Episode 3 - The digital shift and connectivity
Hosted by Dr Kate Hamblin, University of Sheffield, and Tim Mulrey, TEC Services Association.
Technology enabled care (TEC) services and systems are facing a challenge in the form of the switchover from analogue to digital telecommunications networks. The major telecommunications networks are moving their networks from analogue to digital connections, with implications for all people and services that use these networks, including TECS as they may no longer function reliably. This is a pressing issue as although the switchover will be completed in 2025, it is already underway in some areas of the UK.
For TECS to function reliably, service providers and commissioners will need to consider how they will manage the digital shift. There are cost implications related to this shift - not only replacing the analogue with digital devices, but also the resources required for associated installation and support and the ongoing costs related to SIM cards. There are also issues around the functionality of digital TEC devices, as they will not have the same battery back-up as analogue-based devices, which could leave users vulnerable in a power cut.
TEC Services Association (TSA) has been central in driving the case for analogue to digital transformation for the TEC market since 2017 with its initial publication of the white paper ‘A digital future for TEC’. The TSA’s latest publication - Analogue to digital: A commissioner’s guide - is due for release in December 2021 and provides guidance on a series of key topics that commissioners and buyers of digital devices and platforms need to consider in order to ensure that they are making the right long-term decisions for their organisation.
Many stakeholders with commissioning and purchasing responsibility have held back from fully investing in end-to-end digital solutions due to a fear of making an investment decision in technology that would not stand the test of time or be sustainable. However, the latest guidance is designed to incorporate lessons learned from around the UK and abroad to provide stakeholders with accurate and consistent information.
The TSA will continue to work closely with its members and industry stakeholders to provide information and guidance across a range of media in order to support the TEC sector in the progression to full digital solutions.
Sustainable Care programme research with stakeholders from across the care sector, including commissioners of services, found that for some the digital shift was opportunity to rethink and redesign services beyond replacing analogue devices with digital versions. For others commissioning services however, it was a challenge in terms of the scale of investment needed and were hopefully waiting for government guidance/investment.
In our research, we also heard about examples of local authorities facing challenges related to the digital connectivity and infrastructure needed to provide digital TECS, and some that were exploring ways to ‘fix the plumbing first’ and address these issues. With local authorities and users exploring how mainstream digital devices may facilitate care and connections, digital infrastructure is increasingly important.
In the final episode of the Sustainable Care and TSA Digital Care Futures podcast, Kate Hamblin (University of Sheffield) and Tim Mulrey (TSA) spoke to guests from two local authorities that had explored how to promote digital connectivity and inclusion, and the implications for the ways they were using technology in adult social care.
Ann Williams, Commissioner and Contract Manager, Liverpool City Council
Geoff Connell, Director of IMT and Chief Digital Officer, Norfolk County Council
Sarah Rank, Head of Business and Technology for Adult Social Services, Norfolk County Council
James Bullion, Executive Director of Adult Social Services, Norfolk County Council
5G mesh network: Liverpool City Council
Liverpool City Council had begun to explore digital TECS options in the mid-2010s when it became apparent that increasingly people did not have landline telephone connections in place. When the council looked at the cost of replacing all their analogue telecare devices with SIM-card enabled versions, the resources required were prohibitive and instead created its own private 5G network to contain these costs.
Initially focused on a particular ward, Liverpool CC created a 5G mesh network with nodes attached to lamp-posts to allow them to trial new digital TEC devices, as well as providing the opportunity to examine how mainstream devices people may already own may be used to support them to live independently for longer. During the pandemic, the 5G mesh network has enabled remote consultations and assessments, but as it can be used by any enabled devices, it also allowed people to connect socially and schoolchildren living in the area to freely connect to online learning.
Pharmacy in the home
The 5G mesh network allowed Liverpool CC to trial new devices and ways of working. One example of this is the use of a 4K video device Paman, connected to the 5G mesh network, co-designed with pharmacists as a medication prompt linked to pharmacists to watch the service user take their medications. The aim was to reduce the need for homecare visits focused solely on medication reminders and reduce medication wastage. The system also allows the user to ask the pharmacist questions.
