Assistive technology
5.44. "Assistive technology" (AT) is
a broad generic term, defined by the Foundation for Assistive
Technology, a body supported by the Department of Health, as covering
"any product or service designed to enable independence for
disabled and older people". Help the Aged suggest that it
covers:
- Mobility aids, e.g. powered wheelchairs, stair
lifts;
- Aids to daily living, e.g. accessible baths,
showers or toilets;
- Environmental control systems, e.g. infra-red
controls to allow the user to operate household equipment such
as radios, TVs, light switches;
- Communication equipment, including accessible
telephone equipment or videophones used for telemedicine;
- Security devices, e.g. community alarms to warn
carers or other care services if anything is untoward;
- Smart Homes providing electronic or computer-controlled
integration of assistive devices within the home;
- Beyond this, a range of more basic yet vital
technologies aimed at assisting people to undertake activities
of daily living. These include such aids as "jam-jar openers"
and "stocking aids".
5.45. In our Call for Evidence, published in
Appendix 3, we specifically asked for evidence on "the application
of research in technology and design to improve the quality of
life of older people, including technologies which could be used
to a greater extent to benefit older people, and the development
of new technologies". We are grateful for all the written
and oral evidence we received. Plainly this is an area with immense
potential for development. Sadly, our overall impression is that
this potential is far from being realised.
5.46. We find it hard to understand the reasons
for this. The problem is not new, although it is of course growing
with the expanding older population. The incentive is not new:
it has always been the case that people would prefer to live in
their homes for as long as they safely and comfortably can. The
advantages to the State are obvious: research has shown that in
the United States health care costs of those with extensive AT
are approximately half of those with minimal AT.[108]
There is nothing remarkable about the science involved, since
these are overwhelmingly applications of existing technologies
to new uses. We are driven to the conclusion that this is yet
another manifestation of the problem we look at more fully in
the next chapter—the reluctance of industry to address a
market which is ready to embrace any offer of good products at
reasonable prices.
5.47. One reason for this failure of industry
is "a notable absence of the meaningful involvement of older
people themselves in research, particularly in technology".[109]
As with IT, much AT is designed by the young with insufficient
understanding of the old. "The whole of assistive technology
suffers greatly from a lot of technology push and insufficient
user pull." (Q 241).[110]
During our visit to the University of York we saw much interesting
research, but it emerged during discussion that there had as yet
been little direct engagement with the intended users. We have
gained the clear impression that this is currently the norm rather
than an exception.
5.48. Certainly, mobility aids such as powered
wheelchairs and stair lifts have been available for some time—at
a price. Since we have received no evidence specifically relating
to them, we content ourselves with saying that we believe there
is a large market open to those who can produce imaginative designs
at affordable prices. The same must be true of accessible baths,
showers and toilets. Those we saw appear to be adapted from those
available to able-bodied persons, rather than being designed with
the assistance of those for whom they are intended.
5.49. Professor Anthea Tinker explained to us
what could be done:
"One particular project was about mobility
and we started by asking older people what their needs were ...
and top of the list with all of them when we put them together
was climbing stairs. So then we had engineering students who got
together with the research team and we asked what sort of climbing
aid they would want ... The researchers, the engineers and the
students (because it is important that we were educating students
as well about the needs of older people) went away and designed
a very, very simple stair climbing aid which you could go up and
down stairs with. They re-designed it in wood, took it back to
the group, they tried it, they made their comments, it was then
designed and it is now a prototype and it is being patented, so
here is one success story." (Q 228)
It seems to us that this shows, not just what can
be done, but how it should be done: by consulting the end users
throughout the design process.
5.50. Professor Tinker gave us an example of
how this country lags behind in this field. In the Netherlands
stair lifts are installed on steep winding stairs where no one
in this country would have thought of installing them. Within
a few weeks of their being seen by UK housing associations and
local authorities, one of those authorities had installed thirty
such lifts (Q 250).
5.51. As we have said, the term "assistive
technology" is used to cover almost any product designed
to assist older people. Social alarms seem to us to be products
which raise problems typical of those of this industry. We therefore
focus on these.
5.52. One of the few British companies of any
size which concentrates on the needs of older people is Tunstall
Group Ltd. In their written evidence to us they describe themselves
as "the world leader in Telecare", employing 750 people
(mostly in the UK), 50 of these on research and development, and
exporting 30% of their production. Tunstalls explained to us that
the concept of social alarms had been around for over half a century,
and that there were now 1.5 million people in the UK benefiting
from this type of technology, monitored by 280 call centres operated
by local authorities, housing corporations and some private organisations.
A majority are not yet voice-based, and this puts huge pressure
on the managers of the services. A second generation of alarm,
now being installed, is wireless based (and so does not rely on
users pressing a button). These systems are non-intrusive, they
can differentiate between emergencies and false alarms, and they
cover a wider range of risks (such as inactivity, or escaping
gas). Third generation alarms, still being developed, will be
able to predict problems and so avoid crises. By monitoring such
matters as use of kitchen or bathroom, they can detect changes
in the activities of the individual, and action can be taken at
an early stage, avoiding more intensive and costly interventions.
