the highest proportion (over 22%) of people of state pension age and above among the nine English regions, and the lowest proportion (60%) of working age people. Not only is the growth rate of the South West one of the fastest, as is predicted to continue, it also has the longest life expectancy. The chart below shows that the ratio of working-age people to elderly is declining in throughout the region, apart from Bristol where only 6.17% of the population are over 60 yrs. Apart from Bristol, this means that there will be an increasing number of elderly people being supported by fewer people of working age.

image006 Figure 6 Old Age Support Ratios (Source ONS)

2.2.8 Households

There were an estimated 2.2 million households in the South West in 2006, approximately 10 per cent of the total in England. The average household size was 2.26 people, the joint lowest (with the North East) among the nine English regions.

The total number of households in the South West is expected to reach almost 2.9 million in 2026, according to projections based on mid-2006 data. This is equivalent to a 29 per cent increase over the preceding 20 years, the second largest change among English regions in percentage terms. The increase reflects the projected 20 per cent growth in the region's population during this period combined with the expected fall in the average South West household size to 2.10.

The region has the lowest proportion of social rented housing. In 2007, 13 per cent of housing in the South West was rented from registered social landlords or local authorities, the smallest proportion among the English regions. The region had the highest percentage of homes outside London that were privately rented or came with a job or business (14 per cent). The South West had 21 per cent of all second homes in England, but only 10 per cent of the total number of dwellings. 
The median dwelling price in the South West in 2009 was £175,000 compared with the England figure of £170,000[10]. 

2.2.9 Older People and the Internet

The demographic information relating to Internet access and usage in this section is sourced from the ONS and Ofcom (the independent regulator and competition authority for the UK communications industries). At present, it has not been possible to obtain useful county/UA level demographic data on how older people access and use the Internet, so national data will be used to identify information and trends that could be seen as relevant at a regional level.

Ofcom produces an annual Communications Market report[11], 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[12]. With access to the Internet via TV becoming more widely available, this may be relevant to the delivery of AL services for the older demographic. Mobile Internet connections

The ONS has noted a significant growth in the adoption of mobile Internet technology over the previous 12 months. Six million more people reported using their mobile phone to access the Internet in 2011 than in 2010. Although this growth is fastest among those aged 16-24, with Internet use over a mobile phone increasing from 44 per cent to 71 per cent over the previous 12 months, there have been notable increases across all age groups (see Figure 7).

Since 2009, when the measurement of mobile phone Internet use in this survey began, the number of women using mobile phones to access the Internet has more than doubled, from 18 per cent of Internet users to 39 per cent in 2011.Mobile Internet use via a laptop, tablet or other portable computer also proved popular in 2011, with 38 per cent of Internet users using these mobile devices away from the home or workplace.[13]


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

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

However, the biggest increases in confidence was in the 45-54s and 55-64s, age groups, with a ten percentage point rise in both age groups; more than 90% now claim to be confident.
Men are still marginally more likely to be confident in using the Internet than women (97% to 94%), but the gap has been closing[14]. 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[15].

Figure 8 shows that older people are using the Internet increasingly to make purchases. Whilst there has been an increase in purchases made by both those over 55s and over 65s year on year since 2008, there has been a significant increase in the percentage of those aged 55 purchasing online. Fifty nine percent of over 55s compared to 27% of over 65s making purchases in 2011. This pre-disposition to purchase goods and services online in the over-55s may be of relevance to the AL market[16].

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

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


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

3 Regional Economy

3.1 Economic Overview of the South West

The South West is a relatively productive and wealthy region particularly compared with the English regions outside the Greater South East. The northern part of the region is the main engine for economic growth with urban centres exhibiting high levels of productivity, supported by high-level skills, innovation and enterprise. By contrast, some areas - predominantly the more rural and peripheral parts of the region - perform considerably less well than other parts of the country.[17]
GVA per head in the region was £18,211 in 2009, ranking the South West fourth out of the English regions behind London (£34,200), the South East (320,923) and the East of England (18,591)[18].

The average gross household income in the region was £838 per week in 2008/09, above the UK average of £703 and one of the highest, after London.

3.2 Regional Economic Infrastructure

In 2010, the UK Government developed a National Infrastructure Strategy[19] 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[20], revised to include more regional detail in 2011[21], and updated in 2012[22] to report progress against the plan.

