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Hertfordshire County Council's assistive technology offer, Data Inspired Living, wins LGC award for Innovation

Data Inspired Living uses sensors placed in the home to build a day-to-day picture of someone’s normal routine. If the sensors detect anything abnormal such as missed medication or reduced movement, an alert can be raised and investigated by either Hertfordshire Assistive Technology practitioners or a family member or carer. This allows people to stay in their own homes and retain independence but still have support when needed.


Judges comments

In June 2024, Hertfordshire County Council were delighted to learn that it’s assistive technology offer, ‘Data Inspired Living’ had won the prestigious Local Government Chronical award for Innovation. The judges commented:

“Congratulations to Hertfordshire CC for their impressive project that focuses on promoting independent living through innovative and inclusive technology. This project not only delivers improved outcomes for service users, families, and carers, but also sets the stage for a more efficient and effective delivery of public services. The judges said their dedication, passion, and commitment to innovation serve as an inspiration to us all.”

The judges added that Hertfordshire CC had set a remarkable example of enabling service users to stay at home, be independent, and ultimately lead better lives. They were impressed with their approach of co-producing technology that is adaptable and scalable, showcasing a true learning culture aimed at continual improvement.

Background

Hertfordshire County Council (HCC) has a digital telecare service linked to a 24/7 monitoring centre and a responder service that is used by about12,000 residents that can react to emergency alerts in people’s homes. Whilst this service is reactive in nature, it does provide a safety net to residents and their families knowing that help is not far away.

In response to the growing health and social care challenges across the country, Hertfordshire County Council developed an Assistive Technology Strategy outlining its vision to use modern digital technology to support the provision of care services and enhance the support for Hertfordshire’s residents to live independent lives.

We explored using modern technology and data to support social care practitioners to be more preventative in their care planning; enable care planning to be more tailored to an individual’s needs and aspirations; to support people to live more independently in their own homes for longer; and to provide additional reassurance and support to family carers.

Technology and digitally-enabled care to support the early identification of emerging themes before they become embedded, support residents independence, enable practitioners to better target care and provide reassurance to residents and families.

What is data-inspired living?

Data Inspired Living consists of an online dashboard, which provides a view of routines using various small, discreet sensors that are placed around the home.

These small sensors help to build a day-to-day picture of someone’s normal routine, so if the sensors detect anything that might fall outside the norm such as missed medication or a reduction in movement around the home, an alert can be raised and investigated by either Hertfordshire assistive technology practitioners or a family member or carer.

Outcomes from pilot projects

The AT Pilot Study was informed by a nine month proof of concept (PoC) pilot, conducted between December 2018 to September 2019, which explored residents’, family carers’ and professionals’ attitudes and engagement with AT. The PoC intervention was a small study, conducted with 53 residents. Findings from this study highlighted that AT was an acceptable and feasible complementary solution for creating greater efficiencies in social care in Hertfordshire by providing greater support and reassurance for families and helping to improve older people’s health and wellbeing.

Following the proof-of-concept intervention, we scaled up the AT rollout across five districts (Broxbourne, Dacorum, East Hertfordshire, Hertsmere, and Stevenage) to examine the impact of AT across a wider cohort of residents, family carers and partners. The AT Pilot Study was a nine-month intervention conducted between May 2021 and February 2023 delayed due to Covid. The overall aim of the AT Pilot Study was to rollout digitally enabled AT as an integral part of an individual’s care planning on a wider locality basis, with a view to providing robust evidence in support of incorporating AT into a county-wide offer.

The pilot study had one overarching primary outcome and five secondary outcomes as presented below:

Primary Outcome: Achieve efficiencies (cash and time releasing) from investment in AT.

Secondary Outcomes:

  • Reduce the number of avoidable emergency admissions and readmissions into hospital
  • Reduce or delay the use of care homes
  • Improve or maintain resident independence
  • Improve care planning using AT
  • Reduce pressures on family carers and improve their quality of life

Objectives of the Evaluation

The evaluation sought to:

  1. Identify whether the AT Pilot is achieving its intended outcomes.
  2. Explore whether AT is acceptable to residents, family carers and professionals involved in residents’ care.
  3. Explore what unintended outcomes (positive and negative) have been produced.
  4. Demonstrate which residents AT can effectively support and who it cannot effectively support.

