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The Digital Futures Podcast series is a collaboration between Sustainable Care Research program

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funded by the Economic and Social Research Council

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and the technology and book Strategy Board.

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TSA Industry, an advisory body for the UK tech sector.

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Each podcast we invite expert guests to explore with us challenges and opportunities.

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Technology can bring care and caring.

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Hello and welcome to Another about sustainable care program and technology

0:37

enabled Care Services Association podcasts as part of a mini series.

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And today we're talking about technology enabled care services

0:46

and how they can deliver beyond managing risks

0:50

to think about things like wellbeing prevention, proactive services.

0:54

And something that we found during our research was

0:57

although it's traditionally telecare and technology enabled, care services

1:01

have focussed quite in quite risk averse ways on supporting people

1:05

on discharge from hospital, supporting people when they live alone for

1:09

perhaps the first time after bereavement, we're seeing a bit of a shift.

1:13

We're seeing increasingly services, thinking a bit more

1:16

about those sorts of broader agendas, thinking about the spirit of the CARE Act

1:20

and the Social Services and Wellbeing Act in Wales

1:23

and how we can create services that are delivering on wellbeing.

1:27

And I'd like to bring Nathan Downing in now, who works for

1:31

the Technology Enabled Care Services Association, to talk about their work

1:35

and what they've observed in the sector quite recently.

1:38

Thanks very much, Kate. And it's always good to say today as well.

1:42

And just to be able to get more quickly, I think it's pretty clear

1:46

that we have seen over the last 12 months,

1:49

12 to 18 months, with certainly everything that's been going on

1:51

around the world with the COVID pandemic, we've seen a rapidly growing appetite

1:55

for those for commissioning and delivering more proactive services.

1:59

So clearly there's an appetite there and to drive things forward.

2:03

There's an appetite from sons and daughters

2:05

looking out for mum and dad and understand how can they can remain connected, but also know that mum and Dad are safe

2:11

without necessarily always being able to be there.

2:14

But equally we have seen the challenges that have come across from shifting

2:18

to a very much remote working model over the last 12 months

2:22

that the technical and there is a lack of interoperability.

2:25

The challenge around bringing our technical systems up to speed

2:28

with the requirements of services, trying to be

2:31

more outcomes focussed and not be led by by the technology and being really clear

2:36

that it's the service wrapped around these making these proactive services

2:40

far more effective for the end user, for the commissioners, etc..

2:45

We've always been rich in data

2:47

across the world of telecare technology, care, assistive technology,

2:51

but how do we use it from an intelligence point of view?

2:53

And that's been the challenge. How do we take this forward

2:56

and be far more evidence based in our decision making ahead of crisis

3:00

rather than being predominantly focusing on, Yes,

3:03

very important safety, critical services, but always being.

3:06

Reactive? I think that's a really interesting point as well around the user expectations.

3:10

And now increasingly people are purchasing and paying for the services themselves.

3:15

And something that we

3:17

observed in our research and there was a lot of enthusiasm for among

3:21

not just commissioners of services and and technology enabled care

3:24

service providers, but also we spoke to people who access

3:29

care services and carers was around the potential of Internet of Things

3:33

and mainstream devices and the way people were using it in

3:36

quite creative ways to support things like their wellbeing

3:39

and their independence and commissioners sort of on I think waking up to that

3:44

as a potential means to deliver on some of these these aspirations.

3:49

But I think they were again, there are challenges there.

3:52

I think there are challenges around the sort of safety standards

3:55

and data sharing and people being fully informed.

3:59

And it's a consumer relationship with a lot of these devices.

4:02

And you sort of put in a lot of the onus is it on the consumers to understand

4:06

how that data is being processed by human review and how it's being stored

4:10

and things like that? So I think there are always opportunities, but there are always challenges

4:14

and I think there is work going on

4:18

where governments try and think about

4:20

how they're going to create standards around Internet of Things

4:23

and whether that adequately addresses their use and care context.

4:27

I don't know. I think that remains to be seen. I think it's important, I think

4:32

clearly and certainly from a tax and arts subsidiary quality, we will always talk

4:36

about the importance of quality and standards of ethical practices.

4:40

And clearly there's a world that is rife with technology.

4:43

The technologies increasing, growing more intelligent every day.

4:48

But again, for me, it has to come back down to it might say technology

4:51

enabled care, but it's the enabling part that's the most important.

4:54

How can we use a blend of virtual and physical care to support people?

4:58

How can we use a blend of technology and services?

5:01

Effective response Tapping into local community assets and networks.

5:06

That's really what's going to support people to remain in their own homes and communities safely for longer.

5:11

From a technology point of view, let's be clear

5:13

there is not one technology supplier out there that can do all of this.

5:17

They are the technology suppliers out there have to work more effectively and collaborate.

5:22

They have to be interoperable. They have to understand how do they how they part of the solution in partnership

5:27

with service providers and commissioners,

5:30

because frankly, people in their own lives are using technology

5:33

that quite often is far in advance of what we may use in technology enabled care.

5:36

There are almost 15 million smart speakers in the UK.

5:39

People are voting with their feet. Half the battle for them has always been

5:42

Where do I find these services and these solutions?

