Chapter 5: Technology and services
285.Technologies and related services have a role in helping people to live healthily and independently in old age. These include assistive technologies, which can compensate for declining ability and help individuals to cope better with their environment,485 and medical technologies, which can improve health and capability. These two objectives can overlap: improved health can allow greater independence; and independent living can contribute to better health.
Independent living
286.Remaining in one’s own home and community (referred to as ‘ageing in place’) is important to many older people, and can contribute to an improved sense of health and wellbeing. The Centre for Ageing Better explained that independent living can be facilitated by “supportive products, services and environments that maintain people’s functional ability so that they can continue to take part as active and productive members of society, even when their health limits their intrinsic capacity”.486 However, we heard it will be important to ensure that increased “independence does not result in loneliness and an absence of support.”487
Housing and the built environment
287.A basic requirement of independent living is the ability to move around the home and undertake the tasks of daily life. However, we heard that many homes are poorly suited to life in old age. According to the Centre for Ageing Better, the UK’s housing stock is “among the oldest in Europe, with some of the highest associated health and care costs and is not suitable for us as we get older.”488 They told us that “just 7% of housing in England meets basic accessibility standards.”489
288.The Government aims to increase the availability of accessible housing. The requirements for housing accessibility are set out in Part M of the Building Regulations490 and the Ministry of Housing, Communities and Local Government provides guidance for councils preparing planning policies on housing for older and disabled people.491 The ‘Home of 2030’ project, a cross-departmental initiative funded by the Government, is seeking house designs that meet a range of criteria, including being “able to respond to different and changing needs as people move through their lives … being well set up for people to be able to care for children and ageing relatives, such as through multi-generational homes that can accommodate changing caring responsibilities.”492
289.Nevertheless, existing homes without suitable features for old-age living will continue to dominate the housing sector—almost all existing homes are expected to remain in use, and new homes are built at a rate of up to 1% of existing stock per year.493 Many existing homes do not have adequate space to move around with walking aids or wheelchairs, and often lack load-bearing beams for the installation of hoists. Rosamond Roughton, Director for Care and Transformation at the Department of Health and Social Care, told us about the £500 million Disabled Facilities Grant that is available to “help people make adaptations to their homes.” She said that adapting a home “leads to people potentially staying about four years longer, on average, independently at home.”494
290.We heard about ensuring that the local built environment is conducive to independent living in old age. Ruthe Isden said that issues with the local built environment include a lack of accessible transport and whether older people feel safe in their local environments.495 Councillor Ian Hudspeth said that local authorities consider how to make communities more conducive to healthy lifestyles that can be adopted for the entire life-course “so that by the time they are thinking about retirement they are active”. He said local authorities seek to provide services that are accessible to residents, for example using libraries “where communities can come together and more services can be co-located.”496
291.The quality of housing and the local environment are associated with socio-economic factors and age. Sarah Weir, Chief Executive of the Design Council, told us: “Less good housing is disproportionately lived in by older people and by people from lower socioeconomic backgrounds”. She added that these groups experience the combination of “poor health, poor diet, lack of fresh air, lack of places to walk safely near your home, and lack of transport.” She was concerned that initiatives aimed at improving housing could disproportionately benefit wealthier people and hence increase health inequalities in old age, saying, “There is a widening gap.”497
292.We recommend that the Government use planning rules to ensure that homes and communities are accessible for people with limited mobility and adaptable as their needs change with age. The Government should ensure that sufficient funds are available—for example through the Disabled Facilities Grant—to facilitate improvements to existing homes. The priority should be areas with poor housing and infrastructure, in order to reduce health inequalities.
