Episode 1 - Commissioning differently: Evolving personalised care with technology
Hosted br Dr Kate Hamblin, University of Sheffield, and Nathan Downing, TEC Services Association.
Traditionally most telecare, and now ‘technology enabled care services’ (TECS), focused on managing the risks associated with living in the community when people were older or requiring support. TECS helped people to ‘age in place’ at home when discharged from hospital or when living alone following a bereavement. These devices and services were often reactive, creating an alert in emergency situations, either relying on the person triggering an alarm or the system automatically detecting changes in the home environment.
There is now a distinct shift in approach in the UK from reactive to proactive and preventative services. Technologies are becoming ‘smarter’ and better able to relay information captured through a wider array of sensors and ‘Internet of Things’ devices. The design of services around the technology is also developing, using data gathered in more predictive and preventative ways as well as shifting towards ‘proactive’, in-bound calling systems. There is also a growing interest in mainstream devices and the role they can play in supporting people to live well in their communities and homes.
Findings from the Sustainable Care programme research from the University of Sheffield and from the TSA’s experience of engaging with the sector highlighted examples of local authorities and councils exploring and investing in TECS for prevention, taking a proactive approach as well as being focused on the wellbeing of those receiving support. The TSA has also observed in the past 12 months a rapidly growing appetite for more proactive services, both from adult social care commissioners and also people receiving support and their carers.
However, this has been met with varying levels of technical service maturity and challenges, including issues related to interoperability, workforce pressures and limited capacity for analysis of the vast amounts of data generated and evidence-based decision making.
In the recent Sustainable Care and TSA Digital Care Futures podcast, Kate Hamblin (University of Sheffield) and Nathan Downing (TSA) spoke to guests from two examples of services which take a proactive and preventative approach.
Proactive, preventative services: What is the ‘Barcelona model’ and how have Delta Wellbeing adapted it?
In Spain, where there is a statutory entitlement to TECS services, the Barcelona provincial council shifted from a reactive service where an alert is triggered in an emergency to proactive, in-bound calls. In Wales, Delta Wellbeing Ltd - the first local authority trading company to focus on TECS - have adapted this approach to create a person-centred, strengths-based service that uses in-bound calls and community wellbeing officers to coach and mentor people to achieve outcomes they themselves have identified as important to them.
The CONNECT project is guided by Social Services and Wellbeing Act which includes a wellbeing focus but also a duty to provide information, advice and assistance. The project involves an initial wellbeing assessment to establish what their personal priorities are and identify what level of support the person requires to live well. Alongside regular proactive calls, a 24/7 community responder service and community wellbeing support officers empower and coach people to help them achieve their goals and aspirations with a ‘wraparound’ service that links them to local activities and support.
“TEC is really just the facilitator in this and it isn’t actually the main focus of what we’re doing - it’s actually the additional wraparound and enhanced service that CONNECT provides that’s where the success lies.” Carla Dix, TEC Prevention Strategy Manager, Delta Wellbeing Ltd.
Benefits realisation and prevention: A key piece of the puzzle
The ability to demonstrate benefits of TECS was a challenge identified both in the Sustainable Care programme and in our podcast discussion. Benefits realisation was felt to be particularly challenging when adopting a preventative service model, but absolutely vital in creating sustainable care and health systems. There is also a need for a broader approach to outcomes that does not just focus on cost savings to also include the implications of TECS for other parts of the care ecosystem and health, as well as for individual wellbeing.
amica24 have a ‘health, independence and wellbeing outcomes tracker’, which also includes the impact of their service of wider caring networks. Former head Rupert Lawrence, now Operations Director for the TSA, explained “It’s fantastic because you’re seeing what the impact of that technology enabled care package is for that person and for the people around them as well… It’s not just a focus on reducing care package costs, although that is one of the key benefits that comes out, but there’s the whole prevention piece as well. And you can calculate this - you can use insights from social workers for example to formulate that.”
“Don’t put benefits realisation in the ‘too difficult’ pile. It can’t be something we do after the fact - we can’t go back and say ‘did this really make a difference?’ It has to be right up front in everyone’s thinking.” Nathan Downing, Head of Advisory Services, TSA.
Rethinking TECS - key messages
Outcomes first, technology second. Technology is exciting and it can be tempting to be enticed by the latest device, and then look for a problem for it to ‘fix’. Instead commissioners and service providers need an ‘outcomes first’ approach.
…What outcomes? Whose outcomes? Managing risk is important, but people want more than to be safe - they want to live the best lives possible. Local authorities’ wellbeing duty in England and Wales is enshrined in law. Scotland has a personalisation agenda: service users need bespoke and responsive services to help them live well and technology can be part of this. Prevention too is important - technology can be deployed and used in a proactive way.
Technology in care systems is a service and not just ‘kit’. The wraparound support, including monitoring centres and response services, are key but the more embedded and connected with other services TECS are, the better. TECS have the ability to link people with activities and support in their communities that can help them achieve the outcomes that are important to them.
Proactive services require a different funding and commissioning model. A ‘one size fits all’ approach of commissioning and purchasing technology in bulk is not aligned with a personalised approached. A proactive approach with wellbeing as its ethos requires a dialogue with those needing support to create a bespoke service.