5:44

The services? Hopefully we'll hear from today and indeed the people

5:47

that we're working with across the TSA really are at the leading edge.

5:52

But again, I'm sure they would all admits not everybody has the full

5:56

the full range, the gamut of services in place for those that are leading better

6:00

on using technology and data, they may well be struggling on benefits

6:03

realisation for those that have a very clear relationship.

6:06

The conditions are really have that partnership working well.

6:09

They might not necessarily have embedded practices in

6:13

social work and occupational therapy and people seeing enabling care services

6:18

just as they would see domiciliary care or aides and adaptations.

6:22

Something that Segways nicely into introducing our speakers today, our guests.

6:26

So I'd like to welcome our guests today who are Carl

6:30

Dix from Doubts Wellbeing, which is based in Carmarthenshire

6:33

and we parents from Amateur 24, which is in Worcestershire.

6:38

Welcome. And maybe you'd like to start by introducing a bit more

6:41

about yourselves and the organisations you work for.

6:44

College, you want to go first? Yeah.

6:47

So I'm Tech Ventures strategy manager with Dr.

6:49

Wellbeing and be with them now for about two and a half years really.

6:55

But I've been involved in tech since about 2005 and

6:59

I think the the company itself

7:02

is a local authority trading company, So it's unique in as much

7:07

as we're the only tech company in Wales to be to work in that sort of way.

7:12

So we are wholly owned by Carmarthenshire County Council and that was that

7:16

sort of happened a few years back now really where there were lots of pressures.

7:21

And I say from the Council in terms of not meeting budgets

7:26

and as we're all aware, tech isn't statutory provision within within the UK.

7:31

So there are always challenges when we come to sort of

7:34

looking at those budgets and how that can actually be funded.

7:37

So the director at the time, I don't think he'll mind me

7:41

saying it's a bit of a disruptor when it comes to these things.

7:44

Very innovative in is the way that he works.

7:48

It tends to push those boundaries really.

7:50

And and obviously it was was very competitive

7:53

utilising the Social Services Wellbeing Act and those changes

7:56

that we had from a legislative point of view to really drive forward

8:00

looking at a different way of providing this service then really

8:04

and clearly championed the proposal for Delta.

8:08

And I think normally it's about 2 to 3 years for these businesses to be set up

8:12

and I think it was largely within about nine months.

8:15

So you can see that it was very much

8:17

something that they really wanted to drive forward.

8:20

You know, obviously it's very traditional receiving centre arts or

8:25

opportunities thought to just sort of push those boundaries, like I said, really.

8:28

So I think, you know, when we're talking about it

8:32

being a disruptor, I think it's more about the fact

8:34

that actually transformation is really difficult to do

8:38

and you really do have to push to those boundaries

8:41

and to sort of get people to come along with you then I suppose.

8:44

But I think that there's lot said about the Academy

8:49

in terms of that preventative approach and opening those doors.

8:52

And and we all know that legislation to a degree can be

8:56

interpreted slightly differently by, by people.

9:00

But again, put straight to those edges really in terms of locked in.

9:03

And I think the director felt that it was an opportunity then to sort of

9:07

try to sort of make that sort of wholesale change really, and open up those doors.

9:11

It allows doubters to work within the commercial world as they come

9:15

away from some of the bureaucracy that is involved in local authority.

9:20

We still we still are involved in that. But I think we are also a trusted partner for a lot of people because we

9:26

have that connection there. But also on the flip side,

9:31

because we are branded as a separate company, then

9:35

I think individuals, well, you know, end users, family

9:39

and and people that are involved with those clients also see us

9:43

as an opportunity to be something different than statutory service provision, because I think that is a lot of

9:48

not negativity, but people don't necessarily want to be

9:51

seen by your social worker or don't want to necessarily

9:54

be, you know, involved in that sort of statutory service provision.

9:57

So I think we've been in a position to have the best of both worlds a little bit.

10:02

Then we did adopt that and I think we've with the Social Services

10:07

Wellbeing Act as well, there's a duty that being placed on local authorities

10:11

to provide that information, advice and assistance at the front door.

10:15

And Delta actually provided that foot and mouth to council.

10:18

So actually we are Roxanne's conduit then in that person in between.

10:22

So when somebody does fall that front door,

10:25

we are able to look for solutions that don't necessarily involve lock step

10:29

into statutory care and support them in the community for a bit longer.

10:33

And certainly over the last couple of years and with the project the public more to discuss now

10:38

with Connect we're hit a sort of a 25 30% preventative outcome at the front door,

10:43

which is significantly more than it was pre-COVID,

10:47

but also pre the Connect project.

10:49

So I think clearly with hopefully

10:52

you know, with our eye to see, we've probably got significant integration.

10:56

I mean I come from a different local authority

10:59

and although we work quite closely with our health board,

11:02

I'd say certainly within our regional partnership area in West Wales,

11:07

we've got quite a lot of integration with health, social care on towns in

11:10

I think within that sort of a good position then to sort of coordinate

11:14

between them then. And that said, with the mentioned the fact that we've got this sort of very data

11:19

rich sort of environment within the tech world,

11:22

and I think we've got to look at opportunities to be able to share that information appropriately

11:27

because at the end of the day, clients are not interested in telling their story

11:31

15, 20 channels to the same people that have probably supported them

11:35

somewhere along the line, you know what? So I think that as a company, we we've managed to sort of

11:41

push those boundaries and I think we are probably at that sort

11:44

of cutting edge of that and the opportunities are quite significant

11:48

then to to try and push forward from an off point of view.

