This case study provides an overview of the assisted living sector in the West Midlands and is part of a wider UK Capability Map commissioned under the KT4i Project. The case study looks at the Demographics, Health Profile, Provision of Care and the Industrial and Research base within the West Midlands. The mapping exercise is intended to illustrate areas for potential investment, either in service or product development.
2.0 Regional Overview
The map illustrated in Figure 1 shows the 6 sub regions covering 30 Council areas.
- Shropshire: Shropshire Council and Telford and Wrekin Borough Council
- Staffordshire: Cannock Chase District Council, East Staffordshire Borough Council, Lichfield District Council, Newcastle under Lyme Borough Council, South Staffordshire Council, Stafford Borough Council, Staffordshire Moorlands District Council, Stoke on Trent City Council and Tamworth Borough Council
- Warwickshire: North Warwickshire Borough Council, Nuneaton and Bedworth Borough Council, Rugby Borough Council, Stratford on Avon District Council and Warwick District Council
- West Midlands: Birmingham City Council, Coventry City Council, Dudley Metropolitan Borough Council, Sandwell Metropolitan Borough Council, Solihull Metropolitan Borough Council, Walsall Metropolitan Borough Council and Wolverhampton City Council
- Worcestershire: Bromsgrove District Council, Malvern Hills District Council, Redditch Borough Council, Worcester City Council, Wychavon District Council and Wyre Forest District Council
- Herefordshire: Herefordshire County Council
Figure 1: West Midlands Region Map
The West Midlands region covers 5,020 square miles and represents approximately 5% of the landmass of the UK. The region contains Birmingham (1,036,878) the second largest city in the UK. The wider West Midlands conurbation includes the city of Wolverhampton (239,354), the towns of Dudley (307,362), Solihull (206,091), Walsall (256,898) and the city of Coventry (315,739).
The following section describes the demographics of the West Midlands region including the population density, urban and rural population characteristics, population age, life expectancy and population projections.
Figure 2 below ranks the West Midlands 5th in relation to population size across the other UK regions.
Figure 2: UK Population by Region 2010
Figure 3 below illustrates the population of the West Midlands by Female / Male age ranges. The chart shows the greatest proportion of the population sits in the 40 - 59 age range. This is a characteristic similar to the North West, North East and East Midlands.
Figure 3: Population by Age Range
2.1.2 Urban and Rural Population and Population Density
The West Midlands region has a population of 5,455,179 people representing 8.7% of the total population of the UK. The rural counties of the region are most sparsely populated with Herefordshire having a density of 213 people per square mile. This is closely followed by Shropshire at 218 people per square mile. The highest density areas include the major urban conurbations of the West Midlands metropolitan area at 7,630 people per square mile and Stoke-on-Trent at 6,669 people per square mile.
Approximately 84% of the population live in urban areas of over 10,000 people including Birmingham, Coventry, Dudley, Sandwell and Stoke-on-Trent. The remaining 16% live in rural areas representing 3,538 square miles or 66% of the total landmass for the region.
2.1.3 Population Over 65 Years
Figures 4 and 5 illustrate the distribution of the 65+ population over the West Midlands region.
Figure 4: Population by Region
Figure 5: Age Profile Map
The map shows the rural county of Herefordshire as having the highest over 65 population at 21% of the total county population. At local authority level, South Shropshire has the largest 65+ population at 25%.
The West Midlands metropolitan county has the lowest 65+ population at 15% this incorporates Birmingham with a 65+ population of just 13%. The figures suggest an aging population in the rural counties of the region which will place increasing challenges on health and social care providers to meet the demands of an older, geographically dispersed population.
2.1.4 Life Expectancy
The average life expectancy at birth for Females in the West Midlands region is 81.9 years and 77.4 years for Males. Herefordshire has the highest life expectancy for both Females (83.3) and Males (79.1) years. Sandwell has the lowest life expectancy for both Females (80.7) and Males (74.9) years. This is significantly lower than the UK average which is 82.0 years for Females and 77.7 years for Males.
2.1.5 Population Projections
The overall population is projected to grow by 12% (658,300) by 2030. Figure 6 illustrates the projected population for the 65+ age group. The chart suggests that the greatest growth in the 65+ population will be in Females post 2020 with a rapid increase in the over 75 age group.
Figure 7 illustrates the population growth of the 65+ age group over 5 year intervals from 2010 to 2030. Figure 6 illustrates how the West Midlands compares with other areas of the UK between 2008 and 2033.