Evaluation outcomes

Each resident on the pilot had an individual case study completed on their experience of having AT installed and what they thought the benefit(s) to them were. However, the headline data from the Public Health Hertfordshire AT pilot evaluation is:

  • AT supported 54 per cent of residents in the case study cohort to meet their outcomes
  • 16 per cent of residents in the case study cohort were partiallysupported by AT to meet their outcomes
  • Of the residents who met or partially met an outcome, 56 per cent met two outcomes
  • 33 per cent of residents in the case study cohort did not meet an outcome

Developing the solution post pilots

In close collaboration with practitioners and adult care services an in-house team at Hertfordshire County Council (HCC) have developed an Assistive Technology (AT) solution to support residents to remain as independent as possible, reduce the need for hospital stays and provide reassurance for family and carers.

The solution is the Data Inspired Living Practitioners’ Dashboard, which was developed from the ground up and rooted in social care through the collaboration of Hertfordshire County Council’s Adult Care practitioners and Technology teams. The Dashboard provide a near real time online view of residents’ routines at home using various data points which are gathered from a highly diverse set of sensors which are installed and the data they provide is then analysed. These sensors include, movement, temperature, smart plugs, bed mats, medication dispensers and door sensors.

The Dashboard enables carers and practitioners to understand the contributing factors for elevated risks associated with the resident’s health and wellbeing via a complete picture, giving a unique oversight to have informed conversations and assist with care planning. The AT solution provides individually tailored preventative alerts to practitioners and carers, which are generated when sensors are triggered. Examples include an alert being triggered as a result of changes in routine which could provide an early indication of illness e.g. increased toilet usage a possible UTI or decreased mobility over time to warn of possible heightened fall risk.

As an indication, some of the sensors which are being deployed in people’s homes include: door sensor, toilet flush kit, bed and chair occupancy and medication dispenser.

The data from these sensors is then securely imported into a professionals’ dashboard (called Data Inspired Living as detailed below) where practitioners can understand trends in people’s activity which feeds into better tailored and targeted care planning and reviews. This data also generates a range of individually tailored alerts which are sent to either family members or social care practitioners for further investigation. HCC is also in the final stages of coproducing a family view of the dashboard which families and informal carers can use to support their loved ones.

Where we are now

In November 2023, supported by the robust evidence from the pilot, we launched the Assistive Technology solution as part of our Adult Care offer to residents. This involved nine months of work to embed systems and processes in Adult Care, establishing practice policy and guidance for social workers, face to face and online training of the AT solution and referral process so practitioners were confident to recommend and refer their residents to use the technology and the recruitment of a small team of AT Practitioners to support the roll out.

One of the key activity here is the creation of an Assistive Technology Practice Guide which pulls together all the elements of the AT and embeds this into other social care practice. This gives practitioners a one-stop-shop of all things AT, in an easy to read and navigate format that helps join up the various practices that practitioners adhere to when supporting residents.

Working with our residents

As part of our ongoing development of the AT solution, we have collaborated with practitioners to build the dashboard both in functionality and appearance to ensure it meets the needs of the practitioners and the residents. We have also engaged with residents and carers, through the use of focus groups, questionnaires, individual one-to-one support meetings, semi-structured interviews and data examination to gain feedback and ideas on improving and iterating the dashboard. Also that is accessible from a family and carers point of view and we are aiming to build a regular cohort of carers to test new concepts and ideas with as the product develops and new sensors and functionality are added.

A consistent and continuous internal communications plan ensured staff and supporting agencies were aware of the AT work and engaged with the solution and how it could support residents they supported.

Maintaining independence and remaining at home: A practitioner’s view

Practitioner and resident talking while seated on a couch

Carrie* is a social work apprentice within Adult Care Services and has been with Hertfordshire Council for six years, starting her career as a community care officer (CCO).

The key purpose of her role is to get people back to independence and she has worked closely with the Assistive Technology (AT) team from the start to ensure that the solution we have developed is suitable for residents to address their needs. 

For residents referred for AT, Carrie visits them in their homes with family present if possible and AT is always included as a key part of the assessment review. 

