Panel Discussion
Martyn Gilbert, UK 3.0
Heinz Wolff, Brunel University
Richard Foggie, Department of Business Innovation and Skills
Bob Twitchin, PhoneAbility
Graham Worsley, Technology Strategy Board

MARTYN GILBERT:  In the Panel session today we'll obviously be picking up on some of the themes. One particular theme that has arisen during the day. I would like to thank you for those who have stayed this far to participate. It will be participation, there are roving microphones. Where actually are they at the moment?  One here, one here?  First of all introductions. I am honoured to be able to introduce to my right Professor Heinz Wolff, obviously he is known to everybody here, emeritus Professor at bio engineering at Brunel University, a list of accolades and qualifications spanning everything from space science to how we use space. He is an absolute iconic in the world of certain popularising science I am sure is known to all of us.  

Richard Foggie of whom it has been said ---- he leads electronics innovation in the department of business innovation, skills, information. He forges links between Government, both local and central and the private sector and here I have to say Richard is the great communicator of communicators. It first came as a shock to me to realise it actually needed someone to make a connection between local and central Government. Richard does an absolutely amazing job at getting people who need to work together to work together.

Bob Twitchin to my left is on the steering group of PhoneAbility, chair of the IT Can Help and member of the Social Responsibility Committee of the Chartered Institute of IT and participates in international work on tele-working and distance learning.

To the far great Graham Worsley, leads the assisted living innovation platform, probable better known to everybody here as A LA. Before that he headed a mobile communications and health research programme and probably more than anyone here he is seeing the, he has the scars of trying to take some of the technology we talk about new mass use and doubtless he will have a few stories for us.

Where I would like to start is by summarising one or two of the issues which arose. There was really an object lesson for us in something that Collette mentioned when she said that there was research which was going back 18 years in the deployment of technologies for the benefit of elderly and disabled people. 18 years ! we also heard how there are presently 800 people having the benefit of Telecare systems, and that was roughly but one of the speakers said, well she said older, but surely everybody should have this. There's a lesson: going back to the research 18 years ago - 20 years ago, PCs were first starting to find their way into specially small and medium sized businesses and there were so many complaints because they said 'this isn't aiding my business, it is slowing it down. These days the notion of having a business that doesn't make comprehensive use of computers, particularly PCs it doesn't happen, they are an integral part. The difference, the change was when people realised, oh no, I no this usually as an electronic piece of paper, I would have to mould my business around the technology, rather than the technology round my business and as human beings that hurts our egos a lot because we perceive, not unreasonably, this thing we invent for ourselves, because animals didn't invent it should actually do what we want. But it is a different way of doing things. It is this different way of doing things I would particularly like to concentrate on because in order that say Hackney, have not just under 2,000, but thousands of people could benefit from the technology requires fundamental change to the way local authorities, care providers and business operate.

Picking up on that theme of good faith collaboration I would like to start out by asking the Panel: what is the one thing that they consider would be of most value in bringing about that collaboration so as in 20 years time we are not having the same discussion, but in 20 years time this stuff is actually in everybody's home?  Because that surely is the objective. What is it we need to do so that we don't just pontificate about doing this stuff but we actually do it. I would like to start with Heinz.

HEINZ WOLFF:  I think you will find and I think Graham noticed that I have changed my mind. Having spent 60 years... I believe that we have passed the technological age and the problem we now face in terms of producing care, not just alarm systems but care is people. That we are taking no precautions whatsoever to multiply the number of people prepared to engage in care of the elderly against decreasing amount of money to do so increasing amount of elderly people and increasing amount of elderly people who will be less capable, because they will be older, than the elderly people are now. So I have done a complete volt face and say if there's no more technology in the next 20 years it doesn't matter, we need social constructs to allow community to take much larger part in the care of old people and we are working on ways of doing this. But that is now what matters. Obviously the technology must continue to be applied and distributed and to be improved but the problem which a country faces, and Government recognises and (inaudible) recognises, is nothing to do with the technology but to do with are there going to be enough people to actually cook breakfast for all of those people at about eight o'clock. The question of simultaneity of care. It is only solvable with having far more people on board. We do know that a country which is at war, at war with the credit crunch, an increasing elderly population and huge competition from bio technologies, is country that will have to draw in its horns as far as demands are concerned, will have to do it with much much less money and that's what it is all about.  