Figure 6: Population Projections (000’s) of Older People in West Midlands bySsex (2010 to 2030)
Figure 7: Estimated and Projected % of the Population Aged 65 and Over by Region
2.1.6 Old Age Support Ratio
The old age support ratio compares the number of people of working age (20-64) against the retired population (65+) of a given area. Areas with a lower ratio of working age people indicates fewer people able to support the over 65 population.
Figure 8: Old Age Support Ratios
Figure 8 illustrates Herefordshire as the county with the lowest ratio of working age people against the retired population (65+).
2.1.7 Internet Usage
The following diagrams illustrate the internet usage of the over 55 age group. The diagrams are based on data collected by the Office for National Statistics and provide a general over view of usage across Great Britain.
Figure 9: Internet Purchases 2008 to 2011 by Age Group 2008 - 2011
Figure 10: Internet Purchases by Type 2008 to 2011 (Adults Aged 55+)
Figure 9 shows a gradual year on year growth of internet purchases made by people aged over 55. The largest growth is in the 55-64 and 65+ age groups.
Figure 10 illustrates the types of products and services being bought by this age group. The highest percentages of purchases related to travel arrangements (68%), books, magazines, newspapers (66%) and clothes, sports goods (63%). This indicates the 55+ age group are using the internet primarily to make leisure purchases rather than buying essential goods and services. The diagram indicates E-Learning (5%) at the lowest percentage; again this may be indicating that this age group is using the internet for leisure and entertainment purposes.
Figure 11 illustrates the uptake of mobile internet connections by age group between 2009 and 2011. The chart shows a steady increase in connections by the 55+ age group; however this is insignificant in comparison with the 16 – 34 age groups. The lower uptake may be due to fewer people in the 55+ age group using mobile devices for work based activities. The usability of mobile devices can also be prohibitive as age related physical (dexterity) and sensory (sight and hearing) degeneration can make using such devices difficult.
Figure 11: Mobile Phone Internet Connections by Age Group 2009 to 2011
3.0 Regional Economy
The following section describes some of the key facts of the West Midlands economy. The section focuses on the assisted living industry base and regional economic structure.
3.1 Economic Overview
West Midlands has a GVA of approximately £16,788 per head. London has the highest GVA at £34,200 followed by the South East at £20,923. The lowest level of GVA can be found in the North East at £15,621 followed by Northern Ireland at £15,795. In the 1960’s the region was one of the most prosperous in the country, experiencing rapid growth in population, output and employment. However, economic restructuring, market liberalisation and increasing globalisation have had a negative effect on the regional economy.
Manufacturing was and still is the mainstay of the West Midlands economy and the region is experiencing growth in areas like medical technology, aerospace and automotive manufacturing.
3.2 Suppliers of Products and Services
Figure 12 illustrates private companies selling products and services into the Assisted Living market. The chart includes companies whose primary area of business is manufacturing and / or selling the following products and services:
- Telecare: Telecare products and services only, includes devices and managed services
- Telehealth: Telehealth products and services only, includes devices and managed services
- Telecare & Telehealth: Combined Telecare & Telehealth products and services, includes devices and managed services
- Environmental Control: Home Automation and Environmental Control solutions
- Communication Aids: Including Video Conferencing solutions and products and services for people with Dementia, Learning Disabilities and Sensory loss
- Care Technology: Devices and services to support care workers delivering assisted living services in the community
Statutory Telecare and Telehealth providers are excluded from these figures unless they provide a privately managed service option.
Figure 12: Type and Number of Companies by Region
The West Midlands is the UK’s largest manufacturer of aids for daily living with 81 companies manufacturing products ranging from specialist bathrooms, kitchens, bathing aids, wheelchairs and stair lifts. The region has also seen the growth in the number of high-tech companies developing products for the Telecare and Telehealth markets. It has particular strength in the environmental control sector with companies like JSJS Designs launching low cost radio controlled environmental control devices into the consumer market place. Telehealth has also been a growth area with companies like Safe Patient Systems developing and launching mobile phone based Telehealth solutions into the NHS nationally.
The chart suggests that these companies tend to locate in the English regions of the South East, North West and Midlands regions. This may be due to a number of factors including access to technical knowhow and skills and the availability of academic institutions supporting research and development.
