NHS Digital funded Black Country Integrated Care Board (ICB) (previously Black Country and West Birmingham CCG) to examine the feasibility of using Internet of Things technology in a real-world scenario within the homes of residents living in tower blocks.
Arden & GEM was commissioned to provide the project management support to set up the trial to enable a meaningful evaluation of the technology and its potential value as a tool for healthcare systems. The outcomes of the trial will inform both future NHS Digital wireless trials and the digital strategy for Black Country ICB.
Providing people with high quality support in their own homes helps to improve personal safety and avoid admissions to hospital while enabling people to stay in a comfortable and familiar setting.
The Internet of Things (IoT) is a system of interconnected devices that collect data and insight to inform decision-making. The devices discreetly monitor the immediate environment triggering alerts where subtle changes indicate a potential health issue. For residents with long-term health issues, monitoring devices can trigger support before their condition deteriorates.
Black Country ICB wanted to explore the feasibility of using IoT technology in a real-world scenario to improve health and wellbeing for residents living in council tower blocks who may not otherwise have access to digital healthcare. With funding available from NHS Digital, the ICB leaders needed project management support to bring key partners together to identify an appropriate location, technology and cohort for this trial programme.
Recognising that fostering a collaborative approach would be key to the success of the trial, Arden & GEM quickly established a stakeholder group which included:
- Black Country ICB digital team and information governance lead
- WM5G (technical partner)
- Wolverhampton City Council
- Wolverhampton Homes (social landlord)
- The Royal Wolverhampton NHS Trust care coordination team.
Meetings were held weekly with stakeholders to coordinate decisions guided by a common goal of exploring how personal digital tools could improve the health and wellbeing of residents.
Selecting the right technology
The trial was to identify both appropriate sensors and low powered networks to convey the data. Two types of low powered networks were suitable for use in the trial location – the three blocks that make up the Merry Hill Flats development in Wolverhampton. A technical evaluation examined both networks. The group selected DORIS® (Data Oriented Response Intervention System), an established technology solution used previously in sheltered housing settings.
DORIS sensors have a long battery life, require no digital skills for setup and convey data using low powered wide area networks. The devices use machine learning to establish a baseline pattern for humidity and temperature within the flats. Readings outside ‘expected levels’ may indicate different use of kitchen appliances which triggers alerts to nominated teams.
Putting the support in place
As a local provider of community and primary care services, The Royal Wolverhampton NHS Trust’s adult community care coordination team received data and alerts from individual flats via a central dashboard. The team could then contact the resident and/or their emergency contact to check for any change in health status that may require support from another team or an immediate response. Where residents could not be contacted directly, the housing liaison team for Wolverhampton Homes could contact residents through door entry systems.
Identifying appropriate residents
Residents living in Merry Hill Flats who were over 50 and known to be managing a long-term health condition were invited to participate in the trial. Participants agreed to place devices in their lounges and kitchens and provide next of kin/emergency contact details to the care coordination team. Implementing this project during COVID-19 restrictions limited the opportunity for face-to-face engagement but residents of 11 flats were still recruited to the trial through written contact and undertaking follow up calls. All residents are considered key partners in this project and the contribution of participating residents has been recognised with a thank you voucher.
Setting a baseline
To enable outcomes to be evaluated throughout the trial, residents completed an initial questionnaire to measure their health and wellbeing status. The group chose the EQ-5D tool, developed by the EuroQol group of international researchers, for this purpose. Residents were also asked for their recollection of previous emergency healthcare use. Both measures would be repeated at the end of the trial.
Arden & GEM provided regular reports to NHS Digital and the ICB covering challenges, emerging lessons and stakeholder feedback form the trial. This learning is now available to other organisations as they seek to provide personalised digital healthcare and includes:
- Dashboards need to be flexible to meet the needs of the team receiving the alerts
- Wider engagement with end users and their clinicians would help to better understand the health needs and allow for a larger scale trial
- Technical firms need to be able to take account of this engagement in developing solutions.
A key benefit of the project has been the establishment of the stakeholder group. This forum will be crucial in developing a collaborative digital strategy to improve health equity particularly for those living in communities where there are challenges to maintaining good health.
Data recorded during the 2022 heatwaves has already helped to inform council policy for social housing tenants. These ‘unhealthy environments’ alerts can also show prolonged periods of low temperature to help them target practical winter support as residents face difficulties from the increase in energy costs.
"Arden & GEM provided excellent change management support and helped us to get the right people around the table, building excellent relationships with our partners in this project. This enabled us to rapidly deliver this pilot and identify the learning to help us deliver personalised digital care to our local population and particularly those who face the highest health inequalities."
Andrea Smith, Associate Director Digital & IT at NHS Black Country ICB
The trial continues to be monitored, with a review planned for summer 2023. Data and findings will be available to both NHS Digital and the ICB to shape their future strategies.