“Technology can never replace completely the one-to-one care - that’s not what it’s there for. We can help people live independently and longer in their own homes and have a better quality of life. What I don’t want to do is to make sure that some of the technology creates a dependency that then makes them totally locked in their own premises because they don’t feel safe unless they are near a box. And so then they become totally insular, and really almost institutionalised in their own home. We want to get past that”.
Ann Williams, Commissioner and Contract Manager, Liverpool City Council.
LoRaWAN, superfast broadband and mobile coverage: Norfolk County Council
The need to deploy digital TEC devices and services due to the analogue switchover creates challenges related to costs but for some areas of the UK, the ability to connect digitally is more challenging due to uneven broadband and mobile phone coverage.
Norfolk County council were facing issues with broadband coverage from the main telecommunications providers and developed a strategy that has focused on creating and enhancing opportunities for digital connectivity. Several projects have focused on broadband connectivity, increasing coverage of superfast coverage from 42% to 96% in ten years.
In addition, Norfolk and Suffolk Innovation Network is the largest free-to-use public sector long range wide area network (LoRaWAN) in the UK for Internet of Things (IoT) devices to enable innovation and deliver digital TECS. These networks and their focus on promoting connectivity underpins Norfolk’s technology strategy with three strands, centred on citizens (including digital TECS that use these networks), providers (including how these networks facilitate remote visits and electronic care records) and their own workforce (who are enabled to work in agile ways through the use of digital technologies and connectivity).
“A recent development by Norfolk County Council is a project that uses the LoRaWAN with IoT devices and sensors forming a ‘Home Activity Monitoring (HAM) system’ to develop a picture of users’ regular patterns of regular patterns of behaviour, and then provide support should the data generated indicate there has been a change.”
NATALI (Norfolk Assistive Technology Application (for) Living Independently.
“Thinking around technology, it isn’t a one-size-fits all. It’s an enabler, it’s to help. So, I know we’ve had concerns before ‘well, are you going to put technology in? I want that face-to-face contact - I want to see that person’. That isn’t the case - it is around helping and enabling all of our social care practice to be able to deliver the services, but… If technology can help, then let’s use it.”
Sarah Rank, Head of Business and Technology for Adult Social Services, Norfolk County Council.
The digital switchover is an opportunity to redesign and rethink services, and connectivity is a key part of that puzzle. Some areas will face greater challenges in deploying digital TECS than others, and creating networks and infrastructure can be enablers to using technology in adult social care, but will also have wider implications for digital inclusion.
Partnership and collaborative working are key - across different parts of both the public and commercial sector, including the secure sharing and pooling of data. Norfolk County Council for example were working with mobile network operators to share access to tall buildings, to facilitate the creation of a digital infrastructure.
Build a movement for change. reform is on the horizon for adult social care, and technology will be part of that. Local authorities together can come to together to consider, as James Bullion argued “what framework of expectations can set right across local authorities, amongst providers” and engage with the debates on reform.
The combined voice of local authorities and care providers is powerful, and rather than waiting for developers to create technology and solutions as Ann Williams from Liverpool City Council noted “the biggest industry in the world is farming and the second biggest industry in the world, it’s health and social care, so the big tech companies, see this a big market. What we need to do is try and get in there quite quickly and tell them what we want, rather than waiting for them to develop things for us to fit around”.
Spread the learning. Other local authorities and providers will be facing similar challenges and may have already tried new initiatives. Sharing both successes and challenges are important.
Think about the whole system. Technology or digital connectivity do not stand alone. “Technology enabled change is comprised of people, process and technology, and sometimes people have a budget for the technology and forget that tech on his own, it doesn’t do anything - it’s just an overhead. So actually, it’s about not underestimating the digital skills development that we needed in creating these initiatives and also change management - helping people to see what’s in it for them and for their customer, why they should they do it.” Geoff Connell, Director of IMT and Chief Digital Officer.
Take your workforce on the journey towards digital. “We’ve got a team who are deeply expert in this assistive technology, but then you need the wider workforce to understand. They’re never going to be expert, but they need to understand enough of it to spot the opportunities and sell the benefits. I think it’s the same digital inclusions as well - I think all our staff are advocates and they’re kind of emissaries if you like for promoting the opportunities that come from being connected and having digital skills. And so it’s making sure that people know enough to be helpful, but recognizing that we can’t all be experts in everything.” Geoff Connell, Director of IMT and Chief Digital Officer.