“My visits are very conversational and relaxed.  I make sure they have the reactive measures (pendants etc) in place and then build in the more preventative options that are available if suitable for that particular resident’s needs.”

“The benefit of the AT sensors is that they give a longer term solution for residents to provide that preventative measure - such as declining mobility.  A lot of families are so anxious about family members that have fallen and this helps give them reassurance.”

“Some residents and their families are worried that the AT solution is ‘watching’ them so I reassure them that the sensors are not visual and that it allows them to just get on with normal life – it doesn’t impact their day to day routines and gives them reassurance that someone is checking in on them if needed.”

“What I really like the most is that AT is versatile.  It’s another tool in our assessment kit and can be adapted to meet different needs. Each resident is unique – whether you are 25 or 95, AT has a benefit in one way or another for everyone if they are willing.”

Carrie referred one of her residents, Henry* to have AT installed following a fall and long lie at home. Whilst in hospital he had been diagnosed with a TIA and acute delirium. His daughter took extended work leave to stay with him and support her dad to settle back at home. Henry was keen to stay at home and maintain his independence but his daughter was worried and felt unable to leave him alone.   

Following the installation of AT, Carrie and an AT practitioner were able to review the data (below) and ascertain that Henry was back to his normal routine and there were no concerns. This resulted in his daughter being able to return home, return to work and sleep without worrying. 

His daughter has access to a carers dashboard which provides continued reassurance. Henry’s condition had a massive impact on the well being of the family, so installing the AT service has helped reduce this.

Carrie has also used AT as a tool for assessing, over a period of time, how residents can cope on their own at home. “One lady wanted to return home for a residential stay and be in her own home but her family were against it due to fear of her not being able to cope without care. I arranged for AT to be installed in her home and over a period of five months, monitored her activity to see whether she could cope at home. She remained at home for the five months and issues were identified that did require her to return to residential care. However, she achieved her wish of being at home for a period of time and remained safe.”

Another key benefit of AT is around cost. AT is a key factor in enabling people to remain in their homes, vs needing 24 hour residential care which can be cost prohibitive to families. 

So there are savings to be made from delaying moves to residential care both for the individuals (if not financially supported) or to the council.

“The thing I love most about my job is being able to keep people in their homes and have a decent quality of life. I like that AT can ensure that people are well protected and can live their lives as they choose.”

* Pseudonyms 

Maintaining independence and support to keep safe: Mark’s Story

Resident using assistive technology

Mark has a formal package of care and wants to remain as independent as possible at home. He has a diagnosis of Parkinson’s disease and a history of UTI’s. Mark felt that assistive technology could support identification of emerging issues and reassurance that support would be available for both emergency and preventative issues as he does not have close family. A safeguarding concern was raised for suspected financial abuse soon after AT was installed. The AT team monitored data and provided reports to the safeguarding team who then liaised with police to reduce risk and help keep Mark safe at home. 

Intervention Outcome
Motion sensors in all rooms Data identified an emerging UTI 
Smart plugs on microwave & kettle Mark supported to access GP and was prescribed antibiotics
Door sensors Data provided for safeguarding issue of suspected cuckooing
Fridge PIR Identification of dual and multi occupancy during night/early hours
Toilet flush sensor Confirmation people were entering Mark’s home and using microwave, kettle and opening food cupboard and fridge
Sensor on food cupboard ACS colleagues and police provided with information to support keeping Mark safe
Practitioner access to Data Inspired Living dashboard to support review package of care  
Preventative alerts received  
Liaison with Mark when issues identified by AT team  

Examples of outcomes and impact

Each resident on the pilot had a case study completed as part of the Public Health Hertfordshire AT evaluation. Two examples are summarised below:

Richard

Richard was referred to the AT pilot following a stay in hospital with a chest infection. At time of referral, Richard had called for an ambulance four times resulting in four hospital admissions. Richard had a package of care twice a day totalling £204.35 per week to support with personal care & medication. Richard had expressed his wish to reduce or cancel his care package.

