Harnessing technology to support people living with dementia

Over the past few years, a mental health unit in Chertsey has become a periodic home to academics and computer scientists. They have not been there for treatment. Instead, the team from the University of Surrey has been working closely with clinicians at the Abraham Cowley Unit to understand the care being given – all with the aim of developing new support for people living with dementia.

The ultimate result is Technology Integrated Health Management for dementia. Run as a clinical trial, it involves installing a network of 21 small internet enabled devices in the homes of people living with the condition.

The devices collect physiological, behavioural and environmental data which is then analysed by a clinical monitoring team. Machine learning algorithms alert when readings are indicating cause for concern, identifying everything from possible agitation to possible urinary tract infections.

Collaborative efforts

That clinical team is based at Surrey and Borders Partnership Foundation Trust, which is leading TIHM for dementia. But according to those involved in the project, its success – including a win at the 2018 HSJ Awards – has been entirely contingent on the sort of collaboration embodied by those ward-placed academics.

“None of us could do this alone,” emphasises Payam Barnaghi, professor of machine intelligence at the University of Surrey and technical lead for TIHM. “As an academic with a scientific background, I couldn’t do it on my own. I needed clinical expertise. And the clinicians couldn’t implement machine learning on their own. We needed each other.”

Anything we tried to do we were making sure that first the clinicians thought it a useful thing to do, and the end users were comfortable with it and thought it was going to work

It is a point echoed and reinforced by Helen Rostill, director of innovation and development at Surrey and Borders FT. “We had an ambition to improve outcomes and support for people with dementia and their carers. But in order to achieve those outcomes, we recognised that we couldn’t do it solely as an NHS trust – we needed to build a collaboration.”

The academic team was just one element of that. The project has also involved partnership working with the Alzheimer’s Society and eight technology SMEs. “I’m really passionate about bringing together expertise across different sectors,” explains Professor Rostill. “I think it opens up avenues of creativity that you don’t get otherwise.”

It is, she admits, not always an easy path to take. While governance structures can formally enshrine a desire for collaborative work, she argues it is the “softer skills” that make it happen. And that involves paying constant attention to relationships.

“Some of the learning [from the TIHM project] is how important it is to galvanise all of the partners around a common vision, set of aims and common behaviours, and recognising that people enter this sort of project with different priorities and ambitions.”

She says that’s particularly the case when it comes to commercial partners. “SMEs function in a competitive space. So to bring people together in a collaborative space, you have to put time and attention into doing that, and building those relationships.”

Another vital relationship in TIHM: the one with service users and their carers. Early project workshops had a significant presence from people living with dementia. And once devices had been tested in “living labs” – replicas of the home environment – they were deployed to a group of study participants dubbed the “trusted user group” before being rolled out to the randomised control trial.

“One would think of these people as early adopters of the technology,” says Professor Rostill. “They really were our design experts, so they very kindly allowed us to put the early prototypes into their homes, and provided us with feedback about a whole range of things – not just how the technology feels and works in the home setting, but how long it took us to install it, how we interfaced and interacted with the person with dementia and the carers, how we explained things to them.”

“Anything we tried to do we were making sure that first the clinicians thought it a useful thing to do, and the end users were comfortable with it and thought it was going to work,” adds Professor Barnaghi.

Perhaps it is no surprise, then, that feedback reports suggest users feel better supported, safer and less isolated by virtue of TIHM. Carers, meanwhile, say they are more reassured about the health of their loved one and less likely to attend accident and emergency or the GP unnecessarily.

The results have been so encouraging that, after being designated one of the initial NHS England test beds, the team has been awarded a second amount of funding by the national commissioning body and the Office for Life Sciences to further refine the setup for rollout.

According to Professor Barnaghi, the win at the HSJ Awards has been a “catalyst” in being able to look at the next steps for TIHM. “It’s obviously one of the most prestigious awards in the healthcare domain and for us it has been very important to have it. When we talk to people about deploying TIHM more widely, that recognition gives more confidence to people.”

Professor Rostill concurs. “It’s an endorsement to have won the award. We’re tremendously proud of it, and it’s great to be able to use it as part of our discussions with others who are interested in what we’re doing.”

For more information on Surrey and Borders Partnership Foundation Trust’s winning entry visit HSJ Solutions

The 2019 HSJ Awards are now open for entries. For more information on the Improving care with technology category, visit https://awards.hsj.co.uk/categories