More information on UK companies can be found by accessing the KT4i Assisted Living Directory see https://connect.innovateuk.org/web/assisted-living-innovation-platform-alip/assisted-living-directory
3.3 Regional Economic Infrastructure
In 2010, the UK Government developed a National Infrastructure Strategy  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, revised to include more regional detail in 2011 and updated in 2012 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, Figure 13 shows the interrelationships and interdependencies between the care network and the regional economic infrastructure. For example, a poor transport infrastructure can offer opportunities for AL services, whereas a poor digital communications network would be a constraint.
All the elements within this infrastructure depend on utilising the Intellectual Capital within a region, and it in turn depends on these networks to facilitate the take-up of science and technology innovations. The 2011 Infrastructure Plan recognised the importance of good transport and digital communication links in facilitating the development of innovation hubs, science parks and clusters, which will all benefit from investment in world class research facilities. Co-location of these innovation clusters with universities will also foster knowledge transfer and expertise exchange.
Figure 13: Regional Infrastructure Interrelationships and Interdependencies
Access to health care provision can depend upon the ease with which people can move around the region. If roads are congested, people may find it difficult to reach care services, and once there, they may find parking is either not available, full, or presents a costly challenge. Remote delivery of care via AL services, could be a potential solution to transport and travel issues.
The Communications Infrastructure 2012 update reports the following progress on infrastructure delivery programmes and Autumn Statement 2012 capital announcements relevant to the West Midlands region:
• Starting soon: Darlaston Access Improvement Scheme to enhance road access to the area – 2013
• Starting soon: Worcester Integrated Transport Project – 2013
• Under construction: M6 J5-8 expected to complete in 2014
• Under construction: Midland Metro Birmingham Extension – expected to complete in 2015
• New funding announced: M6 J10A to 13 accelerated delivery pilot (part of £95 million scheme)
• New funding announced: M40 J12 works (£10 million)
3.3.2 Digital Communications
Ofcom, the independent regulator and competition authority for the UK communications industries has reported that during the last 10 years, the UK's communications market has been totally transformed. Digital technology has developed extremely quickly, and has changed the way that communications services work for consumers. It has also had a major impact on businesses and networks. For AL to take advantage of these rapid developments, a region must have an adequate digital communications infrastructure. Ofcom is now tasked with reporting on broadband take-up, speeds and availability, using data provided by communications providers.
The connectivity of a region has a direct impact upon the implementation and take-up of AL products and services. The UK Government aims to have the best superfast broadband network in Europe by 2015 by providing all homes and businesses in the UK with access to at least 2Mbit/s broadband and that superfast broadband should be available to 90 per cent of people in each local authority area. There will be a particular focus on making sure that people in remote, as well as urban areas, get good online access.
The most recent information on broadband in the UK has been compiled by Ofcom. The Digital Economy Act 2010 requires Ofcom to report on the state of the UK's communications infrastructure every three years. The Communications Infrastructure 2012 report has been published and highlights the availability and take-up of superfast broadband, the increasing use of mobile Internet services and the completion of the digital TV switchover. The report also provides regional information useful not only for local authorities developing broadband plans, but also for businesses wanting to develop and deliver services – see Figures 14, 15 and 16.
In addition to its UK Communications Infrastructure Report, Ofcom has produced the UK's first interactive map showing accurate information on broadband take-up, speeds and availability, using data provided by communications providers.
Figure 14 shows the availability of broadband across the region based on:
• the percentage of homes with broadband currently not achieving 2Mbit/s speeds
• the percentage of addresses which are within the coverage area of superfast (over 24Mbit/s) broadband networks
• the percentage take-up of superfast broadband
• the total take-up (including superfast broadband)
Figure 14: Broadband availability and take-up by Local Authority (Source Ofcom)
Ofcom has also collected data on the average maximum speeds of existing broadband connections, although notes that speeds achieved in the home will be slower. Figure 15 shows the Average modem speed (Mbit/s) by Local Authority.
Figure 15: Average modem speed (Mbit/s) by Local Authority (Source Ofcom)
Ofcom has ranked each area on a scale of 1 to 5, with 1 the highest or fastest, and 5 the lowest or slowest on how they score on four broadband metrics to provide an overall view of broadband in each region:
• Average modem sync speed (Mbit/s): The average maximum speeds of existing broadband connections. Speeds achieved in the home will be slower.
• Percentage receiving less than 2Mbit/s: The percentage of homes with broadband currently not achieving 2Mbit/s speeds.
• Superfast availability: The percentage of addresses, which are within the coverage area of superfast (over 24Mbit/s) broadband networks.
