My name is Andy Jugg. I look after proposition development and business development for our Connected Care practice in BT Global Services - long history of product development, mainly in the telco side. I'm not a clinician in any way, shape, or form but have been heavily involved with this.
I guess the first thing is, actually, what do you think of BT? But I'm keen to do a quick hands-up, actually: how many people know what telehealth is? Keep your hands up if you're involved with it in any way, shape, or form. Great, good, and same for telecare, who knows what telecare is? Not many. I thought it was going to be short presentation, never mind.
So, BT, what are the first thoughts, what do you think of BT when you first hear of it? Is it great public convenience?
Delegate: Copper cable.
Copper cable, telephone lines - that's what you immediately think of BT, but we're a lot more than that. It is now massive fibre investments going in; it is... we're a TV company - BT Sport, as you're probably aware. We have connectivity into around 20 million households in the UK, either directly from our own consumer piece or by our wholesale customers, so we absolutely directly touch the majority of people in the UK in one form or another.
Internationally: 170 countries, wide area of operations, all sorts of different ICT, but we also havehair a health practice within this. It's a big part of our business that we work on and we have a long history in that space. I'm going to let you read the slides as we go, I'm not going to repeat from them, but it's only when you start looking at actually how long has BT been involved with the NHS and what are the key things?
We do have some big research labs, some of the biggest in the world, at Ipswich. It used to be known as Martlesham, now known as Adastral Park, and we invest heavily in that, around £4bn per year. We also have some specific guys who are scouts, who go across the world - mainly Silicon Valley and Israel, because they're the two hotbeds of innovation - who go, look, see what they can find, see what they can bring back so we can bring the latest innovation.
That's interesting to say with a whole load of engineers in here, so you may have a whole load of innovations as well and if you can find anything in here that you think, "That would fit in telehealth," fantastic; come talk to me after, because we are looking more and more; what else is there that we can do?
Again, just part of our pedigree around the NHS: 51,000 connections, so it's back to connectivity, all of the trusts, GPs. We have what we call 'Spine', so all of your prescription services, secondary user data from the NHS goes in there. We deploy electronic patient record systems across the south of London and southeast - major, major operations within the health service.
That's enough about BT; I'm not here to tell you stuff that you already know. A number of the trends that are going on out there at the moment: we're all living longer; great, I'm pleased about that, but at the same time the budget challenges are out there. We have more and more patient expectations. There's a common misconception that the elderly can't use computers, don't like technology. That may be true for a small minority, but more and more people are out there that want the internet, they want connectivity; they're au fait with actually using technology. I think tablets and smartphones have really brought that along, because they're just so simple and easy to use, so actually why don't we start to use that within our services and our capability?
Increasing demand, other parts of the world: talking to big Chinese healthcare suppliers, the whole organisation of their healthcare industry surprised me. You have a few major hospitals in big cities; if you want an appointment, you get there around 6:00am in the morning and you queue. If you think of a big sale at a supermarket, I've seen the pictures - it's literally like that on a normal weekday.
Nurses do nothing medical. If you want a plaster, you want some stitches, it has to be a doctor; nurses are admin in there, which is a really different world. Big changes are going to happen there and those changes are going to bring economies of scale and impact the rest of the world.
I love this picture; it just reminds me it's not that long ago where you had a mobile phone. I'm talking about the phone, not the hairstyle. Those mobile phones, I can remember carrying it like a case. Now look what you have today, and changes all the time, so much so there are so many challenges - this is me on a good day actually - so many challenges there that it's going to make life interesting. Again I'll let you read some of the stats here, but it makes interesting reading.
I've seen lots of press around how a number of NHS trusts are going to go into deficit, how everything is going to die, blow up; we can't afford it. Loads of press on that; has anyone seen any press on how it's actually going to be fixed, how the problem is going to be resolved? Anyone? That's not a surprise.
As always, I don't think there's one answer, but as an ex-engineer I always look at technology. Part of this is how do you keep patients and serve them away from the hospital, nearer their homes? People don't want to travel in, and you don't want the cost associated with actually bringing them in, into a hospital and actually taking up admission space.
What are BT doing?
We have a vision of our new world of care, with a number of areas. Top left box: interoperability - and I'm just going to skirt over these very quickly.