Alerts and digital services
293.There is a wide range of available technologies that can be used in the home to aid independent living and to give confidence to older people—and their families—about living alone. This is referred to as technology-enabled care, or telecare. Stuart Butterfield, Chief Executive of Canary Care, told us the predominant technologies used for telecare include pendant alarms, pull cords and fall detectors, which send alerts to family members or service providers in emergencies. He said that there are 1.7 million telecare users in the UK but that “that figure has not moved for 10 years”, even though there are over 4 million potential users.498
294.The technology for many telecare systems is quite basic, but significant change is expected over the next few years. Stuart Butterfield explained that most of the alarm systems use analogue technology (phone lines) to send the alerts.499 The digital telephone switchover in 2025 is therefore causing “panic within the industry” because so many existing telecare systems rely on analogue technology. However, he thought that the switchover presents an opportunity for the industry, which should now “start looking beyond the pendant alarm” to “all the other technologies that are available”.500
295.Witnesses told us about digital telecare technologies that can do more than respond to incidents. Newer systems can monitor some of a person’s activities, in order to detect changes of routine that might give early warning of a potential decline in function and trigger action to avert accidents. Stuart Butterfield referred to Canary Care’s service in which wireless monitoring devices are placed around the home to monitor daily activities of an individual.501 The data can be accessed by formal and informal carers, who can make real-time care decisions. The Agile Ageing Alliance said that a wider range of sensors is being developed and could be available by 2035 or sooner. The monitoring could be done directly (for example, by devices which monitor gait, breathing or speech) or indirectly (for example, by devices which monitor the use of the fridge, or utilities such as water and electricity). They suggested that chatbots could be used to assess mood, language and sense of detachment.502
296.Digital service provision is increasingly important for older people’s housing. The Institute of Health Research and Innovation at the University of the Highlands and Islands told us about the fully digital homes in the FIT House project which “demonstrated that adaptable, technology-enabled housing may play a part in allowing people to live independently within their communities for as long as possible”.503
297.However, this is currently not the reality in many older people’s homes. Stuart Butterfield said that statistics from 2018 suggested that “only 59% of one-person households where the householder is over 65 have broadband.” He observed that this widespread lack of broadband connection will be less of an issue as 5G is introduced, because 5G has “the potential to provide those kinds of service connections to those properties.”504
298.More widespread use of telecare services—particularly modern digital systems with monitoring capabilities—may enable more people to live independently in their homes for longer in old age. The upcoming digital telephone switchover provides impetus for this change and is an opportunity for local authorities to introduce more comprehensive services to facilitate safe and independent living.
Data-driven services, robotics and artificial intelligence
299.Data-driven services and emerging robotic and artificial intelligence (AI) technologies could provide services to help maintain independence for older people.505 The National Physical Laboratory described the potential for data-driven technologies to “transform the way the health and care system works.” They told us that these approaches will “support faster and cheaper research” and will “enable the health and care system to perform comprehensive data analysis with greater confidence in the outcomes”. They argued that “full exploitation of the potential of artificial intelligence and machine learning tools” is “vital for future improvements in healthcare especially in diagnosis, treatment and drug discovery.”506
300.Professor Praminda Caleb-Solly, Professor of Assistive Robotics and Intelligent Health Technologies at the University of the West of England, said there are several types of robotics that could assist with independent living. She described a prototype ‘physical assistance robot’ that “can help you to get out of bed and walk”, saying that it is “much like a walking frame, but it allow[s] the user to avoid obstacles and help[s] with navigation”. She explained that the technology is modular, so different ‘tools’ can be added to it to provide multiple functions.507
301.Other examples given by Professor Caleb-Solly included robotic arms on wheelchairs for people who “cannot use their limbs”, “clinical rehabilitation devices for upper-limb rehab”508 and “robotic feeding devices”.509 She discussed ‘socially assistive robots’ that can gather information to “generate a lot more richness in relation to individual issues”. Giving the example of sleep quality, she explained that a robot might ask how the person was feeling and help them identify possible causes of poor sleep.510
302.The Manchester Institute for Collaborative Research on Ageing told us: “Assistive robots have the potential to support people to live independently for longer, with better health and wellbeing. For example, they can provide support for reminders and monitoring of medication compliance, and to encourage people to engage in physical exercises.” They also noted the potential to “offer a ‘personalised’ approach, as the robot can have a specific model of the user’s needs and medical status and adapt its reminders and exercises to the specific and changing needs of the users”. The Institute added that “Pilot studies on assistive robotics for older people, including people with dementia, have shown that robots can play a role in providing assistive companionship for people in their own homes or care home.” They noted a further use for assistive robots in “telemedicine and for remote access and communication with family members, as well as with health professionals.”511
303.The Centre for Assistive Technology and Connected Healthcare at the University of Sheffield cautioned that “it will take some time before robots will play major roles in healthcare.”512 In particular, the UK has had limited involvement in the field, beyond developing prototypes, whereas assistive robots have been trialled more extensively in the EU and Japan.513 Whilst recognising the UK has had less direct investment in such projects, the Manchester Institute for Collaborative Research on Ageing told us: “Targeted and strategic investment in the design, evaluation and uptake of assistive robot technologies can help develop national expertise and critical mass in this area of expertise”. It said that:
“The effective uptake and sustained acceptability of AI and robotics systems for older people care requires the addressing of two grand challenges in AI and Robotics: (1) Machine Explainability, i.e. to enable AI-empowered robotic systems to interpret and explain their actions to support understanding and collaborative decision-making in assistive robots; (2) Machine Trust, to enable users to understand the robot’s decision making and accept its behaviour and recommendations.”514
304.Data-driven services and emerging robotics and AI systems could provide significant support to older people, to enable them to live independently for longer. The results of ongoing projects in the UK and abroad will help to determine what role robotics can play.
