By 2036, around 27 million people in the UK will be over 65. Longer life expectancy is something to cherish and there is a raft of evidence demonstrating the productivity, creativity, vitality and participation of older adults in workplaces, communities, households, and families. With age, however, often comes age-related illnesses such as heart disease and diabetes as well as social challenges including isolation, loneliness and the associated impact on quality of life. It is vital that we can positively support older people, the estimated 1.4 million people in the UK living with learning disabilities and all those with additional care and support needs, ensuring people are able to live independent, happy lives. There are a number of challenges in the sector, however, with over 100,000 current vacancies in social care in England alone. To compound this, social and economic disparities mean those in lower-income groups often feel the burden of illness more acutely.
Could advanced connectivity enable more effective and equal care and support for individuals, helping to narrow the gap between advantaged and disadvantaged members of our society? Analogue telehealth services are being decommissioned — a new generation of solutions is needed to both safeguard our existing social care services and build on the critical work already being done by the sector.
The ability of 5G to power future-fit technologies presents a solution. This is not about removing human interaction from social care, but instead using the capabilities of 5G to support improved outcomes across the system and, crucially, for people receiving care and support.
Amongst social care and support providers there are of course different extents of progress with digital technology. Across the UK, work is underway to support the infrastructure, skills and wider cultural shifts that will enable the sector to move towards adoption and use of 5G. From technology-based solutions to help tackle loneliness to aiding medication adherence and improving quality of life in palliative care, 5G could unlock opportunities to support and empower those receiving care and support, along with the social care sector itself.
Supporting Delivery of Care in Residential Facilities
One of the biggest challenges facing social care is recruitment: in England alone, there are over 100,000 vacancies. Technologies, powered by 5G, can help remove some of the burden on stretched carers, supporting them to work smarter and enabling the delivery of person-centred care even in the face of staff shortages. 5G networks open up opportunities for non-intrusive, continuous monitoring of residents, from hydration and movement to when a resident is about to get out of bed. This enables early identification of issues, quicker intervention when needed and improved health outcomes for individuals. Additionally, Augmented Reality and Virtual Reality can offer a boost to cognitive and emotional wellbeing, particularly for individuals with dementia.
WM5G used 5G to enable remote monitoring of care home residents, and the Liverpool 5G Health & Social Care project developed a non-intrusive chromatic sensor to alert carers of any unusual event such as a fall or seizure. 5G facilitates high-speed data transmission, which is critical for time-sensitive alerts. Such technologies will safeguard residents and enable social care workers to spend time more positively with residents.
Taking this one step further, the Liverpool 5G Create project deployed sensors under care home beds to monitor the vital signs of residents. The technology can notify staff by way of Artificial Intelligence (AI) when the resident is about to get out of bed. This enables more personalised, tailored care and could also reduce the number of falls and related injuries. With AI and machine learning, 5G connected cameras can also be deployed to monitor facial recognitions and behaviours of residents to detect discomfort, reduced responsiveness and indicators of potential issues, before they arise. Such methods are already being used by the Yonsei University Health System in South Korea and could possibly be extended to care home settings. Wireless 5G networks enable continuous monitoring as well as a shift towards preventative methods of care. Critically, this can be done in a non-intrusive way with 5G delivering advanced security of peoples’ data.
The high bandwidth available on 5G networks makes it possible to conduct ultra high-definition video calls, allowing GPs to conduct virtual rounds of care homes. This means care home residents can access quality joined-up care and support, when they need it, without compromise. The delivery of care in familiar environments can also reduce stress and confusion, particularly relevant for individuals with dementia. Additionally, the reduced time spent travelling to residential facilities should enable better access to care homes, delivering greater support for care workers. WM5G and the West Mercia Rural 5G project both successfully tested this functionality. West Mercia Rural 5G also deployed video wearables to care workers, enabling them to benefit from remote support from medical experts not only during remote warding but also in emergency situations before an ambulance arrives. This ensures individuals receive appropriate care in a timely manner, delivering improved health outcomes.