Today your social care system you go into a trust, you may have multiple systems there, different electronic patient record systems, consolidation of the trusts. You may have four or five different patient systems. What are you going to do? Are you going to rip them all out and put one new one in to standardise make life easier, at a cost of many millions of pounds, or actually do want the capability to integrate them together into a single view that makes them useful? You can keep your legacy, but I'm now putting an integration layer in, with a number of portals for the clinicians to look at and actually creating portals for patients to actually access their records. It's a capability that's there today.
I spoke to some trusts where they have health workers that don't even have mobile phones today. They pick up their jobs in the morning, they go out, and they go from one job to the other. They can't update the patient records directly onto the systems - handwritten notes quickly; when they get back to the office, it's then type it up. How efficient. Can we improve and can we bring that back? That's part of the whole mobility plane.
Very much with telehealth, like many other things, is it suitable for absolutely everyone? Actually, no, but you need to be able to find out who you need to provide it for. You need some analysis; you need risk stratification to find which are the key patients that you need to provide it. I'm telling you to suck eggs, but...
Telehealth and telecare we'll go on to.
- this is the classic: a number of trusts have big IT departments, they have multiple computer rooms and actually spend a lot of time focused on IT, instead of focused on healthcare, so actually is there the opportunity to outsource it, put more applications in the cloud, save space and reduce the costs? Maybe.
When you look at telehealth and telecare, there are a number of benefits associated with this. It's probably apt at this time to say BT took over an operation last year, in partnership with the NHS in Cornwall, with the district council in Cornwall. We now run an operation that has 11,000 telecare users and 1,000 telehealth users. There's quite a lot of experience in there that we've been getting and where we're at is actually taking that, industrialising, and then making that available across the UK - and taking learnings and using it internationally as well, mainly focused on the Far East at the moment.
What is telehealth?
The solution we have is based very much on medical devices in the home that actually work via Bluetooth. They connect to a specific smartphone with an application on it; that acts as the hub, connects either by Wi-Fi or mobile, via a back-end system that can then be accessed by our team of nurses. BT is registered with the CQC, so we are clinical as well.
From there, it's very much a personalised patient telehealth pathway is created for each individual, dependent on their condition, in liaison with their medical GP, etc. to actually build what they need - are they suffering from chronic heart failure? Is it COPD related? Is it diabetes? - and actually build a regime for them.
There are triggers that actually remind them when to take medication; there are questionnaires that are built and can be built to say, "How are you feeling today?" You can actually take those, build those into this back-end system to look at trends over time, so if you start to see someone moving outside a range that is set for them individually, then you know it's time to take some early intervention. That's where the nurses come into play.
Just to give you a view - excuse the acronyms, I'm sure you guys all know what they are anyway - these are the main long-term conditions and the recommended pieces of kit that we currently use. We're looking to say, "Actually, how can we expand this?" There are a lot more areas here that we can deal with as part of remote telehealth, so we are looking to expand, develop this further, and we'll talk about some innovation as we go.
Just to give you a view, one of the big questions is of telehealth, "Actually, is there a return on investment on this? Doesn't it cost a lot? Where are the savings? Prove it to me. I don't like change; I want to stay where I am." I think the key thing here is the NHS has to change. I'm not quite sure anyone really knows how, but it has to; it can't stay as it is - my opinion.
If you take a look on here - hopefully it's in the pack and you can have a look later - a person that goes in non-planned, long-stay admission: £2500. What does it cost for telehealth in comparison? It's an immediate return on investment - and that's without GPs, ambulance services; you start to add it all up.
Actually, just taking one piece of that - reduction in hospital admissions - we're always asked, "Give us the one piece of evidence." There was a whole systems demonstrator, which is a bit dated now, which said, "Yes, things are great." Lots of people said, "No, I didn't like the way that was done. The study wasn't accurate," but there are lots of different studies.
What we're doing is just trying to pull together the evidence database, not just hospital admissions; repeat admissions is another classic, how many have come back in in 28 days, how many extra visits to GPs, etc.? We're building our own evidence base from all of the different research. Do you know what? I haven't found any that have said, "There's no benefit in doing it." The percentages vary; I think that's the key thing here.