305.We recommend that the Government makes targeted and strategic investments in research for the design, evaluation and uptake of data-driven services, assistive robot technologies and AI for older people, in order to develop national expertise and critical mass in this important area.
Health monitoring and telemedicine
306.Technology can be used to monitor the health of older people from a distance, and to provide or recommend treatments; this is sometimes referred to as ‘telemedicine’. The Centre for Assistive Technology and Connected Healthcare at the University of Sheffield told us that the potential to monitor health conditions is “rapidly increasing as a result of miniaturisation of sensors, smart and energy-efficient data collection technologies, speech and activity recognition, big data analysis and artificial intelligence.”515 Some telemedicine devices can be worn, while others are implanted in the body, in order to gather data and relay them to the individual and a medical professional or other provider.
Wearable and implantable medical devices
307.Miniaturised devices applied to the skin or implanted into the body can allow precise and timely interventions to improve healthcare, whilst reducing the number of medical appointments. For example, people with diabetes can use implanted technology to monitor blood glucose levels and deliver insulin.516 The Centre for Assistive Technology and Connected Healthcare told us that there are “fascinating developments in the field of micro-robotics that may in the future enable very local drug delivery or other treatments (e.g. microsurgery) within the body”, as well as “non-invasive surgical techniques, ‘robotic’ implants, ingestible robots, in-body sensors for monitoring purposes, implanted drug delivery systems (like insulin pumps), and many others.”517
308.The Manchester Institute for Collaborative Research on Ageing referred to barriers to implementing and developing implantable devices—particularly those using nanotechnology and stem cells—saying: “knowledge of the regulatory requirements is essential and therefore appropriate support is required, even at the very start of research ideas.”518 Professor Graham Hart, Dean of the Faculty of Population Health Sciences at University College London, told us that more research and development is needed for devices to deliver drugs that “fit well with people’s lifestyles/circumstances and are safe and easy to troubleshoot.” He explained that when devices don’t work with patients’ or carers’ lifestyles, they have been known to adapt the devices, “sometimes inappropriately”.519
309.The use of wearable and implantable technologies for monitoring health conditions and administering treatments is likely to become increasingly common. Such technologies have potential to provide more precise and timely treatment, and could contribute to better health and greater independence in old age.
Non-medical products
310.‘Non-medical products’ that provide information about some aspect of health—such as fitness trackers and apps—may be able to contribute to healthy ageing. Dr Nyman said that there is “good evidence” that devices such as trackers are motivational and that they can assist with “self-monitoring”.520 Dr Paola Zaninotto, Associate Professor in Medical Statistics at UCL, said that this type of device “has proved to be very valuable” for research purposes, for example when collecting data on physical activity in older people.521
311.However, some witnesses were concerned about the interactions between the domains of medical devices and non-medical devices. Professor Ferdinando Rodriguez y Baena, Professor of Medical Robotics at Imperial College London, said that wearable technology “blurs the line between the mass market for gadgets and the truly useful wearable for diagnostics and therapy.”522 Professor Esther Rodriguez-Villegas, Professor in Low Power Electronics at Imperial College London, explained that the difference in applicability is due to different levels of accuracy: “Wearable technologies for wellness are not regulated [so] manufacturers do not have to commit to providing a level of accuracy—the output is uncertain … Unfortunately, [some people] are trying to use those wearable technologies for quasi-medical applications”.523 In the example of non-medical devices that monitor sleep, Professor Foster was concerned that inaccurate or incomplete data could alarm people, saying: “Their analysis … can actually be very misleading. … It is causing huge anxiety.”524
312.On the other hand, Charles Lowe, Chief Executive of the Digital Health and Care Alliance, was concerned about the strict delineation between medical and non-medical applications, saying that the Medical Devices Regulation “creates a cliff edge”. He thought that this was “a significant constraint on the development of artificial intelligence by SMEs” and contrasted it to the situation in the USA where “the [Food and Drug Administration] has a much more gradual process and it is possible to approach the concept of a medical device gradually.”525
313.Non-medical devices can be a source of useful information for individuals seeking to live more healthily. It will be necessary for the Government to continue to monitor developments in the sector to ensure an appropriate approach to standards.