5G can power other technologies to support the delivery of care in residential facilities, such as augmented or virtual reality. Immerse Health is using mixed (augmented and virtual) reality for those living with dementia. Care homes where the solution has been deployed report more meaningful interactions with carers, reduced aggression and increased recall of past memories. While the solution doesn’t require 5G per se, advanced connectivity offers wire-free, far richer, more immersive levels of interactivity.
Advanced connectivity can also power solutions aimed at improving the well-being of residents. This was demonstrated, in 2020, by the Liverpool 5G Create project who tackled the Covid-induced social isolation of care home residents with “haptic hug” T-shirts. When a resident was wearing the shirt, their loved one could ‘hug’ them via the app, and the shirt squeezed the resident. The shirts were connected via the project’s private 5G network and required a level of connectivity similar to simultaneously streaming HD video and audio, which 3G and 4G would struggle to support. These devices can have a significant impact on well-being, helping to reduce feelings of isolation and loneliness.
Amongst social care and support providers there is of course different extents of progress with digital technology. However, across the UK work is underway to support the infrastructure, skills and wider cultural shifts that will enable the sector to move towards adoption and use of 5G.
Tackling Social Isolation and Loneliness
Loneliness affects people’s mental health, increases the risk of developing dementia by as much as 20% and is even associated with reduced life expectancy. From virtual collaboration solutions to gaming apps and even emotional robots, 5G’s high bandwidth, reliability and low latency can help to tackle social isolation and overcome feelings of loneliness, enabling people to live richer, more connected lives.
The Liverpool 5G Health & Social Care project explored a number of solutions and devices to tackle loneliness and social isolation. A digital loneliness device called ‘Push-to-Talk’ was deployed to over 40 individuals of different ages and personal circumstances, who struggled to get out their homes and socialise. The device, connected to a 5G network, enables communication with a range of users in different communities. Users simply push a button when they would like to talk and are connected via the device’s software to a person with similar interests who has also pushed their button.
Using 5G’s ultra reliable and fast connectivity, there is a maximum 30 second delay from pushing the button and gaining a connection. The trial showed a marked reduction in loneliness amongst users, with a 25 percent increase in those saying they hardly ever felt they lacked companionship, a 50 percent increase in those who said they “rarely felt isolated” from others, an impressive 30 percent reduction in the number of people who visited their GP, and a 16 percent drop in the average number of GP visits per user. The project also calculated that the potential cost saving of deploying the Push to Talk service was £868 per year per 100 users, showing benefit to the sector as well as service users.
Mary Brandt from Kensington, who was introduced to the Push to Talk solution by the Liverpool Carers Centre, said:
"I love using it. I contact other carers and we talk and have a laugh. It does everybody good. We don't always talk to each other about our problems, we just chat... When i met with people from Local Solutions, who introduced me to Push to Talk, I felt like they were giving a voice to the carers".
A similar solution has been explored by the 5G Barcelona project, which has developed a collaboration platform that allows older people to participate in experiences and activities remotely. Users with health and mobility constraints can virtually take part in activities — including visiting a museum, partaking in a book club, engaging in cooking lessons or contacting their grandchildren. The device features a presence sensor that automatically detects when someone enters the room and triggers instructions to start using the device. Each device is personalised to suit personal preferences and tastes, with individual interests used to create virtual conferencing rooms with other users. With 5G’s security, reliability and high bandwidth, users benefit from high-quality video conferencing with minimal delay and can interact with multiple users simultaneously.
What’s more, Angus Council in Scotland has tested a solution called KOMP: a one-button computer, designed and produced for isolated individuals who struggle with using modern-day technology. KOMP requires no prior digital skills from its user and family, friends and carers can send photos, messages and make video calls. The platform can also be used to administer reminders tailored to an individual’s needs or care programmes.
