This article was first published in The MJ and was written by Mathew Kendall, adults and communities director at Barnet Council, and David Rees, PA Consulting’s head of local government services.
As the King’s Fund highlighted at the end of last year, despite the 2018 Budget announcement of a series of short-term cash injections, social care still faces a projected funding gap of at least £1.5bn by 2020/21.
Equally, with the Green Paper further delayed, there is still no clarity about alternative funding options for plugging this gap.
Given these pressures, local authorities have been, and are continuing to take action to make the most of the resources available to them including money, people and influence. At Barnet LBC, which spends more than £90m per annum supporting some of the borough’s most vulnerable individuals, we are facing ongoing financial and demographic pressures. In response, one area we have been developing is increasing the adoption of technology in frontline care through our strength-based approach.
This aligns with the approach set out in The future of healthcare: our vision for digital, data and technology in health and care published by the Department for Health and Social Care (DHSC) in October 2018 and the likely direction of the social care Green Paper.
Working in partnership with the PA Consulting-led Argenti consortium, we have spent the last two years looking at ways to mainstream technology in care, while improving outcomes and simultaneously reducing costs. The early results of this work have been encouraging, with a total of 2,800 service users receiving technology-enabled care in the first year. The training of more than 240 members of staff has been central to this expansion. It has also delivered a net saving of £0.9m, and a similar figure is likely to be achievable in the partnership’s current year of operation. In the second year to date, an additional 1,200 service users have been supported and the partnership is on track to exceed savings targets.
Barnet is also using care technology to address the challenges of delayed transfers of care (DTOC). Despite the Association of Directors of Adult Social Services (ADASS) report in November that the number of DTOC days attributable to adult social care had fallen by 187,864, saving almost £60m in NHS costs, this remains a significant challenge for many local authorities.
In response, a number of initiatives were put in place including the introduction of a pioneering scheme where individuals are given a small device called ‘Just-in-Case’ before they leave hospital. The technology is intended to reduce pressures on the system by providing support to allow individuals to go home before the final care package has been organised (see below).
Barnet has also been investigating how technology can improve the quality of lives of those in supported living while also reducing costs. We have run a pilot project to give technology to individuals with learning disabilities in supported living. In addition to measuring both qualitative and quantitative benefits, a key objective of the project was to develop a method that would allow this approach to become mainstream for this cohort, in order to extend the project within Barnet and potentially be used elsewhere.
Although the Local Government Association will be publishing the detailed outcomes from the overall programme during 2019, there are a number of initial lessons that can be drawn from Barnet’s experience. The first is that there have been cultural challenges. Care technology may not be as familiar in learning disabilities as it is in other areas of adult social care, and there was a perception that its introduction would lead to a reduction in care quality. Additionally, some providers were apprehensive, not only about what the technology would mean for individuals receiving services but also their income. Effective engagement has been key to alleviating the concerns of both providers and care practitioners.
Secondly, the project has had to address a number of practical problems. Specifically, it has had to be delivered alongside other projects and meet the need to drive out financial savings, and not just be a paper exercise.
However, the early results have been very encouraging. For example, one of the 23 individuals had particularly complex 24/7 care needs and required a second carer due to behavioural concerns. Before being part of the project, they were in and out of supported living and more expensive residential care. They are now settled at a single person supported living flat with support from care technology (a bed occupancy sensor, epilepsy sensor and door sensor). More importantly, the individual feels more independent and secure, while the provider has suggested these improvements have led to a reduction in the care package provided. Overall, the technology has enabled them to provide non-intrusive support and the increased stability has reduced behavioural concerns.
Overall, care technology has increased non-intrusive support, reducing the need for night cover and one-to-one support. In addition, it has provided a better way to match an individual’s real needs and the care provided.
Barnet LBC has identified three factors that have been crucial to the success of the partnership. The first is the focus on outcomes both in the way the technology enabled care services have been commissioned from the start, but also on how they are delivered and managed. The technology has never been seen as a replacement for more traditional forms of care if it cannot deliver a benefit.
Linked to this, the council has viewed the improvement in services as a behavioural change, rather than a technology implementation programme.
Finally, a critical factor has been the integration of assistive technology into the council’s strength-based approach, which focuses on what people can do and how they can engage with the communities around them. This approach aims to prevent, reduce or delay an adult’s social care and health needs from either developing or escalating. Care technology is a critical component in helping to support the strengths-based approach, which enables people to live the lives they want.
While there is still no clarity on when the social care Green Paper will be published, Barnet’s work and approach shows that local authorities are already making progress in developing alternative ways of working that can make a real difference.