By Nick Weston, Chief Commercial Officer
Yesterday I had a conversation with a client that I felt I needed to relay, it got to the nub of quite a few things that have been at the core of challenges we all face with technology in care. What is success? They were telling me about ‘a success’ from using our technology. The service user in question was being moved from their home to an extra care facility, their costs have gone up and this was a success? Hold on a minute, isn’t technology supposed to reduce the packages of care and help keep people in their own homes for longer? So how was this a success? We’ll come back to that, but first I think there are some elephants in the room that need to be discussed.
Elephant no 1. Technology training for front line teams
Technology is not part of a social worker or occupational therapist’s formal training or even the induction process… excuse me but it’s 2022, my 9 year old does ‘coding’ in school. How can the system expect adoption at the front line without addressing this issue? I don’t know if you’ve ever tried to do a 12 year old’s maths homework, but my view is they’ve fundamentally changed the way maths works since I was 12 years old! Is it any surprise then, that there is resistance, fear and suspicion at the frontline when they’ve had no training or exposure to technology in the work environment? How can we better incorporate proper training to help raise the confidence of frontline workers so that they can feel comfortable using technology to deliver quality care?
Elephant no 2. Vendors and their role in adoption
Technology providers want you to use their solution at scale. Often, providers will emphasise collaboration as part of their design, to give you false confidence that they understand your needs. However, we often see that technology is never truly designed with the true input of the staff and end users, and how the user interface and experience can support them in the best way possible.
Rarely does a solution bring any joy to the user. The app interface of health and social care technology is often dull and provides dry functionality. The language is a lot of ‘tech-speak’, and not of value to carers. The mega vendors won’t integrate with other solutions, regardless of whether they pose a threat to them or not. This halts meaningful progress. New entrants skip into the market like prancing ponies with a naive view that they can fix all the problems. It was Steve Jobs who said “Do not try to do everything. Do one thing well.” No wonder the sector is not adopting technology at the pace it could and needs to. The vendors are not helping. We as vendors need to do better and collaborate more. We need to address our blockers.
Elephant no 3. Health and social care are not the same
Social care isn’t the NHS. Every week there is a webinar or conference that talks about ‘digital transformation in health and social care’. To me these events seem to miss the social care aspect in the agenda and speakers. All too often the ‘digital transformation’ is presented from a clinical perspective. Outcomes are presented with a clinical framing, information and insight revolving around patients and their vital signs. Social care isn’t about changes in vital signs, it’s about support to function as independently as possible. Social care doesn’t need or want to know what someone’s blood pressure is. Social care technology outcomes need to focus on supporting the service user to live independently in a proactive manner. Health will benefit from this approach, allow social care to be different and reap the rewards.
Elephant no 4. Procurement processes creating challenges
The rigidity of the procurement process can slow the process down.There is a disconnection between goals of procurement and the needs of people in care. Procurement have the challenge of needing to react to specifications, but no one could have predicted the change and the speed of change that has occured in the last 24 months.
These guys take a kicking daily, we all know the frustrations so let’s give them a day off… but just a side note, if you continue to weigh price so heavily how do you expect to get the outcomes your internal clients need?
Elephant no 5. Proactive not reactive
The health and social care system is screwed, sorry to be so blunt, but we all know it. Times have changed, there’s not enough capacity in any part of it for it to function properly in the interests of those it serves. We have to move to a proactive approach to avoiding a service user going into crisis in the first place rather than reacting to it after an event has happened. This is a massive culture shift at all levels, people, budget, service etc. It’s only going to get more important that we do something before the new legislation comes into effect in October 2023.
Taking small proactive steps can avoid big negative things happening. Seeing data that a service user has been getting up in the night more than usual enables you to say to a family “please take your mum to the doctors I think she may have a UTI”. That could prevent that service user ending up in hospital and then requiring a whole new assessment and package of care – which is costly on the system and emotionally draining on the families and the service user, not to mention the potential for further health decline in the process. We do this in our consumer lives, a sat nav informs you of challenges ahead and offers an alternative whilst managing your expectations around arrival, why not on the front line of social care?
Elephant no 6. Managing risk
I caveat what I’m about to say by being clear that I’m not on the front line of delivering care and service users are not my personal responsibility. However, as a discharge team from one of our customers recently said to me; “Without your solution I have no evidence to tell me not to be risk averse, so why would I not put the bigger package in place to make sure the person is safe.” Fair call. The bigger package, the lack of ‘lets see how they do with this package and some tech’ sets a precedent with all involved. Care packages rarely get reduced. Tech needs to support front line teams, give them evidence and more importantly confidence that it will support the service user in that proactive manner and allow some calculated and appropriate risks to be taken.
Elephant no 7. Measurement of outcomes
I was at a tender brief meeting recently and the procurement team were asked what results they had achieved with tech. They admitted in the last 7 years they hadn’t measured the impact of the tech but they felt they needed to spend less on it! In the words of John McEnroe “you cannot be serious”. At that point I discounted us from the tender process. We know everyone is under pressure and under-resourced and we’ll absolutely help create the outcomes data to justify ourselves but you’ve got to come to the party on what success looks like.
If you’re reading this you’ll have a few of your own elephants to add to the herd, I thought I was going to stop at 4 but like the scene from the jungle book they kept on coming! These for me are the big ones that hold us back, let’s not hide them in the cupboard and try to skirt around the issues.
Defining what success is
So back to the ‘success’ I mentioned at the top. Why was an increase in cost and moving a service user to extra care deemed so. Let’s break this down into the service user and their circle of care and the authority as separate entities.
From the local authority’s perspective, the service user is getting the support they need, the Lilli system showed them an area of risk that they were unaware of and had they not known a crisis would have manifested itself and in their words they would have had to move them to full residential care. Yes the overall costs are increased but they are less than residential care, require less resources and are less intrusive on the service user than the alternative. They have slowed the service users journey through the system down and reduced costs for themselves and the health system. Proactive cost avoidance in action. This is how they are demonstrating success against their own metrics.
From the service user and circle of care perspective. They have seen the evidence to highlight the need, they feel they have been listened to in terms of raising concerns and have clarity around how the service user requirements and need for support, Lilli has given the service user a voice. The perceived knee jerk reaction of going from their own home to residential care has been averted and the service user gets to be in a place called home.
So I agree with our customer, this is a success. The lesson learnt is deploy tech early in the service users journey with social care, don’t wait for a crisis, slow them down and be proactive, little and often averts big and complex.