Interview with David Calder, Knowledge Transfer Manager at Knowledge Transfer Network (KTN). He leads on digital health for KTN, with an emphasis on the delivery aspects for health and care services across the public and private sector. David’s primary areas of interest are digital health and care, extending to consumer models, wellbeing and the prevention agenda.
David talks to IIOL about the critical role of digitalization in the healthcare industry, the role of Innovate UK in the process and how our lives will change in an era of rapidly progressing technology.
Can you tell us a bit about Innovate UK and the Knowledge Transfer Network?
Innovate UK is the UK Government Innovation Agency, they mainly fund industry led research. KTN is funded to connect businesses with other businesses, academia or whoever they need to bring technologies and research to the market. We create an atmosphere where things can happen quickly or maybe that wouldn't have happened without our intervention. We also link to funders other than Innovate UK and to other areas of support. We work on bringing together the components of innovation: ideas, resources (including money), and connections (networks). I specialize in health and care provision. This spans not just areas that people traditionally think of when they talk about health and care, but also areas such as as well-being. This can include technology that people use to stay fit, well and healthy away from the healthcare system. I cover what happens when people consult with their doctor and end up requiring support or social services. The shorthand for that became digital health for quite a while. I was the digital health guy! Now however, it has become increasingly obvious that digital pervades everything in the sector, so having a digital health person is a fallacy and we need to reconfigure, as it is important that my colleagues and I are all concerned with digital health. That's me – I am a mechanical engineer now doing digital stuff in the healthcare sector.
What is the role of Innovate UK in supporting research and business investment to develop technologies and industries in the area of personalized and digital healthcare?
That is a key strategic component of Innovate UK in the delivery of its work through a group of organizations combined under the umbrella of a government body called UK Research and Innovation that also includes the Research Councils. The aim of UKRI is to provide funding that goes right from early academic research through to commercialisation.
UKRI are also working to deliver part of the Government’s Industrial Strategy. Within it, four grand challenges have been identified, Artificial Intelligence and Data, Clean Growth, Future of Mobility and Ageing Society. It’s the Ageing Society Challenge on which much of our work in this sector is focused. These four main challenge areas are the conduit through which funding from The Industrial Strategy Challenge Fund (ISCF) is channelled. In the first wave of the ISCF, about GBP 35 million went into digital health via the Digital Health Technology Catalyst, essentially funding SMEs working on health-relevant digital solutions, to improve patient outcomes, reduce the cost of service provision, improve efficiency in healthcare and so forth. Other initiatives within the Industrial Strategy Aging Society Grand Challenge have supported technology developments in, for example, progressing data towards realising earlier diagnosis of disease, often using digital solutions. There is a cocktail of funding and support going into research on how to use data to improve early diagnosis, and how better to use health information captured by the system. These initiatives are being delivered by UKRI in collaboration with, for example, Health Data Research UK (HDRUK) and Genomics England. The final component, which has yet to break cover completely, is the Healthy Aging theme. This theme is aimed at increasing the healthy life years in later life. Although it hasn't been released formally yet, it is likely that the objective is by 2035 to add five extra healthy life years to people over 80.
There is an Industrial Strategy Challenge Fund for Healthy Ageing aimed at addressing the healthy life years of later life. The objective is by 2035 to add five extra healthy life years to people over 80.
These initiatives are related to an industrial strategy and, clearly, the government needs to see industry pick up the baton. It is not about fixing the National Health Service (NHS), nor social care. It recognizes that they are an essential part of the mix, but when it gets that far, something has already gone wrong.
It is very difficult to get business to realize their role and coalesce industry around the opportunities that are undoubtedly there. If we can address this and join up the way that services are provided that create commercial opportunities, then we will have cracked it and it's something that is potentially exportable, since unwanted frailty and morbidity is challenge across the world. Across the developed world people tend live longer, the next thing is to “live better”. A lot of nations and cultures suffer from the same issue. So we are hoping to create an exportable body of knowledge, products and services.
