Self-service Digital Care Needs Assessment

Full Application: Not funded at this stage

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 an ageing population this vital service will continue to feel the strain, and struggle if left unchanged.

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 receive a 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 and even when austerity has cut as deep as it will, ASC services will still survive. 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.

The discovery phase of this project has brought together a group of ASC service heads to undertake a piece of collective analysis and developed a prototype to begin to digitise a self-service care needs assessment. This project was a cooperative formed of Kent County Council, Stockton on Tees Borough Council and Nottinghamshire County Council.

The cooperative now includes London Borough of Harrow and if we are successful in receiving funding for the alpha development phase we will continue to develop the prototype to produce an alpha product for care needs self assessment.

The vision for the final product includes:

  • Self-service/assisted self-service assessments for all 10 areas of the care assessment
  • Advocate use function to allow family/friends/staff/charities to assist customers to support customers with their assessments, remotely if necessary
  • Submission feature to deliver assessments into the council’s back office systems
  • Supporting evidence 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

The scope for the alpha project is to build on the prototype (already developed), as follows:

  • Develop the animation scripts for all of the 10 areas of the care needs assessment:
    • Nutrition
    • Personal hygiene
    • Toilet needs
    • Dressing (clothing)
    • Home safety
    • Habitable home environment
    • Family and personal relationships
    • Accessing work, training, education or volunteering
    • Accessing community resources/facilities
    • Parenting/caring responsibilities
  • Produce the question/answer data capture and form schema for all 10 areas
  • Establish the evidence requirements
  • Establish the assessment submission mechanism
  • Explore the need for advocacy use features
  • Commission the production of the animations needed
  • Commission the development of the platform in which these animations and assessment questions will be hosted

We will ensure the product is fully scalable, robust and can be customised at a local level for deployment within other local authorities.

Success for this alpha will see:

  • The prototype https://bettercareneeds.lookinglocal.gov.uk/ developed further to include all areas of a care needs assessment, implemented and tested with end users. Feedback will be well documented and any improvements allocated to future sprints. We aim to have the alpha rolled out to a pilot cohort of users for observation. We will measure success by the feedback produced during the user testing
  • A business case developed to allow any ASC department to assess the impact such a product would have and any knock-on benefits to health departments that should arise
  • A blueprint business process and potential implementation plan for reuse by other councils
  • A clear business plan and product roadmap outlining the actions needed to see the alpha progressed into beta phase

The cooperative is already in conversation with c. 11 other councils about the development. The cooperative intend to develop a marketing campaign that will continue to unearth interest through our network of professional and regional groups as development of the alpha product progresses.

Project implementation plan: https://docs.google.com/spreadsheets/d/1D-590JREix8OVrw7_0TLqnF5Goskt08KNvFJMHOK4fI/edit#gid=0

The project will be led and steered by the cooperative. The development of an alpha will be done by an external organisation: ‘Looking Local’ who are co-owned by Kirklees Council. Looking Local were involved in the discovery work and developed the prototype currently being tested. The production of the animations needed will be outsourced to an external organisation yet to be confirmed. The cooperative will share the occupational therapy and social worker resource needed to produce the scripts for the animations and subsequent data capture as well as support on user testing workshops with staff and customers.

The cooperative will work with marketing and communications colleagues as well as Looking Local to develop the marketing campaigns. The cooperative and Looking Local will share the resource required to produce the document outputs required by the fund and those outlined in previous sections.

The results of the user testing and pilot cohort will inform if we have achieved our objectives.

By using a combination of internal subject expert resource (social workers/occupational therapist etc), agile project management, user-centred design experience, external development and film production expertise we are confident we will be able to produce the outputs listed in the prospectus and the alpha product itself by the April deadline.

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. The cooperative are already in conversation with 11 other Local Authorities about how a digital self-service care needs product will help ease the strain. 

Some councils report that only c. 20% of people who go through the assessment process receive a care package, with the remaining 80% being 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.

