For a young disabled person growing up in the 1990s and early 2000s, just as the personal computer was launching its invasion of homes, schools and workplaces; technological developments offered a tantalising glimpse of future liberations from restrictions imposed by my impairment. I have cerebral palsy which means that my condition is unlikely to change very much but, from early on, the running presumption was that technological progress would alleviate some of the resulting disadvantages.

During my teenage years, I could see how word processing, email, instant messaging, web browsing and any number of other software applications might revolutionise the way I worked and played. Yet, at the same time, I was frustrated that my lack of fine motor control meant that I was unable to use a mouse and keyboard.

The gap between what I imagined might be possible in the future when computers eventually became more accessible for someone with my impairments and the limited access options available only gradually narrowed.  I soon found that I could control a cursor reasonably well with a tracker ball or joystick placed under my chin.  However, typing with a chin-operated device and onscreen keyboard was slow and tiring.

Initially, I thought that the next breakthrough in my personal technological evolution would be provided by voice recognition software, although my trials of successive versions of Dragon NaturallySpeaking demonstrated that speech-based solutions would not be able to cope with my slurred speech for some time to come. That was before I encountered eye tracking technology which allows users to interact with their machines simply by looking at the screen. I was soon convinced that eye tracking was the solution to years of toiling with my chin.

The eyes have it

Microsoft’s recent announcement that native support for eye tracking will be included in a future update of Windows 10 is a watershed moment in operating system accessibility. While most of the major operating systems (Windows, Apple, iOS and Android) offer a range of inbuilt support to help disabled people operate their devices, they rarely address the needs of a minority of users with the most profound physical disabilities.

The new Eye Control feature was inspired by a Hackathon event held in 2014 which awarded top prize to a project that enabled a participant with amyotrophic lateral sclerosis to drive his wheelchair with an eye tracking device. The Windows development team jumped aboard an internal eye tracking study group formed after the project and partnered with Swedish firm Tobii to develop the new function (a beta version of which is available to be downloaded from Tobii’s website).

Windows 10 Eye Control lets users access applications by glancing at icons and menus and allows you to input information using a dedicated virtual keyboard and communicate via a text to speech. Like existing eye tracking software packages that allow users to take control of cursor, the mouse feature requires users to select a region of the screen before magnifying the area make fine adjustments. Eye Control also includes a shape writing feature whereby users look at the first and last letter of a word and skim over the intervening characters – a method that can be faster than gazing at each individual character in sequence.

Eye tracking requires specialist cameras that can map out where the user is looking in relation to the screen. Tobii’s cameras do this by emitting infrared light in order to illuminate the cornea of their eyes. Image sensors and image processing software then identify the eyes and detect the position of the iris and pupil. The direction of the user’s gaze is then pinpointed using 3D modelling.

Coming into focus

The history of modern eye tracking stretches back to studies of saccadic eye movements conducted by Russian psychologist Dr Alfred Yarbus in the 1950s. The technology is useful for measuring certain human behaviours like attention, interest and arousal and has been employed by researchers operating in disciplines such as education, medicine, engineering, computer science and marketing.

A combination of cheaper and more powerful hardware, new open source software packages and innovations in the way software can be programmed and trained has enticed consumer brands into the field. Eye tracking is set to become ubiquitous with big name players such as Apple, Google and Samsung joining Microsoft to incorporate it into everything from smartphones, laptops and tablets to video games and healthcare diagnostic equipment.

Microsoft’s Eye Control represents a milestone, making a future version of Windows accessible in principle to users with severe physical disabilities without requiring additional software. The need to purchase a camera is likely to remain a sticking point for many, with prices for most models reaching into the thousands of pounds (they are continuing to tumble). The feature can only currently be used with Tobii’s Eye Tracker 4C while additional options have been promised. However, these developments are likely to be a staging post for an imminent future when the hardware is built into devices of all shapes and sizes along with the software.

This article was originally published in the September 2017 edition of the dispATches newsletter about technologies that empower disabled and older people to be more independent – circulated by Designability. Click here to subscribe

A variety of well-worn tropes dominate discussions about why the over-fifties are often slow to adopt assistive technology. Older people are charged with showing a Luddite-like resistance to new ways of doing things, reluctant to accept that they now represent the primary market for products that they may have previously associated with disability and illness. After a lifetime of caring for others, it can feel self-indulgent to splash out on equipment that promises to make their own lives easier, especially when it comes with a hefty price tag. 

