Abstract

The UK currently spends 70% of its entire health and social care budget on long term (“chronic”) health conditions. These include diabetes, dementia, obesity, depression, COPD, arthritis, hypertension and asthma.
We need to be better at:
— Understanding the cause of these illnesses
— Helping a person to avoid developing them
— Creating new treatments
— Helping the patient self-manage their conditions

All these require working with a patient over months or years, outside of a traditional hospital environment. In a very real way, we need healthcare to go where the patient goes; the single place that most people spend most of their time is their home. Consequently, SPHERE project is seeking to develop non-intrusive home-based technologies for measuring health related behaviours at home over long periods of time.

The requirements for these technologies are:

— They should require little or no action from the patient, since our daily lives are busy; being ill is distressing and time-consuming; and when the benefit may take months or years to achieve, there is often not much day to day motivation to be bothered with measurements or devices.
— They should work reliably in the home; a home is not a hospital or a laboratory – it is smaller, full of furniture, pets and people, often not brightly-lit and often challenging to get wireless network coverage everywhere. This poses lots of problems for researchers.
— They should be acceptable; bringing healthcare home with us doesn’t mean we want to turn our homes into hospital and it definitely doesn’t mean we want people spying on us!

Since 2013 this has been the SPHERE vision and we have worked with scientists, doctors, engineers and more than 200 members of the public to achieve the project’s initial goal of creating a cheap sensor system that can be installed in a home. More than 30 people have had the experience of living with the sensors over periods from days to months and, by the end 2017 we expect more than 200 people will have had SPHERE sensors in their own home, in many cases for months.

Although the first-generation system was only completed in late 2016 and at the time of writing is still under test in the first “pilot” homes, the system is already moving into real patient applications – we are applying for ethical permission from the NHS to use SPHERE for patients recovering from surgery. Later in 2017 we will be applying for ethical permission to use SPHERE with a group of dementia patients.

The initial testing of the sensor system has gone well but, especially as we start to think about large scale use of the SPHERE system across potentially hundreds or thousands of people, the team have learnt a lot from the early pilots and have some priorities for significant improvements:

1. The SPHERE video system needs to be better at evaluating the quality of someone’s movement, such as getting out of a chair, even when the view of the person is blocked by items of furniture. Evaluating quality of movement is important in physical and mental health conditions.
2. The SPHERE wristband lasts for over a month on a single charge, however we want to remove as far as possible the need to charge it at all, because the more ill someone is, the less likely they are to do this.
3. Digital data gathered from sensors needs to be turned into understanding for doctors; this is especially difficult in a home environment because every home and every household is different.

These are major research issues and will be the focus of the technology parts of the SPHERE programme, while the clinical parts move forward with patient populations.

The NHS itself has recently said: “if the UK fails to get serious about prevention then recent progress in healthy life expectancies will stall, health inequalities will widen, and our ability to fund beneficial new treatments will be crowded-out by the need to spend billions of pounds on wholly avoidable illness.”