We already know that the average cost of a care assessment in Kirklees is £620 with 3,112 reviews done annually. This equates to an annual cost of £1,929,440. The aim of this project is to demonstrate that the service unit transaction cost can be reduced whilst maintaining the quality of service. We aim to see a reduction in the failure rate also. There are likely to be cost and efficiency saving to Health as well as the Local Authority. eg faster hospital to home transfers etc

An example of Looking Local re-using service and product design can be found in the transformation of BetterOff (originally developed as a self-service welfare rights platform) into care financial assessments (https://about.lookinglocal.gov.uk/solutions/bettercare/). By drawing complex business rules out of back-office systems and informal business processes into a fully self-service digital assessment front-end, putting the service user at the centre of the process, financial officers reduced processing time by 700% and introduced absolute consistency in the assessment process. The same challenge of self-service was identified by both departments but the services were very distinct. The resulting products share a common base, thus reducing development and ongoing costs.

We would apply these same design patterns to the self-serve care needs assessment to ensure that the resultant product could be utilised by any local authority in the country, not just those from the discovery phase.

Looking Local’s products are built using industry standard tools that support open source working. We 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 our solutions to be completely portable and facilitates their distribution across multiple organisations where needed.

Our discovery phase started in July 2016 with a 6 months analysis piece being conducted in Kirklees Council. The report for this can be found: https://docs.google.com/document/d/1JmPQitSxjvDUxVs_S4InnuWFhHL3eHnG_hKNcW3fzCg/edit

The analysis identified the need for a number of things, one of which was a self-service digital care needs assessment. The average unit cost per transaction that was identified in this piece of analysis was £620. With caseloads in the 4,000-6,000 bracket for the councils involved in this project, the service costs are already close to being unsustainable, and these caseloads will only increase. An alternative service delivery mechanism has to be established.

In this process the cooperative also looked at how the challenge of digital self-service financial assessments had been solved in other locations. The take up of self-service financial assessments is relevant to this project because the customer target audience is identical. If customers were willing to engage in a digital self-service solution for financial assessments for care then it would be likely that they would also be willing/able to use a similar approach for care needs assessments.

It was found that councils using this particular self-service product were able to achieve 80% self-service, 18% assisted self-service and 2% remained traditional home visits. These levels were achieved through careful consideration around advocacy support, UX and guidance inbuilt into the form. We were encouraged enough to want to move into a co-funded approach to care needs assessments and thus a cooperative of local authorities to explore a digital care needs solution was formed.

Looking Local spent a number of days onsite at each of the partner local authorities, shadowing/interviewing staff involved in the end-to-end delivery of care needs assessments, including first point of contact staff, triage, social workers, occupational therapists, financial assessment officers and end service users.

The purpose of the analysis work was to:

  • Identify the needs of users: both staff and service users
  • Be aware of the target demographic and their levels of I.T literacy
  • Understand the current processes, identify pinch points and potential challenges
  • Look at how best to deliver the information to the user (e.g. animations)
  • How signposting into a directory of local services/support and information would help
  • How the ‘indicative budget’ fits into the process and how/where it is displayed
  • Establish a business case to proceed

The discovery phase taught us that:

  • Our end user target audience welcomed improvements to the assessment process this included self-service and around 40% of customers felt they would be able to self-serve, 30% would be able to self-serve with some assistance from family/friends/staff, 30% felt they wouldn’t be appropriate for/willing to self-serve. These percentages would deliver significant savings to the ASC departments involved
  • Our end user target audience would respond well to animations to help them establish what their care needs are in a self-service environment
  • Staff including occupational therapists and social workers would welcome a more mobile option for delivering home assessments to the remaining 30% of users not suitable for self-service
  • Staff would welcome better triaging towards information, advice and guidance for customers not eligible for support from the council
  • Staff would be open to the idea of customers self-serving their care needs assessment provided that mechanisms to assure safeguarding measures were in place
  • The current process for referrals relies on a service user (or their carer/family etc) being available to talk during normal office hours, council staff often struggle to get hold of people and so a self-serve tool that could be accessed by the service user 24/7 would be a useful tool and potentially reduce the number of dropouts

