1. Mark Allen Steve Carefull
Making a step- change in the provision of TECS
Good afternoon – my name is Steve Carefull; I am a Director with PA Consulting and Programme Director for the Argenti Telehealthcare Partnership with Hampshire County Council; Introduce Mark
Our aim today is to explain how we have achieved a step-change in the use of technology to support the transformation of social care in Hampshire
In a moment, Mark will give the commissioner perspective and then I will give the provider perspective.
But I’d like to start with a little audience participation – always a risk I know, but you look game.
Can you please raise your hand if you own a smartphone? You can raise the other hand if you own two!
Please keep your hand up if there is an iPad or similar tablet PC in your household?
Okay thank you. So I want to make two points from that response as context for our session:
Firstly, that technology is now ubiquitous – we all use and rely on it, whether we like that idea or not.
Secondly, and I will make an assumption here rather than ask any more questions; most people don’t purchase expensive technological devices because they contain a 4.8 giga-hertz flux capacitor, or because they are shiny and gun-metal grey. Most people purchase technological devices because they help them to:
Keep in touch with friends and relatives
Follow what is going on in the world
Pursue hobbies and interests
Access ideas
Improve fitness
Remain safe
And increasingly, they help us to define our identity and support our independence in a complex world.
I’d like you to hold those two ideas in your mind as we go through the rest of this short session: that technology is ubiquitous and that it helps us to do some fundamentally important things at a human level
So, a few headlines about the care technology service in Hampshire
Mark Allen Steve Carefull

2. ~500
In 2012/13, the year before Hampshire commissioned PA Consulting and we established the Argenti Telehealthcare Partnership, about 500 people had a council-funded telecare service – that’s a very low number for an authority spending £400m per annum supporting 16,000 social care clients

3. 6,859
As at this morning, we have 6,859 – so we are getting there, but there are still people who could benefit who do not get referred, but we’re not letting up with efforts to make telecare a de facto default provision

4. 93%
We have sought the views of thousands of our users; 744 in the latest 6-monthly survey
93% of them say that their telecare makes them feel safer and more secure at home

5. 98%
98% of them would recommend Argenti to others

6. 9/10+
We have trained over 1,000 Council and CCG staff and each year, we receive online referrals from well over 500 different social workers, OTs, dementia advisors and community nurses
We survey every one of these and more than 9 out of 10 say that telecare is “good” or “very good” at achieving the outcomes they set with their client at point of referral

7. -£0.3m
In that final pre-Argenti 2012/13 year, the Council spent roughly three hundred thousand pounds on funded telecare provision for social care purposes
It is certain that some people found the service useful, however, no feedback was collected and no benefit was attributed to this provision; it represented a net cash outflow to the Council
My discussions with other telecare services indicates that many are in the same boat. Even when the telecare charge to users is taken into account, services can struggle to demonstrate a net benefit, which makes it very challenging to make the case for investment to grow the service

8. +£1.5m
In Hampshire, we set out to track benefits from the beginning. In the contract year just ended, the telecare service generated a net saving in excess of £1.5M. This is evidenced at the service user level in terms of other more costly care elements removed or avoided.

9. +£4.7m
This brings the total net saving from the use of telecare in Hampshire to over £4.7m in three years
As the Deputy Director of Adult Services in Hampshire was fond of saying: “we have a service that improves lives and costs us less than nothing”
I am going to hand over to Mark now, who, as the Council’s Strategic Commissioning Manager, will take you through Hampshire’s thinking on the role of TECS in social care.

10. Commissioner perspective
Extremely impressive figures and by anyone’s standards something to be very proud of. I am!
However, numbers like that only give a partial story. What is commissioners perspective?
Confession – with this hat on, not specifically interested in;
Tech, the latest gizmo, the cost of this widget or that widget, or prescribing anything or having a brochure from which to choose this or that
So what am I interested in? Impacting people’s lives and embedding anything we collectively do in social care practice – Transformation
I do know TECs will have a role into the future so how do I engage with this?? How did we push this?