11:52

That's really interesting. I think that sort of embedded, connected approach I think is is is really valuable

11:58

and great that you want to talk a little bit with her and how it operates.

12:04

Yeah. So for the last six years been leading.

12:07

I'm 24 and when I started that very

12:10

traditional teletext service and a pretty typical experience

12:16

within the local area of telecom models

12:20

and what could be done with those and what the experience was.

12:24

So it's actually been

12:27

quite a negative experience for a lot of people that

12:30

and that was something that we really wanted to, to overcome

12:34

and we're quite well placed as as the third

12:37

party organisation, part of a housing association.

12:41

We were able to be that kind of independent advisor and,

12:46

and essentially a disruptor in the end because we came in with different ideas

12:52

and different models for how a service using assistive technology could work.

12:58

And that was just a really very powerful thing.

13:01

Once we started to really highlight what the benefits of assistive technology

13:07

could be, how you could actually demonstrate the outcomes

13:10

for for people and for families and carers

13:13

and other stakeholders across the piece, that that was a game changer.

13:17

And this is what we really need to highlight across the UK.

13:21

We need to really highlight what the service models are in

13:25

that whole wraparound, because until you start getting

13:28

to the actual outcomes, improving those and really showing those and creating buy

13:35

in from all of the parties, you won't actually get anywhere nice.

13:39

And we're talking by the technology and the need for interoperability things.

13:43

Absolutely. Yeah. I thought that is an absolute must.

13:46

But until you actually get to the service model

13:50

and getting the key stakeholders all involved and bought into that process,

13:55

you're really going to struggle to create an effective technology enabled care service.

14:00

And I keep talking about technology and aged care

14:03

through lots of the conversations I have. And I keep coming back to an idea that I'm really passionate by,

14:09

which is technology enabled health care,

14:11

because I think that's where it needs to go.

14:15

And I think the pandemic has just absolutely highlighted

14:18

that now everybody being more acutely aware of their health.

14:24

I think that's that's been my experience.

14:27

And we've certainly seen it through the service that we've been

14:31

that we operate, you know, that real kind of concern

14:34

for people's health and indeed their wellbeing as well.

14:37

The effects of lockdown, the effects of isolation and loneliness

14:42

has really been brought to the forefront of a lot of people's thinking.

14:46

And I think that that's a key thing for us to grasp in this industry.

14:51

And I think it's a key thing for commissioners to grasp as well.

14:55

We're not going to realise the benefits of assistive technology

14:59

to the fullest extent until we start to really have

15:02

jointly commissioned technology enabled care services.

15:05

And I think that that is where we need movement in the UK.

15:10

We need to have a real appreciation

15:13

of the benefits of technology to everyday life, to everyday health,

15:19

to looking after that of vulnerable people and our communities.

15:23

Because, you know, the pandemic has really highlighted that,

15:26

that we need to have more effective models of care

15:29

and health care into the community and technology.

15:34

Assistive technology is a key facilitator for that.

15:38

And, you know, when we start to move on to the conversation

15:41

around the power of data, not wanting to tell your story to 14 different people,

15:47

this is really the key conduit for that.

15:51

And the assistive technology can really wrap that up.

15:54

And we've got to overcome some of the challenges

15:57

that Carla was talking about in terms of data and people's

16:02

obviously consent for for that things. But these are all things that can be achievable.

16:07

And if we get backing from health commissioners in particular,

16:11

we can overcome those together.

16:14

You know, this is this is not insurmountable.

16:17

It's going to be easier to do that. So these are the key kind of buying that we need to get.

16:22

But once you get to a service that is outcomes focussed

16:27

and you're looking at people's wellbeing indicators on the way

16:30

we use it all for health independence and wellbeing I constructed

16:34

and it's fantastic because you're seeing what the impact of that technology

16:39

enabled care package is for that person and for the people around them as well.

16:45

You know, this is key to, to capture all of that, that feedback.

16:49

People are very accepting of technology.

16:53

Now. I think that that that message is getting completely smashed. Now.

16:57

The people, especially older people, don't want technology.

17:01

They do. They absolutely do.

17:03

They can use it. They want to use it and they see the benefits of it.

17:08

And when you actually link that to their wellbeing, it's really, really powerful.

17:13

These are the key things that we need to get to right across the UK.

17:17

I think. I think both Toby and I think it's refreshing to hear that.

17:22

Let's be honest, in both of your opening statements or conversations,

17:27

the actual technology was probably mentioned pretty minimally.

17:30

It's very much around the service and exactly where we need things to be going.

17:35

Yes, technology suppliers need to play a role in that, but I'd like to think we can support

17:39

all of those suppliers of solutions and services to think differently around

17:44

understanding the language, understanding the needs of individuals

17:47

and services and commissioners and the technology.

17:50

But I mean, to flippant should be the use of it.

