no company logocircle

Response to the ADASS TSA Commission

The Commission findings were given extra weight by key industry leader contributions from Microsoft, PA Consulting, Tunstall, OLM Systems and AXA Taking Care. Here, they offer additional insights progressing the agenda and practical applications for Local Authority to integrate technology into systems for best outcomes.

Microsoft, PA Consulting, Tunstall, OLM systems, AXA Taking Care. Technology enabled care commission ADASS TSA

Clockwise (left to right): Steve Carefull, Care Technology Expert & Programme Director of the Argenti Care Technology Partnership, PA Consulting; Helena Zaum, Industry Solutions Manager, Microsoft; Angus Honeysett, Head of Market Access, Tunstall Healthcare; Steve Gates, Managing Director, Taking Care; Peter O'Hara, CEO, OLM Systems

Helena Zaum, Microsoft

The Commission talks a lot about improving digital literacy amongst the care workforce but also amongst those people and carers accessing support. How big an issue do you think this is and what needs to happen to change things, once and for all?

Building digital capabilities across the health and social care ecosystem is a critical success factor in us being able to deliver care which responds to the needs of individuals and their families, and critically in enabling the delivery of anticipatory care – both are entirely reliant upon data. From the perspective of people and their carers, we envisage a future in which individuals have far more control over their health and care records and in particular how this information is shared and for what purpose. We (the people) must take a more proactive approach to understanding data privacy and consent – something we have become more atuned to in the light of the pandemic. There are additional issues around ensuring that all members of society can participate in an increasingly digitised system – digital literacy, connectivity and access to affordable devices (including “smart” gadgets) are all critical issues. On the other hand, there is a need to support the ongoing professional development for care staff, social care staff and clinicians to work in an environment where digital record keeping, prescribing digital solutions to care needs, and data interpretation are key skills, used in each interaction with people, carers and families. Critical for the workforce, is creating the capacity and time for these skills to be acquired, demonstrating the value of doing this to those individuals (e.g. to improve their work/life balance) and to the wider system. Local government can enable much of this critical change and has demonstrated its ability to be digitally agile time and again during the course of the pandemic. Investment is needed to sustain the momentum.

Local authorities are at very different stages when it comes to digital maturity and their ability to put the Commission’s recommendations into action. What improvement work needs to be delivered around this and how will the proposed Personalised Care Innovation Programme support this work?

Many local authorities have a well formed digital strategy encompassing the three main components required to enable the delivery of services to citizens. The first element is an intelligent workforce/workplace (one which can work remotely, collaborate effectively and work virtually where required). The second involves an intelligent approach to interacting with citizens (multi modal access to services, the ability to tell one’s story once, and great information which helps to manage demand). The third is a data platform approach which allows for place based information to be stored in one place and used to contextualise and add colour to longitudinal health and care records and lies at the heart of delivering anticipatory care, population health management and personalised services. For the majority, funding is the chief constraining factor, rather than ambition.

The PCIP could help to accelerate plans which many local authorities have in place to digitally transform their social care service – and would allow them to embrace the task of targeting preventative measures earlier on in people’s lives to reduce overall costs and improve quality of life for people, supporting them to retain independence and dignity.

What changes would you like to see around information governance when it comes to social care and health data? Why is this issue so important?

Encouraging individuals to be in charge of their information and data will accelerate the ability of health and social care to deliver a joined up and efficient service to individuals. Whilst information sharing agreements have matured, particularly during the pandemic, they remain challenging and often slow to implement, and dependant on varying interpretations of risk etc. Ensuring trust between citizens and their care practitioners and clinicians is sustained and built upon is paramount if we are to deliver services which are powered by data specifically and digital services more generally. This can only be achieved by innovating responsibly and being transparent about why we are collecting data and what we propose to do with it.

Angus Honeysett, Head of Market Access at Tunstall

Tunstall were delighted to be involved with the TSA / ADASS Commission: Exploring how technology can be truly integrated into Adult Social Care that makes four key recommendations for improving social care provision. However, it’s more than just a series of recommendations.

As an industry, we need to look at what can be effectively delivered for the citizen and the system so that everyone benefits.

As TEC providers, we are all aware of its benefits to housing, health, and social care:

>> increasing capacity in the system to cope with growing demand

>> enabling care to be more person-centred and community-based

>> better independence and quality of life for citizens and carers

>> early intervention reducing the need for other more costly care

>> professional development, therefore aiding recruitment and retention

However, we also have a key role to play in supporting integration, not purely from the point of view of TEC being an enabler in more holistic service delivery, but in playing our part in truly understanding what solutions are required. We need to engage earlier in the process to understand the problems, for commissioners, providers and users, in order to co-design products and services that meet the challenges they are facing – a truly collaborative approach.

