Dare to Care Different

In a move which would bring England into line with Scotland, a new report by the Institute for Public Policy Research (IPPR) calls for older adults to receive free social care.

The IPPR argues that the current system is deeply unfair with ever more people of pensionable age having to use their savings to pay for care received at home that is vital to their independence. This would cost an extra £8bn a year by 2030, which IPPR say could be met by raising income tax by 2p or National Insurance by 1.3p.

Reimagining the way we support the needs of an ageing population in our neighbourhoods of the future was a primary discussion point at the recent AAA Congress.

Attendees, a dynamic group of private, public and third sector stakeholders, contributed towards one of the most stimulating meetings of minds I have had the pleasure to oversee. Nicely summarised by Tarsha Finney Programme Lead, City Design, at the Royal College of Art, who said: 

"The future has not yet been written. Collectively we can make a difference"

An area of particular interest to me is how forward thinking corporate brands can set the agenda and become more influential in driving societal change. This is particularly pertinent when living through a period of political inertia. What follows is a summary of the key themes, discussions and recommendations, not covered in my previous report.

Writing in Neighbourhoods of the Future 2019, Nigel Wilson Chief Executive for Legal & General sets the scene: “Legal & General’s mission, as the UK's largest investor, is to help fund the future: directly, by investing in new technologies, cities and neighbourhoods, and indirectly by helping individuals to plan financially.

Alongside longer lives, we need better social care for older adults and more savings for later life. This requires innovative approaches which change both the demand and supply sides across the financial services and care industries.”

One of our keynote speakers John Godfrey, Director of Corporate Affairs for Legal and General, has contributed to the government’s long awaited draft green paper on social care. John told us he is not convinced that the green paper will be bold enough to make a fundamental difference.

A broken market

Speaking about the need to employ “inclusive capitalism” John says it is time to be bold and think different because we are dealing with a broken market that needs to be fixed.

A growing number of Legal & General’s competitors see insurance as a viable solution. John disagrees: “There is no point in trying to create long-term care insurance, this has been tried in the US and failed. Legal & General is adopting a more holistic approach and we are in the process of refining what we call our Retirement Living Solutions business.”

To illustrate the breadth of this approach, John told us about Legal & General’s investment in ‘Care Sourcer’, a service that helps people find the care they need in their local area. In addition to sourcing and training carers, the service could help hospitals find beds for people who are about to be discharged.

The business is also planning to invest in retirement housing and has set up ‘Guild Living’, which recently announced a plan to build 3,000 homes in urban retirement communities across the UK.
Kick-starting the retrofit revolution

Bearing in mind that 80% of the homes that people will be occupying in 2050 are already built Sue Adams OBE, CEO of Care & Repair England, told us that: “Retrofitting homes to make them age friendly is a potentially massive market, as only 7% of homes in England have the four accessibility features that provide “visitability” to most people. These are level access to the entrance, a flush threshold, sufficiently wide doorways + circulation space, and a toilet at entrance level.”

The question remains, how do people pay for the work, and what does a good retrofit look like? Sue Adams says it’s a catch 22 situation: “We need to retrofit enough homes to create a solid evidence base, which will in turn provide the necessary data to promote widespread adoption”.

In the absence of government incentives we are seeing a significant rise in retrofitting or remodelling funded by equity release or lifetime mortgages as they are commonly known. A recent report in the FT entitled ‘Equity release: how to squeeze money out of your home’ states that last year a record £3.95bn was raised by 83,000 homeowners over the age of 55. And the figure could surpass £5bn in 2019 after figures released this month by the Equity Release Council showed the strongest start to any year on record.

The over 55 age group own 85% of the UK's housing wealth

According to John Godfrey: “The over 55 age group own 85% of the UK's housing wealth. That's staggering when you think about it. But the means to access this wealth from what, for many people, will be their best performing asset have been inflexible.”

That said, it is becoming easier to find suitable mortgage products. Last month, the Nationwide Building Society became the first high street lender to offer later-life products through its branches and it is likely that others will follow.

John continues: “Many of us say “our home is our pension” but we don't always intend to see that statement through by selling up. Downsizing is right for many people but it is not always possible, for example a suitable property might not be available, or the owner simply wants to stay in their family home. Lifetime mortgages can facilitate improvements and/or modifications, thereby enabling older adults to maintain their independence by living in their own homes for longer.”