5.53. The advantages of the third generation
alarms are self-evident. Given that there is nothing revolutionary
about the technology, we cannot understand what has prevented
the development taking place years ago, and why these alarms could
not already be widely in use. The problem seems to be one of scale.
These are not alarms which can be sold singly to interested individuals;
local authorities first have to set up the infrastructure. According
to Tunstalls, national policy has been lacking, departmental responsibility
confusing, and guidance to local authorities and health trusts
uncoordinated. Their answer is that "local authorities and
the NHS should work closely together ... to encourage investment".[111]
5.54. Mr Sadler, the Technical Director of Tunstalls,
thought that older people were naturally distrustful of any advertising
that came through unfamiliar channels; they were more likely to
buy his company's alarms if they were advertised through a local
authority, rather than directly (Q 464). This provides a
further reason for involving local authorities in this development.
5.55. We have not seen any comparison of the
cost of supplying the infrastructure for such alarm systems with
the savings to be made in terms of health and social care, but
the United States research to which we referred in paragraph 5.43.shows
that such savings may be considerable. However we can well believe
that local authorities are reluctant to invest money in such projects
when savings will mainly accrue to the NHS and central government.
We therefore agree with Tunstalls that a national policy is essential,
as is the working together of the Department of Health, the NHS,
local authorities, and ODPM which is responsible for them.
5.56. Dr Stephen Ladyman MP, then a Parliamentary
Under-Secretary of State at the DoH, appeared to concede as much
in oral evidence to us. He said:
"We launched the Green Paper on Adult Social
Care on Monday, yesterday [21 March 2005], and we made big play
of the potential of assistive technology in that … we are
spending £80 million over two years, starting next year,
on helping to create pilots for local authorities to try and deploy
this technology ... there is a real opportunity for deploying
the technology in support of older people and their carers ..."
"We [DoH] are big purchasers, and that is why
we have started down this route of investing taxpayers' money
in assistive technology, because if we left it to individuals
to buy assistive technology and they could not afford to buy it,
the result would therefore be they would have more accidents,
end up in hospital, and the taxpayer would pay even more for them.
So it is far better for us to make investment to prevent people
becoming sick, and that is what we are intending to do. Of course
we have people within the Department of Health who have an expertise
in understanding the market-place and negotiating contracts with
purchasers ... I have got them working on how best we can drive
down the price of technologies …" (QQ 567-596).
5.57. This is welcome news, and we are particularly
glad to see formal recognition of the savings which can be achieved
by expenditure on assistive technology. But we note that the spending
of £80 million does not begin until next year, and that the
Department is only now "starting down this route". Given
that, in addition to the savings to be made, there are enormous
but unquantifiable benefits for those whose accidents can be prevented,
we urge the Department to hasten down this route without further
delay.
5.58. The Department of Health and the Office
of the Deputy Prime Minister should make funds available to local
authorities to set up the infrastructure needed for third generation
social alarms. Local authorities should work closely with industry
and with charities concerned with assistive technology in carrying
this work forward.
5.59. Dr Ladyman told us of a trip organised
in October 2004 to study assistive technology in Japan (QQ 590-597).
The party included representatives of his Department and of DTI.
The Japanese were investing more in health-related technology,
like wrist-straps to monitor blood pressure and heart beat, so
that a medical emergency could be anticipated and the patient
moved to an A&E unit before it occurred. The importance of
this was emphasised by the Royal Society of Edinburgh, who
explained that where an elderly person found it difficult to go
to the doctor or to a hospital, computer technology could be adapted
for home medical care, so that for example a patient could use
a digital thermometer or carry out blood pressure tests, and then
communicate with a doctor who could interpret those measurements.[112]
5.60. The Royal Academy of Engineering also stressed
the importance of early diagnosis in improving the effectiveness
of the treatment of many life threatening conditions. Technology
already exists which allows the monitoring of blood pressure,
ECG, respiration etc using simple to operate devices and software
by individuals carrying out basic monitoring of their own health
in the home. The detection of changes in blood and tissue in the
early stages could often lead to arresting or preventing further
onset of disease, thus removing a significant burden from the
NHS.[113]
5.61. There are obvious dangers in excessive
reliance on remote monitoring. One less obvious risk is the potential
for increased social isolation. When deciding whether to use these
techniques in any individual case, this should be taken into account.
Ease of use and avoidance of the need to travel are not the only
considerations.
5.62. For the slightly more distant future, the
Royal Academy of Engineering mentioned longer lasting artificial
joints and new artificial organs (for example, portable kidney
machines) as examples of new and specialised technologies which
might come from the development in materials and ultra-precision
engineering. Miniaturisation of electronics, wearable electronic
monitors, and biocompatible electronics that can be implanted
will help frail elderly people to be monitored remotely.
5.63. The Department of Health's investment
in assistive technology should be extended to include technologies
and devices that can assist in monitoring health conditions and
detecting early signs of health problems by individuals in the
home.
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