Technology has the potential to tackle social isolation — but only if individuals are comfortable using digital tools. Liverpool City Council worked with CGA to create a Loneliness Quizzing and Gaming App, a social gaming app that brings people together to take part in online quizzing, games and chat to combat social isolation. It features video communication to allow users to meet and take part in the game from different locations. Crucially, the app was adapted following feedback from user groups, including: individuals with varied learning difficulties attending the Kensington Community Centre; a residential home with users over the age of 60, many of whom suffer from dementia; and a supported living centre where users had a range of learning disabilities and varied in age from 30 to 80. Trialling on a diverse range of users ensured it was suitable for use and helped to build digital skills, as well as confidence.
The app was a perfect test case for 5G technology because it needed a high bandwidth to drive the device-to-device video capability, requiring around 80 Megabit bandwidth and low latency. Users reported marked reductions in loneliness with a 26% decrease in those who said they often felt isolated from others. Quality of life for service users also showed a positive improvement, with an increase of an average of 1.4 points on the life satisfaction scale.
In California, VITAS healthcare has partnered with AT&T to deliver VR therapy over 5G, which has proved to be an effective way to tackle loneliness amongst the end of life patients. VR technology makes it possible to virtually bring hospice patients out of bed and into situations where they feel more present. Headsets can also be configured to transmit the same imagery between two viewers, enabling shared experiences between a patient and their loved one, carer or another party.
Dr. Joseph Shega, senior vice president and chief medical officer at VITAS, said:
"As a patient approaches the end of life, the effects of illness can shrink their world until it's no bigger than their home or bedroom. This can be incredibly disheartening to patients and their families. Part of leading the way in hospice care is searching constantly for new approaches to enhance quality of life for VITAS patients. Already, VR technology is showing an incredible capacity to elevate our patients' moods, diminish their symptom load, and provide opportunities to explore and remain connected with the outside world."
Liverpool tackled the Covid-induced social isolation of care home residents head-on, with “haptic hug” T-shirts. When a resident was wearing the shirt, their loved one could ‘hug’ them via the app, and the shirt squeezed the resident who felt the sensation of a hug. These devices can have a significant impact on the wellbeing of care home residents, helping to reduce feelings of isolation and loneliness. The shirts were connected via the project’s private 5G network and required a level of connectivity similar to simultaneously streaming HD video and audio, which 3G and 4G would struggle to support.
Perhaps the most radical solution, though, has been tested by 5G Barcelona who deployed emotional robots to the homes of 12 elderly people. The robots are designed to create company for users; they can accompany individuals and engage them in conversation. While such solutions may not be suitable for broad deployment across the UK, they illustrate the extent to which 5G can transform and enhance the way we provide care and support to individuals.
Supporting Wellbeing and Mental Health
Deploying 5G to promote the wellbeing and mental health of individuals will support the health and social care sector transition to a preventative model. High bandwidth-benefiting apps can tackle social isolation and boost digital confidence, while Augmented and Virtual Reality experiences can promote a better quality of life for those with chronic illness, who are unable to leave their homes or are receiving end-of-life care.
The Liverpool 5G Create project developed a 5G connected app designed to boost wellbeing and reduce anxiety amongst children under the age of eight. The Chill Panda application features a panda that expresses the user’s emotions based on their heart rate and mood ratings, with an AI driven recommendation engine creating personalised anxiety reduction content. Informed by paediatric studies,it was designed to improve child mental health and help remove the stigma around mental health challenges amongst children.
Liverpool also worked with CGA to create a Loneliness Quizzing and Gaming App, a social gaming app that brings people together to take part in online quizzing, games and chat to combat social isolation. It features video communication to allow users to meet and take part in the game from different locations. Crucially, the app was adapted following feedback from user groups, including: individuals with varied learning difficulties attending the Kensington Community Centre; a residential home with users over the age of 60, many of whom suffer from dementia; and a supported living centre where users had a range of learning disabilities and varied in age from 30 to 80. Trialling on a diverse range of users ensured it was suitable for use and helped to build digital skills, as well as confidence.
The app is a perfect test case for 5G technology because it needs a high bandwidth to drive the device-to-device video capability, requiring around 80 Megabit bandwidth and low latency. Users reported marked reductions in loneliness with a 26 percent decrease in those who said they often felt isolated from others. Quality of life for service users also showed a positive improvement, with an increase of an average of 1.4 points on the life satisfaction scale.