MARTYN GILBERT:  Thank you very much so the same question then to Bob: what do we have to do to coordinate, to bring people together to make this happen so we are not just talking about this again in the in another 20 years.

BOB TWITCHIN:  To take an example, on the comment the comparable use with personal computers, my background is entirely communications and about 20 years go started to look at the accessibility and the effectiveness of the relay service for deaf and hard of hearing people and we are still trying to improve the relay services for deaf and hard of hearing people and the technology has scum on fantastically. Now, using Internet technologies, there's no possible problem in terms of delivering improved services but there has not been the pressure to get things changed.

I think that the key thing, I am so pleased Heinz is with us today, he is a great communicator and key to collaboration is to make people aware of what is possible I have spoken to Caroline Jacobs from Ricability and she makes a parallel with the way people ask for drugs, people get to know what is available. If people got to know what is available, both individuals finds and carers, we begin to get critical mass to make things happen.

MARTYN GILBERT:  So it is a dissemination exercise in the broadest sense.

RICHARD FOGGIE:  I don't think we need to do a thing. I think necessity has driven us to where we are and I think that because of where we are, we'll know the challenges we face. We all know that there's not going to be the state funding to provide for it. We are therefore going to have to rely on us to do it, ie at the moment informal care contributes 80 to £90 billion a year to the economy if we didn't do off our own bats what we do we could double that deficit they keep whining on about all the time. It is therefore a question of necessity. We are doing it now, it is fair to say over the past couple of decades we have invested heavily in the science and technology perhaps lesser extent in the net works to enable that to be applied. Frankly we don't have an alternative that I see. I think we'll continue as we are but through necessity through the alternative frankly of having people dying in the streets then we'll take on the challenge and it is not a question of that we will succeed; we must succeed.

GRAHAM WORSLEY:  So my interest is Telecare and Telehealth primarily so we have been trying to put together a strategic programme to look at barriers and challenges there are around those areas and the things that need to be done. So I have looked at the technology issues, we have looked particularly at where is the business model. I think that is still one of the major barriers and challenges, something that people have said, where is the business model, where is the economics, where is the cost benefit and we need to do more work in this area. Nobody is going to disagree about the need for more usability and the challenges around usability. The couple of things we have got plans I would like to concentrate on is that you need large-scale demonstration that one of the classics is that people have too many piles, you need to use to tens of thousands of users if you are going to end up with hundreds of thousands of users and maybe millions. At the moment we don't need how to do that, we need to go to the neck stage what I have spent a couple of months on is standards and interoperability around standards and networks. At the moment you can't mix and match different equipment from different suppliers so you don't get the ease of use and the economies of scale and that's one of the things that has been holding back a lot of the big players in this kind of area. If you can think of again classically mobile phone devices and why they are so cheap with large functionality, it is because of the the large-scale dazed on standards and interoperability. My view is there's a whole series of things to do but the thing fresh in my mind at the moment about a practical thing to do is around standards and interoperability.

MARTYN GILBERT:  There's a lot of interoperability work going on, (inaudible) is a national organisation precise lie tempting to great in interoperability for devices in the home and a BSI Committee has as a task identifying the standards and where the gaps are for interoperability in the home interoperability is not just about the electronics; it is about people. I have noticed in the video that we saw that the Telecare alert came in and someone wrote it down on a piece of paper, at which point it fell completely outside of any automated auditing mechanisms, any way of actually judging whether your performance - I don't mean performance - are we doing what we are doing efficiently so interoperability isn't about bits of kit, it is around procedures. I would like to ask is there anybody in the audience who has day-to-day involvement with providing such a service where they would be prepared to work with others to identify how these procedures can be put in place for an open market integration of services?  It is not just coming from one vendor but the complete suit and nuts, the moment someone presses the button to act to getting that service monitoring it, the equipment you use, everything is integrated. Is there anyone in the public sector who would be prepared to say we want this to happen and under in those circumstances, - is there anybody who would like to stand up and would like to say what it should do.

HEINZ WOLFF:  I know the word Telecare has got us firmly in the language. It is nothing of the care the Telecare alarm systems and they don't wipe bottoms or anything else. I went to a Conference dinner with BT on businesses and volunteering, and volunteering is essentially is... it didn't involve wiping bottoms but we are going to be desperately short of people who do wipe bottoms, cook meals, change the sheets on bed ands things on this kind and don't need to be paid because we have not got the money to pay for it and that's the thing if you spend all your time thinking about, how you achieve a method of that kind.