A region's economic infrastructure can have a significant impact upon the ease with which technology innovations can be deployed to meet social objectives such as healthcare. The sectors and networks that are of most relevance to AL are energy, transport, and digital communications and surrounding them all is the region's ability to generate intellectual capital. Given the recent nature of the strategy and plan, there are few statistics at the moment to support the development of the economic infrastructure at regional level. Instead, regional initiatives and projects have been used to illustrate activities in the relevant areas.

Based on the framework in the National Infrastructure Plan[23], Figure 10 shows the interrelationships and inter-dependencies between the care network and the regional economic infrastructure. For example, a poor transport infrastructure can offer opportunities for AL services, whereas a poor digital communications network would be a constraint.

All the elements within this infrastructure depend on utilizing the Intellectual Capital within a region, and it in turn depends on these networks to facilitate the take-up of science and technology innovations. The 2011 Infrastructure Plan recognizes the importance of good transport and digital communication links in facilitating the development of innovation hubs, science parks and clusters, which will all benefit from investment in world-class research facilities. Co-location of these innovation clusters with universities will also foster knowledge transfer and expertise exchange.


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

3.2.1 Transport

Despite being the largest region in England in terms of area, large parts of the South West are not served by motorways. The north and east of the region are served by two major motorways, the M4 and M5 (extending to Exeter in the south). Of the major towns in the region, only Exeter, Bristol, Gloucester and Swindon are on a motorway. Bournemouth/Poole and Plymouth, which are two of the most populous areas, and Cornwall, the largest Unitary Authority, are not served by motorways.[24]

'In addition to traffic accidents, transport can have an effect on health through other channels such as noise and air pollution, and access to health care. The latter is of great concern, especially in regard to an aging population and a large geographical area with relatively poor public transport links.

'A good transport and ICT infrastructure can also improve business productivity and attract businesses and foreign direct investment (FDI) which will improve competition and innovation in the region. As well as the transport challenges that the region faces, opportunities also exist in finding alternatives that "make distance irrelevant" and investing in innovative methods that both increase productivity, improve welfare and, importantly, limit the environmental impact of transport.'[25]

The Communications Infrastructure 2012 update reports[26] the following progress on infrastructure delivery programmes and Autumn Statement 2012 capital announcements relevant to the South West region:

Starting soon: Camborne Pool Redruth Infrastructure project - 2013
Under construction: M4/M5 managed motorway scheme - due to complete in spring 2014
Under construction: Kingskerswell Bypass - due to complete in 2015
New funding announced: A30 Temple to Carblake dualling works (£30 million)

3.2.2 Digital Communications

Ofcom, the Independent regulator and competition authority for the UK communications industries, has reported[27] that during the last 10 years, the UK's communications market has been totally transformed. Digital technology has developed extremely quickly, and has changed the way that communications services work for consumers. It has also had a major impact on businesses and networks. For AL to take advantage of these rapid developments, a region must have an adequate digital communications infrastructure. Ofcom is now tasked with reporting on broadband take-up, speeds and availability, using data provided by communications providers.

The connectivity of a region has a direct impact upon the implementation and take-up of AL products and services. The UK Government aims to have the best superfast broadband network in Europe by 2015 by providing all homes and businesses in the UK with access to at least 2Mbit/s broadband and that superfast broadband should be available to 90 per cent of people in each local authority area. There will be a particular focus on making sure that people in remote, as well as urban areas, get good online access.

The most recent information on broadband in the UK has been compiled by Ofcom. The Digital Economy Act 2010 requires Ofcom to report on the state of the UK's communications infrastructure every three years. The Communications Infrastructure 2011 report[28] has been published and provides some useful regional information not only for local authorities developing broadband plans, but also for businesses wanting to develop and deliver services - see Figures 11, 12 and 13.

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

Figure 11 shows the availability of broadband across the South West 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.

The Communications Infrastructure 2012 update reports[29] that the Government has 'established a framework agreement for Local Authorities to use to deliver rural broadband projects and secured state aid clearance to enable investment to proceed.' Areas in the South West expected to have completed procurement by December 2012 are Gloucestershire, Wiltshire and Devon & Somerset.