Reducing social isolation and loneliness
314.Two million people in the UK people aged over 75 live alone526 and could be at risk of loneliness. We heard about the use of technology to reduce social isolation and loneliness by enabling older people to connect with friends and family on social media or communication platforms. Age UK told us that technology can be an effective way to deliver ‘befriending’ services, such as their ‘A Call in Time’ service.527 No Isolation, a Norwegian technology company, described their product ‘KOMP’, a one-button screen and communication system for older people with limited digital skills with which they can stay in touch with their families.528 The Challenge, a UK charity, explained that, as well as directly improving social connections, technology can help indirectly “by providing older people with the tools to stay living independently in their homes for longer, and therefore stay connected to the community in which they live.”529
315.We heard about the effectiveness of communications technology as a means of reducing loneliness and mental health issues. No Isolation told us that “research … shows that when ICT is used to maintain contact with family and friends it can lead to a decline in loneliness, depression and an increase in overall wellbeing. Video-calls have shown to have long-term effects in alleviating both depressive symptoms and loneliness for elderly residents in nursing homes”.530 Age UK told us: “Evidence around the impact of technology on older people’s mental health and loneliness is patchy, but there are promising signs that technological solutions could benefit some older people if appropriately developed, introduced and supported.”531
316.Witnesses cautioned that technologies should not replace face-to-face interactions. The Institute for Public Health in Ireland told us that this is the case for “interactions with healthcare professionals which for some older people can be a very important source of human interaction.”532 The Centre for Research in Public Health and Community Care at the University of Hertfordshire wrote: “If human support has been reduced as a result of receiving technology but the older person stops using the device over time because it is not sufficiently tailored to their need, there may be unintended consequences such as an increase in the person’s isolation.”533
317.The Government published its Loneliness Strategy in 2018. This recognised that “digital technology can provide a powerful way to tackle loneliness”, but it can “exacerbate some people’s experience of loneliness.”534
318.The Government is to be commended for developing its loneliness strategy. Older people need strong social contacts, with the priority being face-to-face interactions. There is also the need for people to develop digital skills to use technologies that can reduce social isolation and loneliness.
Use of data for healthy ageing
319.There is potential to improve healthcare by using data more effectively, including to provide more personalised services. This approach could assist people to age more healthily. Sources of data that could be used include: NHS primary and secondary care settings; consumer mobile health apps; wearables and sensors; implantable biosensors; and point-of-care testing devices.535
320.Combining data from a diverse range of sources poses challenges. Matthew Gould, Chief Executive of NHSX—a unit which sets national policy for NHS technology, digital and data—identified four main barriers to sharing and integrating health and care data: ‘siloisation’ means that “data does not for the most part flow easily between the two sectors”; lack of technical interoperability results in “systems not being able to speak to each other”; ‘semantic interoperability’, which is “people describing things in different ways”; and “concerns around information governance inhibiting the flow of data”.536
321.The NHS can share data with external organisations for use in research, under strict rules to protect patient privacy. Charles Lowe told us about challenges for SMEs in obtaining permission to use NHS data, including costs, procedures for obtaining ethical approval and data interoperability. He noted that costs were supposed to fall, but that this depended on a new data application, which was not currently available for systems used by most GP practices.537
322.Witnesses from academia were concerned that rules on access to NHS data can delay or prevent research. Professor Julian Peto, Professor of Epidemiology at the London School of Hygiene and Tropical Medicine, spoke about what researchers must do to obtain permission to use medical records in clinical trials. He said that, for primary healthcare records, consent must be sought from individual GP practices—which are legally the ‘data controllers’—rather than a central body.538 Dr Zaninotto gave examples of the challenges in using NHS data in epidemiological studies, saying that it took several years to obtain permission to use data as part of the English Longitudinal Study of Ageing cohort study, and that the data could not be shared with other researchers.539
323.Some witnesses referred to difficulties in accessing data from commercial data sources—for example for wearable fitness trackers. Stuart Butterfield told us that, while individual companies store and use these data, there is “no central repository for all that data.”540 Dr Ewa Truchanowicz, Managing Director of Dignio Ltd, said that siloisation and technical interoperability are issues with data gathered by companies, and that “interoperability and common standards would be really useful.”541
324.We heard views about the accuracy and reliability of data collected in non-medical settings or by non-medical devices. Professor Rodriguez-Villegas explained that there are high standards required for medical devices: “With a medical device, we have a regulatory framework. The technology is linked to an intended use and, as manufacturers, we need to guarantee that what we say is correct so that patient safety is not damaged.” In contrast: “Wearable technologies for wellness are not regulated [so] manufacturers do not have to commit to providing a level of accuracy—the output is uncertain.”542 However, Charles Lowe maintained that data from non-medical devices are useful but are not valued by clinicians: “The current view of many clinicians is that much of that information is not reliable and doctors do not have time to analyse it … We have to overcome the issue that just because information is collected in somebody’s home it is not reliable.”543
325.With much healthcare data now held electronically, alongside data generated by non-medical devices, there is a valuable opportunity to develop more sophisticated methods of monitoring and predicting how well people age. There is a need to further reduce technical barriers to data integration across different platforms and administrative barriers to providing anonymised patient data for clinical trials.