Can you expand on what you said about increasing lifespan and life expectancy.
Increasing life expectancy is not the objective, rather the objective is to increase the number of healthy life years. So, for example, if currently, people are living for 85 years and the last 15 are in poor health, that's not good. If people can live only the last five years in poor health, then they have got 10 more healthy years. That's what the Ageing Society Grand Challenge and, more specifically, the Healthy Ageing ISCF theme is aiming towards. For example, the theme is steered towards products and services. We are not explicitly concerned with further increasing life expectancy, it’s more about quality of life. It's also about taking the pressure off the system.
How do you think our lives will change in an era of rapidly progressing technology? Will the work environment change in the next 30 years dramatically, will we still retire at 65?
Oh, no. I think that retiring at 65 is going to be very unlikely. The 100 year life span, although we are not trying to affect it in this program, is going to happen. Technology is changing and that affects our health and the system designed to support that as well. Consider that during and after the Industrial Revolution where there was a lot of manual labour and poor working conditions the health challenges were related to acute trauma and infection. The NHS was created to deal in part with these issues. That's changing now with the main health challenges being related to chronic disease and multiple morbidities in an ageing population. I think there is another change coming. Increasingly, we will move out of offices and into a more virtual working world. This could, potentially tackle issues like congestion and save businesses money. This is an area where technology can potentially reshape things positively, so we don't need to travel as much. However, the “new type of work” will provide a wide range of psychological and physiological issues. I find the future with Artificial Intelligence (AI) replacing lawyers and doctors and self-driving vehicles hard to imagine. I am probably a little bit concerned rather than optimistic about the way things are moving. But looking back, every time there has been a big switch in the technical base since the Industrial Revolution, it has created more prosperity rather than less. So, hopefully, it will be the same again.
Which of the technological developments do you consider increase our life span and healthy longevity, and why?
I think self-knowledge. So, anything that can look into what your mind and body are doing can help. Digital tools are our friend in this, as long as they can be used unobtrusively and that more people can access them. We require the information feedback in a useful way so that it helps with behavioural change. This is the gold standard for any kind of digital intervention in the health space - does it change the behaviour that is causing the problem in the first place? Can you really influence people to do better for themselves? We need to get people past the “so what moment,” for example, when you see the number of steps you have done for the day. There has to be translation about what that means, how to build on it, internalize the message and make good use of it. To do that, technology needs to work better than it does at the moment. I think that this will mostly come from the smartphone revolution. Let’s look at wearable technologies. I use them but I can see most people don't. In fact, my mum gave me the one I have now when mine broke. She said, “why don't you have mine I don’t use it anymore”. She is a classic example of someone who picks it up, used it for a bit and didn't get anything from it. The technology companies developing these types of devices need to work out why she did that and stop them from being so easy to discard. I like to use my technology but others don’t.
Do you think that the solutions offered by companies are having an impact on how popular wearable technology is among different age groups?
They haven't cracked it yet. So, it's a tech-push at the moment. People buy the technology because they have heard about it and it’s fashionable. Importantly it's also affordable for most but not for all demographics. I am not sure how it splits across age groups. As I said, my mum is 70 and she got one, she wore it a little while and stopped. I got one when I was 50 and used it until it broke but mostly when exercising. I then took my mum’s; my girlfriend is different, she loves to use it all the time, thinks it's great and enjoys it because it looks like a bit of jewellery. The key thing is you need to link them up with other data sources as well. I have talked to companies that are interested in linking up nutritional advice and activity, but it is more complicated than it sounds. You need to understand how to balance energy, food, and activity. To be really effective, you also need to measure the right food groups and the right times and other, more complex, parameters as well. This is when things get difficult and thus become a high-end product and the price reflects that and reduces take up. This is where the challenge lies. I see business models that suggest they are going to scale these things to make money out of them. I wonder in the back of my mind, how many partnerships these businesses have really built or can build with supermarkets, gyms and local authorities. Also where the critical mass is coming from how they will encourage more people to take up this technology, and pay for it. Is it going to be so desirable that enough people will hook into it? Some companies that I see are a bit more targeted. They talk, very specifically, about the proportion of the obese population that really want to lose weight and are looking for help. If it’s true that a high proportion want to change their behaviours then that would represent a decent market for new technology in this space. However, I have my doubts about how many people fall into this category I think a lot more are just oblivious and frankly, don't care. How do you get to people who are not bothered to want to use a particular app or device? Certainly, I don't think it's a question of technology on its own. We need leadership, a shaping and reprioritizing of the health system and cultural shift as well.
