Adult Social Care provides home care support to over 7000 citizens who are vulnerable, frail and may suffer early signs of cognitive impairment. Following guidance from the NICE, and Birmingham City Council’s (BCC) commitment to provide excellent services, BCC increased the duration of its care visits from 15 to 30 minutes to give citizens sufficient time to meet their needs. This resulted in a considerable increase in care costs for BCC as well as all Local Authorities (LAs) that adopted NICE guidance.
On average each person receives 3/4 visits per day at a cost of £80 million per annum – over 6 million hours of home support / year. Not all calls require 30 minutes and some visits could be avoided or targeted better to enable constrained resources to be used more effectively.
New technologies like Alexa & Chatbots have the potential to reduce the need for costly face to face visits. However, there is still inconclusive evidence to assist LAs to determine which technologies are most effective, or a robust framework to enable citizen selection.
Our hypotheses is that a small reduction of 15%-20% in the 6 million hours of Home Support calls can generate savings.
The objectives are to establish a robust framework that will enable local authorities to
- Identify the cohort of citizens where visits could be curtailed or avoided whilst maintaining or improving citizen satisfaction
- Identify the appropriate technologies that provide LAs with the confidence that citizens wellbeing and independence could be being maintained within a community setting despite a reduction in number of calls.
- Demonstrate that a reduction of 15-20% in the 6 million hours of Home Support Calls can be achieved as an evidential base for other LAs to adopt and adapt to meet their needs
By 2035, the number of over 65 year olds will be approx. 203,000, an increase of 38% percentage. Currently, 6.9% of over 65 year olds receive long term care, with 67.7% receiving short term and universal services. We expect there to be an increase of 46% in the number of citizens with dementia or other cognitive impairment issues. BCC Adult Services commissions 6 million calls per year at a cost of £80 million, a large percentage of the 30 minute calls are for prompting of medication and food/fluid, which could be better managed and delivered in more innovative ways.
LA / Service Provider / Commissioning Benefits
- Reduction in social care visits where not required, delivering significant savings and contributing to predicted future funding gaps in adult social care
- A data driven robust framework for better targeting of care support for other LAs to adopt and adapt to meet local needs
- Supports early prevention and predicative analysis to identify those at greater risk and who may require a different support package
- Targeted support and more effective use of resources reducing demand on statutory services
- Significantly reduced commissioning costs – need to justify
- Ability to flex the service at times of high demand such as in the winter months when pressure increases significantly on social care and health partners.
- Potential of interactive digital technologies with built in AI capabilities would reduce social isolation aspect for older people who live at home alone and have care needs.
- Empowered to self-manage, reducing their reliance on others and supporting them to maintain their independence
- Reduces burden on carers improving quality of life of both carers and cared for
- Digital intervention can provide opportunities for citizens to have access to greater information and advice as well as enhancing communication with a range of formal and informal providers to support care needs.
The Discovery phase will be delivered using in–house teams of commissioners and IT colleagues from the 3 partner LAs and specialists procured through the Local Digital Fund. We will work with internal and external service and equipment providers to get their insights to help redesign the future service.
We will use lean methodologies to deliver our objectives ensuring our findings are credible, replicable and scalable across all LAs. Our approach is set out below.
Measures of success
Modelled reduction in care costs calls / citizen
Collaborative data driven criteria assessment tool applied to diverse populations at scale
|Deadline||Event / activity||Milestone|
|12 December 2018||
||Project plan agreed|
|18 December 2018||
||Key sources of information and data intelligence gathered
External SME and Specialist partners secured
|2 January 2018||
||Specialist support procured Contracts issued|
|16 January 2019||
||Multidisciplinary team fully formed and ready to start Discovery activities
key milestones agreed
|28 January 2019||
||Robust evidenced based criteria that identifies citizens type and benefits
Identification of secondary benefits
|28 January 2019||
||Technical specifications and requirements secured
A technical and solution architecture for desired solution established
|11 March 2019||
||Number of care calls reduced and percentage savings in care packages and reduction in visits|
|25 March 2019||Write up and share the project findings:
||Discovery outputs produced and shared|
The Discover phase provides a framework that will benefit all LAs who commission homecare services for citizens who live in their own homes. BCC is collaborating with Worcestershire Council and Solihull Council. It will share learning and solutions through the WM Public Services Reform group and regional networks like the WMAHSN. It will also engage with the UK Core Cities that regularly meet and BCC is an active participant. We will also work closely with external home care providers/agencies to ensure that the technology provides them with the confidence and trust to support the reduction of hours.