Barriers to uptake of technology and services
Design and targeting
326.A significant barrier to uptake of technologies and services which assist healthy and independent living in old age is that they are often designed without input from older people and so might not address the right issues. In the case of technologies such as wearables, Age UK told us: “older people are rarely seen as targets for fitness and health applications, which means that devices are not suitable for them.”544 As well as suitability, devices should be appealing to older people; Sarah Weir said that older people “do not want something grey and boring and that looks as if it is for an old person”.545
327.The Challenge explained that lack of input by older people in the design process may be due to the age profile of those in the technology sector:
“The technology sector is dominated by younger professionals … It would therefore be unsurprising if ageist attitudes existed within the technology workforce, and skewed the kinds of technologies being developed in favour of younger people. Indeed, anecdotal evidence suggests that the technology sector has a culture which tends towards overt disinterest in older age groups.”546
328.Lack of awareness of products and services is a barrier to uptake. Stuart Butterfield said: “people simply do not understand that those [telecare] technologies are available. Typically, people come across them only when their loved one has had an unplanned health event.”547 Similarly, he said that there is a “lack of staff awareness and staff training to be able to use the tools”, such that there are “local authorities that buy systems that sit unused”.548 He commented that “GPs are not really aware of technologies”, and that they “typically do not want to get involved in [responding to alerts]”, but that they could be made aware of the benefits in terms of helping patients who have the most problems and frequent GPs’ appointments.549
329.In order to improve uptake and usefulness of technologies and services that can contribute to healthier and independent living in old age, it is important to base the process of development and deployment around older people’s needs, preferences and abilities. It is beneficial for older people to be involved in the design of these products and services.
Trust and privacy
330.Levels of acceptance and trust can limit uptake. The Agile Ageing Alliance told us that installing technology can be an issue because of nervousness about tradespeople coming into homes.550 For novel technologies such as robotics and AI, the Manchester Institute for Collaborative Research on Ageing wrote that acceptance increased when older people could engage and interact with robots, and that trust improved when AI systems interact and provide explanations for their recommendations.551
331.Privacy was raised as a concern. The British Geriatrics Society and Royal College of Physicians told us that in-home monitoring and assistive devices are a form of surveillance so issues of consent and capacity need to be considered, and applications may need to be made under the Deprivation of Liberty Safeguards.552 The Positive Ageing Research Institute at Anglia Ruskin University explained that older people are often not aware of the ability of companies to collect their data from devices, and that there is little national guidance or policy on the rights and privacy of consumers.553 The Agile Ageing Alliance cautioned that the “interfaces are often poor from a security perspective making them easy to hack, take data from, and own for nefarious purposes.”554
332.Issues of public trust have been at the centre of controversies over recent healthcare data projects—for example care.data555 and DeepMind’s work in the health sector.556 In both cases criticisms centred on not giving enough information to patients, including details on what personal information would be shared and how to opt out of the scheme. Dame Fiona Caldicott, the National Data Guardian, said that the care.data project had caused upset to GPs and patients because it appeared that they would have no control of access to patient data.557 In 2016 the National Data Guardian reviewed patient data security and consent/opt-out options,558 and produced ten data security standards.559 In 2018 the Government launched the Centre for Data Ethics and Innovation, tasked with “connect[ing] policymakers, industry, civil society, and the public to develop the right governance regime for data-driven technologies”.560
333.Public trust in data security is key if data-driven services and new technologies are to be deployed widely and used to their potential. Ongoing public engagement will be necessary to reassure the public on matters of trust and privacy regarding healthcare data, so that people are more willing to share data that can contribute to their own healthcare and to the development of wider advice for healthy ageing.