Figure 11 Broadband availability by SW Administrative Authority (Source Ofcom)

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

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

Ofcom[30] has ranked each area on a scale of 1 to 5, with 1 the highest or fastest, and 5 the lowest or slowest on how they score on four broadband metrics:

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

Figure 13 shows the ranking (1 = highest /fastest, 5 = lowest/slowest) within the South West region by administrative authority. 10 out of 16 local authority areas have a ranking of 2 or above. The lowest ranked area is the Isles of Scilly (ranked 5), with Devon, Dorset and Somerset with a ranking of 4.

Figure 13 Overall Broadband Performance by SW Administrative Authority (Source Ofcom)

3.2.3 Energy

With smart meters being considered as a potential important opportunity for the delivery of AL, the roll-out of smart meters represents a significant milestone.
As part of its National Infrastructure plan, the UK Government aims to make every home and every business an intelligent part of an electricity network, to help moderate demand at peak times and to preserve supply and demand balance despite increased amounts of intermittent, renewable electricity generation. The aim is also to ensure greater energy interconnection with continental Europe and Ireland.

Currently, there is no regional data available, but by 2019, the Government will 'complete the rollout of smart meters, so that electricity customers can participate actively in helping reduce carbon intensity (by consuming less energy) and maintain security of supply (by smoothing their consumption over time). Development of the communications and data infrastructure required to support smart meters is expected to commence by 2014.'[31]

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.'[32]

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.

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

4 Health and Social Care

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

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

The new health and care system for England become fully operational from 1 April 2013 when NHS England, Public Health England, the NHS Trust Development Authority and Health Education England took on their full range of responsibilities[33]. Nationally, NHS England commissions specialised services, primary care, offender healthcare and some services for the armed forces[34]. 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[35]. 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[36]. 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)[37] 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[38]. Board members will collaborate to understand their local community's needs, agree priorities and encourage commissioners to work in a more joined up way. As a result, patients and the public should experience more joined-up services from the NHS and local councils.

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

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

4.1 Health in the SW - Long Term Conditions

Long Term Conditions (LTCs), are conditions such as diabetes, asthma and arthritis, that cannot currently be cured, but whose progress can be managed and influenced by medication and other therapies.

The incidence of LTCs in the South West is 1,520,574 out of a regional patient population of 6,829,104. This implies that 22.27% of the SW patient population suffers from an LTCs, 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, 22.27% may be a reasonable ballpark figure to use in order to estimate the percentage of the South West patient population needing to access products and services for LTCs.

The balance of specific LTCs within the SW patient population is shown in Figure 14, broken down into nine specific conditions:
Heart Failure
Coronary Heart Disease
Chronic Obstructive Pulmonary Disease (COPD)
Learning Disability

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 (6%) and Stroke (7%). The second largest condition is Diabetes (15%), which also has strong links to Coronary Heart Disease, which has the third largest (13%) patient numbers.

fig14Figure 14 SW England - Specific conditions as a percentage of all incidences of LTCs July 2010 (GP data)

Figures 15 and 16 show patients with long-term conditions in the South West in each Primary Care Trust (PCT). Figure 15 shows the number of people with LTCs registered with their GP. The data does not take into account patients registered with co-morbidities. Figure 16 shows the number of patients with LTCs as a percentage of the total patient population for that PCT.

Although Bath and NE Somerset PCT have the second lowest number of patients with LTCs (47,740) this actually accounts for 50% of all patients within that PCT. Whilst Devon PCT has the largest number of patients (219,103) with LTCs, this only accounts for 4% of their total patient population.

Within the SW PCTs, apart from Bath and NE Somerset, patients with LTCs account for an average of 3.8% of PCT patient populations.

Figure 15 SW England - Patients with LTCs by PCT (GP data)

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

5 Existing Care Provision

In 2010, a new system for registering and regulating health care and adult social care in England came into effect, as a result of the Health and Social Care Act 2008. The changes in recording data about health care provision has made collecting relevant data difficult, either because the way the data is collected has changed or the data is not yet available. Because of changes in the legal requirements for registration, it is not possible to make direct comparisons with figures about provision and capacity from previous years.

A variety of sources have been used to collect the data in this section, including the NHS Information Centre (NHSIC), the Care Quality Commission (CQC) and the Office of National Statistics (ONS).

Each year, the CQC, which is the independent regulator of health care and adult social, care services in England reports on the state of health and adult social care in England. The latest report[39] 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[40] 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 17 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 17, the population figures are indicative only for the purposes of providing a comparison with care provision. To obtain actual population figures, multiply the figures shown in the table by a thousand.

