The digital doctor will see you now
Startup 2018: A vast chunk of primary healthcare could soon be provided through a smartphone.
Like many elements of the UK’s health system, the care sector is in a state – and it’s only going to get worse. The number of over-75s is growing (around 5.5 million in 2017), while government money to care for them is being slashed year-on-year. Yet, unfazed by all that, a collection of startups see in the sector an opportunity to have a huge societal impact – and make a healthy profit – by offering a 21st-century model of home care.
As it stands, elderly people are boomeranged between local councils and the NHS, carers are underpaid, and 58% of elderly care agencies are poorly rated. Communication between hospitals, local authorities, GPs, consultants, carers, patients and their children is muddled at best, and often non-existent. Of the UK’s over 7,000 home care providers, 80% still rely on paper-based systems.
All the while, bed blocking costs the NHS £900m yearly, and has increased 40% from 2016. One in four care companies went outof business in 2016 and on average 900 carers leave the sector each day. Meanwhile, council budgets for care have been slashed, for cing them to work with budget providers.
It’s a mess. Yet there’s a £15bn market in care itself, growing at 6% per year, and a heap of savings to be made for the NHS from its £110bn budget – of which the elderly currently use around 40%. There is also the potential to create new jobs that can fit around people’s lifestyles, and require the kind of empathy that means they can’t be taken by robots.
Several companies are gearing up for this massive challenge. All are swapping paper for technology, pairing up users with carers based on their personality fit, offering speedy service and better pay and prospects for carers. Yet each of the three leaders in the space – Elder, Cera and Vida, all founded in 2016 – are taking a markedly different approach.
Elder wants its live-in care model to be ‘the alternative to the care home’, says co-founder Peter Dowds. Traditionally, live-in care has been an expensive option for elderly people who need help around the home, but with scale, lower margins and technical efficiencies, Elder undercuts the cost of many care homes with its one-on-one model based in the patient’s house.
The cost of care homes has, in part, escalated due to wider changes in the property sector; they are expensive to build, costing on average £70,000 per room. Live-in care, on the other hand, is unaffected. ‘We’re utilising the customer’s asset,’ says Dowds, whose 1,000 self-employed carers work in 75 cities and towns around the UK. Why build homes when elderly people already have them?
While he admits that Elder’s carers ‘aren’t best-placed’ to look after people with severe dementia or very advanced conditions – who would most likely need to move to a nursing home – Dowds says live-in care is hugely beneficial for patients’ wellbeing, from reducing loneliness and depression, to cutting down the number of falls a person has. He also reckons there’s potential to encourage people in need of temporary accommodation like say, PhD students, to work in care for a few years, to bolster
the number of workers in the sector.
For those people who rely on selling their homes to finance their care, Elder also has a solution. It’s launched a lifetime mortgage, which lets customers draw equity out of property while still living in it. ‘Someone has to pay for care – society’s getting older,’ says Dowds, questioning whether it’s fair that younger people shoulder the cost through taxes, or whether older people should fund care with their assets. ‘The government’s going to have to tackle these things.’
Cera, which provides hourly, full-day and live-in care, has two big plays. It’s using technology to enhance the skills and knowledge carers already have. It’s also joining the dots between a bunch of services that can help elderly people manage their lives, from taxi firms to fitness trackers.
Currently, carers and customers use Cera’s app to schedule on-demand care, and read and update patients’ records. However, founder Dr Ben Maruthappu has much bigger ambitions for it. He is excited about new technology Cera is building, which will ‘analyse all of our care records, and predict deteriorations in our patients’.
The big aim for this predictive technology is to nip treatable conditions in the bud, so that people in care rarely need to visit the doctor, let alone go to hospital. Some infections common in older people are easily treated with antibiotics if caught early enough, for example. The hope is that warning signs will be captured by the app, and carers duly alerted.
Of all A&E attendances from older people, 20% are due to deteriorations that could’ve been avoided, says Maruthappu. In practice, Cera’s carers ‘collect a whole host of information, such as what the user may be eating, drinking, medications that are or are not taken, and what their mobility’s like’. Access to this information has numerous benefits: it helps raise the quality of care, predict the onset of treatable illnesses, inform family members of the state of their loved one’s health, and gives healthcare professionals a clearer picture of their patient.
‘We can also move services down the “healthcare food chain”, so in the same way that GP tasks may now be done by nurses in some instances, carers could do things that otherwise nurses would do,’ he says – such as checking medication.
With prompts from the app, Maruthappu says carers with two years of experience can provide care similar to someone with 20 years of experience, and be more efficient with the limited time they have to spend with a person.
As with all machine learning apps however, it will take time for Cera’s platform to collect and analyse enough data to be robust. It won’t just be data inputted directly to Cera that will help. Maruthappu says plenty of smart home appliances, from Fitbits and Amazon Echo to devices that track when people fall, or open the fridge, are offering new means to collect information about elderly people’s health, and habits.
Crucially, Cera is also offering its partners – the likes of taxi companies Uber and Gett, food delivery services, and smart home management app Gideon – a means to reach a generation not familiar with accessing services via the internet. Maruthappu says Cera doesn’t take a cut from these add-on services; instead it’s all part of a long-term plan to become ‘a one-stop shop for patients’.
Care is just the start.
‘There’s absolutely no technology that enables care to be delivered efficiently,’ says Devika Wood (pictured on cover), co-founder of care app Vida. Yet running a care agency is a huge logistical operation: Vida manages a rota of 300 carers in Greater London for around 100 clients spread out across the city, each of whom has changing needs.
Streamlining that process – and making massive cost and time savings – is Vida’s mission. In its current guise, Vida is a Quality Care Commission-approved care provider, but down the line, it plans to make the majority of its profits from franchising out the technology it is developing to other highly-rated care providers.
‘We’re not in the market to make money off the care,’ Wood says. ‘We’re trying to prove that operating this way, at this price, can be sustainable.’
Vida is also trying to make care a more attractive career. It pays carers at least £11.50 per hour (above the national living wage) and is developing a ‘gamified app’ through which carers will be able to learn new skills and, potentially, become specialists and move up a pay grade.
There are plans to train all carers in tasks that district nurses are currently relied upon to carry out, such as emergency first aid and changing stoma bags. ‘We want to bridge the gap between healthcare assistants and carers,’ says Wood.
Vida is also ‘in talks with universities’ to offer its carers a route onwards in the health sector, into nursing or occupational therapy. Wood reckons it would both ‘increase the funnel’ of staff into the care industry, and ‘keep them in the community’ regardless of which path they took.
Any positive steps care startups can make will be more than welcome. Since the referendum last year, the number of EU nurses working in the UK has dropped by 89%, while the number who left jobs in the UK also went up by 69%.