Or alternatively, devise a machine that does wipe bottoms. At a Conference a few days ago there was reluctance that people would buy things ---- my which won't people consider that appliances are bought in ion indirect way by the carer, not the patient, the sacrifice of saying I need one of these things is one of the obstacles that gets in the way of sales. You wouldn't have carpenter would expect to find the tools for making a bookshelf already in the house, he would bring his own tools. Much of the Telecare equipment are toolkits that should definitely not belong to the client.

MARTYN GILBERT:  It begs a question for Graham, have people taken on board the question that electronics and all the rest of it is really only a tool for people to use and it is what happens at the ends of those tools which is important?  Has there been any work taking a serious look at policies procedures and the physical act of wiping bottoms or not, what human beings can actually do at the end point.

GRAHAM WORSLEY:  What the projects - one of the projects based in the North-East led by time tech has come up with a 400 person user trial using A-call, a spin out from Age Concern, along with the housing associations in the North-east. One of the outcomes of the project was a practical user guide to what installers need to do when going into premises. So the house would certainly be one of the outcomes in the project so I would say yes to that. Can I say quickly though while I have got the mic, the in sue with standards, there are 6 BSI committees with interests in this matter, continued alliance, ITU, CENELEC all working in the same area. It is not that straight forward, it is like the forth bridge on bottom wiping, the issue is there are products available but they are too expensive.

MARTYN GILBERT:  What kind of sums are you talking about?

GRAHAM WORSLEY:  I have been to Sheffield University and seen a guy there who has had a project funded by one of the MHR programmes to do a low-cost toilet machine that is easily wheeled about and cheap to assemble and cheap to put together and with good usability. I don't know what has happened to that. It was about a year ago. The issue was cost. In trying to do something low-cost.

MARTYN GILBERT:  I want to add to that please given one of the things you do is head up a group of people who actually give help and assistance to others, if any of this stuff, in order that it gets to the widest market, to what degree do you think we can actually avoid having training or is training for people in the home, assisting them, going to have to be in principle part of that.

BOB TWITCHIN:  If I can go back a step, the first, one of the things I was impressed with in one of the presentation about Hackney is that they have the demonstration flat, they were showing people things, giving people chance to use things. That's so different from the experience of people in our local area where there's an alarm system, one type of pendant you hang around your neck and which most people won't wear and there's no choice. Talking about carers buying equipment, it is so important that people have the equipment that is right for them and know how to use it so that is absolutely key, I think. I really was quite worried by your automatic bottom wipers because these things are so individual, thinking about some kind of - but you have to see the different things available and you really have to become an expert. It's so important people have the equipment that is right for them and know how to use it.  That is absolutely key, I think, and I really was quite worried about the automatic bottom wiper because.  These things are so individual.  In our household we've been thinking about some kind of (inaudible) but you have to see the different things that are available and you really have to become an expert.  It's interesting our title today smart living is what every disabled person has to do smart living every day, but you just want to make it a bit easier.

MARTYN:  Questions from the floor, please: 

FROM THE FLOOR:  Talk about business model and so on.  My question is I think my view is that the whole automation and energy efficiency and machine activities are a little bit faster than Telecare based on standardisation technical realisation.  Later on, smart (inaudible) or city automation.  What is the business case if you have to use existing infrastructure and what is the requirements of timing and so on later on?  I see here they're a little more faster than your Telecare.

RICHARD:  Indeed.  Crikey, I've been looking at digital services into the home for a decade and in the early stages we were looking what is it that people in their homes will need to deliver digitally and sign up for and that will be great because that will be the Trojan that gets the first one in and then add additional services.  Add a very small incremental cost.

I suppose in large part the roll out of telecommunication networks and IP networks now is getting more ubiquitous and becoming more affordable so the infrastructure that permits any number of service its above and beyond infotainment is getting that.  On the energy related front it's another imperative, the environment imperative, that is driving that business model that is as acute, arguably more, with the aging demographic ‑‑ discuss ... I think it is certainly the case that where one service is predicated on one model goes in, it then becomes easier to overlay another service, ideally exploiting resources that are already put in to deliver additional services.  So the whole thing becomes easier over the passage of time.