17:53

Clearly, there's you know, there's new new apps,

17:55

new devices coming out every 5 minutes and we know there's a large piece of

18:00

of ongoing work for services and commissions to be doing around the shift from analogue to digital solutions.

18:05

And I know in other podcasts there'll be more discussion around that.

18:08

So I don't want to and plus, I'm not technical enough to be able to talk through that.

18:11

But I do think seeing digital as an opportunity to think differently

18:15

about services rather than seeing it as a just a switch, you know, like,

18:18

like replacement of what you've got now for a digital version is crucial.

18:23

Understanding that you cannot expect people to leave their own devices behind

18:26

when you're in the home and say, Well, that's great.

18:28

That might supported you and helped you with independence, but here's what we're offering you.

18:33

And similarly, technology enabled care is as you both said, is outcomes focussed.

18:38

So some of these outcomes to be able to get down to the shops,

18:41

how do we support them with technology sitting in the background

18:45

and whether that be people almost with a plan in their pocket

18:48

to help them understand what's going on through their day and help them next?

18:50

So some new learned villages, accents, communities,

18:53

whether it's somebody wanting to connect with friends or knowing

18:56

where the local sit down yoga club is or gardening clubs or what it may be.

19:01

That's part of the service offer, that's part of the ongoing signposting.

19:04

Hopefully we'll be able to come on to in terms of the service wraparound.

19:08

So that's the goal. I know I'm kind of pushing on on our suppliers, but it's out to them

19:12

to really understand the use case for the services

19:15

rather than being led by a piece of technology.

19:18

Now when people said. Yeah, I think you're absolutely right that often it is tech.

19:22

Tech first, you know, it's very, you know, exciting.

19:27

The technology inherently new bits of kit are exciting, but we can't get led away by that.

19:32

And it's actually the service in the reference, as you say, colleague.

19:36

Let's talk a bit about the Connect projects and how that is

19:40

very much embedded in the work you're doing.

19:43

Yeah, absolutely. So this is this is my I've lived and breathed connect

19:48

to the last couple of years, to be honest with you,

19:50

and probably could have a whole podcast about it because I do tend to go on a little bit, but I will tell you so Connect really

19:56

has come from a transformation programme that Welsh Government

20:00

provided support across our regional partnership board.

20:04

So again, I suppose it's a little bit different in Wales than it is across across borders.

20:09

So we have our health boards and they work then

20:13

quite closely with the local authorities within that health board footprint.

20:17

So we've got Mark in Japan, Lakshman Kendig on and I have a

20:20

the health board that we work within.

20:23

I suppose there's there's an element of that's perhaps why things are a little bit more integrated

20:28

for us in terms of the fact that they suppose they've sort of been

20:32

forced to work together a little bit, seeing those budgets being pooled,

20:36

albeit it's a, you know, a grant award as opposed to budgets truly being pulled them, I suppose.

20:42

But it gives us the opportunity then to to actually, you know,

20:44

get that sort of proof of concept out there then really and make things work.

20:48

So Connect certainly does focus on prevention

20:53

and being proactive in the delivery.

20:56

Nathan's already touched on the fact that actually Tech really

20:59

is just a facilitator in this and it isn't the main focus

21:02

of what we do in and it's the additional wraparound

21:05

and enhanced service provision that Connect provides, which is probably where the success lies

21:09

in in. James, what's going on? It's been adapted from the the Barcelona model which anybody

21:16

that's lived in tech world for the last however many years is probably aware of.

21:21

But I believe that we've actually we spent a lot of time really adapting that model

21:27

and making it fit for purpose for our customers and clients.

21:30

And that's not having anything negative.

21:32

But what what the Spanish model is. But it is a completely different sort of world

21:36

that we live in and they have in the statutory world

21:38

what their biggest sort of difference with a non-stop tutoring.

21:42

So I would say support is of the next iteration from a UK sort of perspective.

21:47

Then in terms of that model and you know, the core functionality,

21:50

as I said, is about that tech being there and everybody has a lifeline and,

21:55

and we are looking at other opportunities as we get to that sort of digital world

21:59

sort of work a bit differently and be more innovative in what we're providing.

22:03

But we provide them that whole wraparound service, which is very bespoke to an individual.

22:08

You know, we link in with our social services wellbeing assessment in terms of the ethos

22:13

around it, the person centred, what can, what are their strengths, how,

22:17

how are they coping, how are they managing?

22:20

And then we will look at then those areas where they want to improve things.

22:23

They may want to make some changes and what we are trying to do with our

22:27

community wellbeing officers support and is a bit like a key work event.

22:32

So you know, not social workers, but would a step back in terms of that community support.

22:37

We then empower coach mentoring individual

22:41

to sort of move them, I suppose in terms of their wellbeing

22:44

and trying to achieve the things that perhaps they feel that they can't do.

22:48

So we've obviously got the remit of people that are fairly capable, able,

22:54

still able to access things in the community,

22:57

probably very low level in terms of need right the way through to those

23:00

that are actually, you know, have got like pull care calls a day

23:04

and are cared for and, and perhaps have a limited in terms

23:08

of actually perhaps being able to get out and about the things.

23:10

But actually the service are covered across all areas.

23:14

We originally in the project had two years of service.

