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Across Bristol, North Somerset and South Gloucestershire (BNSSG) we have a growing population with the number of over 75’s growing by 31% by 2025. This will put an estimated additional £30m of pressure on the local health system and by 2025 the national adult social care funding gap will be around £3.5billion.
Health and social care are turning their attention to what we can do to prevent people entering the Health and Social Care system and reduce the years lost to disability. The BNSSG has a large frail population and it is expected to grow.
Diagram one: Over 75+ frail population in BSSNG (proportion) – see PDF
Public Health interventions are focusing on increasing the physical activity levels of older people, taking account of the Chief Medical Officers advice ‘Every minute of activity counts and it is never too late to start’. Indeed, the British Medical Journal recently highlighted that physical activity in those that are most frail has the biggest benefit. Showing the importance of continued intervention with people regardless of co-morbidity and frailty.
Providing professional support to help all older people remain active is beyond the reach of today’s Health and Social Care budgets. However, technology-based interventions can increase the reach of Health and Social Care, and has being effective when they are added to, or substituted for parts of, usual treatment. To date technology designed for older people often takes a protectionist view aiming to keep an older person safe, rather than building on their inherent strengths and life skills. Therefore, it is not a surprise that technology can be rejected by older people as irrelevant to them. Research in the sector advocates a client-centred approach to technology design, as this was found to be an important factor for an effective service and satisfied users.
Our aim is to explore how technology can assist us to increase the activity levels in the over 65’s.
To explore this problem, we have brought together stakeholders from across health and social care in Bristol, North Somerset and South Gloucestershire. We will use the outcomes from this discovery phase to support development of an integrated frailty service, share best practice across the sector, improve commissioning practices and develop products and services to support increased physical activity in older people.
For this work to be successful we will have to engage with residents across BNSSG, the health and social care sector and the technology sector. The North Somerset Technology Enabled Care team are in an excellent position to take on this work as they have experience in iterative service design and prototyping within these communities.
Across the BNSSG we are already working in partnership to reduce frailty in the older population, and are drafting plans for an integrated frailty service. This is underpinned by a focus on a strength-based approach to help people make the most of assets that are available to them.
A review of the latest academic research shows that there has been little work in co designing and using technology with older people to support physical activity. However, there are several projects across the BNSSG area that are seeking to use technology in this space, focused around wearable activity monitoring and awareness raising. In the discovery phase will ensure we link with existing projects to understand how older people have experienced these interventions.
Our research in the discovery phase will be split into three parts:
How users manage their physical activity levels and any barriers to this
Understanding individual narratives around physical activity will be key to us developing effective technology tools to make a difference in people’s lives.
Acceptability of different types of technology to users
We will work with older people to understand how they view technology and what technology would be acceptable; this will include reminders, monitoring and physical assistance.
Design with people for people
We will develop and prototype different solutions with older people in order to build up a picture of what technology will be effective for them
Best practice around physical activity and older people
Working with professional leads across health and social care to pinpoint best practice to inform technology development.
Understanding the root cause of reduction of physical activity
Bring in expertise on frailty that can physically and mentally affect somebody’s ability to exercise.
How does physical activity affect the health and social system
Develop an understanding of the impact that lack of exercise has on local health and social care. Explore how sharing information about frailty and physical activity can lead to more integrated and effective care.
Technology industry engagement
How can technology used in the commercial sector be adapted to meet the needs of public sector?
Using expert technology knowledge to explore the use of different platforms to support older people maintain or increase physical activity.
We will use existing networks across the BNSSG to undertake this research including the Healthwatch network, local older people’s networks, 65 High Street and our extra care service user group. We will use several research techniques that focus on community development, iterative design and prototyping. The full research design will be developed with older people and the support of the University of West of England’s public health department.
The research from the discovery phase will allow us to create the following outputs:
- A business case that explains the cost of the problem and the benefits
- A user research report
- A conclusion proposing what product or service to move forward with
- An application for additional funding from the Local Digital Fund, as appropriate.
The cost of not changing the way we support people in the Health and Social Care system is huge. Below is a table that estimates the increase in health costs of aging populations.
Diagram 2: BNSSG growth in health service cost – see PDF
If we do nothing older people will cost the local health system an additional £50.57m per annum. In addition to this increase, frailty means more people living in care homes and by 2025 it is anticipated there will be a 31% increase of people living in care homes in the BSSNG area. This equates to a projected increase cost of £62m to Councils and self funders.
Diagram 3: Projection of people living in care homes – see PDF
It is estimated that the number of people unable to manage self-care in BSSNG by 2025 will increase by 29% which will lead to increase pressure on already stretch social care budgets. The Local Government Association estimates that by 2025 the national adult social care funding gap will be around £3.5billion.
Increased frailty is also having a financial impact on the family members and friends that care for them, with informal carers losing income and pension contributions which may make them more vulnerable as they get older. But it also has cost implications for other council services including housing, transport, community services, planning and trading standards as they must modify their services to support an increasingly frail population.
The Health and Social care system must find a way to activate peoples inherent strengths and support them to remain healthier for longer. The aim of the discovery is to explore how technology can assist us to increase the activity levels in the over 65’s. This will contribute to reduction of frailty and reduced future costs for the Health and Social Care system.
This problem is affecting Health and Social care systems across the country and tables below show the extent of the funding gap predicted nationally.
Diagram 4: Social care and Health funding gap – see PDF
Any learning from this discovery will contribute towards finding a solution to this funding shortfall. People with lived experience of frailty can contribute to being part of the long-term answer, and reduce their frailty in the short term.
Across the BNSSG we have a robust technology network under the banner of Healthier Together Sustainability and Transformation Partnership (STP). This well-established group will act as the project board for this group and meet bimonthly. A Prince2 project management approach will underpin our work together, so all partners are aware of timescales, responsibilities and outcomes to report against. The project manager will sit within North Somerset Council, they will manage the budget as well as being a touchstone for the team and have overall responsibility for project delivery. During the set-up of the project team we will agree arrangements for remote working which will include, video conference, messaging facilities and cloud-based storage for shared documentation. All information shared will be done within GDPR.
The team that will lead this work is the Technology Enabled Care Team that sits within North Somerset Councils, contracts and commissioning team. This team has a track record of delivering and operationalising Technology Enabled Care projects that are both collaborative and iterative. This project aligns to the Council’s Technology Enabled Care Strategy and the Vision for Adult Social Care in North Somerset.
The support that the team has had from other government funded projects has been invaluable to guide and support the skill development of the team. I would like to formalise my teams project management and service design skills so any support for Prince2 training, iterative and agile design would be most welcome. What is also very helpful is to work with others who are trying to deliver similar projects. We would be interested in talking to other projects in the discovery phase who are focusing on codesign and development with residents.
An early indication of how you would like to receive the outputs from the discovery phase would be essential to us, alongside support calls and project days. Project days where the projects come together and focus on design and delivery are extremely helpful to create a sense of energy and move projects on at a pace. Support to link in with suppliers in the technology sector promoting physical activity would be helpful, though we do already have some partners in this area.
Finally, we have found with past projects that when we have built up more of a reputation around a project people have told us of similar bits of work that other local authorities are doing. This has enabled us to share outcomes, lessons learnt and pool our resources. Promotion of funded projects is key so we can find the partners undertaking similar work. Also support for any network opportunities to share our work and broaden our collaboration is of value.