David Rees and Richard Ellis
6 January 2015
Like all providers of adult care, Hampshire CC faces a combination of significant cost pressures and rising demand. Of the county’s total population, around 16,000 vulnerable adults have been assessed as having ‘critical or substantial’ needs. The majority of this group, 10,000-11,000 people, are receiving services at home.
For some time, Hampshire had recognised that telecare was a potentially powerful response to these demands. It enables better targeting of resources by ensuring that service users have constant access to emergency help at a low cost to the council. However, the previous piecemeal approach to telecare had used services from a range of different providers and only covered a few hundred people. Facing significant financial pressures, it recognised that a radical change was required.
During spring 2012, a business case for the wider adoption of telecare confirmed its potential to reduce total costs of care, but only if it was used much more widely and instead of – not as well as – other care components. As Gill Duncan, Hampshire’s director of adult services, explains: ‘We embarked on this initiative because we believed that, systematically deployed, telecare was a powerful way to improve our service to older adults and those with disabilities and sensory needs, while containing costs’.
Following an Official Journal of the European Union procurement in the summer of 2013, Hampshire appointed Argenti (a consortium led by PA Consulting and including Medvivo, Tunstall Healthcare and CareCalls).
They took complete responsibility for the service, from its redesign through to assessments, installations, equipment provision and monitoring. The targets for the first year were to achieve 630 installations and savings of £788,000 and, one year on, these have both been exceeded.
There are three key reasons behind this success. The first is that the Hampshire/Argenti partnership took a radically different approach to providing telecare, treating the project as a major change programme rather than a technology deployment.
They started by convincing care professionals and service users of the benefits of telecare by providing classroom training for 720 referrers, such as social workers and occupational therapists. These sessions provided demonstrations of the equipment and examples of real-life case studies that illustrated telecare’s benefits.
This investment in early engagement has increased both the quality and quantity of referrals. At the end of the first year, an online survey of all 720 referrers found that four out of five thought telecare had been ‘good’ or ‘very good’ at achieving desired service user outcomes. It has also meant that the initial target has been significantly exceeded, with over 2,000 users recruited.
The second key success factor was Hampshire’s decision to make telecare available free of charge to everyone with critical or substantial needs, regardless of their financial circumstances. This reflects the council’s view that telecare is a low-cost intervention which, appropriately deployed, keeps people independent and prevents or delays the need for other more costly services. It believes that these benefits outweigh those that might be gained from charging users for devices.
The final reason this approach has been so successful is the focused way it measures benefits.
The redesigned referral process requires the social worker to state what other care components can be taken away or avoided as a result of using telecare. After auditing by the council, these values are tracked, user by user, and provide robust evidence of the savings achieved.
With domiciliary care costing an average of £160 per week and a fully-funded week in residential care up to £572, these are potentially significant cost reductions. In the first year, Hampshire’s overall savings, after all costs, totalled £806,000.
In addition to these tangible benefits, the initiative has improved the quality of life for individuals. User surveys show that 92% believe that telecare had increased their feelings of safety and security and 95% of users would recommend the service to other people.
A central strength of the initiative has been its focus on collaboration and shared objectives. This is reinforced by an element of payment by results, which either imposes a penalty for under-performance or rewards good performance at the end of each contract year.
This is determined by a simple balanced score card which has a small number of inputs (for example, the number of live connections or call response times) and outcomes (such as service user happiness or the delivery of net financial benefits to the council). Such is the success of the approach that is it is to be adopted more widely in other areas of adult services.
Gill Duncan summed up the project’s achievements, saying: ‘Our first year of working in partnership with Argenti has rewarded our faith in the idea of making telecare a mainstream service. We have exceeded our own expectations in several areas including take-up, which at 2,000 people is over three times our original projection, and cost savings are above target’.
Richard Ellis is deputy director, adult services, at Hampshire CC and David Rees is head of local government services at PA Consulting Group