HEINZ:  Particularly with the business model for.  I think the word "business model" has done more damage to the inclusion of technology in homes than anything else.  If you go to a local (inaudible) with new guys, the first thing is to say with business model and we see if there's any model and of course it doesn't because it has a Project Manager and a whole superstructure of doing it.  Graham has done something of having long enough where at least this biasing towards high cost management of a trial is not quite so obvious.  But I think that if somebody starts off with saying "this thing has to prove itself in a financial way before we look at it", rather than saying "this will improve the quality of life" and that in turn will mean possibilities ‑‑ it's the wrong way of going about it.  The word "business model" should be expunged.

NEW SPEAKER:  It's easy for those in the private sector who want to sell stuff and I am obliged to agree.  Are there any people from the public sector who have already found instructions on their desks telling them to cut their budgets?  Anyone seen that yet?  (Richard's hand up).  Good for one or two reasons.  You have already been sacked.  The whole notion of business models cuts through what I was saying in my presentation about best practice because best practice definitely militates against making individual provisions of people because people are individual ‑‑ let's take Bob, obviously an individual and let's assume, genetically there's only one Bob.  So if one looks to the evidence base of what Bob might want and where is the benefit for it, show me the proof, there's no proof unless we start as is presently the case taking people into categories and totally removing any notion of individuality which is essentially what you're saying.

So this comes to the word "mainstreaming" and the notion of how can you mainstream something if there's only one or two people who want it?

What are we talking about with the word mainstream?  I have my views, but microphone, please.

NEW SPEAKER:  Hopefully I can follow on (inaudible) cause a bit of controversy.  I'm the President of the Chartered Society of designers and director of the European Institute of (inaudible).  I speak with several hats and proud to be one of the early team members of Heinz's at Brunel and at the medical research tools for living programme.  Colette mentioned 18 years.  We go back 29 years and beyond.  Having 30 years been involved in this area, it still scares me that we see presentations of alarm systems 41 years after we walked on the moon and someone saying "wow, isn't this amazing".  One of the reasons we're held back is we treat this sector as something special and different and we're being held back because there are too many vested interests.  The business model is simple for industry.  Tell us how many of you want it and the more the cheaper it will be.  If all else fails, use training.  We're not designing every day products for human beings to use anyway, let alone the inclusive agenda.  So let's improve the quality of usability of all products and then you'll reduce the need for special products and they then, as Heinz so rightly says, come back to specific tools for living to improve quality of life.  All we need to get the model into healthcare is to put a (inaudible) rating on each piece of technology and when we work on our budgets for case assessment, we can see cost benefit analysis.  But really we shouldn't be looking at technology through the eyes and delivery mechanisms of healthcare providers or carers because, by and large, more provocative perhaps, we're using the wrong people to provide the technology.  People go into healthcare and caring because they're person centred and not technologically driven, yet they're the group of people having to deal with more and more technology and they're ill‑equipped to deal with making the decisions.  If gaming technology is driven in the same method as assistive technology we'd still be playing bomb so let's get rid of the special thing.  We need to use what we've got better and for real human need.  Let's get more human need into the design process.

MARTYN:  I'd like to add to that.  Some of the comments I made because I was running out of time I talked about collaboration in good faith within the public sector and private sector and one of those things is trying to end this notion of market dominance by one or two players.  Not pointing fingers, but you tend to get their influence on the market is incredibly restrictive.  Apologies to BT.  ADSL and all the restrictions that has with it is because the idea was to exploit three twists per inch copper wire, whereas if you go to Singapore, smaller, south Korea, not so much smaller and they have enviable systems.  Why don't we have it?  There are dominant market players it suits for things to stay as they are.  You cited time tech, wonderful and really nice people, and yet the technology is IP based but it has been put about that IP based stuff is inherently ‑‑ I know lots of people who have horror stories from nonIP based equipment and does it work and whenever you have a dominance in the market place it distorts it and slows it down.  So we need collaboration between the people who say what we want the technology to be used for so we can have that larger market and more ‑‑ if more people said what they wanted you have an open market and people can supply.

NEW SPEAKER:  Human beings are only a 2.64 bit processing capacity.

NEW SPEAKER:  I'll remember that. 

NEW SPEAKER:  My background is in the commercial world.  I was a business development director for a couple of companies and I've come into this area 18 months ago looking at technologies to assist (inaudible).  My observation is that you have to have a market to sell into and it seems very much that this ‑‑ the organisation that are trying to do good are trying to do good to people and not people actually asking for the help.  There's no bottom up.  It's all top down.