23:18

So our biggest fear was about that sort of preventative group,

23:22

those that are not receiving statutory service provision, about 65% of people

23:26

that we deem to work with their 30% in that intermediate to perhaps

23:31

sort of dipping into sort of some sort of refurbishment services or distribution

23:36

and things of that. And then 5% at the top tier.

23:39

And what we have found and it may be a little bit of the COVID

23:43

sort of situation, but we are actually hitting about 15% in that top tier.

23:48

But I think that probably gives you and I feel it sort of suggests

23:53

that actually prevention can actually still be used for individuals

23:57

that have got complex needs.

23:59

This is about maintaining them at that level

24:02

and still keeping them in the community, keeping them in their own homes

24:05

without having the need to go into that sort of a residential placement or whatever.

24:08

So I think is quite that's quite interesting

24:12

for us to understand sort of where we can pitch these sorts of things.

24:16

The Connect Project, I mean, there's lots of information out there

24:19

about it on our website and things like that. So I'm not going to go into sort of a of detail, but the additional in-house

24:25

service provision really said, citing the tech

24:27

we have a digital pathway, so it is about connected individuals

24:31

that are digitally enabled to be able to sort of engage.

24:35

And we are finding that we are linking a lot more with health.

24:38

And also we've got a telehealth project going on in the region as well to try and pull those together

24:42

because invariably it's the same customer, people with long term

24:45

conditions that would benefit from attending health provision.

24:48

And actually I'm sure we're all aware of the fact that I think telehealth is still not quite

24:53

got to where it needs to get and again, move back to as the sustainable condition

24:58

is within health, perhaps not understanding the the true value

25:02

and benefit of actually supporting individuals back in the community,

25:06

stopping them from going in and hitting those services that they need to provide.

25:11

So our digital pathway is now looking at it's moved on a little bit and is linking,

25:15

I suppose, our social care finance with our health clients as well

25:19

and actually trying to provide that wraparound.

25:21

So it's quite, quite exciting because that's an adapted path of the model really for us.

25:25

It wasn't what the plan was know initially.

25:29

We've obviously got our community based pathways of support,

25:31

so we haven't changed any of those, those of things that are already there.

25:35

But we are analysing and trying to understand whether or not there are any other gaps in that provision

25:40

to make sure that actually if we've got like a high level of thought in going on,

25:46

then perhaps we need to then support commissioners of those sorts of services

25:50

to provide something to support those clients.

25:52

So again, we're not changing anything there. We just utilise what's already in place.

25:57

But the biggest thing for us has been the response to this.

26:00

And Nathan, you touched on appropriate response in terms of that.

26:03

When I came into this in 2011, it was one of those things

26:07

when we need a response services tax, a bit of a blast, scratch it.

26:11

If you can't, if you've got to wait four plus hours for an ambulance to come

26:15

when you're actually not injured and I mean for being very generous

26:19

and I know we know of people that are on the floor for ten plus.

26:22

I was waiting for something because they are an injured and it's not life threatening.

26:28

And we all know the consequences long lives and those individuals and it sucked into the house

26:33

the social care system because you know the consequence of that

26:37

our community welfare response has been and it's been a challenge.

26:41

It's been quite scary on two occasions to me

26:43

because it's something new and in terms of that, but

26:46

it's been absolutely wonderful, the experience that we've had of being,

26:51

you know, you can you can see it there, can't you, when you actually go in

26:54

and picking somebody up and making sure that they're comfortable,

26:57

whereas, you know, they would have been on the floor before

26:59

that was our staff have been brilliant all the way through COVID and again,

27:04

was quite a risky sort of situation, you know, mean to everybody.

27:07

And we're going to get into the thick of it, really.

27:09

And they've been and actually well, they've been amazing media.

27:12

But one thing that we decided to do is to actually register

27:15

our response to this with the Care Inspectorate Wales, which is it's a C, c

27:20

c I think in England is, isn't it, in terms of the Capital Code Commission.

27:24

So we the only response service in, in Wales anyway

27:28

that has actually got the ability to provide that personal care provision.

27:33

So we've got some response services that are part of a domiciliary cat vision,

27:39

which is fine, but they tend to get clogged the scheduled calls.

27:42

So they're not reactive and not responsive to that.

27:45

But that's also opened up doors in terms of adapting our model to be able to work

27:49

with our hospitals, work with Welsh ambulance service trusts,

27:53

to be able to provide another sort of bridge in service

27:56

provision in the hospitals and also some opportunities for us

27:59

to actually take off of the stack with Welsh Ambulance service to deal with those low level calls.

28:05

So I think, you know, we've we've been very agile and flexible and quite open minded

28:09

and although it's a project and it's got quite significant in terms

28:13

of what it's outcomes should be and what we should be doing in Delta,

28:18

we've been able to sort of flex a little bit really as things are coming through with an app.

28:22

So I think I can sit and sort of gush about connect for a bit.

28:25

But you know, we've had some challenges.

28:27

It's been really sort of difficult in terms of trying to get it right.

28:32

And I think the key for us is continue learning and changing and adapting.

28:37

So if something doesn't work, okay, let's figure out what can work then and try that then a little bit.

28:42

So and very much, although I don't like it very much of the ethos of the whole Dr.

