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The Government’s current strategy for healthcare is to place greater emphasis on care delivered close to, or even in people’s homes. This changes the emphasis of delivering much of healthcare through large hospitals. The next decade will see these shrinking in size and concentrating only on highly specialized aspects of healthcare which demand multiple and often costly diagnostic and therapeutic facilities.
Modern technology is the key to delivering a greater proportion of care in the community and to sustaining and supporting people to overcome the disabilities which affect their daily lives.
Few people who need glasses would consider themselves to be disabled – a reflection perhaps that defects in eyesight are common and the technology for assisting it has been around for decades. It is a technology which is both simple and effective. But other technologies are beginning to find their place in assisting disabled people to enjoy fuller lives. What has become known as Assistive Technology covers a multitude of applications.
In the past people were often greatly restricted in what they could do at home, sometimes threatening their ability to live in their own homes altogether. New services provided by Tremorvah Industries of Truro on the behalf of Cornwall County Council are giving people a better quality of life and enabling them to continue living at home or go to work. Simple aids can be supplied for daily living include self help aids for use in activities such as bathing, cooking, dressing, eating, and even home maintenance.
Modern electronic equipment provides people with the ability to carry on doing the sort of thing that most of us take for granted; closing the curtains, turning on the light or the television or opening the front door to a visitor. A ‘half way house’ will be opened next year where patients can visit a real home, fully equipped with the latest aids. There they can be trained on the use of equipment most suited to their needs. Cornwall is leading the way in the implementation of the broadband revolution and there will be many opportunities as we build or refurbish our building stock to introduce systems that will benefit both people working from home and those suffering from handicap.
For people with limited or no speech there are communication aids including devices which can be used to augment speech capability through the use of special communication boards and displays. Educational Aids that allow people with disabilities to perform work or school-related activities are increasingly available. Examples are modified or alternate keyboards, and special software (including speech recognition software) that allow people with disabilities to use a computer.
Mobility Aids allow easier movement and include patient lifts, transfer aids, and all types of wheelchairs. The Cornwall Mobility Centre, a charitable trust which is also based in Truro, provides Peninsula-wide services for both children and adults who need wheelchairs. It also serves adults who need special adaptations to their cars to enable them to carry on driving. The Centre is one of a nationwide network staffed with professionally qualified staff and has the most comprehensive range of such services on offer in the UK.
Other aids include artificial limbs, braces or other devices to augment, replace, or substitute for missing or non-functioning body parts. Developments in these areas have been truly exciting. Artificial limbs employ the latest materials technology and facilitate Olympic level sports performance. Others have inbuilt intelligent computer control systems which adjust the limb’s performance depending on the speed of walking – a far cry from the wooden limbs of less than a century ago. Finally Sensory Aids help people with visual or hearing disabilities and include hearing aids, low-vision aids, and telecommunication devices for the deaf.
The last decade has also seen the worldwide emergence of technologies which allow the monitoring of patients’ medical condition in their homes. Unobtrusive devices can be used to monitor a person’s activities – for example systems which monitor how often they get out of bed at night and how long they are away from bed can give warnings when something is amiss. Other devices which can monitor a person’s posture can tell whether they have fallen – a real problem for many people living alone.
Other devices can be used to measure the heart’s action and, by using radio links can transfer the information to a remote facility where abnormalities in the heart’s action can be monitored and alerts given of impending problems. This can lead to a rapid visit by health professionals to treat potentially life-threatening conditions which might otherwise require hospitalization.
An exciting new service, being pioneered in Cornwall in association with the Met Office will ensure that those suffering from Chronic Obstructive Pulmonary Disease (COPD) can be alerted to weather changes that could adversely affect their health. This alert enables appropriate action to be taken by the patient or their doctor or community nurse in time. COPD is recognised as both a major cause of winter pressures on the NHS, and of premature deaths in the UK. It is also the third most common cause of lost working days through certified illness.
Other studies elsewhere in the UK are investigating the use of a nurse led call centre. This is linked to a system which monitors certain data on each patient. When adverse trends are detected, the system alerts the patient and automatically dials NHS direct and the patient can be advised of what steps to take. It is anticipated that this will lead to reduced hospital admissions by facilitating intervention during the onset of a deterioration in their condition.
A great deal of technology is developed for and by the defence industry and fortunately much of this eventually finds its way into more peaceful applications. Several exciting projects are underway each of which is a pointer to the future. Many of these projects are focussed on the extension of hospital care to those in the community who would otherwise require hospitalisation. These include evaluation of methods to aid patient transfer, wireless monitoring techniques, diagnostics and telemedicine aids.
The invaluable role of ambulance crews and paramedics in delivering care in the community is often overlooked. Their role is particularly important in an area like Cornwall which has an unusual geography and difficult transport access between remote areas and hospitals, particularly during the summer.
A project called e-medICS is supporting paramedics in Surrey in their treatment of injuries and ailments in new ways. Using speech recognition technology first developed for Eurofighter pilots, paramedics feed information into the e-medICS system through an intuitive computer programme originally developed by Defence Medical Services for training military medics.
The system provides diagnostics aids and treatment menus and online support for taking decisions normally made by highly trained doctors. The system covers a wide spectrum of acute medical emergencies and trauma to aid the treatment of patients. The unit stores records of all patient treatment and interventions and is capable of then relaying a patient's vital signs such as respiration rate, temperature and blood pressure, digital images of injuries and summary reports back to Accident & Emergency experts in advance of arrival at the hospital. They can, if necessary, provide additional advice on how to treat a condition while the patient is in transit thus maximising the chances of a successful outcome.
Cornwall and indeed the Peninsula is a byword for excellence in cancer care which is co-ordinated through the Peninsula Cancer Network. The treatment of many cancer patients involves repeated courses of chemotherapy. During most of this treatment cycle the patient will feel fine but at some moments they will feel distinctly unwell and may require treatment within a few hours. A facility which meant that the patient only comes into hospital during these critical periods would have many benefits – not least the minimisation of potential exposure to infectious diseases.
A pilot system developed by QinetiQ allows physiological data to be collected from monitors worn 24 hours a day. These allow data collected to be analysed for potentially life threatening trends and values. If this is detected, or the patient indicates to the monitor that they are feeling "unwell" then the patient is asked to attach themselves to a conventional patient bedside monitor in their home.
At the same time the hospital doctors are alerted via an e-mail or pager message. By logging a standard desktop PC at the hospital the clinicians can look at the data and make an assessment of the seriousness of the situation and take appropriate action. This system has been successfully piloted in London but would have enormous benefit in Devon and Cornwall.
Anyone who has worked in the arena of defence technology knows of the highly exacting standards which have to be met. The same is true of assistive technology and telemedicine and if patients and doctors are to have absolute confidence in the systems which are now available and under development, they must be able to meet equally exacting performance and reliability standards. Cornwall has the opportunity, through such developments as Cornwall Medi-Park, and the research activities of the Peninsula Medical School and the Combined Universities in Cornwall, to create the industrial infrastructure needed to develop and support such technology.
It has only been possible in this short article to describe a few of the areas where technology is starting to be applied to care in the Community, but if the Government’s strategy is to be successful, we will see many more emerging over the next few years. Much if the successful implementation will depend heavily on telecommunications. Fortuitously, and despite its remoteness, Cornwall has a greater proportion of broadband internet connections per capita than anywhere in the UK. It is therefore in an unrivalled position to capitalise on the widespread application of assistive technology and telecare.
The future bodes well.
Professor Colin Roberts is a professional medical engineer. He is currently Chairman of the Royal Cornwall Hospitals Trust and Cornwall Medi-Park Ltd.
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