Looking at a bit of a case study, this is George, but actually - I'm going to put this up - it could just as well be my own dad. He has lung disease, respiratory issues, COPD, he has heart conditions and has very little mobility; he doesn't get out of the house much at all. He also, within eight months, went under blue lights three times into the A&E, an 18-mile trip. Two short visits sorted him out; third visit was at least seven days - interesting, worrying times.
Thankfully he's back out, but the whole power of this is to give some indication of actually when to take action. A lot of people have got their stock of a rescue pack of drugs at home, but actually when do you start it? When do I start taking my antibiotics or my steroids to actually make a difference? That's what telehealth does; you've got a nurse there monitors, spots the trend, off you go.
Since he's had that instruction, that support, he actually hasn't - touch wood - been in A&E, and that's for the last six months now, which is good for us because it's less worry. I live three hours away from them, so that is really good, but that is some of the benefits. It feels immediately, if you take it down to the personal level, there is intrinsically a benefit of a telehealth service.
So this is... "What has it done for this character?" and it's pretty key in here: it does actually help patients start to get more involved with their own care. It's not something that's done to them, it's something that they're actually involved with and start doing; they learn a lot more. I've got another survey from our patients down in Cornwall that we can actually show as well in a few moments, but it's not just the COPD; UTIs - big issue. Again, catch it at the right time; early intervention, it makes the difference.
This kind of speaks for itself when you look at this: 60% have said, "It actually makes me feel more supported, more safe. Someone's there, there's a safety net; they're actually looking after us."
That's telehealth. Telecare - and these are intrinsically linked -this is, very simply, the provision of devices, sensors, peripherals in the home that are linked, either via broadband or direct via your telephone line, via a platform, monitoring platform, again to a 24/7 monitoring centre. This is the classic... Actually, in Cornwall about 80% of the users just have the pendant.
You've probably seen the pendants or a wrist strap. If you fall over, if you've got a problem, you press the button; it immediately sends an alarm to the monitoring centre, they try and establish a contact with the person, check over a voice path, can they make contact? Are they okay? It may mean calling the emergency services immediately or going to one of the responders - and it could be one of your relatives, your parents that you're a number on. You'll get an alert 24/7, "Yes, my mum has fallen over; she needs help." It's an extra, again, safety net there for a carer and if the carer's not there then there's the A&E to be immediate.
A couple of pieces on it: how many times do you hear in the paper a person has had a fall and they've stayed lying on the floor for over 24 hours before someone has found them? This is an insurance policy to that extent. We actually find in Cornwall that most of the users are over 75, but it doesn't have to be the elderly.
Actually, when you sell this, you actually sell it to the relatives, the children, because whenever I talk to my mum - who's 80, by the way - and say, "What about this mum?" "No, that's for those old people." Right, okay (Laughter). It is selling to people that care and that's where a big, big benefit comes in.
One of the things we see is the amount of residential care and the cost of residential care. If this enables people to stay in their own homes longer for having technology in the home, then actually why not? It's a darn sight cheaper than actually having to go in, less than a pint of milk a day type of pricing level to enable someone to stay in their own home. To me it's a no-brainer.
In terms of the sensors - and I'm not going to dwell too much - there is a range. We're looking for what else there is. We've already got in our research labs guys that you may have extreme temperature sensors, they've got the capability of remotely going in and changing the temperature. If your mum is sitting at home freezing cold, actually I'd like to go in and just say, "Turn that heating up. Forget the bill, we'll cover that; just turn it up." There are more and more capabilities there and I think this is an area where a lot more can be done.
As I say, today most people just take the pendant. Some people use a number of these, especially the movement sensors, almost as a precursor to decide: should a person go into residential care? Can they support themselves?
I spoke about our interoperability; this is very much bundling the telehealth/telecare in with everything else. It's an integration layer where you take the electronic patient records, but you can also put all of the telehealth information on as well, so I get a joined-up picture. I know what's happening from their social care perspective, I know what's happening from their telehealth events, and I know what their patient records are; I can see what's going on and create one picture across the piece. It's got to save rework; it's got to be more efficient.
I thought, as engineers here, Robotics has got to come in, hasn't it? Can anyone spot the flaw with this? Anyone?
