Intelligent care: A solution to the crisis

As time and resources become increasingly limited, technology offers a lifeline to a care sector on the brink of collapse

Jacob has been in and out of hospital all his life. Born with spina bifida, which is when a baby’s spinal cord doesn’t develop properly in the womb, he underwent his first surgery at just a day old. Since then “he’s had [so] many surgeries, I’ve lost count”, his mum tells me.

Now 13 years old, Jacob, from Aberdeenshire, suffers from a condition known as Arnold-Chiari malformation – when part of the brain is pushed downwards into the spinal canal – and last year his mother Kirsty was faced with a decision no parent should have to make: “I was given the news that there wasn't really much for doctors to do any more. [Either] I agreed to an operation to try and prolong his life, which was a tracheotomy ventilator, or I agreed to switch off his ventilation in ICU and they would put him into end-of-life.”

Kirsty went for the former, and now as she sits beside Jacob’s bed at the Aberdeen Royal Children’s Hospital, she tells Holyrood how a world-first tech device has given her the opportunity to feel “responsible” for her son again.

In July, Jacob became part of a UK-first trial of a new ‘Bedside Intelligent Cabinet’. Developed by IT solutions firm Kinetic-ID, the SMART cabinet stores routine medicines securely and alerts carers when it is time for a patient to take their medication.

“I don't like chasing the staff, knowing that they are really busy. But obviously if your child's got a set time for a set medication and they're not getting it at that time, then it can kind of knocks them off as well. So having to go and say to a nurse ‘can I please get my child's medication?’, I just feel bad for doing that because they are understaffed. They're very busy, especially leading up to the winter period,” Kirsty tells Holyrood.

As Kirsty points out, the Scottish health and care sector is at a breaking point. In September, Norman Provan, associate director of employment relations at the Royal College of Nursing Scotland, said NHS Scotland was yet to employ “the number of nursing staff it says it needs to deliver safe care”, while a report by the Coalition of Care and Support Providers in Scotland showed that, across 2022-23, 95 per cent of organisations found it either ‘very difficult’ or ‘quite difficult’ to recruit frontline staff.

Against this, technology has emerged as a much-needed lifeline for professionals and those they care for. “The technology has also helped the relationship between staff and parents. Often when children are in hospital, nurses take over managing medicines, even existing drugs that parents and young people themselves would have been in-charge of taking at home. That can be unsettling for parents who really want to look after their children, and on occasion that can make things a touch tense”, Andy Keen, clinical lead for innovation at NHS Grampian Innovation Hub, explains.

“It's given back the parents independence but also allowed the nurses to have a bit of an easier relationship with them.”

Meanwhile, cutting-edge technologies like virtual reality (VR) and augmented reality have revolutionised training, offering a dynamic learning experience that has made the sector more “attractive” to potential staff, Nicola Cooper, technology and digital innovation lead at Scottish Care, says.

In 2022, Care Reality won the Civtech 6 challenge – the Scottish Government’s innovation accelerator programme. The VR simulation platform offers an opportunity for aspiring health and social care workers to remotely assess the skills needed for the job, such as the ability to accurately measure and record a patient's vital signs. It is understood that the service is the world’s first VR training platform for adult social care.

Technology also offers solutions for other pressing issues such as bed-blocking. From 2022-2023, there were more than 661,700 days spent in hospital by people whose discharge was delayed, according to Public Health Scotland, and the Scottish Government acknowledges these “are usually due to a lack of appropriate care or services available within the community”. 

And Lucy Fraser, head of innovation at Albyn Housing, is amongst those fighting to demonstrate that technology can bridge this gap in care.

The housing provider has been working towards tech-driven homes for over a decade after one of its tenants died and lay unfound for more than a year. The person was disassociated with their family and the public sector, didn’t partake in the community and had everything set up through direct debit. “There was no support network for them,” she explains.

“This is far more common occurrence than you would think. And with more people being single, it's going to happen more often.”

Since then, with seed funding from the Inverness and Highland City-Region Deal, the housing association has developed ‘fit homes’. Fitted with predictive behaviour pattern sensors and equipped with artificial intelligence (AI) and machine learning, these residences can provide live information to carers, letting them know if the tenant is in danger.

Gary Baillie, head of BR24 – a telecare monitoring centre – and assistive technology development at Bield Housing & Care, says: “It’s not just about the tech itself, but about the peace of mind it brings. For instance, integrating predictive and analytical technologies into the homes of tenants who are on a supported journey allows care staff to monitor patterns and identify risks including falls or changes in daily routines. This ensures that individuals receive the right support at the right time.

“From my perspective, it’s a way to maintain dignity and control while ensuring safety and wellbeing – a balance that’s at the heart of good social care.”