• Average take-up: The number of existing broadband connections as a proportion of premises, excluding superfast broadband connections.
Figure 16 shows the ranking (1 = highest /fastest, 5 = lowest/slowest) within the West Midlands region by local authority. The majority of local authorities within the region have good broadband performance with a ranking of 1 or 2. Shropshire and the County of Herefordshire have the poorest overall performance with a ranking of 4 and 5 respectively.
The Communications Infrastructure 2012 update reports 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.' Herefordshire is one of these rural areas that is through procurement and into delivery. Coventry is one of the first ten 'super-connected' cities that has been successful in its bid for funding to deliver ultrafast broadband and public wireless connectivity.
Figure 16: Overall Broadband Quality by Local Authority (Source Ofcom)
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.'
According to the Government's National Infrastructure Plan, 2011 'widespread use of smart meters can be accommodated within the current digital communication network infrastructure, but potential future developments of smart energy grids might require further innovation and investment in communications infrastructure.'
1 Intellectual Capital
Intellectual capital is vital for attracting inward investment, stimulating innovation and allowing the UK and its regions to be competitive in the global knowledge economy. In its Infrastructure Plan 2010, the Government recognised the important role that Intellectual Capital plays in the UK's economic infrastructure and is committed to providing funding to develop the UK's Intellectual Capital, for example:
• enabling investment in science, research and innovation through provision of research facilities and equipment in universities.
• supporting (including by way of capital investment) the work of the Research Councils and investing in innovative technologies in and for infrastructure.
• supporting the Technology Strategy Board to incentivise business led technology innovation;
• establishing a network of Technology and Innovation Centres.
See Section 6.1.1 for information about regional Centres of Expertise and Innovation.
4 Health and Social Care
The new health and care system for England became 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(25).
Nationally, NHS England commissions specialised services, primary care, offender healthcare and some services for the armed forces(28). 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(26). 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 (27). 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) (30) 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 (29). 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 will provide a powerful voice for patients and local communities.
The following section describes the health and social care landscape of the West Midlands region. The section looks at the health of the population and the levels of provision available from statutory and private providers.
4.1 Health Overview by Long Term Conditions
Figure 17 illustrates the percentage of people suffering from the following long term conditions, Diabetes, Coronary Heart Disease, Heart Failure, COPD, Hypertension, Epilepsy, Dementia and Stroke. The figures are based on data published by NHS Information Centre.
Figure 17: Long Term Conditions Profile for the West Midlands Region
The incidence of LTC’s based on the NHS Information Centre data suggests that 30% of the total population suffer from an LTC. Hypertension represents the single highest condition at 830,920 both Diabetes (290,526) and Coronary Heart Disease (203,026) come in a close second and third.
5 Existing Care Provision
The following section outlines the existing care provision in the West Midlands and looks at the levels of support to enable older and disabled people to live at home. The section also examines the availability of residential care and NHS beds by county area. This information provides insight into where there may be lower levels of provision.
5.1 Elderly Living at Home
A total of 1093 households within the region are receiving intensive home care services to support elderly (65+) residents. 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. This is less than half of the level of provision in comparison with London where the number is much higher at 2518 households. Figure 18 shows the number of households receiving intensive home care across England.
For figures covering Scotland, Northern Ireland and Wales please refer to the separate reports. Figure 19 shows the proportion of elderly households receiving intensive home care as a percentage of the total number of elderly households receiving intensive home care.
Figure 18: Households Receiving Intensive Home Care Aged 65+
Figure 19: Households Receiving Intensive Home Care Aged 65+
5.2 Residential and Domiciliary Care
The West Midlands has a total of 1402 registered Care Homes, 446 Nursing Homes and 776 Domiciliary Care Providers. Figure 20 illustrates the number of care providers and available residential beds for the region. Figure 21 shows the population over 65 for each county set against available Care and Nursing Home beds and the percentage over 65 receiving Domiciliary Care.
Figure 20: Care Homes and Domiciliary Care Agencies in the West Midlands
Figure 21: Population Over 65 Compared to Care Home Beds
Figure 21 illustrates the percentage of Care and Nursing home beds available and percentage of people receiving domiciliary home care by county. This is set against the percentage population over 65.
Figure 21 suggests that care provision doesn’t necessarily follow the general population needs. For example Hereford has the highest percentage of over 65’s but has the lowest provision of domiciliary care. The West Midlands metropolitan area has one of the highest provision rates for domiciliary care but a relatively low 65+ population. Care and Nursing Home bed provision appears to be fairly level across the counties irrespective of the percentage over 65.
