Improving assessment for home adaptions using smartphones

Derbyshire County Council explored the potential for smartphone technology to support rapid assessments for adaptions of client’s homes.


Occupational therapists and community care workers undertake assessments for both major and minor adaptations to domestic properties in Derbyshire. The occupational therapy profession has a vacancy rate of 15-20 per cent in Derbyshire and a high demand for services. The number of assessments is affected by vacancy rates, travel times for staff (affected by rurality) and limited investment in technology. Present figures indicate that there are 600 clients across the county on the waiting list, some of whom may wait up to 11 weeks for an assessment.

The project team focussed on the problem:

How do we improve assessment processes for equipment and adaptations?

Key aims and achievements

  • Technology has allowed remote assessments to be carried out at the first point of contact, improving the efficiency of the team and allowing more complex cases to be prioritised.
  • Forecast cash savings of £144,600 in the first year and £180,000 non-cash benefits over 10 years.
  • Covid-19 has been a lever for change encouraging staff to adapt to new ways of working remotely.

Implementation

During the implementation, the project developed the supporting infrastructure and team, to allow remote assessments to take place and build the capacity of council carers in a trusted assessor role to prevent duplication of visits. The project was split into two areas of development:

Technological

This focused on smartphones and delivering remote video and audio tools. As a part of the implementation phase, Derbyshire council rolled out smartphones to staff, adopted the widespread use of Office365 and Microsoft Teams as a collaboration tool and began to implement the guided use of photos and videos to aid virtual referrals / assessments.

While there has been a focus on Microsoft Teams as a platform for this work, other technologies are also an option (WhatsApp and Zoom) and were also piloted on a smaller scale as part of the implementation phase. However, there are security concerns related to the use of WhatsApp. Skype was previously used, but has now been decommissioned due to concerns around the user-friendliness of the platform.

Non-technological

This focused on streamlining referrals processes both internally and through external agencies, reducing the referrals waiting list, streamlining web pages on the council website and improving and utilising existing relationships with the Home Improvement Agency.

User research and prototyping

Several potential technologies to be used for remote assessments have been tested with both staff and service users.

Staff survey

An initial survey was completed in May / June 2020. This received 40 responses which indicated that 50 per cent of the staff who responded had used technology such as Skype or Microsoft Teams in their role. Thirteen staff members had emailed photos and videos, seven had used Skype, one had used Microsoft Teams and two had taken photos on a smartphone. A second staff survey was undertaken in the Adult Care Assessment and Triage Team areas in December 2020, which yielded positive results and had 119 respondents. This time, 69 staff members had used technologies such as Microsoft Teams, WhatsApp and emailing of photos. Of these respondents, 52 reported technology provided an average saving of one hour per assessment. The remaining staff members reported that the time taken to complete activities was similar to existing practice.

Client survey

Consult was quick, easy and thorough... and referral was swift.
Service user who received a remote assessment

A survey was sent out to 65 service users; 18 responses were received. Overall, the remote assessment process has proved satisfactory, with over 78 per cent of respondents stating that they were either very satisfied or satisfied with the process and 83 per cent stating that they would agree to a remote assessment again as they felt  this had speeded up the process of allocating appropriate adaptations. 

Additional user testing

Different apps and technologies were tested: Microsoft Teams, Skype and WhatsApp. Microsoft Teams was identified as more user-friendly than Skype. There are various safety concerns around WhatsApp, including the risk of contact sharing between trusted assessors and service users. However, following a pilot it has been approved for video calling use, through a Derbyshire County Council staff device only. An additional pilot is currently being undertaken to assess the usefulness of Zoom.

83 per cent of service users would be happy to do a remote assessment again if it meant their needs were met quicker.

Financial and social benefits

Throughout the implementation phase, project teams produced reports forecasting the cash, non-cash, societal and quality benefits. The following benefits have been forecast over the next 10 years:

Forecast benefits
Benefit Description
Cash
  • £144,600 of savings are forecasted this year, related to the increased numbers of assessments which can be completed through the Adult Care Assessment and Triage Team (thus reducing the numbers going through to locality teams).
  • The project team at Derbyshire has reported £10,484 of cashable savings to date.
Non-cash
  • £180,000 attributable to hospital avoidance and fall prevention thanks to speedier resolutions for adaptations and equipment.
  • The project team at Derbyshire have reported £26,972 worth of non-cash benefits to date.
Quality
  • Speedier outcomes will lead to improved service user satisfaction. Individual service user case studies have been developed to evidence this.
  • The website re-design for “ask Sara” has led to increased click through, enabling service users to access self-help more easily.
  • The development of a trusted assessor model will be beneficial for staff.
  • More effective use of staff for assessment will reduce wait times for survey users.
  • Reduction in mileage through remote assessments will improve the efficiency of staff and allow them to re-prioritise workload, creating benefits.
  • Reducing mileage through remote assessments will also be beneficial for the environment.