It seems that the biggest thing you can give is a voice to people with disability and a voice to people that need the support to actually demand the things they want.  That's what is missing.  It appears that people who have disability just don't want to kick up a fuss.  That is why they don't get the resources or the support and that is why people don't take notice of them.  I would suggest the biggest single thing is empower people to ask for what they want and generate it.

BOB:  I think one of the things it's important to recognise is just what hard work it often is to live as a disabled person.  Equally as people get older.  You don't have that much spare energy to kick up a fuss.  So it needs to be made as easy as possible what is available.  I think going back to the point I was making earlier, so that people know what is available and know there are things that can work ...

But also on the mainstream side, while I was talking to (inaudible) I was recalling that in our home we have burglar alarms and you see the technology is there.  Let's get to people what can be done and build up this critical mass in terms of people actually generating the demand.

MARTYN:  To pick up on your question, the ‑‑ in most homes there are alarms and a lot of installed stuff and a colleague of mine whose parents died relatively close to each other and it's very sad because he wasn't expecting when his mother died, when that ‑‑ just before that happened, he was trying to get Telecare into her home and pleading with the local authority to provide it and they wouldn't and she died a couple of weeks later.  One of the things that we were hearing about the Hackney experience is the discretionary nature because they have a certain budget and where do they apply it.

Once you put in, if I can say it, (inaudible) systems and use them for lots of things, the justification to install them is not just about Telecare.  Picking up on John Gill's comments about good design for elderly and disabled is good design for us all.  Once you start putting in systems that enable not just one service but within the UK (inaudible) we identify over a hundred service categories and not just services, so when we put something into someone's home that costs no more than one service you make it applicable to the wider market and that's how we do it and stop the banging on the wall about one service, one service because people are different with different needs.

NEW SPEAKER:  A couple of comments you said the video in Hackney about using paper and it becoming unrecordable and that triggered the parallel with the assisted living area and getting involved and we make software which integrates systems in commercial buildings, airports down to a house and we're very much involved in discussions around the use of this in the home and the problems are identical in terms of the compatibility issues that Graham Worsley was talking about because we have lots of different network protocols and communications standards and you just want to make it all work and the technology exists to pick up on Heinz's point that we have plenty of technology to do this stuff, it is just a matter of getting it into the market in the right way, which is the bigger problem the comment about the problem about pencil, the analogue, how many hours between building environment and assisted living. Buildings need to be looked after as well and there's a whole industry of maintenance management software that automates process sands looks at making it more efficient because sending out engineers in vans to fix things is very expensive so people have woken to this and say how do we optimize it. But this kind of technology doesn't seem to be deployed on any scale in assisted living or caring for people in homes even though people are far more important than the equipment that gets looked are in buildings. I guess one of the reasons is because back to business case issue, the economic costs involved have not become too acute yet but it is clear they will. Again, software is there, there are very sophisticated software packages that track everything, you don't have to resort to … point, it is entered digitally at the Helpdesk and from then on is trackable and traceable, all known stuff; it is not difficult.

MARTYN GILBERT:  When you say this, it is not an issue, I suspect it is, because the services are discretionary and if you have a problem you can't just say County Council, help me, they will say 'no'. So I think it is probably more of an issue rather than less.

NEW SPEAKER:  No, the thing I was saying was not an issue was the technology.

MARTYN GILBERT:  So there's - is it Maggie?

NEW SPEAKER:  Maggie Ellis, London School of Economics. I want to make three quick points. Heinz Wolff mentioned superfluity of the use of word 'business plan; business case and business anythings because it is one of the most misused set of words in the whole of Europe; it is mainly because people now are being asked to include this topic in their research applications. On the whole it is being dealt with by people in technology world who know little about running business. They know about developing technology, they know little about the users of technology and that is the failure. I am delighted the technology strategy board has finally said enough is enough, we want to know if it is actually going to save money good on you , I say so that's point 1.

Point 2, I think that we shouldn't be too depressed about what is going on in this country. We have the biggest research project anywhere Europe with the demonstrator £80m, it may not be the project you want but it is there and some people are benefiting. In Scotland already the government have funded 23,000 people to have technology, Telecare and Telehealth and telemedicine at home. That is saving money. They have the figures to show it.

So I think we shouldn't under estimate how many people are benefiting. Thirdly, it is a plea to all of you: because I think one of the most important things that we should all be doing is to banish the QWERTY keyboard. We all learned the alphabet when we were children. We are spending millions in this country teaching children employees and everybody how to use the QWERTY keyboard. It is astonishingly 1920s technology and in my calendar it is 2010.