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

Figure 17 shows that the South East has the largest population of older people (male 65 years and female 60 years) and greatest number of domiciliary care agencies and care homes both with and without nursing. The North East has the smallest population of older people and the fewest domiciliary care agencies and care homes both with and without nursing.

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


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

5.1 Adult social care provision in England

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

Care services can be provided in a variety of ways:

Care homes, including residential homes and nursing homes
Care in own home, usually referred to as domiciliary care or home care
Community venues, such as day care centres and drop-in centres.

There are also different types of social care available:

Personal care, such as help with washing, toileting, dressing, and eating, etc
Practical help, such as help with shopping, cleaning, etc
Nursing care, which is any service provided by a registered nurse in any setting

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

Over the past few years, the adult social care sector has been evolving in response to the development of new types of provision aimed at helping more people to live at home for longer. The 2011 CQC report into adult social care provision noted that extended stays in hospital are being replaced by new or expanded models of provision, such as Extra Care Housing/Housing with Care, and short-term nursing care in homes. CQC registration data shows that there are 564 such Extra Care housing locations across England.[41].

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'[42].

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 authorities 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[43] 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".[44]

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[45], summarises how social care in England is funded at present:

In England, social care is funded through the following:
central government funds allocated to the local council
council tax revenues
individuals' contributions to their council care package, and/or
  ndividuals' 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[46] to categorize an individual's level of need as low, moderate, substantial or critical.

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

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

5.2 Domiciliary Care (Home Care)

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

According to the CQC report[47], there were 5,894 home care agencies in England in July 2011. The South East has the highest number, with 1079 agencies, followed by the North West and London with 795 and 745 agencies respectively. The North East has the lowest number of domiciliary agencies, with 263. Agencies vary in size and the number of people they serve. A single agency will usually be registered to provide care for more than one type of person.

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

Figure 18 shows the number of households receiving intensive home care based on data from the NHS Information Centre (NHSIC)[48]. Intensive Homecare is defined as the number of households receiving more than 10 contact hours and 6 or more visits during the week. Households receiving home care purchased with a direct payment are excluded. The total number of households receiving home help/home care excludes double counting of households receiving care from more than one sector.

Figure 18 shows that the South West has the second lowest number of households in receipt of home care (27390), 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.

image017 Figure 18 People aged 65 and receiving Home Help and Home Care by Region
(Source: NHSIC Community Care Statistics 2008, Home Care Services for adults, England 26 Mar 2009)

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


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

North Somerset (58%) and Gloucestershire (60%) have the lowest percentage of households over 65 in receipt of intensive home care. The Isle of Wight shows that the population within that council in receipt of intensive home care comprises 100% of people over 65.

For four councils, 80% of the homecare they provide is for those aged 65 and over: Bath & NE Somerset (87%), Dorset (85%), Bournemouth (84%), and South Gloucestershire (81%).

5.3 Residential Care

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

In July 2011 in England there were 4,608 registered care homes with nursing and 13,475 registered care homes without nursing. Figure 16 shows the regional variations in the number of care homes with nursing, care homes without nursing, and domiciliary care agencies. The estimated population of older people (M65+/F60+) in the South West in 2010 was 1,223,000[49]. In July 2011, in the South West there were 34468 beds in care homes without nursing and 24771 beds in nursing homes with nursing.

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

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

image019 Figure 20 Population of older people compared to social care provision in the SW (Source: CQC)

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


Figure 21 SE Population compared to care provision in the South West (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'[50].

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 health and social care services to an individual using a combination of information and communication technologies and sensor technologies'.

Local authorities are beginning to recognize the role telecare can play in easing the demands on a health and social care system that is suffering from budget restrictions and increasing demographic challenges. Figure 22 shows expenditure on telecare between 2006 and 2009 in each local authority in the South West. 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.