We also have the challenge of working simultaneously on a short, medium and long term basis. As much as we have the immediate need to solve today’s issues, at the same time wehave to look ahead. Technology will play an increasing role in the way we deliver services in the future, but we need to take a strategic approach to this, considering cultural change as well as processes, and embed TEC into five and ten year plans. Simply, if the culture isn’t right, we run the risk of doing what we always did and not focusing on new and more effective solutions.

But it’s difficult.

Technology has historically been seen as a barrier, with a fear it will replace practitioners, rather than enable and help them and the citizensthey support. Social care and health must lead from the top to ensure TEC is a natural part of professional practice. There is also a lack of awareness of and confidence in TEC solutions; Tunstall is aiming to address this by introducing the Tunstall Academy, a series of education and training programmes, but more must be done by the public sector to promote the benefits and embed a technology first approach.

Aside from the policy push, working more collaboratively is simply common sense.

A large part of the population have both health and care needs and it makes sense to join them up, saving the tax payer money whilst improving the patient/citizen experience. The NHS and social care are inextricably linked, with success or failure in one impacting significantly on the other. Their integration has been a long discussed goal, but by realising the potential of technology along with taking more proactive and preventative approaches, the prospect of a true healthcare service is a very real possibility.

Lastly, but in terms of priority firstly, we need to listen to citizens, understand their needs and wants, and build a system around them. Population health management relies on shared common outcomes; health and social care sharing common goals and working together to put people at the heart of decisions made about them and their care.

Steve Carefull, PA Consulting and the Argenti Care Technology Partnership

What can the COVID Pandemic teach us about how to commission Care Technology?

The adoption of video-calling technologies mushroomed during the COVID restrictions. As illustrated in BBC WORKLIFE, they enabled virtual contact and helped people feel less isolated. Many who had not previously used FaceTime or Zoom turned to their iPads or PCs to connect with family and friends in a more engaging way than by phone.

Some of those who have only recently adopted video-calling will continue to use this technology post-pandemic. For clinical consultations for example, which have also spiked, as explained here: Effect of COVID on telehealth usage. Their aim will be to save time or enhance communication, and they will be largely disinterested in the device or software they use. I’m reminded of the UK mail strike in 1988, when 150m postal items languished in sorting offices. That year sales of fax machines rocketed, and the technology became ubiquitous.

The lesson is that whilst new technology may enable a change in behaviour, the driver is the user’s wish to achieve a particular outcome.

Paradoxically, when the focus is on the desired result, people can be more accepting of a new solution, as long as it works, because we are unforgiving of technology that doesn’t!

This should give councils considering their care technology options pause for thought. Just buying TEC without identifying what they are going to achieve with it can mean being left with a storeroom full of unused devices. The Department of Health learned this in 2006-08 when councils spent their Preventive Technology Grant with the apparent aim of, well, just spending it.

Unfortunately, commissioning for outcomes is more complex and riskier than commissioning things that can be measured upfront, like pallets of devices, or price. No commissioner will be fired for appointing the bidder with the best price per TEC solution. But if these don’t go on to improve the lives of people with care needs or reduce the overall cost of care it’s not best value, it’s a missed opportunity.

Innovative digital solutions will fuel the next decade of growth in TEC, by integrating with peoples’ own stuff, and generating data to inform preventive action in ways traditional telecare never could. But, strong leadership from Directors of Adult Services will be required if councils are to commission the right thing and maximise the benefits of digital care technology.

Care technology commissioners must be given the confidence to negotiate through the fog of TEC hype. Having just evaluated the latest crop of digital TEC alarm units, I can confirm that no-one has yet got this staple of the care technology world 100% right. There are not, nor have there ever been, any TEC silver bullets out there; the focus must be on thoughtful selection of the right solution to achieve clear outcomes.

Twelve months of COVID has done more to increase the understanding and use of technology to achieve care outcomes than decades of effort by the TEC sector. This new ‘demand pull’ should come as a blessed relief from the relentless ‘supply push’ we previously thought of as normal.

Commissioners should tap into the zeitgeist and challenge the market to collaborate in preventing and solving care challenges at scale. Warmed-over telecare solutions from the days when fax was king need not apply.

>> Download your copy of the ADASS TSA Commission here

Peter O’Hara, OLM Systems Group

The Commission highlights interoperability as a major barrier to health and social care collaboration and true integration with technology. What are the central problems that need to be overcome and how can real change around interoperability be achieved? What action should local and central government take?

The Commission heard from Directors that silos constitute a significant barrier in social care and health, with enhanced collaboration being key to improving outcomes. The latest advances found in today’s cloud technology, alongside modern integration techniques certainly help solve the technical issues and cost burden of joining up systems. A contemporary framework can also provide you with a platform to use robotic process automation and AI to help solve problems and reduce workload, alongside plug-in systems and apps. Technology is part of the jigsaw, with projects moving at an impressive speed, but even this fantastic technology needs to be used in context.

