Implementation: The Key Factors
Evelyn Pellow
Enabling Concepts

Why is Evelyn Pellow standing in the front of you today and what is my journey?  My journey began 12 years ago when I came into the construction industry at the building research establishment and I am sure many of you have been there and gone through main gates to the right hand side, the wonderful dream house of the future. I was involved that and that's where my interest and excitement with technology came from. Over the 12 years I have been a bit frustrated, I would love to think it would have moved faster but I think it is ceding up. At the moment, I am working on two projects.  One is ALEP2, assisted living any time anywhere, and it sounds a bit like a song title, and then I'm working with the national development team for inclusion in Portsmouth and talking to elderly people with high levels of disability about what is working for them and what is not working for them and how we can support them and make housing more a part of the communities.  We have had a busy and informative day and I'm sure you continue to be inspired and excited by the latest ideas on smart living.  Perhaps you're suffering from brain overload.  Can I ask you to keep going a little bit longer while we tackle training, who pays for what and ethical guidelines?

What are the critical issues?  Ensuring that the dream of smart living becomes a nationwide reality.  I recently read in terms of adaptations in people's homes in the region of 60 per cent kit and equipment is not used or used effectively.  That is not just frightening.  I think it's terrifying.

The reasons given were either the equipment had not been installed properly in the first place.  Or the user had not been shown how to use the equipment properly.  Or even when it had been installed and they had been having the benefits that it broke down and they had great difficulty in getting someone to come and repair and maintain it.

So as we go from grab rails to smart homes, we have to ensure that this is not the norm.

The training element of the project is a major key to success.  It has to be an integral part of the smart living.  If it's an after thought, it will fail and people will be denied the huge benefits of smart living.

So how do we deliver quality training to the installers?  The users?  And the carers?

How do we make it happen?

I think we need to raise awareness of what smart living is and what it can deliver for everyone in every community.  We need to be out there changing attitudes.  That is never an easy task.  But there are tried and tested strategies for that.  We need to use these.

We might all be convinced of the benefits of smart living, but lots of people out there are not.  Lots of people don't trust technology.  They have had bad experiences.  They don't see that smart living has the potential to transform all of our lives.

So, through publicity and campaigning, we must build confidence and help to make people comfortable with technology.  We need to make the technology seem normal.

So we need to be trained.  The users and families and friends and carers and professional:  In terms of the installers, the industry and manufacturers and various training establishments and professional bodies have major responsibilities here.  The manufacturers are very much aware of the huge growth and ongoing growth of this market and are becoming more sensitive to the needs for high quality and appropriate training for installers.  There are various organisations which help to deliver training and we need quality training with ongoing quality control, inspection and monitoring.  There are organisations such as the Telecare services association, 350 members from local authorities, housing associations and manufacturing.

Particular elements of the training has to be around an awareness and sensitivity to older and disabled people.  I could regale you with horror stories I've heard about the appalling treatment from installers and we have to ensure that's a practice from the past.

So what about the users and their families and friends?  I think this is best achieved by a combination of the well trained installer and the professional care staff.  Training opportunities should be comfortable, clear and concise, with opportunities for the user to comment and interject and ask lots and lots of questions.

That comes from me being a primary teacher.  There must be simple and straightforward information sheets which the users can refer to and a big plea for helplines, absolutely essential.

Hampshire County Council have been involved with Telecare for five years and the feedback from users indicates that the helpline is hugely successful.  They have also created a system for regular visits from the carers to discuss the Telecare and healthcare kit and an annual review takes place.

I'm also wondering is there a place for peer group sessions?  Learning wisdom from each other at local community centres, health centres, pensioner association meetings.  I'm very interested in the growing intergenerational activity scene and I've been heartened by older people's enthusiasm for young people helping them learn about technology.  I was recently involved in a project in Pimlico and it was the refurbishment of a (inaudible) and the residents were elderly and I got the local primary school involved and we brought nine year olds in to show them what the people were living with and what we were hoping to do and what astonished me with nine year olds was their sensitivity.  They said," "I hope you're going to do something about this", and fantastic.  So I think we need to support this.  So why not a schools and college programme to support smarter living for older people?

Who is going to fund and support me to set that up?  We'll see.

I also think family and friends should be part of these training sessions in as many of the activities as possible.

Training the professionals.  Despite the tremendous workload and responsibility that professionals carers have, they're responding well to training.  It's emerging that the majority of professional carers who have attended Telecare and Telehealth smart living training courses have found that this technology training becomes a catalyst for staff who found new ways of working in general terms.  That is fantastic, isn't it?

They felt empowered by their new understanding of technology.  And felt more confident in helping their clients and patients and more able to feedback observations and suggestions for improved and enhanced smart living.

We come to the very topical and tricky one.  Who pays?  In the present financial climate, it will be essential we're able to put the best possible case for the expansion and national roll out of smart living.