Figure 22 SW Local Authority Expenditure on Telecare per person over 65 yrs 2008-2010

5.6 Third Sector Provision for the Elderly

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

The government recognises that these organisations have a critical and integral role in health and social care as providers of services, advocates, and in representing the voice of service users, patients and carers. The sector makes a substantial contribution to the delivery of high quality health and social care services. The government also acknowledges that these organisations have a strong track-record of designing services based on insight into clients' needs, and are often well placed to respond flexibly to those needs. In 2007, the Department of Health commissioned research to examine the potential contribution that third sector organisations could make to the delivery of health and social care. The research involved surveys of third sector organisations and local authorities. The resulting 'Third Sector Market Mapping' report[51] 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 CITATION DH07 \l 2057 (DH) care services for those 65 years and over.
  • Most common social care needs: physical disabilities/sensory impairment (32%), mental health issues (24%) and learning disabilities (23%).
  • The two most common social care services: advice / counselling (42%) and education (25%), which account for 45% of the sector's expenditure on social care.
  • Organisations providing transportation services are most likely to be recipients of public sector funding (84%), whereas those providing advice/counselling are least likely to do so (5%)
  • Most common client health care groups: those with mental health issues (31%) and those with a physical disability/sensory impairment (29%)

The South West has 131 organisations involved in providing services for the elderly, with the largest number of these in Bristol. Total income across the South West of the top 5 organisations in each county is just over £50million, with total expenditure of the top 5 just over £40million. The largest (in terms of income) TSOs operating in the South West are shown in Table 1.

Table 2 shows the number of third sector organisations (including income and expenditure) that provide services for the elderly in each of the coutnies and unitary areas in the South West.

Table 1 Largest Third Sector Organisations (by income) in the South West (Source: Guidestar)

Third Sector Care Organization

£ Income (all counties)

The Gloucestershire Care Partnership


Age UK


Help and Care


Centre for Sustainable Energy


The Carers Centre


The Care Forum


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

Isles of Scilly








SW Total

Total no. of organisations










% third sector organisations










Total income top 5 organisations










% total income










Average income top 5 organisations










Total expenditure top 5 organisations










% total expenditure










Average expenditure top 5 organisations











6 Current Assisted Living Activity

6.1 Suppliers of Products and Services

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

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

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


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

There is very little data available for companies operating solely in the Assisted Living sector, with evidence of 8 companies involved in AL solutions. There are only a few companies operating solely in the Assisted Living sector in the South West. However, large medical technology companies (focusing on diagnostic technologies) do have a strong presence in the region[52].

The Technology Strategy Board's Assisted Living Innovation Platform (ALIP) has a directory[53] of technology suppliers ranging from traditional Telecare and Telemedicine through to Environmental control and Memory support and Prompting devices, that can be searched on by region.

6.2 National AL Projects and Initiatives

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

6.2.1 Delivery Assisted Living Lifestyles at Scale (dallas)

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

living it up logo

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

ifocus logo

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

mi logo

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


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

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

For more information see:

6.2.2 TECS Technology Enabled Care Services (3 Million Lives)

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

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

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

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

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

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

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

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

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

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


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

6.2.3 Academic Health Science Networks

NHS England has confirmed the designation of 15 new Academic Health Science Networks (AHSNs). AHSNs have the potential to transform health and healthcare by putting innovation at the heart of the NHS. This will improve patient outcomes as well as contributing to economic growth.
AHSNs present a unique opportunity to pull together the adoption and innovation with clinical research and trials, informatics, education and healthcare delivery. They will develop solutions to healthcare problems and get existing solutions spread more quickly by building strong relationships with their regional scientific and academic communities and industry.
The AHSNs provide an important mechanism for achieving step-change in the way the NHS translates research, innovation and best practice in to effective and cost-effective treatments and services for patients. They will help to develop better technology and make better use of the skills of NHS staff. Designated Academic Health Science Networks

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

6.3 Regional AL Projects/Initiatives in Health and Social Care

6.3.1 Local Councils and NHS Trusts

There are approximately 15 projects in telehealth and 19 projects in telecare being undertaken in the South West region by local councils and NHS Trusts. Further details of these telecare and telehealth projects and services in the South West and the rest of England can be found at the following Google map links (last updated spring 2011)

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

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


6.3.2 NHS Cornwall & Isles of Scilly 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:

The Cornwall Telehealth project is aimed at patients who suffer from lung disease, heart disease and diabetes. The Telehealth equipment enables patients to monitor their own health from the comfort of their own homes. It also enables the Community Matron or Specialist Nurse to monitor trends developing over a period of time. This gives a more consistent picture of health and helps identify problems at a much earlier stage.
Telecare and assistive technology uses equipment that supports independent living through automatic prompts, reminders or alerts. The aim of the technology is to enable or maintain independent living. It can be used to support living in a manner chosen by the individual, safe in the knowledge that help can be raised in an emergency. When an alert is raised by pressing a red pendant, usually around the user's neck, the control centre endeavours to speak directly to the person, if this is not possible they will either phone the carer (responder) or contact the emergency services.