Outcomes after AT installed:

  • Medication data evidenced Richard was taking his medication regularly and on time.
  • Care reduced (in agreement with Richard) to twice a week for a shower at a cost of £84.86 per week
  • No further ambulance call outs or hospital admissions at time of review

Summary: Had AT not been installed, it is likely that Richard may have returned to hospital more frequently, which would have meant more ambulance call outs, risk of deconditioning for longer hospital stays and increased frailty. Care costs may have either stayed the same or increased.

Susan

Susan was discharged from hospital with a package of care consisting of 4 x daily visits at a weekly cost of £303.52. A referral for AT was made alongside this to provide reassurance to her family.

Outcomes after AT installed:

  • Care reviewed 1 month later post AT install and reduced to 1 x daily visit as Susan had regained her strength and independence.
  • Therefore, weekly cost reduced to £75.88 within 1 month of Susan’s return home.
  • Support for resident / family members to help maintain wellbeing.
  • No further admissions to hospital at time of review
  • Family know Susan has an established night-time routine

Summary: Had AT not been installed, it is likely that the cost of Susan’s care would have remained at £303.52 per week. Susan would not have had the reassurance of assistance being available through the preventative service and family would not have information around Susan’s routine unless they were present with her.

As part of the evaluation we sought comments from family carers with one of the comments below:

‘Without this technology she [mum] would have been very fearful. I would have been even more anxious… It means someone doesn't need to be there 24 hours a day- mum is a lot more independent.

(Family Carer)

Social care practitioners were also heavily engaged in both the development and evaluation with one practitioner stating:

“The benefit of the AT sensors is that they give a longer term solution for residents to provide that preventative measure - such as declining mobility. A lot of families are so anxious about family members that have fallen and this helps give them reassurance. What I really like the most is that AT is versatile. It’s another tool in our assessment kit and can be adapted to meet different needs. Each resident is unique – whether you are 25 or 95, AT has a benefit in one way or another for everyone if they are willing.”

Challenges and opportunities

There were a number of barriers (or challenges) that had to be overcome, including (this is not an exhaustive list):

  • Ethical – as this entailed remote monitoring and, due to the evaluation considered as research we needed to ensure we had ethical approval to proceed.  Activities to achieve this included, full resident information and consent, one-to-one support where needed, only residents with capacity to consent where included in the pilot, withdrawal at any point, resident consent to disclosure of personal (anonymised) information/data
  • Mental capacity – ensuring there is a robust pathway into the AT offer for residents deemed to lack, or have fluctuating capacity
  • Data Protection – detailed work to ensure GDPR compliance including DPiAs, data sharing agreements, etc.
  • Cyber Security – equipment had to be penetration tested to ensure robustness and meeting security requirements
  • Practitioner engagement/acceptance – it was vital to ensure practitioners were signed up to this pilot, were aware of its intended use and limitations and were engaged at all points of the pilots development and implantation
  • Resident/family consent/acceptance – residents needed to be assured that this was not going to replace a carer and that the whole system was safe, secure and robust
  • Identifying individuals who would benefit from having AT installed (closely evaluating their individual needs and circumstances) and ensuring sufficient support is in place for the resident to get most benefit.

Next steps

There are a number of key actions that we will be concentrating on over the next six to 12 months, including:

  • Embedding AT into the core Hertfordshire social care offer ensuring all residents that could benefit from AT is offered the service
  • Implement the newly developed carers/family dashboard view across Hertfordshire and implement a continuous development process of family engagement
  • Developing the equipment offer further by adding more sensors so that more activity data can be available ensuring a rich data source for practitioners
  • Refreshing pathways from AT into community health services to speed up referrals when AT has identified an emerging health need
  • Ensuring the AT offer is available to all Hertfordshire communities including those hard to reach
  • Work with health colleagues to develop a system approach to AT and virtual monitoring
  • Develop a pilot and evaluation framework with health to implement a system trial to evaluate a social care and health virtual monitoring offer supporting frailty pathways, prevention of hospital admission and more efficient hospital discharge.

In order to help us develop this offer further HCC is offering another local authority a trial opportunity to work collaboratively to help develop, improve and iterate this offer as an early adopter. Any authority wanting to discuss this opportunity should contact HCC using the contact details in this case study.

Contact

For more information contact [email protected]