The UK has a population problem. Due to a mixture of falling birth rates and longer life expectancy, the share of people over the age of 65 has risen from 10.8 per cent in 1950 to 18.5 per cent in 2019. By 2039, the Office for National Statistics expects that to rise to 23.9 per cent. Soon nearly a quarter of the whole population will be aged over 65, massively increasing the demand for elderly care.
“I call it the new climate change,” explains Max Parmentier, the CEO and co-founder of Birdie. “I talk to policymakers and they say we know this problem is coming but we cannot address it right now.” Birdie is part of a new wave of technology start-ups aiming to upend the social care sector in the UK and help crack the problem of developed economies’ increasingly ageing population. Birdie recently raised $11.5m in venture capital funding to support their growth.
It is far from the only company making waves in the sector. Cera Care has raised tens of millions of pounds by promising to create “smart” elderly care using AI. Other start-ups like Lifted, KareInn, Log My Care also have had success raising funds and growing their profile. All of these companies promise to use a mixture of apps, machine learning, remote health monitoring and more to revitalise the UK’s stagnating social care system.
These companies are trying to innovate a sector that is infamously dysfunctional. Despite constant promises to reform the social care system by recent governments, no concrete proposals have appeared. Even prime minister Johnson, who in 2019 had promised to solve the crisis in his first speech outside Downing Street, keeps delaying announcing any plans. Meanwhile, social care spending is £600m lower than it was in 2010 despite a constant increase in demand, nearly 1.5 million people aged over 65 don't receive the care and support they need, and every year 17,000 elderly are forced to sell their homes to fund their own care.
But Birdie’s Parmentier says he isn’t fazed by the scale of the challenge. The company he co-founded in 2017 offers a bespoke app to centralise medical data about a patient’s care so it’s more easily accessible to carers and users, as well as allow carers to publicly log their visits and get prompted on necessary tasks. Currently, when care staff visit a home there is a huge array of paper admin tasks and complicated IT systems that chew up the time they can spend with patients. Birdie hopes that a centralised app can cut down that wasted time, improve the quality of at-home care and ensure elderly people can live at home and avoid entering care homes for as long as possible. “The social contract is broken,” as he explains it. “We are supposed to look after our elders, and we build care homes, that were not things that existed for our grandparents.”
Some companies are going further than Birdie. “We work to make the care we’re giving more data-driven and less of a shot in the dark,” says Nicholas Kelly, co-founder and CEO of Axela. Axela already cares for thousands of people in the UK, with their work centred around a platform able to collate a user’s medications, care visits and needs, behaviours, GP records, and more. Their work is all the more important given how hard it is to get information in the social care system: data is logged across countless systems and care agencies often spend weeks trying to access medical records from the NHS. Also, by using everything from fall detection cameras to Withings smartwatches, Axela offers remote health monitoring for when carers aren’t around. The data is then all run through a machine learning system that aims to predict the needs of each user.
“That's what we’re trying to do,” says Kelly. “Learn more about the individual and use machine learning to cut through the data we can’t process.” While he admits the medical data from wearables isn’t a perfect science (electrocardiogram or ECG measures on smartwatches, for example, tend to be much less accurate than medical equivalents), he explains that "some data is better than no data at all”.
Remote health monitoring can go beyond wearables. “We’ve seen a huge increase in the technology infrastructure that's available in the home,” says professor Ian Craddock, an expert in digital health at the University of Bristol. “Our ability to get data from individuals who are living at home… is greater now than it ever has been.” Craddock is the director of a project called SPHERE (or “Sensor Platform for Healthcare in a Residential Environment”) that uses home appliances like smart TVs to observe changes in patient behaviour in order to help diagnose or monitor medical conditions. While both the SPHERE project and Axela Innovation’s platform could raise alarms about data protection and privacy, Craddock highlights that much of this data is already collected, but not used medically. “We already have those devices and many will be sending data back to companies: so we’ve already crossed that bridge,” he explains. “From smart devices at home it is possible to diagnose mental health conditions – even inadvertently, and despite the fact [they were not] designed to do that.”
But how much of an impact could these companies have on the UK’s stagnating social care sector? To understand that, one has to understand the UK’s (and especially England's) social care crisis, which consists of several different crises rolled into one. First, the impact of austerity on the councils, which fund social care – many local authorities saw their spending power slashed by a third – has meant the strain on these services is massive. This leaves millions going into debt to finance their own care privately, and millions more unable to even access care in the first place. Cuts to services also resulted in a postcode lottery, with wealthier regions having far better services than deprived ones, which operate on shoestring budgets. Then, there are severe staff shortages for care workers: low pay combined with huge workloads and immigration restrictions has created a shortfall of 100,000 paid carers. On top of that, the strains on the system are increasingly pushing care services to offer one-size-fits-all care with strict time slots for at-home visits by carers.
Finally, and in many ways underpinning the previous issues, the government’s lack of a vision for social care has made the system extremely fragmented. Thousands of private companies administer care through a patchwork of care homes and at-home visitation, a system funded partially by local councils and in part by individuals who pay for their own care.
“There’s this moment in the 1940s where the NHS comes roaring into being and it's very clear what the founding principles are: free at the point of need and universalising the best possible care,” explains Chris Thomas, an expert on health and social care for the Institute of Public Policy Research. “But social care never gets those clear founding principles and is still reminiscent of the situation before the welfare state was introduced.” The hope for many new companies in this space is that they can help reduce costs and improve care, helping lighten many of the issues in the sector, while circumventing the bigger systemic issues.
The coronavirus pandemic has changed how the industry sees many of these start-ups. “Due to Covid all the red tape that slows down adoption was lifted and the sky hasn’t fallen down,” explains doctor Anas Nader, CEO and co-founder of Patchwork Health, a tech start-up that helps NHS hospitals share pools of staff. Take things like virtual GP appointments, which have become a necessity during lockdown despite making little progress before Covid.
Yet change still comes slow in health and social care. “There’s an obvious culture issue between the digital tech sector and the health sector,” explains Craddock. While the impetus in much of the tech world involves constant evolution and disruption – to move fast and shake up entire industries – the priority of health systems is to take things slow, test systems and ensure that technology will help, not harm patients in the long run.
Despite innovation and successful attempts to attract fresh venture capital, the care-tech sector still pales in size compared to the health-tech industry, which is valued in the hundreds of billions. The reasons why social care technology is overlooked vary – some think health-tech is seen as intrinsically sexier than elderly care, while other industry figures blame the fragmentation of the UK’s social care system (instead of one centralised NHS, the UK has some 17,000 care agencies registered across the country).
But most people agree that above all it’s about a lack of money in the social care system. If care services and the local councils who pay for them are struggling to even cover the basics, expensive new technology that promises to save money and improve care in the long run is far from a priority. “If the service is really stretched to the limit just providing today’s service, it’s really unlikely to have the capacity or leadership or skillset to understand how new technology could change the sector,” explains professor Craddock. And if the system is unable to afford bigger solutions, it risks adopting cheap tech being that reinforces the worst traits of the current system. Thomas cites the anecdotal rise of productivity-tracking software in the care sector, which some companies use to ensure visits to people’s homes are no more than fifteen minutes.
That highlights one of the biggest issues when asking what impact new tech can have on the social care sector. The sector’s existing problems limit how effective new technology can be. A system that is massively fragmented, underfunded and unable to serve millions of people in need, is not going to be noticeably changed by technological innovation. Until those issues are solved by policymakers, several experts told me, the growing number of social care start-ups will struggle to make enough of an impact.
“The government has a big role to play,” Nader says . “These are things that sadly techies are not here to solve.”
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This article was originally published by WIRED UK