Affordability
334.The cost of technologies and related adjustments to homes was raised as a key barrier to uptake for individuals and public bodies. Stuart Butterfield said that evidence of cost-effectiveness of ‘passive activity-monitoring systems’ was “siloed and very patchy”, because of the difficulties of “having people with full access to the data who can say what the outcomes are and what the financial models are”. However, he cited two reports by Northamptonshire County Council showing “savings of £8,000 over a year every time they deployed the system” through “cost avoidance and cost saving”.561 Professor Caleb-Solly said the £8,000 cost of a physical assistance robot should be considered alongside the avoided costs of providing this care in person, particularly in the context of staff shortages in the care sector.562
335.Where technologies are provided by a local authority, it uses its Integrated Community Equipment Services (ICES) fund. An ICES fund is often used in conjunction with the Government’s Disabled Facilities Grant (DFG), which is for adaptations to homes.563 Coordination between funding streams was identified as an issue affecting uptake. At present, the DFG—but not the ICES—is part of the ‘Better Care Fund’, which brings together budgets from health, social care and housing to enable “the NHS and local authorities [to] work together, as equal partners, with shared objectives.”564 A 2018 review recommended: “The DFG and ICES budgets [should] be in the same funding pot … to join up DFG services with equipment provision and minor adaptations.”565
Digital literacy
336.Several witnesses highlighted digital literacy and lack of training as barriers to the uptake of new technologies by older people. Office for National Statistics data in 2019 show that, while the proportion of older people using the internet has risen rapidly, of the 4 million people who have never used it, more than half are over 75; and just over half of adults over the age of 75 had not used the internet in the previous three months.566 The Centre for Ageing Better wrote that non-internet users are more likely to be poor, less well educated and in worse health than their peers, and there is a risk of further entrenching inequalities in older age if they cannot access digital technologies and services.567
337.Age UK told us that, as health information and services are increasingly accessed online, “digital technology [is now] a form of health literacy”, which in turn is linked to health outcomes.568 In a similar vein, the Agile Ageing Alliance told us that people can find systems confusing because of the “technological fragmentation of the smart home ecosystem” such that “many devices are ‘stand-alone’ [which] leads to problems around interoperability and confusion.”569
338.We recommend that Government ensures internet access for all homes so that older people can access services to help them live independently and in better health. The Government should promote and support lifelong digital skills training so that people enter old age with the ability to use beneficial technologies. Greater support should be provided to the large proportion of the current older generation which lacks these skills, so that they do not miss out on the benefits of available technologies.
Support for innovation and deployment
Funding for technologies and services
339.Through the Industrial Strategy Challenge Fund, and as part of the Ageing Society Grand Challenge, the Government has allocated £98 million “to invest in developing projects that will help older people remain independent and in research into further understanding of healthy ageing.”570 The funding is available for technologies and services at different stages of development, and for interdisciplinary academic-led research into social, behavioural and design aspects of healthy ageing.
340.Several witnesses told us these funds are focused on larger companies and are not suited to SMEs, which generate much of the innovation in a market. Catherine McClen, Founder and CEO of BuddyHub, said: “There were barriers for smaller innovative start-ups to get involved, because it looked like the focus was on consortiums of bigger organisations.”571 Luella Trickett, Director of Value and Access at the Association of British HealthTech Industries, said that SMEs find it hard to obtain smaller investments that match the scale of their projects—for example to repurpose existing technologies.572
341.We were told there is a shortfall in funding to commercialise innovations in the UK.573 The same issue applies to existing technologies, where there is limited funding to support deployment. Stuart Butterfield said that the focus should be on “technology that is available”, as there is often “money available to develop new stuff but no money available to use the stuff that is there.”574
342.Ami Shpiro, Founder of Innovation Warehouse, said that small companies struggle to attract equity if their product offers only linear returns on investment: “if there is no hockey stick, as they call it—a potential exponential return—they will not get funded … At the moment, there definitely is a gap, and not just in this sector. There are businesses that can make contributions to society, but there is no way for them to get funding”.575
343.The funding for new innovation in products and services seems to be aimed more at larger companies, presumably in the hope of achieving commercialisation more quickly and with less risk. However, small and medium-sized enterprises contribute significantly to innovation, and there would be merit in these organisations having easier access to funding to support innovation.
344.There is significant potential for development of new technologies and services to support healthier and independent living in old age, including medical devices and robotics. There is scope for further deployment of existing technologies such as telecare and ‘activities of daily living’ systems.