Scotland has the highest rate of single-person households in the UK, with more than one in three living by themselves, according to data from the National Records of Scotland. Linked with the country’s trend for an ageing population, with the 2022 census data showing that the number of people aged 65-plus had increased by 22.5 per cent since 2011, those in need will soon significantly outnumber those able to provide support. And, unless the government creates a strategy focused on implementing innovation across the health and care sector, a two-tier system will soon emerge, Robert Rea, head of innovation at InnoScot Health, warns.

“If we don't innovate here, if we don't do these things, then we're going to end up in a situation where people's quality of lives will suffer. And it's going to be people who live in cities that have access to care that will be ok and people that live in remote communities are going to be the ones that suffer.”

Indeed, for the past three years, the Scottish Government, in partnership with COSLA and Digital Health and Care Scotland, has delivered an annual delivery plan for care in the digital age. However, Rea claims the strategy was too ambitious for the allocated timeframe, leading to some aims not being “fully met”.

While it has been successful in delivering initiatives like the Seer2 programme, which provides near real-time information to care professionals to inform decision-making, it has failed to address key challenges which will affect the success of rolling-out a tech-enable care service. For instance, according to the strategy’s deadline, it should have by now helped bridge the digital divide, yet two months ago a report by Audit Scotland showed the number of people who are digitally excluded has risen by almost 60 per cent since 2022 when the first strategy was published. 

And when it comes to social care, Cooper says that there is a “real gap” in innovation support. “There are really good and innovative solutions coming out of industry and academia and I don't feel there's a route to market for them in social are."

If we don't innovate here…then we're going to end up in a situation where people's quality of lives will suffer

However, social care minister Maree Todd has previously seemed certain of the power of technology to revolutionise the sector. While visiting Albyn Housing’s fit homes in Lairg in October, Todd said it was “great to hear directly from tenants” on “the huge difference this technology can have on someone’s life”. She added: “It’s important for people to have the opportunity to grow old in their own community and more innovations like this will ensure this is a possibility in the future.”

Bield Housing’s tech expert agrees with her. Baillie tells Holyrood: “I’ve spoken with many tenants who struggle with loneliness and isolation – issues that are only exacerbated without access to the right support. Technology, whether it’s AI-driven monitoring systems or tools that enable virtual connections, can bridge these gaps.

“Without rolling out these innovations we risk leaving many people disconnected, vulnerable, and unable to fully enjoy their later years independently. From my perspective, embracing these technologies is not just an operational priority for Scotland, but a moral one.”

Still, despite these warm words, the controversial National Care Service Bill falls short of matching this enthusiasm. As introduced, the 38-page long bill fails to mention technology even once. The bill, which aims “to improve the quality and consistency of social services” across Scotland, overlooks the very tools which could help deliver its ambitions.

Scotland, however, is not short of medical tech breakthroughs. Last year Scottish care homes began trialling an AI assessment tool called Paincheck. Capable of detecting pain by analysing facial micro-expressions, the device predicts deterioration signs for people with dementia, which affects around 90,000 people in Scotland.

Embracing these technologies is not just an operational priority for Scotland, but a moral one

Unsurprisingly, much like the rest of the tech sector, medical technology is facing a funding gap when it comes to research and scale-up support.

“We often don't have huge amounts of evidence for cutting edge technology that can radically improve healthcare outcomes, and we don't have huge amounts of money to buy these technologies if we did. So, our problem is probably those two things, evidence and resources,” Keen says.

“We are in a bit of a state of flux, where we haven't worked out how to robustly but quickly evaluate technology to see if it can help improve care, nor how we can smoothly regulate without causing substantial delays every time products are improved . I'm sure we will happen in the coming years”.

It is also held back by a regulatory framework that “isn’t quite ready” for certain cutting-edge innovations such as AI.

Keen says: “If you think about something like a drug trial, you go through years of tests and then when you get to the end, you're still testing the same thing as you were testing at the beginning in general. And you've proved that that thing works or doesn't work.

“Technology it's not good at adopting that kind of process because if it takes you five years to get the level of evidence that in general, we would look for a drug [and] by the time you're adopting it, it's out of date.”

With Christmas around the corner, technology has given Kirsty and Jacob a better opportunity to be home for the holidays. “It's gave me the chance to understand what medications he's on, what each medication is for… It's given me the chance to know that when he goes home I can go back to administrating his own medication so I'm not having to rely on other people,” she tells Holyrood.

The evidence and benefits are clear. Technology is not just shaping the future of care— it's transforming it, offering a better life for those who need it most. As Baillie puts it: “It’s a win-win for both individuals and the broader system”.