As part of the discovery phase we used established gov.uk design principles to build a prototype, developed and tested with end users. A report on the outcomes is due shortly. The prototype can be seen on https://bettercareneeds.lookinglocal.gov.uk/. The cooperative have currently produced the animation scripts for the introduction and the personal hygiene section of the care needs assessment. These can be found here:

Introduction: https://docs.google.com/document/d/18Qd7UDYT7OdY16nvXuwZLCSVCe3O2xhCAw5UzSZE1aw/edit

Personal hygiene: https://docs.google.com/document/d/1HhZkgixpioP4_QXn9KXCghecLKSt8kJe8i0QQjkzHtY/edit

The challenge around delivering ASC is one shared by every local authority across the country and as part of the discovery phase we’ve already brought together a group of ASC service heads to undertake collective research and analysis, including onsite visits to a number of different locations to capture common challenges/considerations. Moving into the alpha phase we plan to share lessons learnt and the journey we’ve been on, allowing other local authorities to join the collaboration and input into the ongoing development of the product.

During the development of the prototype we have already acknowledged the need to consider:

  • 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. The cooperative propose to share their blueprint for its implementation for others to reuse if they wish

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.

Looking Local’s products are built using industry standard tools that support open source working. We 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 our solutions to be completely portable and facilitates their distribution across multiple organisations where needed.

The outputs from the alpha project will be:

  • The prototype https://bettercareneeds.lookinglocal.gov.uk/ developed further to include additional areas of a care needs assessment implemented and tested with end users, with feedback well documented and any improvements allocated to future sprints. We aim to have the alpha rolled out to a pilot cohort of users for observation. We will measure success by the feedback produced during the user testing
  • A business case developed to allow any ASC department to assess the impact such a product would have and any knock-on benefits to health departments that should arise
  • A blueprint business process and potential implementation plan for reuse by other councils
  • A clear business plan and product roadmap outlining the actions needed to see the alpha progressed into beta phase
  • A conclusions document justifying the reasons for proceeding to beta phase

The cooperative have allocated dedicated expert and project management resource to ensure the outline project plan and all its outputs can be delivered in time for the end of April deadline. Looking Local, the external development provider, have confirmed they are available to deliver the alpha product and support in the user testing activities in line with the project plan provided.

The intended audience for this product are service users who might be new to adult social services and are enquiring about or requiring support with their care needs. They might have been advised that they need an element of support to remain in their home, but aren’t sure what type of support they need, what is on offer and how much this might cost. There are various community assets/support groups available to support people to live independently, but people in the target demographic often struggle to find the support they need and often contact the local authority as a first port of call.

This product is also intended to be used by current users of care services during their review processes.

For customers who are unable/not suitable for self-service we intend the platform to be used by staff/friends/family on the customers behalf.

Through our experiences with and research into self-service financial assessment tools we have insight into how this particular demographic have engaged in a related transaction and understand the common challenges around supporting them.

Through the user engagement activities undertaken during the discovery phase we have an understanding of the proportion of users who are likely to engage with a self-service product and what tools might be helpful to support them. As a cooperative we plan to continue to tap into the insight these users are willing to provide and also recruit new user testers available to us via our ASC teams to undertake user research and collate feedback that will help shape future development/new features within the product.

Our user testing objective is to establish:

  • Can users navigate to and use the prototype when set particular tasks?
  • Are the explanatory animations clear and easy to understand?
  • What mechanisms for providing supporting evidence are needed to ensure the council receives evidence in a timely manner?
  • How can we make best use of advocacy tools?
  • Can we lower barriers of entry for local resources like directories of services or information, advice and guidance?
  • Are customers able to understand their ‘indicative budget’ calculation?
  • Do users walk away from the transaction knowing what their next step or outcome is?

We would welcome training in user testing techniques. Whilst we have the expertise we require for user testing within the external development provider Looking Local, we would welcome the opportunity to develop these skills within the broader cooperative.

We have not been granted funding for this phase of the project in the past. The discovery phase of this project and the resulting prototype was funded collectively by the original collaboration partners (Kent, Nottinghamshire, Stockton on Tees)

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