John acknowledges that more work needs to be done to qualify best practice. Consequently Legal & General has invested in pilot projects to refurbish run down homes to meet the Decent Homes Standard, and they are exploring options to do more. By way of example, here is a video link to a retrofit pilot project case study in London.

Sue Adams summarised: “A retrofit revolution is good for everyone. It will be great for individuals who want to age well in the homes they love. It will drive revenue for far sighted companies in the finance, building and tech sectors, as more money is spent by older householders to future proof their homes in ways that add value, rather than devaluing. And it will benefit the public purse, reducing calls on the NHS, as the 9.5m older people living in ordinary homes are less at risk of housing related injury or health decline.”

What's missing is the evidence base necessary to define what a good retrofit should look like. Our panel agreed on the need for more work to qualify and then promote best practice.
Technology in housing and care for older people: what can it do for us?

This is the question posed by Lord Best, Chair of the All-Party Parliamentary Group on Housing for Older People.

General consensus among AAA experts is while technology has a crucial role to play, this is essentially a systems challenge, requiring more in the way of joined up collaborative thinking and action if we are to take full advantage of a rich stream of enabling technologies heading our way.

5G in particular could be a game changer, promoting widespread adoption of the Internet of Things (IoT), driving new services and industries. For consumers, 5G is expected to broaden the global market for smart home devices to 1.5 billion units by 2020 when commercial 5G networks are online, according to Dun & Bradstreet.

Such a trend will help grow the number of so-called smart homes to about 300 million worldwide by 2022, according to an estimate by ABI Research.

Technology giants such as Amazon.com, Google, Apple and China’s Xiaomi have already ratcheted up their efforts to churn out more smart devices, remotely controlled via smartphone apps or voice assistants. Clearly we need a joined up strategy, and investment through the Industrial Strategy Challenge Fund, to provide UK businesses with a fighting chance in this rapidly escalating market.

Playing devil’s advocate, Sebastian Conran, CEO of Consequential Robotics, warned about getting too carried away with autonomous tech: “The fact is, no research laboratory on this planet is close to making an autonomous robot that could open the door, walk into your home, boil a kettle of water and make you a cup of tea, let alone open and serve a bottle of champagne!”

Sebastian advocates adopting a more pragmatic approach: “We have had domestic dishwashers for over half a century, but now we are also collaborating on the design of kitchens that can fully prepare and cook meals from fresh ingredients, as well as clean up afterwards. We are also developing a comfortable robotic chair that can move omnidirectionally and autonomously around your home. It can raise up to the sink or cooker, and help you get in and out of bed.

Vitally, all of this needs to look like something we aspire to have in our homes not in a hospital ward. Outstanding product design has an essential role to play in ensuring that these devices are emotionally things we crave, not just physically need.”

A gap for real-world testing

According to Wendy Tindale OBE, Clinical Director of the National Institute for Health Research Devices for Dignity MedTech Co-operative (DVD) one of our biggest challenges is to fill the gap for real-world testing and evaluation of assistive technologies in home and community environments.

Wendy sees this as "a fantastic opportunity to re-establish the relationships between people, the built environment and services. Let’s create a blueprint for a cultural shift from reliance on health and care services to more emphasis on the reassurance enabled by the sharing of information and communication between services and people in their own homes.

The need for a system-wide response and shared responsibility not only means a re-design of NHS services, as outlined in NHS England’s recent Long Term Plan, but also investment in future homes, communities and wider services. We need creative approaches to using assistive technologies, and to design services to meet the wide variety of circumstances, aspirations and needs of people as they age.”

A finely calibrated daily life

Tarsha Finney Programme Lead, City Design, at the Royal College of Art is also concerned that we are getting carried away with technology at the expense of human interaction: “Typically, we are thinking that solutions to ageing can be found by skinning the interior surfaces of our existing homes with new technology: smart walls, smart floors, machines that speak to us, that help us to retain mobility, that aid our getting in and out, on and off things.

What we haven't noticed in the move from ageing in an institution, to receiving care in our homes, is the critical need we have for a finely calibrated daily life together, one that exceeds the false intimacy of the TV, of 15-minute care visits, or a robotic future of automated care. What we're ending up with is a profound and existential crisis of isolation and loneliness."

Tarsha says the logic of the single-family dwelling, or the single apartment, no longer holds but we don’t yet know what other forms of intergenerational, non-familial housing there might be. She shared details of new housing projects in Germany, Switzerland, Australia, Austria and Spain that challenge the typical forms of ownership and governance that we find in housing in the UK.