You need to understand how to balance energy, food, and activity. To be really effective, you also need to measure the right food groups and the right times and more things as well.
How best can we deliver digital healthcare across public and private sectors?
Firstly, digital healthcare has to become healthcare, as it is in other industries like banking and travel. These sectors have deployed a self-service model because that puts capacity into the system by transferring activities to the consumer, who can gain control and customer satisfaction. The global challenges that every nation face is related to how to deal with data and information. Digital technologies produce data, and so the attitudes to things like health information are a challenge everywhere in terms of a perceived problem with privacy and trust. There is mistrust of the holders of that data and what they do with it. There is concern about how it flows, where it goes and who can use it, analyse it and turn it into value. That question is a thorny one for everybody. Personal health records, electronic health records, are treated with the utmost care, and that's correct. However, we need to find a way of unlocking this data safely and in a way that people trust. And I think that it will end up in a revolution. If we can get it to flow through the system more efficiently, more people will stop worrying about the scare stories they read in the daily papers and it will help massively. There is an issue, and these are my words, not the KTN’s, with the desire for change. It is not just in the citizen issues either, but it comes from SMEs and companies working in the health system. There are some that don't want to change. The system of public and private practice has also gone some way to entrench the issue here in the UK.
It is a totally different model in the U.S., and it’s easier to deploy those technologies there. The insurance system offers people reduced premiums for a particular behaviour, it's then easier to sell and to start up, so often innovators end up there first in terms of where they exploit that technology. As a result of that, the NHS lose out a bit. The NHS is a wonderful place to do the development work though because they are very willing to engage if there is funding available. So, you can get quite a lot started in the NHS but you can’t get it finished, deployed, embedded and certainly not diffused around the system. It is bizarre how hard it is to move a successful service concept or technology, whatever it might be, from one NHS Trust to another.
Why does this problem occur?
It is a serious obstacle and the reason often given is that they have their own standards of evidence. A lot of the barriers are well known and have been well described through initiatives like the Accelerated Access Review (https://www.gov.uk/government/organisations/accelerated-access-review). Then there are all the risk to do with pure disruption. Many innovations are potentially extremely disruptive to the way the whole system in an NHS Trust flows. So even if they are quite progressive in their thinking, with all the day-to-day pressures they face, and scrutiny, they become risk-averse.
To finish on a lighter note, can I ask you about your personal strategy and what you do to remain healthy for as long as possible?
I have had some health problems. Going back many years, I was acutely ill and I'm still living with the effects of that now. I can live a normal life but as a result of it, I am diabetic. All the parameters that they measure in humans matter more to someone with diabetes because there is a bigger risk of heart and kidney disease, and trouble with your eyes and so forth. Blood pressure and blood glucose are important, although I don't need to take any insulin, it is all managed by my lifestyle. I am slightly different because not only have I got that as a motivator, I have also found that I can respond to it. So, my personal strategy is, with the exception of having too much red wine every now and then, is to not do those sorts of things that are bad for the human condition. So, I eat as healthily as I can with low-carb intake. I also take my exercise quite seriously. I run on average around 10 or 12 miles a week. That works. I lost weight and my blood pressure has gone back to what looks like more normal. I take it seriously and can physically do it. I measure on my Fitbit and I map my run tracker on my phone which I carry around and I can see how many miles I have done and how many calories I have burnt. It is then that I realize I can have two glasses of red wine the next day. I use technology but mostly it’s down to self-motivation.