Figure 22 illustrates the percentage of the population over 65 compared with NHS bed provision across the regions PCT’s and Acute Trusts. The diagram describes the number of acute beds including Intensive Care, Palliative Care, General Acute and Elderly Acute. The diagram also shows residential beds including Elderly and Learning Disability short and long stay beds. Many of these residential beds are within mental health wards. These bed types have a direct relationship to users of assisted living technology. The chart illustrates that there are slightly more acute beds available in comparison with residential beds with the exception of Herefordshire where provision is almost equal. The highest levels of acute provision can be found in the West Midlands conurbation area, this area also has the lowest percentage of people aged over 65. Both figures 21 and 22 suggest the lowest provision of both care and NHS services in comparison with the percentage of people over 65 is Worcestershire.
Figure 22: Population Over 65 Compared to NHS Bed Provision
6.0 Current Assisted Living Activity
The following section details some of the key assisted living activity in the West Midlands ranging from research activity, projects and centres of excellence.
6.1 Regional Projects in Health and Social Care
In Worcestershire the county council and local health bodies are working together to develop a joint telehealth / telecare service for the people of the county. The Assistive Technology Project involves the main players in the local health and social care economy, namely Worcestershire County Council, Worcestershire Health and Care Trust, Worcestershire Health and Care Trust, Worcestershire Acute Hospitals Trust, and three clinical commissioning groups (Wyre Forest, Redditch and Bromsgrove and South Worcestershire). It is the intention that there will be no quarrel about whether equipment is funded from health or social care, if an assessment is needed, it will be provided. The organisation is cautious about the potential gains, but has set a target of £1.5m in savings over the next five years. Initial plans are to involve 2,000 service users, but this will scale up to 20,000 reasonably quickly, with the potential for a further 10,000 at a later stage.
A trial funded by the Queen Elizabeth Hospital Birmingham (QEHB) Charity called myhealth@QEHB is a leading edge patient record portal developed by the in-house Technical Development and Informatics Team at University Hospitals Birmingham NHS Foundation Trust (UHB). UHB initially ran a trial with a number of liver patients, the system is now being phased in through 11 other specialties. Myhealth@QEHB allows patients in long term care to remotely access much of their clinical information held at the hospital, including their letters and laboratory results. Patients can submit information direct to their consultant, allowing their consultant to instantly see the updates and respond where necessary. Patients can store and share files pertaining to their health on the system, view and add their own appointments at and away from the hospital, as well as receive reminders, and much more. myhealth@QEHB is the UK's first patient-focused social network. Patients can interact with each other within the portal and create their own support networks of fellow patients who they wish to contact for help, advice or friendship. Patients can converse with each other, start journals about their health, publish information to their support network, view other patient's news feeds, and more. Myhealth@QEHB is simple, flexible, modern and empowering.
NHS patients across the West Midlands will benefit from a new multi-million pound research project to support faster and more effective roll-out of key treatments and services. A £10m investment announced by the NIHR will be complemented by £20.6m match-funding from local health and social services to continue evaluating and developing healthcare over the next five years. The funding has been awarded to the CLAHR for West Midlands (CLAHRC-WM), an innovative partnership between local health services, universities and local authorities. Its research will focus on four crucial areas of health: 1) Health for Mothers and Children; 2) Mental Health; 3) Care for Long Term Conditions; 4) the Prevention of Disease. Also involved in the partnership are a number of other NHS trusts, local authorities and Clinical Commissioning Groups. They will also help to evaluate and develop services in collaboration with the WM Academic Health Science Network. In five years time the outcomes should be better health, a better prospect of staying healthy, and a service in which every pound of the public's contribution goes on services that use the best evidence of what works.
Walsall is currently trialling a dementia screen tool using an iPad in 8 GP surgeries and 3 in the hospital. The tool has multiple languages built in, takes only ten minutes to complete and screens for depression also. Walsall has just commenced a pilot with the Alzheimer's Society which will see one of its Dementia Support Workers using this tool on behalf of some GPs as this may reduce the stigma for some patients.
In April 2013 a pilot scheme was launched with the aim of improving the quality of life for hundreds of older Worcestershire residents. The Falls Response Service will help elderly residents who have fallen in their homes and is set to cut the number of non-emergency calls to ambulances. The 24 hour service will reach about 12,000 people throughout the county during the pilot period. It will be operated by the Community Housing Group with Festival Housing, Rooftop and Worcester Community Housing. The aim is to reduce the number of inappropriate hospital admissions and enable residents to maintain their independence at home for as long as possible.