All quality benefits have been realised with the exception of “speedier outcomes will lead to improved service user satisfaction”.

Measuring success

During the discovery phase, the council developed a logic model to guide the implementation phase and to help in quantifying the inputs, activities, outputs, outcomes and impacts which are likely to result from the delivery of this project.

Key outcomes and impact measures:

  • clients get access to the right service at the right time for the right cost. User research revealed that 83 per cent of clients who responded to the client survey would be happy to do a remote assessment again if it resulted in a quicker response to their requirements
  • more assessments will be carried out remotely at first point of contact (which has commenced during the implementation phase)
  • increased efficiencies in processing will allow a refocus of workload, with more emphasis on complex cases and prevention
  • greater consistency of approach, improving the outcomes for individual
  • reduced wait time for service users to receive an assessment.

Project benefits

  • Technology has allowed remote assessments to be carried out at the first point of contact, improving the efficiency of the team by reducing travel time and allowing a refocus of workload with an emphasis on complex cases, reablement and prevention.
  • Toolkits have been developed to assist with remote assessments. These toolkits are now being widely shared, including amongst social workers. New policies and procedures have been developed which are in-line with best practice.
  • Covid-19 has been a lever for change encouraging staff to adapt to new ways of working remotely which sped up the process of achieving staff buy-in for the use of new / different technologies.

Challenges and lessons learned

  • The project is inter-dependent upon multiple other projects including the Derbyshire Shared Care Record, Home Improvement Agency Projects, the Council’s Channel Shift Programme and Mosaic developments which have the potential to impact upon timely progress with improving assessment processes for home adaptations.
  • Sickness in the Adult Care Assessment and Triage Team has limited the project teams' ability to reduce occupational therapy waiting lists.
  • Covid-19 has led to a number of challenges including workload re-prioritisation and lack of staff buy-in regarding virtual training. Priority was given to the Covid-19 response by frontline managers and staff, therefore it has been difficult to implement any changes.​​
  • Service users and their families / carers may not have the skills or ability to interact with video streaming or other technological aspects of the project. Most service users indicated that they would like to use WhatsApp for video streaming; however, security risks around the use of the platform persist. In particular, Skype was not viewed as being user friendly and has been decommissioned.
Impact of Covid-19
  • COVID-19 led to components of the project being re-prioritised; however, timelines were largely unaffected.
  • COVID-19 has changed the way the Derbyshire team work to deliver training for staff, which has now been conducted remotely. This caused issues with more time being required to undertake staff engagement and secure buy-in. Trusted assessor training has re-commenced virtually.
  • COVID-19 has accelerated the uptake of technology such as Microsoft Teams more generally at Derbyshire County Council due to the move to remote working, creating benefits for the project.

Future potential

This type of remote assessment can be adapted and implemented across other areas of adult social care, for example, with social workers and for financial assessments. In addition, this remote assessment approach may be viable in certain areas of children’s social care. Within the council, other professions have started to think about how aspects of the project can be adapted for their own role - in particular where a client / service user may struggle with social interaction.

In terms of replication of this project elsewhere, the council have already been in discussions with another county council and the NHS on how the toolkit could be used within their organisations. The council have begun to collaborate with the Royal College of Occupational Therapists to develop a set of standards for occupational therapists in relation to remote assessments which can be applied across a wider area; this collaboration is set to continue.

Find out more

Gina Knowles: gina.knowles@derbyshire.gov.uk

Bev Capel: beverley.capel@derbyshire.gov.uk

Parveen Sadiq: Parveen.Sadiq@derbyshire.gov.uk

Related links

Social Care Digital Innovation Programme – Derbyshire County Council (PDF)

SCDIP 2019-21 Discovery phase report January 2020 (PDF)