Partner geographical locations will ensure that we have access to a significant cohort of citizens from various socioeconomic & cultural backgrounds in rural and urban communities. This means that our findings can be replicated and scaled. There will be regular physical meetings as well as online tools to ensure each partner fully benefits from the findings. Use cases will be published taking perspectives from local government, service users, technology providers and care providers/agencies & make our findings available via social media channels, webinars, newsletters etc.
By April 2019 we will produce the following outputs:
|Business case||This project has been designed to deliver a range of outputs that will benefit partner and supplier organisations but will also be able to support replication of the process. The costs and design for the existing service delivered/commissioned by the 3 organisations will be analysed and benchmarked to ensure consistency and comparableness. A market review of existing technologies and a gap analysis will be undertaken to establish an options appraisal of the most effective solutions. A robust and replicable methodology will be developed by social care experts to establish the cohort of citizens suitable for the pilot. The business case will be owned by all 3 LA partners, with project management resources made available by BCC. This will require considerable collaboration and collective agreement of the design principles by all 3 LAs|
|User research report||User research will be undertaken by business analysts as well as external and independent organisations to ensure credible and unbiased approach. All research findings will be shared amongst the partners as well as WMCA Public Services Reform Group and published on partner websites. A challenge-led approach will be used to target universities and the tech community to ensure both existing and market shaping solutions can be identified through the research. A final user research report will also be produced.|
|A summary report & recommendations||We will produce a report that either proposes how to take this project forward to alpha stage or explains why the work should not continue. We have the last week of March reserved for this work to ensure that the deadline is met.|
|Redesigned service map||This project will redesign how LAs can deliver/commission a needs based care support service that can be flexed to meet ever changing demands. It strips out a regimented and wasteful approach to home care support and enables the development of new models using technologies which in isolation may not be effective, but as an integrated and interoperable solution with built in feedback loops for monitoring and control purposes, it proposals a paradigm shift in the way services could be delivered. A process map and solutions architecture for the “to be” service will support the development of a prototype for the Alpha stage.|
The project is aimed at citizens who require home care services in their homes based on a care needs assessment. A robust methodology and framework will be developed to identify those citizens where there is scope to reduce the number or duration of a call without detrimental impacts on the quality of care or customer satisfaction. Our initial observations suggest that those will mild cognitive impairment or those just requiring prompt calls to remind them to take medication or ensure that they eaten meals and are taking in fluids could be an initial cohort. This could be extended those citizens who may have recently been dis-charged following a Hospital stay as they can have access to urgent care via the digital intervention in their home instead of a short stay in a residential home following the hospital procedure.
We recognise that there are a number of illnesses that may need to be taken into account in order to build a full view of the types of support that will be needed for each individual user.
We will aim to do user research with users who are candidates for or are receiving ASC services from project partner councils.
The research will be a combination of desk top and primary research. It will involve face to face meetings with services users, their friends and family as well as workshops with service providers and challenge led technology events.
The engagement will be by independent researcher and internal social care as well the Council’s Information, Technology and Digital Services team in conjunction with the 3 core LA partners.
A number of a service users will be selected from those identified through the research to to pilot the solution for the Alpha stage. .
User research objectives
User research objectives are to:
- evaluate the suitability of technologies to reduce the number of care visits or the length of the call
- quantify the effectiveness of these technologies
- define the types and cohorts of service users for which this type of technology could be beneficial
- Identify the barriers that potentially limit the use of existing and /or emerging technology in reducing the growing demand for home care.
The project team would benefits from the following;
- Access to GDS user research labs (to help us bring down the project cost for user research sessions)
- Course on basic Agile training for the whole team
- Ability to send communications via MHCLG channels (like newsletter, twitter, etc) to help us ‘work out loud’
- Help with sharing the outputs with the local gov sector
- Help with engaging with other county councils that may want to feed into our project.
None of the partner authorities listed in this proposal have been funded for this project in the past