'Think Formula 1 and don't make token gestures', telecare designers urged

Manufacturers of telecare and telehealth devices are being urged to think more like Formula 1 designers and not make 'token gestures that create barriers to independence'.

The plea was made by Team GB 2012 Paralympian wheelchair basketball player, Clare Strange, at the annual international Telecare Meet The Buyers event at Stoke Mandeville Stadium in Buckinghamshire recently.

Paralysed from the waist down in a horseriding accident in 1997 at the age of 18, Strange has not only strived for athletic success, but has also taken a keen interest in the design of the equipment she uses on a day-to-day basis.

It's token gestures that create barriers and it's about how we challenge and innovate and find different ways to do things

And, she says, if telehealth and telecare devices are to help patients stay independent in their own homes for longer, then manufacturers have to move away from a one-size-fits-all approach and find more flexible solutions.

She told delegates: "Let's be Formula 1 about it and bring this level of innovation into everyday life. When we design something we need to ask ourselves, does it prevent people from doing what they want to do and ask how do we push the boundaries that not only help people to be independent, but also enable them to push the boundaries in terms of what they think they can do. We need to ask whether we are limited in our belief of what people are capable of. When you do take risks and push the boundaries, it is amazing what is possible. It's token gestures that create barriers and it's about how we challenge and innovate and find different ways to do things."

Over the past 15 years, Strange has had a number of wheelchairs, and said concerns about health and safety often override the more important issues of comfort and performance where medical devices and aids are concerned.

She said: "My first wheelchair had to have room for a coat because that's what the manufacturers had been told it had to have. The second was too narrow, and I don’t want to sit on a pressure cushion because it causes scoliosis. In the past few years I have been able to get involved in designing my own wheelchair and, while it did not cost any more, it was built with me in mind and so meets my needs much more effectively.

"Sometimes the obsession with worrying about health and safety gets in the way of performance. The Paralympic Games has changed the mindset towards disability and now it's about finding ways that people can become really integrated and giving them the tools with which to do that.'

The Paralympic Games has changed the mindset towards disability and now it's about finding ways that people can become really integrated and giving them the tools with which to do that

In the same way her purpose-built wheelchair has helped her, so too, she said, could well-designed assistive technologies give independence to sufferers of long-term medical conditions who might otherwise be hospitalised or have to live in nursing or care homes.

"Things that make people's lives easier do not necessarily cost money if they are considered from the outset," she added. "For example, when they built the accommodation at the Olympic village, everyone said they had built something specially adapted for the Paralympic athletes. That's not true, they just built the accommodation with disabled people in mind. It didn't cost more not to put lips on the flooring where there are doorways or to lower the light switches and sockets. It is all about mindset and thinking about design from the very earliest stage."

The need to create solutions that can be individually tailored was also voiced by Dr Allison Graham, a consultant physician of spinal injuries at the renowned Stoke Mandeville National Spinal Injuries Unit. She told the conference: "It does feel that some of our healthcare services are on one side of a canyon and there is a promise land on the other side. We are having difficulty getting across and to do this effectively, we need to make sure that the technologies we are creating are fit for purpose.

"In the NHS our cupboards are full of equipment we have bought over the years because we were certain it was the next big thing, but which is now gathering dust because it didn't do the job.

It does feel that some of our healthcare services are on one side of a canyon and there is a promise land on the other side. We are having difficulty getting across and to do this effectively, we need to make sure that the technologies we are creating are fit for purpose

"We want to continue to look after people while they are living longer and with less funding. There are lots of things out there that can help us, but we need to work together to get through the barriers that exist. We don't want the status quo. We want to make people better and to help individuals. Patients are not terrified of technology, but we have got to get it right."

Also speaking at the conference were a number of telecare and telehealth manufacturers already operating in the UK marketplace. They provided some further insight into what local authority, health and social care purchasers, and patients themselves, were currently looking for in assistive technology innovations.

Simon Eckett, director of health at Buddi, which supplies mobile personal alarm systems, said: "As a technology company, we are always talking to customers and finding out what they need, then as a manufacturer it is up to us to find out how we can deliver that.

"Things like packaging are important, but above all the device has to be simple. Hardware must be small and discreet, if you are using GPS it has to be precise, and you need to provide 24/7emergency cover. It terms of software, we have found that customers want access via the internet, as few clicks as possible and, when they are tracking people using GPS, they want to know their immediate location at any given time.

"One of our customers, for example, is a 31-year-old man with Down's Syndrome who lives with his parents, has a job and likes to socialise with friends, but does have a tendency to wander and get lost. He carries one of our personal alarm systems and his parents can set specific parameters so that if he does wander past these, they are alerted and can help him. It is about tailoring the solution to the individual so they can maintain their independence and stay safe."

We don't want the status quo. We want to make people better and to help individuals. Patients are not terrified of technology, but we have got to get it right

Hossein Sharafi, managing director of Care Harmony Solutions, added: "Ease of use of these devices is very important and a long battery life is also a key consideration when developing assistive technologies. We claim that these devices can help people to lead a more independent life, but one customer said to us that carrying a device, or having equipment in their home, made it clear to people that they needed help and were less able. That's still a dilemma for us as designers and manufacturers as we have to develop tools that people want to use."

The huge potential market for assistive devices in the UK follows a number of key developments over the past year, including the publication of the outcomes of the Government's Whole System Demonstrator, the world's largest controlled randomised study of telecare and telehealth innovations. This revealed a major positive impact on healthcare costs and disease management.

Ben Ramsay, Intel-GE Care Innovations' UK market development manager, said: "We have seen more changes in the marketplace in the past 18 months than we have in the last five or six years. Technology should be considered an essential tool and should not be tagged on at the end.

"Strategic planning is vital from the outset. We need to ask what it is our customers want and how are we going to deliver that. It is unlikely that there is going to be one single solution and because we have a range of patients, we should have a range of technologies."

And he warned that as well as being innovative in terms of technology design, industry would also have to come up with some alternative funding options as public spending across the UK is curtailed.

"There is no capital to be spent at the moment," he told delegates. "We have got to consider pay formats based on an element of risk sharing, considering things like patient volume commitments and we need to be looking at revenue-based models that will show a return on investment over a very short period of time.

"The UK has been really slow at adopting assistive technologies and the pilot schemes, while often successful, involve only a handful of patients, so the old systems remain in the background, preventing widescale adoption of new ways of thinking.

"We need to ask are we creating barriers through technology and we need to restructure our funding models and also raise awareness and give providers and patients the confidence that it is going to work."

We need to ask are we creating barriers through technology and we need to restructure our funding models and also raise awareness and give providers and patients the confidence that it is going to work

Firas Sarhan, a senior lecturer at Bucks New University, concluded: "We want devices that will meet the needs of the individual and ensure their safety as well as helping them to lead a normal life outside of hospital.

"In the UK we need more demonstration facilties, more field trials and case studies, better evaluation and auditing, improved training and education and we need to encourage leadership, reaffirm our goals and be much better at sharing knowledge and information about the impact assistive technolgies can have.

"We have got to have a vision and a very clear vision. There is no journey without obstacles and you have to get past the first mile and then everything will hopefully become clearer until you reach your goal, and in this case that is to see assistive technologies used to deliver supportive care."