Birmingham City Council has celebrated the first anniversary of its joint citywide telecare service, which has to date benefitted 7,000 people across the city. The Birmingham Telecare Service, which aims to support 27,000 people by 2015, enables residents with a wide range of needs to remain living independently in their own homes. The success of a telecare service in Birmingham has led to plans to invest in telehealth technologies in the near future.
6.1.1 Regional Universities and Centres of Excellence
Birmingham and Black Country Collaboration CLAHRC is a partnership led by University Hospital Birmingham NHS Foundation Trust and the University of Birmingham. CLAHRC stands for Collaborations for Leadership in Applied Health Research and Care. The Birmingham and Black Country Collaboration has been awarded £10 million from the National Institute for Health Research (NIHR). The NIHR is the research and development arm of the Department of Health. The programme is part of a national initiative and is split into 9 themes looking at research into Paediatrics, Mental Health, Maternity and Diabetes care. Theme 4, Housing and Health has a specific focus on assisted living and the importance of safe, appropriate housing. The research looks at housing quality, tenancy demographics and the impact of Telecare and Telehealth initiatives. See http://www.clahrc-bbc.nihr.ac.uk for more information.
Coventry University Health Design Technology Institute (HDTI) was designed to build on the University's excellence in the teaching of design and healthcare and the track record of knowledge transfer to SMEs in the region and beyond. Activity is concentrated on the design and validation of assistive technology products and services required for healthcare provision in the community, and self-management of health and wellbeing for people living with long term conditions. The University has a strong reputation in the field of user involvement in research and evaluation. For example, the University is an acknowledged national leader in the delivery and academic evaluations of self management programmes for people with long term conditions, such as the Expert Patient Programme.
Also, the University is leading a research project on evaluation of user views of patient held medical records. HDTI is leading CO-MODAL a consortium project funded through the Technology Strategy Board's Assisted Living Innovation Platform. The project aims to support the development of a consumer market for assisted living technologies with a focus on people who are approaching retirement and older age. The project aims to gain an in depth understanding of the barriers to market development and create a consumer-led business model through collaboration with industry, the third sector and end users. See http://www.coventry.ac.uk/hdti for more information.
The Institute of Digital Healthcare launched in 2010 was set up to tackle a number of healthcare issues, including the use of monitoring and communication devices to support people in their own homes, and improving the communication within and between health and social care teams. The institute is a collaboration between Warwick University and NHS West Midlands. The aim of the institute is to improve health and wellbeing through the use of innovative technologies. For more information please see https://digital.warwick.ac.uk
6.1.2 Support Organisations
Medilink West Midlands is part of Medilink UK a national health technology business support organisation, working across all sectors of the life sciences sector.
Medilink UK helps companies take new concepts through to commercialisation and supports collaborations between academics, clinicians and industry. Medilink UK is made up from the following organisations MediWales, BioBusiness Northern Ireland, Medilink North West, Medilink West Midlands, Medilink Yorkshire & Humber, Medilink East Midlands and the South East Health Technology Alliance. For more information please see http://www.medilinkuk.com
Medilink West Midlands has been at the forefront of developing the assisted living sector in the region. Through the Advantage West Midlands i-Health programme MedilinkWM was able to support over 800 small to medium sized companies in the assisted living sector. The support included developing the i-House, an innovative technology demonstrator used to showcase assisted living products to health, social care, industry and users. In addition MedilinkWM brought together the i-Deal consortium a Technology Strategy Board Assisted Living Innovation Platform funded project. The partners were brought together by a common goal to develop a framework to involve users in the design process. i-Deal focused on the evaluation of electronic assistive technologies to support industry partners in the design and development of “fit for purpose” products. The project supported the development of 6 new Telehealth and Telecare products which were designed and tested with close end user consultation.
7.0 Summary: Regional Opportunities for Assisted Living
The ageing population will be the key driver for the development of the assisted living sector in the West Midlands. The region has an ageing population profile typical of the UK average. The regions 65+ population is projected to grow by 58% by 2030 with the steepest growth in the Female population post 2020. The health profile indicates that 30% of the total population currently suffer from one or more long term conditions (LTC’s) with 51% of those registered suffering from Hypertension. Hypertension increases the risk of stroke, heart attack, heart failure, aortic aneurysm and is a major cause of chronic kidney disease. Therefore closer management of patients is required to reduce the risk of further health complications.