People should be careful not to get too caught up in the media buzz of AI. Technology can do great things and will do even greater things in the future, but it will always be people that use the systems. Social Care is a complex area and will forever be a people business. When you get down to basics, the job is being able to connect people to the support that would be best for them at the right time in the most efficient manner possible. Integration, AI and RPA will have ways to support the journey but are not solely the answer. Automating a process that is not 100% right in terms of outcomes will create a more efficient failure.

It would be best if you had a deep understanding of the citizen's experience, how the people who currently support that person feel, and how all these aspects work together to deliver a better life for that individual. Once you understand the current challenges and how this impacts the support provided, you can look at what solutions will solve this.

I am not saying don't invest in technology; the sector badly needs a refresh but invest wisely. If you have decided to invest in new technology, then you need to make sure that you are investing in a system that is ready for the massive amount of change that will hit the sector over the next decade.

There is no need to be at the cutting edge of AI. Social care has some much simpler low hanging fruit regarding improving practice and technology before getting caught up in the media hype. We hear from Directors and Assistant Directors that technology is too static in social care, with the inability to test new ideas. With infrequent and costly upgrades (Only 2-3 upgrades a year) alongside difficulties in changing the system quickly to reflect new working practices being pain points. Social care needs to be able to change and test at pace, learning from data and continuously improving like other industries are doing across the UK.

Another big sticking point is people owning and controlling their own care data. Why is this so important and how can it be achieved?

I am a big fan of the open notes movement that you see in other countries. I believe that we are recording people's stories on the system and having a right to see their records. We want to be able to feed into them and make sure they recognise themselves and their goals in their independence plans. Technically, I think moving to this model won't create any issues with the modern technology platform approach.

We have fantastic social workers doing a great job, but they are overstretched. The question is will councils look to bring this in without a push or more money from Government.

This is a fundamental shift and requires local authorities to be brave, as opening up records could create an environment of more criticism, more changes and potential conflict. I hope they are bold, though, as it will open up the conversation between social workers and the client should issues arise. The ability to see your notes will ensure an open, trusted relationship between the two individuals.

The purpose of Adult Social work is and has always been about helping people in the best way for that individual, letting people do what they love with the people they love. When you look at it like that, you question why we have not given people access to their own information already?

Steve Gates, Managing Director at AXA Taking Care

What can be done to make care technology more predictive and pre-emptive going forward? What changes need to be put in place across the industry to encourage this more widely?

To become more predictive/pre-emptive will require a total re-think of our past approach as an industry. We are far too comfortable with “binary” alarm approaches which are either “on” or “off” and we haven’t traditionally had a whole lot of opportunity to get involved in someone’s life and health outcomes when the alarm unit is “off”.

We’re going to need to embrace a far wider range of devices to collect a far wider range of health indicators and become far more comfortable with using algorithms and machine learning to interpret the data and highlight different stages of people’s mobility and frailty journey.

Once we’ve done that we will also then need to totally rethink how we deliver “behaviour change” with the involvement of our customer/service user – as the one crucial thing about prevention is that it requires the active involvement of the customer to WANT to change and to have a clear way of ACHIEVING that change.

We all intuitively know that we should eat more vegetables and drink less alcohol, but most people don’t - so as a TEC industry we are going to need to become experts in supporting “behaviour change” amongst our customers, some of this over the phone and some of this via direct intervention within their homes.

This requires a fundamentally different mindset and staff capabilities than have traditionally been resident in TEC (so how many TEC providers employ data scientists, health algorithm designers or data privacy experts, just as a starting point) and represents an amazing opportunity for TEC to step up to becoming a major part of the prevention challenge within health – about which much is said and written but, in practice, far less is actually delivered.

What are the realisable benefits for health and social care if we can take this step around proactivity in care technology?

TEC is already involved in prevention, as we can have a major impact in reducing the additional health impact of a fall-occurring by ensuring that the individual is provided with personalised and speedy support. Taking Care’s work with Aston University’s Research Centre for Healthy Ageing demonstrates that there are evidence-based clinical studies that TEC can already reduce (by 50%) hospital admissions due to falls, reduce (by 50%) unplanned hospital admissions, reduce the length (from 15 to 8 days) of hospital stay following a fall and reduce the time taken to find missing individuals with dementia.

As TEC moves further into preventing and avoiding falls, the health benefits will only increase – if we can prevent an individual falling and entering the “cycle of frailty”, then their life expectancy and health outcomes will only be further improved. We can also potentially have a major positive effect on the NHS budgets – with the total cost of fragility fractures to the UK estimated at £4.4bn per year, which includes £1.1bn for social care, with hip fractures accounting for around £2bn of this sum.

Imagine the financial and health outcomes if TEC can support our service users to increase their healthspan (ie. the years of healthy living) and not just their lifespan.

>> Download your copy of the ADASS TSA Commission here

Partners & Associates