In this article, Paul Burstow, TSA President, discusses the benefits of a preventative approach to healthcare in the face of the COVID-19 pandemic.
COVID-19 has acted as an accelerant for changes in healthcare and an amplifier of trends, both for good and ill. Adoption of person-centred technology enabled care (TEC) is one positive example. More GPs, community nurses, physios, and other healthcare professionals are assessing patients via video call. Personal alarm monitoring is being adopted to speed up hospital discharge and tablets are now a staple in many care homes, reducing lockdown loneliness, and inactivity.
However, there is another development that the COVID-19 pandemic has fast-tracked: the move from reactive to anticipatory healthcare. TEC, the data it gathers and the intelligence it provides, all have a vital part to play in this shift.
A preventative approach to healthcare
Traditionally, health and care services have responded to an event or need for help. The problem with this approach is that both the individual and their informal carer are often at a point of crisis. Not only are interventions, at this late stage, more costly for the NHS, local authorities and care providers, they increase the risk of carer burnout and reduce people’s choice and control.
However, during the last six months there are signs that a shift to a more preventative tack in health and care is underway. Although it is not yet mainstream, there are providers that have redesigned their services, identifying individuals at risk of reaching a health crisis before they get there.
Fuelled by the need for social distancing and the sheer scale and cost of the coronavirus crisis, support has been put in place earlier with the goal of building people’s confidence and skills so they can better manage their own health, in their own homes. This asset-based model taps into family and community networks, it reduces dependency on statutory services, and it cuts the burden on informal (and formal) carers.
Take Torbay and South Devon NHS Foundation Trust. One of their patients, Alice, is in her sixties and has severe asthma and diabetes. In 2019 she spent more than 100 days in hospital. With COVID–19 posing an increased risk to people with breathing difficulties the community matron, specialist respiratory nurse and the heart and lung department at the hospital joined forces to consider how best to help Alice to self-manage her condition.
She was given a bluetooth pulse oximeter and blood glucose monitor, both connected to an Internet of Things (IoT) analytics platform and she was coached on how to use the devices every day and interpret a simple results dashboard – which clinicians can also see. If her readings are not normal or her symptoms are worsening, Alice can video call nurses using a smart home hub connected to her other devices. As an extra precaution, the whole system sends an automatic alert to nurses if the readings indicate a problem.
The impact of Alice using this digital dashboard at home has been dramatic. Between March and June 2020, she was admitted to hospital for just three days, compared to 43 days for the same period last year. Her anxiety levels have dropped, she has reported a sense of control over her condition and a better quality of life. Alice’s face-to-face nurse visits have fallen by 11% and NHS costs have reduced by approximately £13,000 since the technology was introduced, based on the drop in hospital admissions and bed days.
The benefits of assistive technology
Another example of this preventative approach in action is the ARMED project in Cardiff. Prompted by physiotherapists at Cardiff Council predicting that the pandemic may increase falls amongst the older population due to the deconditioning that comes from lockdown inactivity, assistive technology organisation, Telecare Cardiff put preventative measures in place.
Muriel, who is in her eighties, had fallen several times in the last six months. She and 19 other people who were identified as a ‘falls risk’ were given smart watches which monitor their sleep and mobility. ARMED (Advanced Risk Modelling for Early Detection) software uses this data to predict health risks before they become noticeable. If trends are found, then steps are put in place to prevent a fall, such as alerting a GP or community rehab physio. Often individuals are signposted to the council’s strength and balance team who will ask them how and why they fell and put measures in place such as installing a grab rail, fall detector, or making changes to their diet and activity routine.
Although it is too early to evaluate the economic outcomes of the project, Cardiff Council is confident that the anticipatory steps it’s taken will reduce the number of falls, GP calls, and ambulance call outs amongst vulnerable service users. Many people say the watch has ‘given them their life back’ because they feel more confident and reassured and this has encouraged them to be more active which in turn improves sleep. Crucially, the technology engages individuals with their own health and the support that has been ‘wrapped around’ the initiative encourages self-care.
TEC interventions for COVID-19
With a second wave of coronavirus now taking hold and winter just around the corner, anticipatory care models are more important than ever. The question is this: how can we encourage widespread adoption?
- A first step is selecting the proactive TEC interventions that have shown the greatest outcomes and using these to fast-track the specifications and plans that local authorities and the NHS have for health and care service delivery.
- Action is also needed to assure the quality of new service and technology innovations, particularly in the complex, ever-growing digital ecosystem but also in the traditional world of telecare where some infrastructure that still relies on analogue technology will become obsolete by 2025. TSA’s standards arm, TEC Quality which runs the only UKAS-approved industry accreditation scheme, the Quality Standards Framework, is working hard with suppliers and providers to make sure that new services and systems achieve the latest standards. Plans are also afoot to develop guidance for both commissioners and suppliers, helping them to navigate the complex world of TEC commissioning.
- Having the right human resources in place is also key to achieving widespread adoption. Clinical and non-clinical leaders must be well positioned to support roll-out and frontline staff are also crucial to ensuring the success of preventative programmes locally. Assuring these human factors must be a top priority.
As our population lives longer and continues to grow and we battle COVID-19 for the long haul, tackling treatment backlogs and reduced capacity, TEC and the prevention it enables must be at the heart of a reimagined health service and a reformed social care system.
Paul Burstow is a social policy expert and former Minister of State for Care and Support. He is President of TEC Services Association (TSA), the national body for technology enabled care services www.tsa-voice.org.uk.
Download a copy of TSA’s Sector Insight Report 2020 – From Stabilisation to Innovation: The Response and Redesign of TEC Services During Covid-19 https://www.tsa-voice.org.uk/campaigns/download-the-tsa-sector-insight-report-2020.