Feasibility of the Ageing Society Grand Challenge mission
345.We asked witnesses whether technology and services could achieve the target of five more years of healthy, independent living by 2035, whilst reducing health inequalities. As per the various examples given in this chapter, there was enthusiasm that technology and services have an important role to play, but there was not strong confidence in the feasibility of the target. The Northern Health Science Alliance judged that independence in old age is likely to be more achievable than improving health.576 Age UK cautioned that “technology should not be seen as a silver bullet”, and said that “investment is needed in public health, housing, communities, transport, and welfare, alongside investment in the NHS and social care … Technology can support strategies but should not be seen as a solution in itself.”577
346.In particular, there was concern about the contribution of technology to achieving the second part of the mission—to reduce health inequalities. Some witnesses thought that technology is not the right approach. Sinead Mac Manus, Senior Programme Manager in Digital Health at Nesta, said: “I am very sceptical about reducing health inequalities. It is a very complicated area which technology is not going to contribute to.”578 Others were worried that technology would increase health inequalities. Several of the barriers to uptake of technologies have a socio-economic gradient, as Professor Marmot said: “In general, innovations have a big equity implication, because they tend to get taken up first by people with more education, more money and the like.”579 The Government Office for Science raised this concern in its 2016 report on the future of an ageing population: “people with higher incomes are likely to be healthier and to own and use new technologies”, which means there is a risk that “the potential of technologies to support health will not translate to those with highest need, exacerbating existing health inequalities.”580
347.To avoid widening health inequalities, witnesses advised promoting uptake of technologies by groups that are disadvantaged or face barriers to uptake. The Institute for Public Health in Ireland told us “it is particularly important that assistive technologies are tailored very specifically at those who may not be computer-literate and that special efforts are made to find effective interventions for these cohorts to enable them [to] access the benefits of technological advances.”581 Catherine McClen was concerned about the risk of increasing inequalities, but said: “As long as [technologies] can be adopted and the public purse eventually pays to allow people on a lower income or who are suffering health inequalities to be able to access them, hopefully the challenge can meet its aims.” 582
348.Technology and services can contribute to independence and social connectedness in old age, and to health to a lesser extent, but it seems unlikely that they can add five years of healthy and independent living by 2035. Moreover, there is a risk of technology and services widening health inequalities in old age, due to barriers to uptake that are more prevalent in disadvantaged groups. The Government will have to intervene decisively and for the long-term in order to make these tools ubiquitous and beneficial for the whole population in old age.
349.When allocating funding through the Ageing Society Grand Challenge, we recommend that the Government supports the deployment of technologies that contribute to healthier and independent living—both those available now and those that may become available in future. This should prioritise disadvantaged groups in order to bring the greatest health benefits, whilst also realising economic benefits of innovations that are developed in the UK.
485 See, for example Centre for Ageing Better, Industrial Strategy Challenge Fund—Healthy Ageing Challenge Framework (2019), p 8, Figure 2 and related discussion: https://www.ageing-better.org.uk/sites/default/files/2019–02/Healthy-Ageing-Challenge-Framework.pdf [accessed 12 October 2020].
488 Centre for Ageing Better, ‘Transforming later lives–our strategy’ (31 July 2018): https://www.ageing-better.org.uk/news/transform-later-life [accessed 12 October 2020]
490 Ministry of Housing, Communities and Local Government, ‘Approved Document M: Access to and use of buildings’ (1 March 2015): https://www.gov.uk/government/publications/access-to-and-use-of-buildings-approved-document-m [accessed 12 October 2020]
491 Ministry of Housing, Communities and Local Government, ‘Housing for older and disabled people’ (26 June 2019): https://www.gov.uk/guidance/housing-for-older-and-disabled-people [accessed 12 October 2020]
492 Design Council, Home of 2030—A Public Vision for the Home of 2030 (July 2020), p 72: https://www.homeof2030.com/wp-content/uploads/2020/07/A-Public-Vision-for-the-Home-of-2030-July-2020.pdf [accessed 12 October 2020]
493 Ministry of Housing, Communities and Local Government, Housing supply; net additional dwellings, England: 2018–19 (13 December 2019): https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/850825/Housing_Supply_England_2018–19.pdf [accessed 28 October 2020]. In the year 2018–19, over 241,000 new dwellings were built in England, which was about 1% of the housing stock at the start of the that year; that building rate was higher than in previous years. Around 8,000 existing dwellings were demolished; that is roughly typical of previous years.
499 Ibid.
501 Q 80 (Stuart Butterfield). See also Canary Care: https://www.canarycare.co.uk/ [accessed 12 October 2020]
503 Written evidence from the Institute of Health Research and Innovation at the University of the Highlands and Islands (INQ0028). See also Technology Enabled Care in Housing (TECH), ‘Albyn Housing Society—Fit Homes’: https://techousing.co.uk/fit-homes/ [accessed 12 October 2020]
505 See, for example: written evidence from the Manchester Institute for Collaborative Research on Ageing (INQ0033); and written evidence from the Centre for Assistive Technology and Connected Healthcare at the University of Sheffield (INQ0026).