Concluding with a passionate call to action Tarsha said: “The RCA is fully committed to this important collaborative initiative. The ambition is to draw a broader public into a conversation about other possible futures, creating actively engaged citizens, not passive consumers of mass produced-housing, where we are all involved in the project of questioning what is possible together, what we can share, who we can be together. The future has not yet been written. Collectively we can make a difference.”

Outstanding product design has a vital role to play

The import of great design was a recurring theme at Congress this year. Jeremy Myerson, Helen Hamlyn Chair of Design at the RCA, called for housing designers to flex their creative muscles.

Simon Bayliss, CEO of award winning architects HTA, showed truly aspirational housing schemes that incorporate networks of green spaces and outdoor amenities that encourage social interaction and physical activity. A message reinforced by Marta Fernandez, Director of RMIT Europe, who flew in from Barcelona to remind us that “The success of housing is intimately linked to the environment and the accessibility of nearby streets, sidewalks, parks, squares shops and so on.”

Learning from our neighbours

A number of European colleagues found time in their busy schedules to come to London to share their experience, we are most grateful.

Alberto Sanna Director at the Advanced Technology in Health & Wellbeing Centre at the Scientific Institute San Raffaele Milan Italy talked about lowering the invisible cultural, organizational, economic and environmental barriers that hamper stakeholders’ effort towards “healthier, greener and fairer behaviours in everyday life”, both for Individuals and business/social actors. Alberto has been busy designing and testing autonomous vehicles tailored to meet the needs of older adults and is currently exploring potential 5G use cases with Vodafone.

Olivier Horbowy, spoke about ACTIVAGE, a 20 million Euro EU funded large scale demonstrator. Which aims to enable the deployment and operation of Active & Healthy Ageing IoT based solutions and services, across 9 Deployment Sites in seven European countries.

Olivier is Head of Marketing for Microelectronics, an ACTIVAGE industrial project partner. I asked if he was optimistic regarding the commercial impact post grant. Olivier said that in hindsight the partners should have invested more time refining their collaboration agreements pre-launch as the route to commercialisation for participating SME’s has been compromised through lack of clarity in terms of intellectual property. (Worth noting UKRI.)

Tore Borthen, shared details of an ambitious multigenerational project his company is developing in Norway. Tore explained that sharing time with so many like-minded stakeholders in London, inspired him to head home with a spring in his step to complete his own project and collaborate with others.

Alexandre Grutman, Founder and CEO of Inner-Fuel Ventures Switzerland, explained how there is no shortage of funding for health and care related communal housing for older adults in Benelux countries and believes that we should be doing more to promote cross border funding initiatives.

Another international venture capitalist Yael Benvenisti, CEO of Mediterranean Tower Ventures, the first VC in Israel to focus exclusively on the Silver Economy, also says working together will help breakdown some of the artificial barriers that the current political situation in Europe has thrown up.

So, there you have it. Key messages: Need for more creative collaborations; focus on multigenerational neighbourhoods; co-creation and the need to involve older adults up stream; tech must retain the human factor; innovation in markets is needed as well as innovation in ideas; good health is a state of complete physical, mental and social wellbeing – not merely the absence of disease or infirmity...

With so many interesting and provocative key notes, panel discussions and delegate interaction, it is impossible to cover everyone’s contribution in one, or even two articles, so I will address other themes in future correspondence. These will include Fostering Innovation, Planning for Change, Reimagining Public Health, the AAA London College of Fashion Design Challenge, and the Reference Framework for Agefriendly Housing in our Neighbourhoods of the Future. I will also keep you posted on developments related to work in progress. If you missed it, this is a link to part one of this article.

A final word of warning

Before drawing a line under Congress 2019, I thought it prudent to share these wise words from the lovely Karen Holden, Founder and CEO of a City Law Firm:

“Anyone designing disruptive technology should be thinking strategically about data protection, beyond the here and now. This is particularly true for any technology designed for the home, and especially the homes of potentially vulnerable people. Product and system designers and their companies should be working with legislators and regulators to ensure the authorities are fully aware of what's coming down the pipeline and how these could affect society. It may even be that the regulators become involved in the design and implementation of new technologies `upstream', moving to a `preapproved' or `pre-validated' internal operating system."

“The potential for abuse is growing every day. With any advancing technology, we must balance its capabilities with human rights and privacy.”

Until next time: Stay Agile.

Image: AAA Congress 2019 by Jane Petrie