I think we need to do a cost benefit analysis and that would help us to put the case.  The cost of care and the return on it.

In this 70s and 80s, I was campaigning  around education.  It was proving extremely difficult to put the case.  Then we heard about a project in the States called the "high school foundation" about quality early years intervention and they got some international economists, not American economists, to do a cost benefit analysis and what they found was for every dollar invested in quality education, there was a 7 fold return in terms of behaviour, examinations, less teenage pregnancy, et cetera, et cetera, and when we went to the politicians, local and national, with that sort of data, they changed their minds.  So I think it would be really useful to have some cost benefit work done on this.

In terms of government, well, there are so many departments involved in smart living, I think we've got to be very smart.

The new personalised budgets for social care represent a significant change for policy and practice.  People with social care needs who meet the local authority's eligibility criteria can choose the services they want, instead of having allocated to them.  If an assessor agrees that the chosen goods and services meet the person's needs and they're cost effective, the person can be given money to buy what is agreed or a broker buy these things on their behalf.  Things are underway for health related goods and services and the scheme will be rolled out nationally if the pilot is successful.  It's all forms of disability, including age‑related, and the implications of these changes are stark.  We must never forget the needs and aspirations of users.  There's a project the transforming community and services commitment programme, run by the Department of Health, that promotes the availability of simple technology through high school retailers.  I was speaking to her yesterday and she said the (inaudible) is starting to be kitted out and she's excited.  People will receive a prescription and product catalogue and if the person wants to enhance the service paying additional costs, they will be able to do so.  For complex equipment, distribution is central and pilots of the models are taking place on a number of places across the country.  Watch this space.  The challenge for manufacturing is to keep costs reasonable so value for money and affordability are promoted but not to the detriment of quality.  That includes safety.

A major challenge for manufacturing firms is the need to rapidly develop a business model to meet the needs of two markets, traditional purchase market of the health providers that doesn't encourage innovation or quality improvement and the emerging retail market which operates to a different set of values.

Now we come to ethical considerations.

Smart living Telecare, healthcare have the potential to revolutionise the care of the elderly, disabled and dementia sufferers, but can it be acceptable to make changes to a person's life and home against their wishes, even if it increases their safety and is deemed by their family and former carers to be for their benefit?  We come to the very complex, and I use the word advisedly, scary issues of ethical considerations and guidelines.

In our approach to this, we must be morally and professionally meticulous.  There are no simple answers and solutions and we must respect people before the technology.  I hope ‑‑ I know that's a difficult one for some of us to swallow.  Smart living like all the technology is evolving rapidly so we need guidelines and protocols that are applicable to emerging kits and products.

Many of the concerns are not only a consequence of the technology because such intervention is highlighting the long‑standing issues in the whole care setting and at the top of the list is consent.  No kit should be installed until consent is obtained from the user.  But as we're well aware, individuals' conditions decline and carers will increasingly have to intervene, an ethical challenge writ large.  How are the critical decisions to be made?

There's the Mental Capacity Act of 2005 which should be referred to throughout the consultation programme.

So how do we proceed?

Every effort must be made to obtain a person's consent, providers and installers provide the user with care and concise information in a manner that is understandable from that individual.

If a person is unable to consent due to lack of capacity, those acting on their behalf should consider the (inaudible) of all concerns, the needs and wellbeing of the informed carers, they also have to be taken into account.

The consent needs to be continuing.  Just because a person has agreed to something once, it doesn't follow they will always agree.

Manufacturers and providers need to offer a high quality of product and service and information.  They need to actively promote the products so people can access the system which is required for them.  Of course, the equipment should be reliable, responsive, practical, affordable and designed to make it fit for purpose and benefit the end user.

Any smart living intervention should be reviewed and reassessed regularly to address the user's changing needs.  There should be agreed timescales for carrying out these reassessments.  Something that I think I want to re‑emphasise to you:  The equipment must never result in an individual being ridiculed or discriminated against.  We have to be very careful here and avoid the association with tagging and the criminal justice system.  It's something I hadn't thought of until someone pointed it out and I think it's a very delicate area.

So let me just repeat.  We must respect people before the technology.  I know that the list I've given you is weighty but I think we can do it.  Can I suggest that perhaps we need some smart living champions.

I'll finish with a little piece I saw in last Thursday's London evening paper, the Standard.  I was sitting on the tube reading it and I noticed this piece in the corner and it said pants can save lives.  Better read that!  It said under pants that can save the wearer's life and have been created in California.  A sensor printed on the waistband can measure blood pressure, heart rate and other vital signs.  And could one day even direct the release of drugs.  Fantastic, I thought.  Absolutely brilliant.  Let's hope this really happens:  I read it again and I'm going to put this question to the women in the audience:  Under pants that save the wearer's life.  Are we going to have to go back to big knickers?