509 Ibid.
511 Written evidence from Manchester Institute for Collaborative Research on Ageing (MICRA) (INQ0033)
512 Written evidence from the Centre for Assistive Technology and Connected Healthcare at the University of Sheffield (INQ0026)
513 Written evidence from Manchester Institute for Collaborative Research on Ageing (MICRA) (INQ0033)
514 Ibid.
515 Written evidence from the Centre for Assistive Technology and Connected Healthcare at the University of Sheffield (INQ0026)
516 Diabetes UK, Type 1 Technology—A guide for adults with type 1 diabetes (2017): https://www.diabetes.org.uk/resources-s3/2017–08/JDRF-Type1Tech-Adults-8.pdf [accessed 12 October 2020]
517 Written evidence from Centre for Assistive Technology and Connected Healthcare, University of Sheffield (INQ0026)
518 Written evidence from Manchester Institute for Collaborative Research on Ageing (MICRA) (INQ0033)
526 Age UK, ‘Loneliness’: https://www.ageuk.org.uk/information-advice/health-wellbeing/loneliness/ [accessed 12 October 2020]
528 Written evidence from No Isolation (INQ0039). See also KOMP, ‘This is KOMP—Easy communication technology for elderly relatives’: https://www.noisolation.com/uk/komp/ [accessed 12 October 2020]
533 Written evidence from Centre for Research in Public Health and Community Care, University of Hertfordshire (INQ0059)
534 HM Government, A connected society: A strategy for tackling loneliness – laying the foundations for change (October 2018), p 45: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/936725/6.4882_DCMS_Loneliness_Strategy_web_Update_V2.pdf [accessed 12 October 2020]
535 PHG Foundation, The personalised medicine technology landscape (August 2018): https://www.phgfoundation.org/documents/phgf-personalised-medicine-technology-landscape-report-50918.pdf [accessed 12 October 2020]
538 Q 140 (Professor Julian Peto). In that same question, Professor Peto made a similar point about samples for analysis, saying that the Human Tissue Act required that samples be destroyed and hence are not available for research.
551 Written evidence from Manchester Institute for Collaborative Research on Ageing (MICRA) (INQ0033)
555 The care.data programme was an NHS England initiative that ran from 2013 to 2016. The NHS England webpage from 2013 says: “the care.data programme will link information from different NHS providers to give healthcare commissioners a more complete picture of how safe local services are, and how well they treat and care for patients across community, GP and hospital settings.” NHS England, ‘NHS England sets out the next steps of public awareness about care.data’ (16 October 2013): https://www.england.nhs.uk/2013/10/care-data/ [accessed 22 October 2020]
556 DeepMind is a UK-based AI company. There was controversy about its collaborations with healthcare providers. The issue is discussed in the following report: Select Committee on Artificial Intelligence, AI in the UK: ready, willing and able? (Report of Session 2017–19, HL Paper 100)
558 National Data Guardian for Health and Care, Review of Data Security, Consent and Opt-Outs (June 2016): https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/535024/data-security-review.PDF [accessed 22 October 2020]
559 NHS Digital, Data Security Standards: Overall Guide (2018): https://www.dsptoolkit.nhs.uk/Help/Attachment/24 [accessed 22 October 2020]
560 Department for Digital, Culture, Media and Sport, ‘Centre for Data Ethics and Innovation’: https://www.gov.uk/government/organisations/centre-for-data-ethics-and-innovation [accessed 22 October 2020]
563 Centre for Public Health and Wellbeing at the University of the West of England, Disabled Facilities Grant (DFG) and Other Adaptations—External Review: Main Report (December 2018): https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/762920/Independent_Review_of_the_Disabled_Facilities_Grant.pdf [accessed 22 October 2020]
564 Department of Health and Social Care and the Ministry of Housing, Communities and Local Government, 2019–20 Better Care Fund: Policy Framework (10 April 2019), p 2: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/821676/Better_Care_Fund_2019–20_Policy_Framework.pdf [accessed 22 October 2020]
565 Centre for Public Health and Wellbeing at the University of the West of England, Disabled Facilities Grant (DFG) and Other Adaptations—External Review: Main Report (December 2018): https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/762920/Independent_Review_of_the_Disabled_Facilities_Grant.pdf [accessed 22 October 2020]
566 Office for National Statistics, Internet users, UK: 2019 (24 May 2019): https://www.ons.gov.uk/businessindustryandtrade/itandinternetindustry/bulletins/internetusers/2019 [accessed 22 October 2020]
567 Centre for Ageing Better, The digital age: new approaches to supporting people in later life get online (May 2018): https://www.ageing-better.org.uk/sites/default/files/2018–06/The-digital-age.pdf [accessed 22 October 2020]
570 UK Research and Innovation, ‘Industrial Strategy Challenge Fund’: https://www.ukri.org/innovation/industrial-strategy-challenge-fund/healthy-ageing/ [accessed 22 December 2020]
580 Government Office for Science, Future of an Ageing Population (2016), p 86: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/816458/future-of-an-ageing-population.pdf [accessed 22 October 2020]