Birmingham

Context

Birmingham is characterised by ethnically-diverse neighbourhoods, a growing population of over 60 years of age and inequalities in health and quality of life. Many are on low incomes, do not have access to broadband in their own home, are unemployed and lack the digital skills required to improve their quality of life. Older people feel isolated in their own homes and unable to use digital technology to help improve their health and well being. Initial research undertaken recently found that by 2020, 57,000 people over the age of 65 will be living alone in Birmingham (37% of the age group) and this rises to almost 81,000 (almost 53% of the age group) when those with a limiting long term illness are included. These proportions are higher than the England and regional figures. Almost 18% of this group will be from a BME or mixed heritage background almost 5 times higher than the proportion for England. Poverty will also be a significant factor with over 96% of over 65s in the poorest super output areas living in income deprivation. Personal mobility, and access to safe public transport, is important to the older citizens of Birmingham. Public transport is viewed as a form of social connection, enabling social interaction. Additionally, walking, and access to local food shops, is important to the elderly in Birmingham. Technology is viewed as a potential asset to healthy ageing, supporting independence and resilience in the elderly population of the city.

City services involved

Birmingham City Council (BCC) is one of Europe’s largest unitary local authorities delivering services to over 1 million residents. BCC places a high priority on the integration of health, social care and public health services for healthy ageing. Integrated care is increasingly offered to elderly populations in the region. The People’s Directorate within Birmingham City Council is responsible for health and wellbeing, social care and public health and as such plays a key role in co-ordinating activities across different providers and groups of commissioners. Adult social care accounts for 1 in 3 of every £ spent by Birmingham City Council. It is the Council’s largest area of direct spend and because of the scale of public cuts, the current level of spend is unprecedented.
The technology infrastructure proposed for the Birmingham test bed will build on the priorities and needs of the city. Birmingham currently offers a personalised portal for citizens (called the Digital Log Book). This provides information about social housing services from BCC. The Digital Log Book will be central to the intervention planned for Birmingham as it will provide a personalised portal for the pilot users and will enable communications and user feedback in relation to the pilot interventions and act as portal to enable assessments and impacts to be measured. Leveraging the Physical Web, and building on the experience of cities such as Los Angeles, the Birmingham test bed will deploy a network of beacons across two defined city areas (Washwood Heath and Shard End – 2 distinct neighbourhoods one predominantly BME and one predominantly white) in order to provide elderly citizens with transit information (bus timetables, routes etc), and information about proximate facilities (food, seating, restrooms). The neighbourhoods are distinct and this will identify whether there are any specific differences in relation to the types of interventions due to the populations being targeted. This is consistent with the vision of Smart Birmingham and that interventions are personalised to the needs of the individuals accessing them. Data to be collected from the pilot will both in relation to personal data and data that comes from tracking and monitoring of wearable devices such as Smart Phones, Watches etc will be collected via development of plugin and linked from within Digital Log Book Personalised Portal. The Digital Log Book is available across all digital channel, smart phones, tablets, web etc. The Digital Log Book already enables data to be shared (with the consent of the individual) with family, relatives, and the care team, allowing formal and informal carers to support the elderly citizen. Behaviours (and behaviour change) can be monitored via the Digital Log Book. The utility of the portal itself will be expanded with the addition of citizen-generated health and wellbeing data, adding significant value to the services offered to elderly citizens in Birmingham.

Target elderly population

Elderly citizens over 65 years, capable of walking without aid, who use public transport.

Interventions planned

Aims of the interventions:
- Aim To increase the age of which people with long-term conditions such as MCI can live independently by helping them to manage them within their communities (through innovation, technology and in-community support).
- Aim to help the elderly citizen to improve their quality of life and health and well-being by using the proposed technologies (The Digital Log Book, Discover Platform – Digital Skills for Carers to understand MCI,) to help them to identify and find useful information including helping them to gain specific digital
skills, find and identify activities, use journey mapping and tracking and help them to look after their own health.
- Aim to increase the usage of online and transactional services by older people over 65 to transform the way health and well-being is perceived and delivered, with emphasis on prevention and self-management of their own care with specific regard to mobility and those suffering from early onset of MCI and to support people in communities to remain well and prevent health needs developing.
- Aim to develop a user journey by using the gateways of influence model to change behaviours by working with the elderly and other healthcare professionals to identify the inputs and outcomes to help the elderly citizen take advantage of the technologies to help manage their independence to achieve specific outcomes e.g. walking more, taking part in local activities, being more engaged within their community, aiding social inclusion and reducing isolation and digital exclusion.
- Aim to work with the elderly using specific technology such as smart phones, watches and beacons, to push information and track and monitor specific information to understand activity levels, number of journeys undertaken, sleep patterns and how this impacts on their quality of life.

To screen those taking part in the trial using a QMCI app for MCI in order to provide baseline metric information before the intervention and start of the trial.

To give all older persons that meet the criteria their own personalised portal (A digital log book) which will enable them to record information, access information, undertake specific training on device interventions and give them their own platform which can be shared by them with others if appropriate. We will work with FCC and train our Social Care and Health colleagues who interact directly with the elderly to enable them to observe using different methods how the elderly citizen needs are being met by using the interventions this may take form of observation, questionnaire, etc. We will educate these citizens about the capabilities of the urban beacons and how to take advantage of their presence in their city using their smart phones. The beacons will be configured to provide the elderly citizen with vital information to locate important services (nearest bus stop, place to sit, food shop, restroom) in order to encourage and support walking, and the use of public transit, in the city.

Interventions planned
We will screen elderly citizens for MCI via the QMCI app. This will generate a baseline metric of MCI in the sample population before the intervention. We will enroll a total of 90 elderly citizens in our intervention (excluding those with disabilities, including Dementia). We will educate these citizens about the capabilities of the urban beacons and how to take advantage of their presence in the city. Issues of privacy and consent will be thoroughly reviewed and discussed. The ability to opt out of the intervention at any stage will be communicated to the elderly citizens. We will ask the elderly citizens in our test bed to carry their smart phone with them at times, and we will provide each with a wearable device (a Withings Activity watch that captures data about personal mobility and sleep patterns). As the elderly citizens journey around Birmingham, they will encounter the beacons. The latter will be configured to provide the elderly citizen with vital information to locate important services (nearest bus stop, place to sit, food shop, restroom) in order to encourage and support walking, and the use of public transit, in the city. Data will be collected on the personal mobility patterns of the elderly citizens via mobile phone and smart watch. This will be calibrated against proximity to the beacons. Data will also be collected on sleep patterns over time. With consent, this data will be made available to family and relevant carers via the Digital Log Book.

Quantitative objectives

To increase the take up of digital technologies by older people over 65 to transform the way health and well being is perceived and delivered, with emphasis on prevention and self care with specific regard to mobility and those suffering from early onset of MCI

To support people in communities to remain well and prevent health needs developing

To help people with long-term conditions such as MCI to manage them within their communities (through innovation, technology and in-community support)

To increase the use of online and transactional services by older people to manage their own independence

To develop a Gateways of Influence Model for older people with mobility and early onset of MCI

To identify how technology can enable self-service and change behaviours in order to encourage citizens to be engaged in their community and to aid social inclusion, reduce isolation and digital inclusion.

To incorporate DISCOVER (Digital Skills for Carers Platform) within the Digital Log Book portal that enables people to gain digital skills, and gain an understanding of their MCI.

Unobtrusive personal data available

Open data sets on urban transport and use of services for the elderly