28:46

Pepper something, you know, what's the worst that can happen really, as long as you're

28:49

not doing anything illegal, then really give it a go.

28:52

Because actually our customers are much more discerning and they want us to do something.

28:57

They are less risk averse than we actually are.

29:00

And it is a challenge from a health perspective, definitely,

29:02

about being sort of less risk averse, but we sometimes just get to go with it.

29:06

And that's what happened in government. You know, we're hoping to see a lot of evidence

29:11

falling into the window during COVID because you have to do something.

29:14

These people have to make a difference and change the way that they worked.

29:19

And I think that's added to the success not just of connect,

29:22

but I think a lot of the proactive services across the UK that we see and having success is that,

29:27

you know, we took those barriers down and were able

29:30

to actually achieve what we should be achieving for our clients.

29:33

And then I just hope that we don't revert back

29:35

to sort of putting those barriers back up again, really, because it would be

29:39

it would be disappointing because we've all probably been bagging our heads

29:43

up against a brick wall for a long time about, well, look, this is common sense.

29:46

We should just do this. It's the right thing to do.

29:49

And this is what our customers want us to do. So let's sort of let's go with it, really, and so on.

29:54

So yeah, connect being them being the reason for quite a lot of sleepless nights.

29:59

But actually it's it's heartwarming to see and that those personal stories

30:03

that are coming through, you know is on a daily basis

30:06

and you clearly can see the difference loss making.

30:09

Thank you call it Rupert Did you want to come in and talk about it

30:13

24 and how you preventative approach and whether as as with so to wellbeing

30:20

did the pandemic for you open take down some barriers

30:24

and drive things forward or was it more challenging them.

30:28

It's been

30:31

a really, really interesting time too to see how a proactive

30:36

technology enabled care service performs within a pandemic environment.

30:41

And one of the key things that I've taken from it was thank God

30:46

we had proactive preventative

30:49

technology in place in Worcestershire before the pandemic hit,

30:55

and I've had that feedback to me from commissioners.

30:57

I've had that feedback to me from lots of different stakeholders

31:01

within service, and that's

31:04

because we didn't have to introduce that approach.

31:08

It was already embedded. We were already looking at how we problem solve and Carlo was talking

31:13

about how you need to evolve your your service and things over time.

31:18

And we've very much done that.

31:20

And I think that I think what Carlos talked about was,

31:23

you know, you've got to you've got to take some leaps of faith

31:26

with assistive technology and, you know, we always talk about

31:30

when we were coming up with the service was backed by the art of the possible.

31:35

Let's start looking at things in a more positive way.

31:38

So can we find a solution to that individual's situation?

31:44

That's it. That individual circumstances, you know, nice and talks by,

31:48

you know, enabling someone to go down to the shops?

31:51

Well, let's do that. What technology can we use to actually facilitate

31:56

that so that person and and I think during the pandemic, we were, you know,

32:02

faced with a different set of circumstances, much more challenging.

32:05

And the team were absolutely fantastic in terms of getting out

32:09

and making sure that people had those those devices and solutions to

32:14

to help them to maintain that health independence and wellbeing.

32:19

And, you know, it's really come into its own.

32:21

And one of the key things that I think we need to take forwards

32:26

over the next year or so is this real focus on sustainability

32:31

because the pandemic changed everything

32:34

in terms of the way that health and care needs to be delivered.

32:38

And we saw some really fantastic examples, but

32:41

there are a whole set of other challenges that we've got which we can't ignore.

32:46

You know, we're absolutely aware of our ageing population,

32:49

you know, the increasing prevalence of long term conditions and disabilities,

32:55

you know, there's lots and lots of demographic factors there

32:59

that we need to be aware of and the shortage of carers as well.

33:04

You know, the workforce is under real pressure in terms of delivering tests.

33:09

When I was talking about the importance of response services,

33:15

absolutely. You know, these solutions and packages can really start

33:19

to help with that whole sustainability piece.

33:24

And you know, we're very fortunate in Worcestershire.

33:26

We have a full response service operated by Platform Paisan,

33:31

which is a local organisation and it's fantastic.

33:36

You know, people getting a response when they're

33:40

when they're simply on the floor and needing that help to get out.

33:45

The reassurance, kindness, the interaction, you know, that's,

33:49

that's really showed during the pandemic as well and a really cost

33:53

effective solution to helping someone who who isn't injured

33:59

but is at risk and you're actually making a positive intervention.

34:03

And when you look at the grand scheme of things, it's a much more sustainable approach.

34:08

You know, calling out an ambulance for someone who's uninjured on the floor,

34:14

putting extra pressure on the ambulance service is not doing anybody any good.

34:19

And you see it within the results. I think our record for an ambulance sue

34:24

to turn up at a property for someone who had fallen.

34:29

It wasn't in Worcestershire actually, but it was 15 hours.

34:33

And when you're seeing that play out within an arc environment,

34:39

it was amazing because it actually went over three different shifts, you know?

34:43

So you had this call post.

34:45

It's bonkers. It's absolutely.

34:47

And we must really promote the use of response services

34:52

that really needs to be something that goes up the agenda in the UK

34:58

because they make positive interventions every single day.