11. risk
My initial focus is on risk – how can what we put in place address risk = on both multiple levels and the different ways risk is perceived?
In particular --The risk that SU’s face in daily life! As a commissioner I have to be confident that the services I make decisions about can address this in the most effective way possible. And more importantly, that my social work colleagues feel that too!
Oddly – lighten up

12. outcome It’s not the how it’s the what Multiple levels SU
Better SW practice or impact on case work
Systemic

13. benefit Equally important for transformation.
SU – not just an outcome but has impact on life and wellbeing plus unseen benefits, e.g. carers
SW practice – embedding, transformative, complements other activity - IT FITS
Organizational – so important now

14. evidence Evidence, Evidence, Evidence! Critical on every level!
SU’s, Cares, family, friends – all have their stories of how things worked and we have to ‘know’ it has
SW’s – impacts on practice. Is it part of how we work no?
Systemic – efficiencies, better use of resources == organisational buy in!
All of the above needs addressing. In the world of TEC’s this isn’t something we (LA’s) do we which is why in Hants we sought a partner to help us - Steve

15. Provider perspective
Thank you Mark

16. risk
So, as Mark’s provider, we too are focused on risk. The referral form we co-designed with care practitioners asks them to identify what risk their client is exposed to, for example, falling, isolation, wandering and so on
There is no requirement on the care practitioner to select equipment; we concluded that asking them to pick boxes and wires from a catalogue would either put them off making the referral in the first place or result in the client receiving a sub-optimal technology solution

17. outcome
Of course, what care practitioners ARE interested in is the outcome for their vulnerable client. They discuss and agree with the client what outcome is sought and that goes on the referral form; outcomes are described in clear simple terms that emphasize the human not the technical:
For example:
Carry on living at home
Remember to do important things
Be more independent
Get help when needed
Stay safe
My team’s job is then to install a solution that maximises the prospect of achieving those outcomes; tailored for each client in their own home environment

18. benefit
Mark talked about benefits. In the past, local authorities had enough cash to say ‘we hear good service user stories about telecare, so let’s invest some money providing it’
We should be in no doubt; with cuts to Local Government budgets of 50% by the end of this Parliament, they won’t for much longer be spending on telecare simply because clients like it
In Hampshire, we ask the care practitioner to state on the referral form what other more costly forms of care they are either going to remove from the package or avoid adding to the package as a consequence of providing telecare.
The benefit to the client is the achievement of the care outcome; the benefit to the commissioner must be a saving either through the direct removal of an existing care component or the explicit avoidance of a new care component.

19. evidence
We have worked with many local authority telecare services and one universal weakness is the lack of robust evidence of impact. Many telecare services charge their clients and claim that this income results in a ‘surplus’.
In fact, when we have taken a forensic look at service cost in some local authorities, accounting for not just the cost of kit; installation; maintenance and monitoring, but also the cost of collecting the charge; bad debt and other ‘hidden’ costs, we often find that even fully ‘self-funded’ services are in fact costing the council money
Hence for us the future is in showing how the service is actively reducing other costs of care. The average cost of a domiciliary care package is about £200 per week. So forgoing a £3 or £4 per week charge for telecare, as we do in Hampshire, in order to take a £30 or £40 chunk out of that Dom care expenditure makes clear business sense – as long as you can make it happen and evidence it robustly, which does take time and effort.

20. r.o.b.e.
So, to achieve a step change in the way care technology is used in the social care context, we were commissioned to work collaboratively with Hampshire County Council and together we keep in mind those two points from the start of this session:
Technology is ubiquitous, so why would we not use it routinely with vulnerable people?
And
It’s not about the kit – it’s about addressing some human needs; to be in touch; to be informed; to be safe
Then we keep a focus on Risk, Outcome, Benefit and Evidence. These words mean something slightly different if you are a commissioner, a provider, a care practitioner or a service user, but in Hampshire we have been able to drive telecare into the mainstream by ensuring that the needs of all of these stakeholders are addressed.
To conclude: Too many commissioners come to market for just the commodity components of a care technology service: equipment; installation capacity; monitoring centre connections and so on. In our view, providers cannot drive mainstreaming unless they are given greater scope to change referrer behaviours and transform the end-to-end system.
So if there is one thing that would drive a step change in pushing care technology into the mainstream, it is if more people like Mark COMMISSIONED THE RIGHT THING; by focusing on technology not as an end it itself, but as a means to drive transformation and achieve better care outcomes at lower cost
Thank you