NEW SPEAKER:  I wanted to say that I have heard a lot about collaboration and before that gentleman spoke I had heard nothing about collaboration between the service users, the disabled people and technology people. But right at the point of a project being developed, not when it is more or less done and dusted and just wants to be tried out for market, but actually in the whole development of it and somebody else said people aren't asking what they want. Sometime people don't know exactly what they want until they are actually involved in a project where they know something has not been right with the way they have to live their daily life but they couldn't put their finger on it. But when they have been involved in a research or development project, looking at how to make disabled people's lives easier, then actually can begin to ask what they want. You don't know what you don't know.

Also, there has to be a whole cultural change in the way personal assistants and, if you want to use the word, carer is looked at. It is a very under valued job and it is actually a highly skilled job. That should be looked at in that way and it should not be looked at as something you can persuade relatives to do for nothing or other people to do for nothing but that actually it is a highly skilled job that should be valued like that. As Professor Heinz Wolff said tools for living are vital and people are tools as well and need to be used properly. Consultation has to happen right at the beginning level for things to be developed that really work well.

MARTYN GILBERT:  Thank you. That question for Richard, because this theme of individual consultation is something that certainly arose in the Mon Ami project. Because it is a project these things have to be - how do you involve 3m people and the answer is you can't. You have to adopt strategies where there are core architectures to systems and the closer you get to the individual you have opportunity to take individual contributions. The problem with that is specially if we are to see them in the UK these systems, not in 20 years time or not in 29 years time but in one year or two years. What has to be done to get the Government, even if it is not necessarily money to actively coordinate all skills and all existing budgets to start to see these architectures which already exist, such as Chris mentioned, being deployed out there and have mechanisms such as individuals can say what they like and don't like. What has to be done for governments to actually be engaged in this process.

RICHARD FOGGIE:  I put in word for the TSB here, I have had a long debatably successful history of companies, technologists, forcing things on people and the first competition TSB ran under the assisted living programme was about user centric design. To a greater or lesser extent, typically to a greater extent, did involve the representatives of various user communities, now also an issue over how well do those user representatives actually represent users, the community they purport to represent but nonetheless there has been a lot of work getting that sort of input into the projects and genuinely trying to fashion products and services that users do want.

You have then got the question of finding how to do that in some sort of isolation, and not untypically it is a special interest group that gets involved so they are representing the views of a small group to some extent. When looking at scaling that to three hundred users, I think that to some extent we have to follow the examples of auto motive industry so you have mass ---- assuming anybody can afford to buy a car again in the not too distant future it is not a cakes of going in saying I want that one, that colour, that engine size, you try and buy a... these days there's a thousand permutations of the build that can be put together, such you come up with something, although mass produced, it is customised.

MARTYN GILBERT:  Of those nine projects, how many are seeing deployment in the market now.

GRAHAM WORSLEY:  They are our projects, I can say hand on heart none of them.

RICHARD FOGGIE:  We are working on it.

GRAHAM WORSLEY:  They will have done two years of a three year project but the hardest part is not the technology project, it is then going into deployment. The technology is the easy bit the deployment is the hard part.

MARTYN GILBERT:  The point was about consulting with individuals and so we keep coming up, anything that involves consulting with individuals, it appears not to be mass market so we come back to being ---- the car it's a mass market product and the point raised about once it is in volume you can do it, cars - the first car wasn't famously, any colour you like as long as its black because that was the first colour. If you extend that analogy to homes, you can have any service you like as long as its Telecare. If had to pick the three things that a smart home would do that in your world would make it a mass proposition, what would those three things be.

HEINZ WOLFF:  I happen to be concerned with one of them, a single gateway, a single innovation gateway to which everything from banking, shopping, medical information alarm systems and so on would go. The second one is that you have to make it attractive for neighbours and friends to do things for you and it is not a secret I keep lecturing about it, I am working hard on a scheme where the care you obtained when you are older depends on how much care you had given when you are younger I believe it is the only way we can get anywhere near enough human input into the caring system. That would be my second requirement.

My third requirement would be to have IT as unobtrusive as possible, IT that doesn't dominate but IT that happens to be around and is in conspicuous.

