Sunday, 1 December 2013

Pennies, pence, sense and sex

I've collected some thoughts about the Health 2.0 Europe conference held in London last month. Now in its fourth year, this event is a coming together of ideas, creativity and plentiful energy chasing dollars, pounds, pennies and pence. There's interest in making sense out of digital health's huge remit and its potential to transform later life and end of life care. Or is there?

The context for this event was punctuated by reminders of the problems still plaguing the Obama Care rollout in the states, along with potent reminders of the mid-Staffordshire fiasco and the Colchester cancer records scandal. Uncomfortable truths locked in a swirl of gamesmanship, dilly dallying, management weaknesses, human error and that unmistakable whiff of institutionalized corruption, again. Only this time we are talking about violations to our basic human access, to dignity. Unutterable, amidst the whole, shiny shebang, was the specter of what Health Secretary Jeremy Hunt has labeled our national shame; the new untouchables, our lonely old.

It seems however, that we're putting the cart before the horse here. The US has apparently spent some £2B on digital health compared to £700M in Europe. That's a lot of dough. There is some evidence that self tracking of chronic conditions seems to be working and "Big Data" is happening.  In NY state, a reported 19M people out of a population of 19.57M are sharing health data over a network! Then, in the UK there is a remarkable resource called the HES or Hospital Episode Statistic that contains records for the entire population where each interaction of the NHS has been tracked since 1989. Wow, but what does this actually mean?  I'm curious about this sharing and tracking - with who and what data? Clearly, patients are becoming more demanding about involvement in their own care. This is a good thing because chronic disease management is certainly one of the biggest challenges our ageing planet faces. But while all the signs of progress that were bandied about at the conference sound exciting, it somehow doesn't jive with the statistic that 80% of care homes in the UK have zero internet access. Shocked? Surprised? Data access and even data collection aside, assuring that data content is meaningful, so that it can be beneficially interpreted, seems to be another missing link. Taking this down to the basics, it is probably a good thing to track how many times someone has fallen down. Wouldn't it be more important to understand why they fell in the first place?

In the opening remarks and again at the keynote, mention was made of a £1B innovation fund. I must have misheard that because I can only find mention, on November 15th, of a new Regional Innovation Fund (RIF) of £5million made available this year to support and promote the adoption of innovation and the spread of best practice across the NHS. This, on the heels of the October announcement that NHS England had scrapped a £50m fund designed to promote innovation as part of the flagship government policy aka Innovation, Health and Wealth. This IHW program was announced in 2011, finally rolled out in August 2013 and then "suspended indefinitely", two months after its launch.  From £1B, to £50M to £5M? Exactly how serious can we really be about moving the conversation forward? This is not just technology and treatments, it's about the patient provider dynamic and the future design for optimizing the most basic ADL (activities of daily living) for an increasingly, ageing global citizenry.

Leaving the sadness of loneliness aside, the wave of older people dealing with increasing frailty and the projected increase in people living with dementia is the profoundly shocking visual to take on board, beginning with the people who are innovating and designing for our future. Older people and even the ageing boomers may not be so technologically savvy as we'd like to believe and while advanced technology can be great, personal interaction is not advanced. We need cleverer, simpler ways for the increasingly, simpler needs of these now, not as clever people.

Help Age International continues to hammer home the message that the continual exclusion of ageing from national and global agenda's is inscrutable and must be addressed. This makes the first ever G8 Dementia Summit in London, on December 11th, a very important gathering for anyone living.  The point is clear, ageing needs to be on the agenda and fast, but I disagree with Victor Wang of GeriJoy who says that ageing isn't sexy, so we need to make it as sexy as global warming. I don't see ageing and global warming as comparable. Climate change has slid sideways on the agenda because of insufficient, conflicting evidence. Evidence of ageing surrounds us, if we choose to look. Silence remains the most outspoken form of denial. Ageing is multi-dimensional, complicated, challenging and reaches far wider than health care alone because it is rudimentarily social.

Ageing is about real life. So is sex. The race to make ageing, a sexy part of life, is officially on.

Deborah Gale

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