Working with the Royal Liverpool and Broadgreen University Hospital Trust, the Liverpool 5G Health & Social Care project delivered 5G connected VR headsets for palliative care. The headsets were used as distraction therapy to help manage patient pain. Patient feedback was overwhelmingly positive, reporting increased quality of life and some reduction in pain medication. The hospital sees applications for the tech beyond palliative care, supporting patients in critical care units with rehabilitation and ventilation weaning.
David Walliker, Chief Information Officer at the Royal Liverpool and Broadgreen University Hospitals NHS Trust, said:
"Using 5G technology we have been able to expand out virtual reality (VR) use in our palliative care service to provide VR sessions for our patients who need it most. Previously we were limited to a preloaded beach or forest experience of 15 minutes, but since connecting our VR devices to Liverpool 5G Health and Social Care's 5G network we have been able to offer patients a personalised experience as an effective distraction therapy technique".
A hospice in Leicester has also been using VR in end of life care, with a focus on improving quality of life. VR experiences are used for those who are unable to leave the hospice, providing experiences such as the chance to virtually explore new locations.
A similar approach is being taken by VITAS, America's leading provider of end-of-life care, who is assessing the therapeutic effects of VR and augmented reality. Utilising newly available 5G in the trial areas, the study analysed how low-latency connectivity and on-demand streaming could comfort and calm hospice patients. Care teams found that in addition to helping physical symptoms, the technology eased anxiety and loneliness.
"VR technology is showing an incredible capacity to elevate our patients' moods, diminish their symptom load, and provide opportunities to explore and remain connected with the outside world."
said VITAS Chief Medical Officer Joseph Shega, MD.
Supporting those with Long-Term Conditions
Chronic conditions can be more effectively managed in community and home settings with 5G. From remote monitoring to medication adherence, 5G’s high bandwidth and low latency can deliver next-level telecare, ensuring effective, continuous but non-intrusive oversight of individuals for quicker identification - and resolution - of issues and empowering individuals to feel more engaged with their own treatment. Devices connected to 5G are also expected to consume less power, reducing concerns over battery life.
With increased quality and timeliness of care, remote monitoring can have a positive impact on individuals’ lives, offering them greater independence and confidence in their own homes, increased flexibility in their daily lives through not having to wait in for care visits, and a reduced need to explain their care and support needs, outcomes and experiences multiple times. It can also offer operational efficiencies and scale to care and support providers. Research shows that this technology could free up 1.1 million hours for GPs and 5G-enabled telecare will help reduce social care budgets by around five per cent, saving £890 million to reinvest in other services.
The Liverpool 5G Health & Social Care project explored the potential of 5G to support medication adherence through the deployment of PAMAN, a remote monitoring system with a simple video audio device. After a medication review with a clinical pharmacist, over 30 users were provided with a device in their home that connected to the PAMAN monitoring centre with a simple button. This enabled pharmacists and pharmacy technicians to observe people in their homes taking their medication; the team can also answer any questions the user has, liaise with pharmacies and GPs on their behalf and facilitate repeat prescriptions. 5G provides a reliable, consistent connection and enables ultra high definition video. The results of the trial were striking: with medication adherence levels rising to 95 percent (compared to the 55 percent national average), a 51 percent drop in the number of service users who had a medication error, a 50 percent reduction in medication costs through reduced wastage and a significant reduction in carer hours needed to provide medication administration support. Importantly, the quality of life for users also significantly improved with a 73 percent increase in those feeling confident and happy to take medication, 53 percent increase in those who felt safe, and 40% increase in feelings of independence. These considerable benefits combine to deliver a potential cost saving to health and social care services of £208,800 per 100 users per year.
High definition video and remote support is, however, not the only way to monitor medication adherence. Abilify Mycite is a smart pill used to treat schizophrenia and contains a sensor that connects to an app to record that medication has been taken. While the pill does not require 5G, next generation connectivity provides a more secure and reliable service.
