Exploring a digital self led Care and Support Assessment (CSA) to identify an individual’s strengths and support requirements.

Adult Social Care (ASC) is currently one of the most analogue and expensive services that councils deliver. The Care Act increased the pressure particularly around assessments and with both an ageing population and a population with increasing complex needs this vital service will continue to feel the strain, and struggle if left unchanged. The discovery work unearthed a need for the following to be addressed in any digital solution:

• Self-service/assisted self-service assessments and reviews for all 10 areas of the care needs assessment
• Advocate use function to allow family/friends/staff/charities to assist clients with their assessments, remotely if necessary
• Submission feature to deliver assessments into the council’s back office systems
• Supporting documentation upload facility
• Use of local directories of service/advice/information for users whom the system triages as not being eligible for care services provided by the council
• Assessment/resource allocation calculation will display ‘indicative budgets’ for service users/staff where appropriate

Responsible officers across the country are all facing the same challenge and some councils report that only c. 20% of people who go through the assessment process actually receive an ongoing care package. There is still the responsibility to undertake the assessment and signpost to self-funding services and information for the other 80%. Clearly there will be variation around the country, but the challenge is ubiquitous.

Every local authority in the country has to deliver ASC but the way in which ASC is delivered must change. We believe digital can play a vital role in the ASC assessment process. Done with sensitivity, significant savings can be delivered, whilst still protecting the needs of the most complex and vulnerable cases. It should also be possible to improve the customer experience through enabling participation in assessment outside of office hours which is often a constraint with the current operating model.

In addition to new assessments, the majority of councils are not able to administer an annual review process for all clients in their area. Annual reviews are a requirement of the Care Act, and the introduction of a self-led approach to determining a clients care and support requirements could streamline/improve the annual care assessment review process, enabling councils to comply with the Care Act requirements sooner.

Some of the local subtleties around Care and Support Assessments did change from our starting position in the discovery. For example:

• The subtleties around the rules for calculating the ‘indicative budget’, specifically how they vary from local authority to local authority. The alpha will build on the work of the prototype to allow for the dials to be tuned towards each organisation’s local rule base, ensuring that the solution is tailored for each partner authority
• Each organisation bringing their own product and approach to the local directory of services element of this product. The alpha will allow each organisation to make a decision about what directory product/approach they want to use to present services, advice and information which is tailored to the end users needs
• The mechanisms for delivering the assessments into each council. Some will have the need for integration and others will prefer standalone options eg an admin console
• The different business processes currently in place will require the product to be flexible in its deployment. Training is absolutely key here. The cooperative propose to share their blueprint for its implementation for others to reuse if they wish

 The partner organisations are reusing the user research from previous pieces of analysis and discovery work conducted within multiple other Local Authorities. Specifically ‘Kirklees Council Care Assessment Analysis Report Nov 2016’ and ‘Care Need Assessments Analysis’. The research points to clients experiencing a disjointed and delayed service and staff unable to cope with existing demands. The hypothesis that we are testing is that a self-led approach to this assessment will improve the outcome for clients and reduce the time it takes to complete these assessments. Early triage of those clients who aren’t eligible for support from the council will free up social worker time to focus on those that need the support most.

User journeys can be found in Appendix A of the attached Care Need Assessments Analysis document.

The discovery phase produced a series of animation scripts which can be found in the attached document titled ‘Personal Hygiene Scripts’

The prototype work can be found here: https://bettercareneeds.lookinglocal.gov.uk/

We know that ASC is an expensive service that councils must deliver. The Care Act increased the pressure, particularly around assessments, and with an ever-ageing population this vital service is struggling to meet demand in the face of decreasing budgets.

Many councils report that only c. 20% of people who go through the assessment process actually receive a care package. This means that the majority of clients don’t qualify for support from the council. Those remaining 80% of clients need to be directed to self-funding services and information, advice and guidance (IAG) resources. The challenge here is a shared one and is not one that should be tackled in isolation by each local authority. By forming this cooperative we aim to share resources and knowledge and develop a product that can be implemented within every local authority.

The discovery phase produced an outline business case which can be found in the attached ‘Care Need Assessments Analysis’ document section titled Business Case. We already know from the previous discovery phase that the average cost of a care assessment home visit is around £620. 

Coventry undertook 1,941 new assessments last year and should also conduct reviews for around 2,990 additional cases. On average each case would receive 2 home visits over their care and support assessment journey. This means that in a 12 month period the number of home visits that coventry ASC staff would have conducted would be in the region of 9,860 which equates to £6,114,440 based on the Discovery work. Solihull receive 720 new assessments each year and conduct 2,660 reviews. Applying the same principles, the number of home visits conducted in Solihull would be in the region of 6,760 giving a service cost of £4,191,200.

The aim of this project is to demonstrate that the service unit transaction cost can be reduced whilst maintaining the quality of service. We plan to test the hypothesis that a self-led approach would reduce the effort of assessing a client’s care and support needs by 50% and conservatively estimate that 40% of their clients would be willing and able to self-serve. For Coventry alone, this could lead to a saving of over £1.2m per annum – the resource for which would be reinvested into clients (and their annual reviews) that really need their more intensive support. It’s not difficult to see how the savings mount up once you apply this approach to all three of the consortium, let alone providing this platform to many other councils around the country. In short, the business case here is compelling.

The cooperative already have established mechanisms for sharing resources, documents and communicating with each other. We use Google Documents to collaborate on documents like video scripts, business cases and user testing feedback. We have frequent show ‘n’ tells via conference call facilities with the external development supplier to demonstrate progress and discuss the coming sprints.

The project group will form a Project Sub Group (PSG) which consists of the key people in each participating organisation. It is a regular scheduled opportunity for the group to discuss progress, assess risks and raise any concerns about the coming sprint.

Looking Local’s products are built using industry standard tools that support open source working. They use GitHub repositories synced with Travis CI for wider collaboration which ensures that any teams that need to contribute can do so in the easiest possible way regardless of location. Everything is integrated into workflow tools like Jira and Slack to keep everyone up-to-date and informed. Using these industry standard tools enables all of their solutions to be completely portable and facilitates their distribution across multiple organisations where needed.

As a consortium we are keen to be scrutinised ‘in the open’ and plan to publish all of our updates online. The proposed ‘show n tell’ will also be delivered both in person, but also as a webinar that can be either accessed in real time or on demand afterwards. We believe this broad and very open approach will ensure appropriate levels of governance whilst enabling the project to proceed in a very dynamic and nimble way.

The key project team members outlined in 2.7 from all three participating councils are keen to explore the potential for project team and leadership training opportunities that may arise from the Local Digital Collaboration Unit. 

As the project unfolds we are keen to review the potential for this and engage where resources and availability align. No additional procurement training is required – all organisations are familiar with the digital marketplace.