As reported in last month’s dispATches, a new white paper confounds some of these assumptions and throws a spotlight onto the failures of the assistive technology sector to respond to the needs of their customers. A study commissioned by Accord Marketing that probed the behaviour of customers in the over fifties mobility market found that customers are savvier and more discriminating than many suppliers tend to assume. 

Unfulfilled demand

As with any other key purchase, respondents valued honesty from companies and were careful to make informed choices. The most cited reasons for buying from a company were excellent customer services, product quality and the use of discounted offers and fair prices. Shoppers were also heavily influenced by recommendations from family and friends and information available online, including on social media. 

The findings resonate with other surveys that show the baby boomer generation has a great appetite for new technologies where their benefits have been clarified and are likely to consider the private purchase of assistive living equipment for themselves and their loved ones. 

However, manufacturers, suppliers and retailers are ill-equipped to cater to everyday consumers. Most businesses only sell through business-to-business contracts with health and social care services. These privileged arrangements have produced a legacy of captive markets that are often commanded by a handful of major players with little incentive to look beyond their core clientele. 

Know your customers

In a study published in 2016, Professor Gillian Ward of Coventry University and colleagues found that businesses operating in the field of assisted living technology lacked a basic understanding of the needs of older consumers and the size and make-up of the market. The research also uncovered evidence that companies tended to overestimate the impact of other people’s negative attitudes on consumers and did not pay enough attention to other concerns such as the reliability, design, safety and cost of running a product, its complexity and sensitivities around information disclosure.

The industry must stop blaming consumers for their apparent lack of enthusiasm and become better advocates for its products and services. It can start by establishing national standards for more products to reassure people that they can be confident of the quality of their purchases. Firms should also heed buyers’ expectations of a robust retail experience with outstanding customer service, opportunities for hands-on demonstrations and try-before-you-buy offers and money-back guarantees.

Demand for assistive technology among older people is significant and growing. The sector must strive harder to meet it.     

This article was originally published in the January 2018 edition of the dispATches newsletter about technologies that empower disabled and older people to be more independent – circulated by Designability. Click here to subscribe

This article was first published at Social Care Innovation

As many social care service users know, being able to explain one’s care needs and how they might fit within the broader context of one’s life is essential to securing a suitable care and support package. Indeed, social workers are required to take into account what the individual considers to be important when making care arrangements — something that would be impossible without the person’s input.

However, there are occasions when an individual might find it difficult to fully participate in decisions about their care in the absence of additional support. They might have a learning disability, mental health condition, communication impairment or another potential disadvantage that could prevent them from engaging in the process. In these situations, the Care Act 2014 requires social services to ensure that there is a suitable person involved in the decision making who is able to support the individual and, if not, appoint an independent advocate.

Enabling empowerment

Advocacy is grounded in the belief that people should be able to express what matters to them and decide what services they need to achieve a good quality of life. Advocates aim to represent and advance their clients’ views in order to empower the individual by increasing their personal autonomy, encouraging their inclusion and improving access to services that might not otherwise have been offered to them.

Helping people to self-advocate as much as possible should be the ultimate goal of professional independent advocacy services. However, there is strength in numbers, and group advocacy gives people the opportunity to influence policy and service provision. Peer advocacy provided by trained volunteers who have been in a similar situation can lend additional potency to an individual’s voice. Advocacy has many different forms and a mixed approach ensures that everyone’s needs are served.

The Care Act’s advocacy duty applies from the first time someone makes contact with the local authority and at any subsequent stage of their care assessment, planning and reviews as well as during safeguarding enquiries and adult safeguarding reviews. Council officers must consider whether the client is likely to have substantial difficulty in making their own decisions in relation to four distinct areas:

• Understanding relevant information
• Retaining information
• Using or weighing information
• Communicating views, wishes and feelings

The Act specifies that the advocate cannot be a professional who is already providing care or treatment to the person, someone the person does not want to have supporting them, someone who is unlikely to be available to provide adequate support or someone who has been implicated in a case of abuse or neglect in the past.