6.3.3 Healthy Outlook®

Healthy Outlook® is a preventative service, aimed at helping people with Chronic Obstructive Pulmonary Disease (COPD) stay well. The service helps patients with COPD manage their condition more effectively by warning them of periods of increased risk to their health. There is a strong link between with Chronic Obstructive Pulmonary Disease hospital admissions and environment factors such as the weather and levels of circulating infections. The Healthy Outlook® COPD Forecast Alert, and associated anticipatory care, has been developed to use this knowledge to help prevent exacerbations and keep people out of hospital. The service is typically commissioned by Primary Care Trusts and patients are recruited through GP practices. For more information see:

6.3.4 The Portsdown Group Practice

The Portsdown Group Practice operates across 4 surgeries and covers Portsmouth and the surrounding areas.The Practice wanted a way to reduce the pressure on their clinicians, empower their patients to self-manage and help to keep patients as healthy as possible for as long as possible. The latest results reveal that in November 2012 Medvivo's Fully Managed Service produced savings of £31,141 and 89 bed days were saved from 19 hospital avoidances. Since the re­search began in June, 696 bed days and £249,128 have been saved.

7 Centres of Excellence

7.1 National

7.1.1 The Telecare Learning and Improvement Network

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

7.1.2 The Kings Fund

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

7.2 Regional

7.2.1 NHS Innovations South West

NHS Innovations South West is one of nine regional Innovations hub set up from 2004 to champion the cause of healthcare innovation and to identify, develop and commercialise innovations and intellectual property created by NHS staff. NHS Innovations South West serves the South West to develop and take forward new innovative ideas - both products and services - to enhance healthcare delivery.

7.2.2 Health Innovation and Education Cluster South West

Health Innovation and Education Clusters (HEIC) are partnerships between the NHS, higher education, industry and other public and private sector organisations. They support the spread and adoption of innovation locally and strengthen professional education and training. There are 17 HEICs throughout England. The HEIC-SW works with partners and its extensive network to ensure rapid adoption of best and leading edge practice and deliver substantial benefits. For more information see the HEIC-SW website:

7.2.3 Centre for Health and Social Care Innovation (CHeSCI), University of Plymouth

This multi-professional research centre is driven by the challenges that face health and social care. Members are engaged in local, national and international research from clinically based studies to theoretical work.

In order to generate innovation in specific areas, the Centre supports a number of research clusters in areas of:
• Ageing and Rurality
• Applied Health Genetics
• Clinical Skills Innovation
• Dietetics and Health
• Drug and Alcohol Use (Drug and Alcohol Research Unit DARU)
• e-Health
• Rehabilitation
• Social Science and Health
• Sustainability, Society and Health

7.2.4 University of Bath, Dept of Health - Assistive Technology & Rehabilitation

The Department for Health has a number of multidisciplinary research groups engaged in research and development within the area of assistive technology and rehabilitation.

Current research projects:
• Real time measurement of changes in physical performance following rehabilitation of patients with chronic pain
• Computer based sensory re-training systems
• A prospective observational study to measure free living activity in patients with COPD
• Optimising quality of sleep among older people in the community and care homes: an integrated approach
• Development and evaluation of compliant seating for disabled children
• Development of sensors and support equipment for people with dementia
• Evaluation of an RF-based smart home installation
• Support equipment for children undergoing Targeted Training

7.2.5 Bath Institute of Medical Engineering (BIME)

BIME is a design and development charity working in the fields of medicine, health care and assistive technology for disabled people. They have a team of electrical and mechanical design engineers who work on a large number of projects ranging from technology for people living with dementia, to very practical items of daily living equipment. They are able to take an initial idea through to a finished product. Their design philosophy is inclusive and the views of disabled people, carers and professionals are integral to their work. The Institute aims to ensure all successful designs are made available to whoever can benefit.