35:02

When you talk with the the end user in the situation,

35:06

they much prefer to have that response service

35:11

coming out to them and looking after them, doing all of the forward.

35:16

They onwards forwards assessment work and things like that

35:20

and it just joins things together and this is

35:24

what has been central to the service that we've been operating in.

35:27

Worcestershire is, is by joining things together, we crucially assess

35:32

people properly when we're designing the technology enabled care packages,

35:36

the links that we've got with with adult social care

35:40

and the social work teams, the individual social workers

35:44

being part of the reflective practice

35:47

meetings and really engaging with them and being that

35:53

that expert advice for them

35:56

really, really paid dividends.

35:58

And it's not just a focus on

36:01

reducing care package costs, although that is one of the key

36:06

benefits that comes with our service.

36:09

But there's the whole prevention piece as well, and you can calculate this,

36:15

you can use different insights from social workers, for example, to formulate that.

36:21

And that avoidance, it is very, very simple to show how you are going

36:26

to help someone to avoid going

36:29

into residential care unnecessarily.

36:33

People don't want that. They don't want to go into it central care if they can avoid it.

36:38

And you can design solutions that are able to achieve that for people.

36:44

And, you know, I think that's the whole sustainability

36:49

angle on this is absolutely crucial because,

36:53

you know, health needs to be involved in that conversation.

36:57

They need to be involved in the commission and the services

37:00

because you can really show kind

37:04

the costs and sustainability around care

37:08

and a person's journey through care.

37:12

Now we talk about life curve and you know, how

37:15

you can actually help someone to manage their progression.

37:18

And these are the key things that have been part of our service

37:22

and people have bought into it as well.

37:24

Been really fortunate. We got great commissioners and which is a really,

37:29

you know, kind of grasp the concept.

37:31

You know, they've said, you know, we know this is a good idea.

37:35

You know, this is it's a bit of a no brainer.

37:37

You know, we know that assistive technologies is great

37:41

and that it helps people. So we've got to do this.

37:43

And they made that leap of faith. And, you know,

37:45

you're seeing it with with services like Karlis and others around the country.

37:50

We just need to really progress this up, you know, make that leap of faith.

37:55

I would again, totally agree with everything I got.

37:58

I can't find anything to disagree with.

38:01

I think for me, how do we take this from the two excellent examples

38:06

we've heard from so far today into the much wider

38:10

spectrum of enabling care services across the UK?

38:12

You know, there are 175 long receiving centres across the UK

38:18

service providers that some of which provide the whole and train service,

38:21

some provide just in my response rate or the installation service.

38:24

And it's trying to raise the game

38:27

across the piece and not just those who supply services, but clearly those

38:31

that provide the solutions and those the commission them.

38:33

This has to be a partnership approach. It can't be the days of a transactional relationship

38:37

asking somebody to install a thousand alarms a year or

38:41

go and carry out in 2000 batch of checks or whatever it may be.

38:44

It's got to be that partnership approach and people understanding that common language.

38:49

I think Rupert put it clearly around that

38:52

this is when we're not looking for a one size fits all approach to attack.

38:58

You know, everybody that is over 65 automatically gets three things.

39:01

It's got to be that trusted adviser role, putting your trust

39:04

in the hands of the service providers to be heard from today

39:07

based on referring into the service around outcomes

39:10

risks alongside professional practice, you know, positive risk taking,

39:14

just enough support and those sorts of approaches

39:17

rather than I'm going to prescribe that you, you install

39:21

a few pendant, an alarm and a few other bits and pieces.

39:25

So it's giving the social or just the confidence that the service providers really know what they're talking about

39:29

and they will go and find the solutions, They will go and innovate

39:32

and they will challenge the very suppliers that that's actually what you've got isn't good enough.

39:35

We need solutions that can do X, Y and Z.

39:38

So I do think the challenge commissioners to think differently around this model,

39:43

they believe they need to when they talk about proactive services,

39:46

frankly, it isn't the same funding model they used to.

39:49

Let's be honest, you don't, you know, a proactive

39:52

and focussed call talking to their friends on a monthly basis about your exercise

39:57

routines or doing a video

40:00

visit to agree to taking the medication and watch.

40:04

They're talking about a few questions, not necessarily totally scripted,

40:07

but again, around the things that we know around actors that they living around wellbeing.

40:11

And that's a far different service. That's not a 32nd call, get the phone down, get ready for the next person.

40:16

So it needs to be an adult conversation about what you expect

40:19

and how do you fund this and indeed, how do you collectively between the commissioner,

40:23

which tends to be social care at the moment,

40:25

how do you take that conversation with that commissioner to health

40:28

to lead to actually this is the benefits. You explain the what's in it for me across the piece,

40:33

I think we've talked to the staff about reverting back to practices.

40:36

I know, I know there'll be a challenge, particularly in the health sphere personally, of, you know, massive

40:41

improvement in remote monitoring solutions that have been used the last 18 months.

40:44

But as we open up safely,

40:46

I'm not going back to saying, well, that's the crisis kit

40:49

that goes in the cupboard. Now let's go back to the way we normally did things.

40:52

And I guess finally before I get my soapbox,

40:55

we are seeing far more activities now in the world of the analogue

40:57

to digital shift. You know, we've had 12 months of stabilisation and nothing and what do we do?