With 5G’s ability to support a far greater density of connected devices, individuals with long-term conditions can now be more effectively remotely monitored from their own homes. This provides a continuous stream of data related to an individual's condition, such as blood glucose levels or heart rhythms; providing far more insight than would be possible with a daily district nurse visit, while 5G’s low latency enables real-time response if a problem should arise. As a result, long-term condition management can become less reactive, helping to identify and resolve issues before they become emergencies.
5G was used to deliver telehealth monitoring for the Liverpool 5G Create project. The Care Portal device, which is used by the individual, includes a built-in ECG monitor and connects to a Telehealth Hub staffed by nurses and healthcare assistants. This real-time monitoring provides clinicians with more data and can help identify problems before they become emergencies, reduce unnecessary district nurse visits and enable people to stay in their homes for longer.
A variety of solutions already exist to monitor and manage those suffering from chronic illnesses. For example, home glucose monitoring is essential to the management of diabetes and the prevention of complications. Diabetacare trialled a new blood sugar level device with remote monitoring capability across 800 patients in Bangalore, India. Working in tandem with eight day clinics in the city, the devices provided regular monitoring along with personalised treatment schedules; specially trained nurses monitored the daily data and diabetes doctors reviewed progress and dealt with emergencies. The trial has been successfully deployed without 5G but since 100 million people suffer from diabetes in India, rolling out more broadly on existing connectivity solutions will be challenging. With 5G networks there is capacity to scale to a far greater density and enable ubiquitous secure connectivity. This will enable more complex monitoring for instance of individuals with multiple long term conditions.
Remote Care monitoring for Supported Discharge
With an overnight stay in a hospital bed costing the NHS £400 a night, extended stays and the issue of bed blocking have huge financial implications on a budget-constrained sector. What’s more, studies in Australia, US and the Netherlands show that older people can lose as much as 5 percent of their muscle strength for every day they spend in hospital. Of course, 5G can't single-handedly solve these complex challenges, but the high bandwidth, reliability and ultra-low latency of 5G networks can play a supporting role. Advanced connectivity enables pervasive real-time monitoring that allows hospitals to safely discharge people earlier, with greater confidence, fewer re-admissions and improved long-term outcomes.
The Liverpool 5G Health & Social Care project partnered with the Royal Liverpool and Broadgreen University Hospital Trust to develop a telehealth in a box solution, using 5G. The network connected the hospital to community patients through assistive technology to support earlier discharge. A portable multimedia telehealth monitor was used to record clinical, lifestyle and quality of life data each day. The device also delivered information, supporting people to self-manage their conditions more effectively. This resulted in improved health for service users who were more readily able to manage their own health, in addition to a decreased use of primary health services and hospital services.
In Greece, the Vodafone Telehealth Monitoring service has enabled remote monitoring of patients post acute care. The project focuses on remote communities, where travel for follow-up hospital appointments can be time consuming and expensive; this offers significant convenience to patients, as well as increased efficiency through reduced readmissions for the healthcare sector.
Another example of how connected equipment can add value both indirectly improving quality of care and indirectly contributing to improving operational efficiency is the use of smart beds, which use contact-free sensing and real-time analytics to monitor patients and thus improve care outcomes. Integrated bed sensors can monitor a variety of patient data and vitals (e.g., weight, body temperature and heartbeat) and detect blood, oxygen and pressure levels. The beds also record patient movement; some can communicate with a patient verbally (e.g., remind a patient to refrain from getting up). One such example is Multicare, an intensive care and therapy bed designed by LINET, which helps prevent pressure ulcer development through bed articulation, which increases envelopment capacity in the sacral area. This is critical for patients with medical conditions that prevent them from being turned manually. The vascular position capability optimises venous return and reduces swelling (edema) and back pain.
Swansea University meanwhile is running trials with 5G smart bandages: 3D-printed bandages, fitted with nano-sized 5G sensors, are able to relay data about the progress of the wound, as well as information about the patient’s activity. This will enable safe discharge from acute settings and the development of tailored treatment plans.