There's a room of engineers here; you've got to spot the flaw.
Delegate: The stairs.
Andy Jugg: The stairs? No.
Delegate: There's a power cord.
Andy Jugg: The power cord! You're not going to go far with this, are you? Yes, so I don't think this is going to quite be there, but there is a lot of innovation that we're finding and looking. Some of this you may know of; this is just some that we've actually spotted.
The top left is an interesting little unit - very small device. Hold it to your temple; press the button for 10 seconds. It tells you your blood pressure, your temperature, your pulse ox; it also links with other devices. That's going into pilot now in the States, going for FDA approval, so not here yet but it all came from the idea of can we replicate the Star Trek approach: one device, scan, that's what's wrong? That is quite an innovative piece of kit, if it does what it says on the tin - and we're kind of assured it does. It actually sits on NASA's research site, which is the company that does it.
BT Companion: this we've actually done some trials on. This is very much video on your TV and this is the capability to help remove social isolation, so actually you can dial up, you've got video over it. Yes, you have broadband in there as well, but it uses the TV with a very simple control. It is that simplicity and not having to buy £3,000 or £4,000 video conferencing units; it's just a couple of hundred pounds, sits on your TV, off you go. We're trialling that at the moment, but that's looking good. I'm not going to say, "Mobile apps," you can find an app for everything now; just pick what you like in the store.
Wearables: this starts to get interesting; more and more companies now with shirts building in sensors. You can even have the sensors in the pill now that you can take and it will remotely work for a short period of time. It's all sitting there; there's a lot of innovation coming in this space.
True-Kare, this is a little Portuguese company that actually have combined telecare with telehealth. This is a mobile where they've built in a tele-care radiofrequency into it that will enable you, wherever you go, to actually raise the alarm. I'm out of the house, I'm down the street, immediately raise an alarm, back to the monitoring centre, pulls up a map; they're here, great. I can talk to them, but also I can now actually know where they are if I need to respond. It also combines a blood glucose monitor capability, medication reminders, as well as blood pressure. We haven't got them in our portfolio yet; in fact, we haven't launched any of these yet. This is just innovation that's coming along that we're looking at.
Where does that take us? Video. Everything today has been audio, data flows; more and more video we're already seeing. We already see the cases of a clinical centre providing a video room in a care home and in a prison. These are the two models that we've seen; a few hundred of each are actually out there at the moment, and you can see why. What's the biggest cost of providing medical treatment to a prisoner or consultation? It's getting the security, putting them in a van and taking them to the A&E. If you can avoid that by a video consultation, you save money. There's also less chance of escape. I shouldn't draw a parallel with care homes, but it's almost similar in a way that you've got a room there that you haven't got to subject the elderly person to an ambulance journey, so that is an immediate benefit.
That's video, but where we're going to go from this is, "Actually, I want to see my GP. Do I really need to go to a GP surgery and mix with all those other people with germs? Why do I make my life worse? Can't I book up and just do a Skype or a quick video call to them and do a face-to-face video?" Why the hell not? Lots of issues around process, scheduling, funding, how do GPs get their money, etc.? That's all going to be fixed; it has got to be. We see some trials of this already starting, but it has got to be the way to go.
Again when we talk about wearables, telehealth today is very much I will do a scheduled check, I'm prompted when I do a check of what's going on. You may have a portable ECG that monitors and then feeds back, so actually aren't we moving towards I can do 24 by 7 monitoring? I wear a vest, comfortable, and it permanently tells the clinician what's going on. I have a health record, a health update. Talk about early - you're going to have this whole 24 by 7 set of data for your condition.
To summarise - So our connected care and just, in fact, anyone's connected care, this is just a general piece: the outcomes of telehealth and telecare, when applied, improves quality of life, makes sure people are more independent, stops the residential home element, or delays it anyway, and helps enable care in the home instead of in the hospital trust.
As part of that there are savings. Is it enough to save the NHS? We'll see, but it's got to be something radical that happens and this could be just one part of it.
I will leave it there, if anyone has any quick questions...
Andy Juggs presentation may be downloaded here: http://www.ebme.co.uk/downloads/viewcategory/14-2014-seminar