The prevalence of LTC’s will grow in line with the ageing population and put increasing pressure on services. Provision of Care and Nursing Home beds is constant across the region irrespective of the population percentage over 65. The same applies to NHS bed provision. The largest gaps in provision appear to be in Herefordshire and Worcestershire, two of the region’s largest rural areas.
The West Midlands, like the rest of the UK is in the grip of major reforms within health and social care. These reforms have been put in place to reduce the costs of health and social care in order to meet the demands of the aging population. The changes are creating a climate for private providers to enter the sector and deliver services on behalf of Social Care and the NHS through “Any Willing Provider” contracts. Section 6.0 of this report illustrates some of the development work the region has been undertaking in Telecare and Telehealth. Despite the strong evidence produced by these initiatives the move to mainstream Telecare and Telehealth to all who require them has been slow. This is in part due to the need for organisational change to enable these initiatives to embed within services and operate at scale. However the current redesign of health and social care provides an ideal opportunity to put in place the required organisational changes.
At the time of writing 2 major initiatives are looking to support and underpin the mainstreaming of Telecare and Telehealth.
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 (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.
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 (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: http://connect.innovateuk.org/web/dallas
TECS Technology Enabled Care Services (3 Million Lives)
NHS England Integrated Care for 3millionlives :
(Delivering Improved Heath and Wellbeing through Technology Enabled Care Services (TECS))
Launched in December 2011 3millionlives is underpinned by the idea of service integration to improve patient care and outcomes. When different services and sectors work together, towards shared goals, patients get far more flexible, better, and more appropriate care. To achieve true service integration, NHS England recognise that 3millionlives needs to be delivered through a genuine partnership across NHS England facilitating collaboration between clinicians, and empowering patients to better self manage their conditions, with the use of technology. They also recognise this cannot be achieved through technology alone the key will be to deliver service transformation through realising the potential of that technology to support clinicians, patients and carers.
It is known that there is a growing elderly population, a growing number of people with Long Term Conditions (LTCs), and growing numbers of people with multiple LTCs. This is putting an increasing strain on already stretched NHS resources. One in three people are living with at least one chronic condition, such as asthma, heart and lung disease, arthritis, hypertension and diabetes and half of people over the age of 60 have one. One in three of the population in England amounts to just over 15 million people with an LTC and its estimated that by 2025 this will rise to 18 million. People with LTCs are the biggest users of the NHS, accounting for around 50 per cent of GP appointments, 64 per cent of inpatient appointments and 70 per cent of inpatient hospital beds meaning 30 per cent of the population accounts for 70 per cent of the spend. If care is continue to be managed in the same way as it is now then NHS can expect to see an estimated of additional cost in five years. In the new NHS and social care landscape, we need to find new approaches and service delivery models that will deliver more efficient and effective care. There is a need for better health outcomes and innovations that support people to live more independently, and the NHS know that technology enabled care services can transform peoples lives. The challenge now faced is integrating these technologies into the NHS and wider health and social care services, so they become a mainstream service, not a side-line proposition. And this is where the 3millionlives programme, delivered in the right way, can really make a significant difference
NHS England took action on implementing the delivery programme from April 1st 2013, a rapid review of 3millionlives implementation to date was conducted, as there was a significant risk the programme as previously delivered would not hit the interim ambition of 100,000 new users in 2013. The review resulted in a need for a significant shift in strategic direction for the 3millionlives programme, including a redefined vision, mission and objectives for delivery, and bringing on board strong clinical and technological advocacy and a reframed partnership with Industry.
An early outcome from the review was an agreed change in governance arrangements, so that 3millionlives will be delivered going forward through a matrix approach of clinical advocacy, service improvement and technology strategy making it a true partnership and synergy within NHS England.
There is now tri-partite accountability for the successful delivery of the programme at Director level, with co-ordination for delivery and implementation of the programme residing with the Collaboration for Excellence Team.
Under a redefined vision for the programme, the Collaboration for Excellence Team intend to engage with, work with, and enable the 3millionlives brand to be associated with a much broader range of technology solutions and organisations. Its therefore essential to ensure that industry is working with NHS England as a true strategic partner in the delivery of 3millionlives. NHS England has now convened a much wider 'Integrated Care for 3millionlives Stakeholder Forum', bringing together Industry including all of the original members of the Industry Group commissioners, providers, colleagues from Social Care, the Third sector, and Local Government and housing, to form a collaborative group to collectively debate and resolve key system-wide issues around the delivery and implementation of the programme.