41:02

As you know, the Telecoms Network changes over the coming years

41:05

and already is happening. It's not no point just saying 2025 and think of a wait until then to start looking at it.

41:11

So there's a lot of work to do. There's a lot of work on suppliers to make sure they can maintain supply.

41:15

We know there's a global microchip shortage that again,

41:17

I'm sure will be covered in another podcast.

41:19

But equally from a planning point of view, almost not diverting

41:23

all your attention towards digital shift and the technical aspects not losing

41:28

sight of what we've talked about today, there is a danger that people say, Well, actually we only got so much in our heads.

41:33

We'll focus now on the service on the technical side,

41:36

and we'll forget about all the good learning and all the things we have learnt during COVID that clearly, as you all said,

41:41

consumers, users and users, sons and daughters, you know, Fred and Frida,

41:45

they all want a service that supports them to deliver their outcomes.

41:49

Let's not lose sight of that by then thinking, okay, but now anything more technical?

41:53

And I do think that's our job in GSA to help share the benefits of this,

41:57

to help services really think differently, to help those commissioners

42:00

and those senior decision makers to understand that this isn't

42:04

almost the last thing on the list of service

42:06

you can choose from, which, frankly, it has been for a number of years.

42:09

This has got to be right up front. And don't think of it as technology.

42:12

It's not number one priority. And you can't see Rupert put his finger up on the screen.

42:15

But I okay, it's a number one priority to see enabling solutions at the

42:20

at the heart of care and health supports

42:23

rather not an afterthought or not as an add on after review period.

42:27

And as I said, we've been led by consumers that are telling us, you know,

42:31

some of the doors are telling us this is what they want.

42:33

Let's not let's not almost brush that off and actually go back to reverting to time.

42:37

Yeah, I think and it links really well to the sort of sustainability and spread

42:41

thing and the benefits realisation and what we observed in the project

42:45

with lots of lots of pilots, very similar pilots being done

42:49

and not sustainable, not not scalable because every commissioner

42:54

wants to try it in their own context, not taking that leap of states.

42:57

It's Barcelona model, taking what you can learn from it and adapt it to your specific context.

43:03

You can't just transform things you to do it.

43:05

You have to think about context

43:07

and it's just, yeah, just the same pilots being done it again.

43:10

And then the results of those pilots, the commissioner, the person

43:13

with the ultimate decision making power, that's very nice,

43:17

but it's a very small scale pilot that's not persuasive to me.

43:19

You haven't given me the evidence I need to invest in this.

43:23

And I think that is the challenge that we we found in the project was prevention

43:27

being quite a challenging thing for some people to find the evidence base on.

43:31

How do you prove both doing X you prevented y.

43:37

I especially if Y is a health cost and that budget is not joined,

43:40

where is the incentive there for the Commissioner in adult social care to invest in that?

43:44

I think that's really good to hear from you, Rupert, that you all pushing

43:47

that sort of evidence base and you are able to and there are ways to do it.

43:50

You know, you can build in economic costing and you can work out with

43:54

with by engaging with people with expertise in this sector.

43:57

What would happen if this hadn't been put in?

44:00

What was the likely scenario? What would then put a cost to that?

44:02

It can be done, and I think it's a question of finding

44:06

a way to share where good practices happen, share how could say savings with.

44:10

So it wasn't. That is quite a persuasive argument.

44:13

Share how you come to wellbeing outcomes, which again is a challenging thing

44:16

to capture because wellbeing is a very personal thing.

44:19

How do you standardise that? How do you capture that?

44:21

How would you, you know, persuade a commissioner around that?

44:24

And I think it's an ongoing challenge, but I think it's something that as an academic, I have a role to play

44:30

and I think the TSA has a role to play and in sharing good practice.

44:34

And I think when commissioners and service providers get it right, they can really, you know,

44:41

use every opportunity to sort of make it loud and clear where it's going on.

44:45

Well, and hopefully other people can think about

44:47

applying similar models in their context.

44:51

I do think clearly we are seeing far more interested

44:54

in investment from NHS X Department, Health and Social Care in

44:59

independent living at home. How do we better support people

45:02

in care homes through technology and enabling services?

45:06

We have a real opportunity to have a better discussion

45:10

with integrated care systems as they are developed to ensure

45:14

it is at the heart of that thinking that it is an opportunity to champion

45:19

a collective voice across social care, housing and health

45:23

and not not be predominately health led.

45:26

And I think all of us, as as I said, is we've got the ability

45:31

and the opportunity to start to tell the story around how do you measure the benefits, how do you provide that,

45:35

What's in it for me for all services and not meet benefits?

45:40

Realisation almost in the too difficult pile and and something we do

45:45

after the FTA, after the fact to go back to this really make a difference.

45:49

It has to be right up front in everyone's thinking alongside all the stuff we

45:52

talked about today. Thank you, Nathan,

45:55

and thank you for co-hosting today, and I'd really like to thank Kyler Murray

45:59

for being so inspiring and sharing their experiences

46:03

of delivering services that go beyond that risk.

46:06

To think about prevention and proactive and well.

46:10

And thank you very much for your contributions,