BOB TWITCHIN:  I think a simple control, one device people can use to operate all the systems, that will interface with whatever system. It has to be easy to use and could I actually add something about the user discussion choice would like to - I don't know how many people, in terms of web accessibility, there's a new initiative called Fixed Web, the idea for a blog, an interactive blog, to bring together disabled people who have problems with websites and web designers, techies to deal with it. So this is actually encouraging users who have problems then to talk to an expert about it. That is one thing that would have enormous possibilities.

MARTYN GILBERT:  The key thing is couplings, connecting people to together. I would like to tell you a short anecdote. I was talking to a gentleman named Martin Lewis who used to be a newsreader on ITV. He is Chairman of a charity that - the formal name is youth net but they dropped the youth bit because they thought young people would find it patronising. It provides help for young people with a variety of problems. Until I first knew these people, it was organised by Richard, I was unaware of hundreds of thousands of young people who self harm and have all manner of problems. They recently had a big expansion and are now ten years old. One of the services that I was talking about with them was the... 1 thing the charity does it gives advice to young people anonymously, but specially from their peer group and one of the things they try to do is provide volunteering opportunities for them. I was talking about a television based service where elderly people or anybody with limited mobility want to do their shopping but if you try to access a conventional website it is pretty much opaque. Why not have some young people who are very technologically savvy sat in front of a PC on a volunteering basis and what the older person sees on their television in their home is a picture of that person and they say, well I would like to have T shirt - talking on the phone 'I would like a T shirt please for my grand daughter' so they can see the person they are interacting with, even though it is not physically in person you have an older person talking too younger one. We have had as well times how people at age extremes get on very well together. So using the smart home here as a means of independence because the person in their home is able to do their shopping and the most important part is not actually the shopping, but they are talking to someone. Rather like the experience of years ago: you went into a shop and talked to someone across the counter. The point is it is on your television. There's presently trying to work that up into a project so that the technology is being used to connect people in that way so that on the one hand you are connecting generations and on the other hand you are providing assistance. And for the young person, what it does for their self-esteem knowing they are helping is immense.

MARTYN:  And there's we're trying to work that up into a full project so that the technology is being used to connect people in that way.  So that on the one hand you're connecting generations but on the other hand you're enabling the sans for the young person what it does for their self‑esteem knowing that they're helping older people is immense and the issue of self‑esteem is important but just a bit about that and hopefully you'll hear more about it soon. 

NEW SPEAKER:  I work on mobile phones for the senior market.  A whole jumble of different things.  Heinz's point of not enough people for the support, I would argue it's possible there is a growing army of people who are the older people.  The reason we have older people is everyone is living longer and healthier and I think you confuse older with decrepit.  On the business case, one of the differences between older and disabled is a lot of older people are wealthy.  Eighty per cent of the money in America is controlled by people over 65, so often you can build a business case on something in small volume making it very expensive.  The Department of Transport talked about how aeroplanes have got lighter and trains need to get lighter as well.  That is happening in the same way.  McLarens announced the first road car with a pressed carbon fibre body, superstrong and superlight, £100,000 car which will be rare, but it will filter down to the ordinary cars, but it takes time.  So you don't need things to be mass market instantly for the benefit to come later.

MARTYN:  The technology we're talking about, twenty years to avoid it having the same conversation in another 20 years, what you have to do.  However, I suspect we are running out of time.  I'd like to do one last run through with the Panel for their final comments, starting with Graham, please.

GRAHAM:  I need a new word for "business model".

RICHARD:  There are so many points.  I think indeed why is it going to be different from now on?  I think we've reached a tipping point, probably in socio‑economic terms.  I don't see a viable alternative, frankly, and I think necessity will drive this forward.

HEINZ:  I believe that the government will maintain the health service as well as it can, but will not maintain the comfort, quality of life service for chronic disease for elderly people because they can't afford to and at the most extreme cases, (inaudible) and the community haven't yet taken any steps to take it up.

BOB:  I think I want to echo what Heinz is saying that I do agree we're at some kind of tipping point, but I'm very concerned as to how this will pan out in terms of the quality of life of an awful lot of older and disabled people, unless groups such as we have here today can get together and start making things happen.

MARTYN:  n I have a show of hands.  Who feels that they would like to be involved in making this mass market available, available to everyone? Everyone? Who would like to play a part?  Not to commit to, but who would like to play a part in breaking from 20 years to one more year? A show of hands, please? Excellent. I was hoping for that. Thank you.