Now all of the different stakeholder groups with an interest in delivery of 3millionlives have been brought together to look at issues collaboratively and The Forum met for the first time in October 2013. The programme will also now look much more widely across the system, to harness where the energy lies locally for delivery of 3millionlives.
The programme is closely aligned with both the integrated care and technology strategy agendas, and has been repositioned as Integrated Care for 3millionlives It will be delivered as a unique collaboration between the NHS, Social Care and Industry to support integrated care, management of Long Term Conditions, and the enablement of 7 day services.
The team established four rapid Task and Finish Groups, one to progress each priority area and the findings and recommendations of these Task and Finish Groups informed the publication of a 3millionlives NHS England Delivery Plan for 2014-17.
Academic Health Science Networks
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. 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.
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
1. Knowledge Transfer for Implementation - KT4i is a knowledge transfer programme underpinning the dissemination of outcomes from the Technology Strategy Board's Assisted Living Innovation Programme. KT4i is managed by the HealthTech and Medicines KTN. For more information please go to www.alip-healthktn.org
2. Office for National Statistics (2010) Population estimates: United Kingdom estimated residential population for constituent countries and regions
3. UK National Statistics (2011) Population Estimates for UK, England and Wales, Scotland and Northern Ireland - Mid-2010 Population Estimates
4. Office for National Statistics (2011) Life expectancy at birth and at age 65 for health areas in the United Kingdom 2007-09
5. Office for National Statistics, (2008) 2008-based sub national population projections by broad age groups for Regions and Local Authorities in England & Office for National Statistics (2011),
6. Office for National Statistics, (2008) 2008-based sub national population projections by broad age groups for Regions and Local Authorities in England
7. Office for National Statistics, (2008) 2008-based sub national population projections by broad age groups for Regions and Local Authorities in England & Office for National Statistics (2011), Principal projection - Wales population in age groups (2010-based) & Office for National Statistics (2011), Principal projection - Scotland population in age groups (2010-based) & Office for National Statistics (2011), Principal projection - Northern Ireland population in age groups (2010-based)
8. UK National Statistics (2011) Population Estimates for UK, England and Wales, Scotland and Northern Ireland - Mid-2010 Population Estimates
9. Office for National Statistics (2011), Internet access, households and individuals
10. Gross Value Added (GVA) is used to measure the economic output per head of population for a given area
11. Office For National Statistics (2010) Regional Trends - Directory of Online Tables
12. Medilink West Midlands source data on UK healthcare companies
13. 13 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
14. HM Treasury, "www.hm-treasury.gov.uk/ppp_national_infrastructure_plan.htm," 2010 1-March
15. HM Treasury, "http://cdn.hm-treasury.gov.uk/national_infrastructure_plan291111.pdf," 2011 1-November
16. HM Treasury, "https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/221553/national_infrastructure_plan_051212.pdf" 2012 5 December
17. HM Treasury,"www.direct.gov.uk/prod_consum_dg/groups/dg_digitalassets/@dg/@en/documents/digit
18. 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
19. Ofcom, The Communications Market 2011, 4 August 2011,http://stakeholders.ofcom.org.uk/market-data-research/market-data/communications-market-reports/cmr11/?a=0
20. Ofcom, "Communications-infrastructure-report 2012 update," 20 December 2012, www.ofcom.org.uk http://stakeholders.ofcom.org.uk/binaries/research/telecoms-research/infrastructure-report/Infrastructure-report2012.pdf
21. Ofcom Broadband Speeds Map, http://maps.ofcom.org.uk/broadband/
22. Ofcom, "Communications-infrastructure-report 2011," 6 July 2011, www.ofcom.org.uk
23. 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
24. HM Treasury, "http://cdn.hm-treasury.gov.uk/national_infrastructure_plan291111.pdf," 2011 1-November, www.hm-treasury.gov.uk
34. The NHS Information Centre (2011) Compendium of Population Health Indicators
35. NHSIC Community Care Statistics (2008), Home Care Services for adults, England 29 March 2009
36. NHSIC Community Care Statistics (2008), Home Care Services for adults, England 26 March 2009
37. Department of Health (2009) Average daily number of available beds by ward classification, NHS organisations in England, 2008-09