7.2.6 Science Parks and Business Incubators

Innovation, science and technology are critical to South West England's prosperity. Underpinning this success is the region's network of science parks and incubation centres, providing the environment to support the growth of innovative and enterprising individuals and companies. There are 4 science parks in the region:

Bristol and Bath Science Park, Bristol,
Exeter Science Park, Devon
Tamar Science Park, Cornwall,
Tetricus Science Park, Wiltshire

7.2.7 Business Incubators

University business incubators enable businesses to take advantage of a range of support and facilities, and access to expertise. There are eight business incubators based within the region's universities:

Enterprise Pavilion, Arts University College at Bournemouth
Bournemouth University Innovation Centre (BUIC)
Innovation Centre, University College Falmouth
Bath Ventures Innovation Centre, University of Bath
Business Incubator, University of Bristol
Working with Business, University of Exeter
Formation Zone, University of Plymouth

8 Research and Education

Figure 24 shows the expenditure on research and development (R&D) in the South West region for 2008 and 2009 as reported by the ONS (8 June 2011)[58].

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.

The South West had the fifth highest R&D expenditure in the UK in 2008 (£2,020m) and 2009 (£2,001m). The South West had the highest R&D expenditure (£5,323 million) in the UK in 2009, and had the second highest expenditure (£5,083m) in 2008 after the East of England (£5,162m).

image023 Figure 24 Expenditure on Research and Development in the South West 2008-2009 (Source: ONS 2011)

8.1 Universities and Higher Education Institutions

There are 13 Higher Education Institutions (HEIs) in the South West region. Those with significant AL research activity are listed in Table 3.

The universities of Bath, Bournemouth, Bristol and Plymouth are actively involved in Assisted Living projects. There are currently 10 ongoing projects (2007-2014) focused on Assisted Living involving SW Universities with a value of nearly £13.5million. The main source of funding is the Engineering and Physical Sciences Research Council (EPSRC).

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

Table 3 Universities in the SW with AL related activity (Source: Universities)



AL-related Research Cluster/theme

Bournemouth University

School of Health and Social Care

Wellbeing and quality of life

University of Bath

Department for Health

Assistive Technology and Rehabilitation (multidisciplinary)

University of Bristol

School of Social and Community Medicine
School of Community and Applied Health Studies

University of Exeter

College of Engineering, Maths and Physical Sciences

e-health informatics

Translational medicine, personalised healthcare and public health
Peninsula Ageing Research Collaboration

Plymouth University

Centre for Health and Social Care Innovation (CHeSCI)

Ageing and Rurality
Applied Health Genetics
Clinical Skills Innovation
Dietetics and Health
Drug and Alcohol Use (Drug and Alcohol Research Unit DARU)
Social Science and Health
Sustainability, Society and Health

University of the West of England, Bristol

Centre for Clinical and Health Services Research

Long term conditions and critical care
Public health and wellbeing
Health, ethics and society


9 Regional Opportunities for Assisted Living

The South West has a higher percentage of over 65s than the national average - an important driver for the healthcare sector, in particular, for AL. Like the rest of the UK, the market is being driven by the need for healthcare improvements and efficiency - needs that AL can deliver against.

Two other important factors that mitigate for the adoption of AL in the South West are the poor transport links and the Government's commitment to the installation of broadband Internet coverage. Poor transport affects care providers and those requiring care equally and AL can provide a service both routinely and in when the circumstances are more serious. The availability of broadband further reduces the barriers to the installation and use of AL.

The South West does have an excellent example of the use of AL in the Healthy Outlook® service run in conjunction with the Met Office.

It can be assumed that in the South West 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 that have long-term benefits for the individual and the statutory sector alike.

The provision of an assisted living service is complex, requiring several organisations to work together to provide all the components of an end-to-end assisted living service: referral, assessment, equipment provision and installation, response and review. It is clear that in the South West there is not a well-developed AL sector although there is clearly the intellectual capacity to do this. However, the opportunity may lie in the development of AL service delivery companies to take advantage of the favourable infrastructure conditions for both the statutory sector and the private sector rather than the further development of devices.

10 Bibliography

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[12] Ofcom, The Communications Market 2011, 4 August 2011,‌a=0.

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[14] Ofcom, The Communications Market 2011, 4 August 2011,‌a=0

[15] ONS, Internet Access - Households and Individuals 2011, 31 August 2011,

[16] ONS, Internet Access - Households and Individuals 2011, 31 August 2011,

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