Surveys conducted during the early phases of implementation suggest that relatively low numbers of people have been accessing advocacy in some parts of the country, implying that some local authorities are failing to offer advocacy services to everyone who needs them. Some commentators have argued that financial constraints on local authorities have meant that they have not been able to offer these services or do not have the resources to train frontline staff on the advocacy duty.

However, the failure to provide advocacy can also be costly, resulting in flawed assessments and legal challenges. In 2015 a landmark ruling determined that the London Borough of Haringey had failed to provide an independent advocate to an Afghan asylum seeker suffering from post-traumatic stress disorder who also had no understanding of England, and ordered that she must be reassessed.

Uneven provision

A survey on the commissioning of advocacy involving nearly half of English local authorities was conducted last year by the University of Birmingham and the University of Central Lancashire. The survey found that the rigour with which the advocacy duty is being applied varies widely. Only 48% of local authorities had tendered contracts for the provision of advocacy services since April 2015. While in some areas there have been fewer than ten referrals for advocacy since the introduction of the Care Act, others have seen over 400 referrals. Just 47% of councils involved service users in the commissioning process.

The researchers found that councils were using different tools for estimating likely demand through a combination of local and national information and guidelines, some of which were insufficient for the task. Service providers that also took part in the study said that arrangements for referral often do not work, partly because of a lack of understanding among frontline staff of the duty to refer.

The evidence indicates that councils have yet to come to terms with the full implications of the advocacy duty. An understanding of advocacy and the different forms it can take is important, not just in the most critical cases where the person lacks the capacity to make decisions regarding their care and support, but also to ensure that those who are capable of making such judgements are able to do so. Councils must provide training to help staff discharge this complex responsibility.

Effective advocacy support must be rooted in the aspirations of the person being supported. Local authorities should establish organisational structures and promote a culture that gives advocacy a central role in services. Service users and carers should be involved in commissioning services from board level down.

This article was first published at Social Care Innovation

In recent years January and February’s coverage of the peak demand on the NHS during the winter months has been accompanied by reports of stubbornly high rates of delayed transfers of care from healthcare settings.

And for good reason. A new analysis of delayed transfers data from last October by Impower shows that while there have been continual month on month improvements, 68% of councils failed to meet the targets for reducing the number of overlong hospital stays. Extended hospital stays can increase patients’ risk of likelihood, create extra stress and anxiety, and compromise their recovery.

Obstructed care

Delayed transfers are caused by patients being directed through the health care system via the wrong routes, too slowly. Too many face lengthy pauses in treatment produced by waits for the results of diagnostic tests, poorly designed internal processes, inadequate administration and a shortage of intermediate care places.

According to the Nuffield Trust, between 50% and 60% of bed days on acute care wards could be spent elsewhere. While 19% of patients on extended stays could probably return home without any form of additional support, the rest are likely to need care after their departure from hospital. For example, 28% may require nursing and social care support with input from clinical or rehabilitation specialists and a further 12% would be better served in a long-term care home. Others would require rehabilitation services, step-down care and palliative support.

Local authorities and health bodies have demonstrated that it is possible to expedite people’s progress through the system as long as the right combination of skills and resources are in place. Dudley Council has achieved a 58% reduction in delayed discharges among older people by establishing new specialist support teams to work alongside hospital accident and emergency departments and ambulances in order to prevent unnecessary admissions.

Astler Living in Somerset has been commissioned to help patients plan to return home by installing new furniture and equipment in their houses, repairing hazards and making sure people are receiving the benefits to which they are entitled.

Take a step back

Specific interventions can be effective at smoothing transitions between services, but it is also vital to look at the system-wide issues that cause unnecessary admissions. The Care Quality Commission has recently warned against focusing too much on delayed transfers at the expense of underlying problems in the local health and social care system. Primary and community care services need to work together to prevent people reaching a crisis point and make sure that there is sufficient local capacity to provide a range of care and support packages.

Making sure there is out-of-hours social work provision, that everyone is allocated a single keyworker who signposts and coordinates their health and social care, and professionals ranging from the GP to the community pharmacist are kept informed about patients’ care needs can reduce the need for intensive medical support and help people get back onto their feet after a stay in hospital. Councils and local health services need to be able to coordinate services that meet the needs of the local population, including planning for periods of elevated demand.

High delayed transfer rates are a sign that the current mix of health and social care services does not match the local demand. Health and social care commissioners have a critical role to play in designing better routes through the care system.