See examples of local care technology approaches being taken by councils to support the adult social care COVID-19 response.
The COVID-19 pandemic has meant care homes need to maximise staff capacity and streamline all opportunities to connect with health services whilst minimising the risk of infection. Where this can be done virtually is critical. Where there are COVID-19 outbreaks, care homes are limiting visitors to professionals from essential services only, meaning that system professionals also need to find ways to connect with care homes virtually too.
The original ambition of Health Call Digital Care Home was to support all older people’s care homes across the County with technology adoption over a two-year period. When the COVID-19 pandemic hit, activity accelerated and achieved this within 14 months whilst opening up a wealth of opportunities because virtual care was already well established in many care homes thanks to this roll out. The roll-out has been achieved almost a year sooner than the original timescale for the work.
Durham County Council and County Durham & Darlington NHS Foundation Trust have, over the last 27 months, been working together to support local care homes with technology adoption – particularly technology which would help facilitate integration with the NHS and wider care system and support remote monitoring approaches for residents.
Health Call Digital Care Home was rolled out as a system to support electronic referrals into community health and primary care services but also remote monitoring of residents. Furthermore, it permits the creation and sharing of baseline observations to develop a record of what is ‘normal’ for each resident and also identify signs of deterioration. Resident information is then pulled through to the electronic patient record. Subsequent developments have included the addition of wound care and undernutrition services for residents. The ability to use the system for video consultation is being explored as well.
Care homes receive a pack with tablet and medical equipment to use for remote monitoring plus training and technical support. It is funded through iBCF with the council as the lead commissioner. However, the council and health partners have a track record of working together in County Durham and in April 2020, an integrated commissioning function was introduced to formalise this.
COVID-19 has accelerated the roll out of Health Call Digital Care Home which is now live in 94 older people care homes, two specialist (Learning Disability) care homes and seven extra care establishments and is targeting the following:
- Enabling access to remote health support
- Reducing footfall in older people care homes and extra care -reducing exposure and spread of infection by enabling remote monitoring
- A process for COVID-19 resident testing through the Trust where they make referrals through Health Call Digital Care Home
- Submitting weight of residents going to dietetics services that will be able to trigger necessary responses from the service
- Sharing securely photographs of wounds to seek remote advice and also to create a record of wound progression on the electronic patient record.
- Video consultation – especially where care homes have struggled with other software such as MS Teams or AccuRx
- Video consultation that enables MDTs
- Easier for care providers to make quality referrals
- Reduced time for care staff spent on the telephone, frees up their capacity to deliver direct care
- More effective and efficient use of local health staff resource, with better prioritisation of workloads
- Improved care for the resident / service user
- Establishing a baseline of what is normal for the resident / service user
- Identifying early signs of deterioration
- Care Providers and residents can continue to access remote health support
- Reduction in the spread of infection
- Reduction in unnecessary admissions to hospital - pre-COVID-19 it was found that the system led to a reduction of 2 hospital admissions per care home per month
How is the new approach being sustained?
- Joint engagement sessions in the early phase of implementation between the council and NHS before the pandemic was key to raising awareness of the programme and enable providers to express an interest and ask questions.
- Co-production and direct feedback from care homes meant they worked as a partnership throughout to solve a shared problem and develop the right local solution. The digital solution has been developed using feedback from partners. For instance, concerns about being unable to send referrals through the app if connection unexpectedly dropped. The solution has been designed so that if this happens and the app is refreshed, no data inputted is lost. Instead, it will be held and uploaded once the signal or connection is available.
- The council commissioned the local NHS Foundation Trust to manage the project implementation which included providing ongoing training and support – from training on the device to follow up technical queries.
- Partnership informed continuous product development, working directly with:
- 94 Older People Care Homes
- 7 Extra Care Establishments
- County Durham and Darlington NHS Foundation Trust
- GP Federations
- Health Call Solutions (technology provider)
- More recently, the Council and local NHS Foundation Trust have developed video tutorials on how to use Health Call Digital Care Home on both the app and web portal to supporting ongoing training needs.
- COVID-19 has driven the digital agenda - bureaucracy and other barriers are being removed
- Technology infrastructure has been a big challenge and during COVID-19
- Purchasing of kit during the pandemic has been a challenge (e.g. tablets, thermometers, pulse oximeters and thermometer covers)
- The tech is simple - engaging the right people in the right way is the challenge
- CQC can’t endorse specific software solutions, however, are keen to understand and learn from where innovation in technology is helping to support high quality care
- Often, it’s the small things which make a difference – such as the ability to date and time stamp referrals which previously wasn’t possible when telephone based
- Care homes could feel overwhelmed with contacts therefore it’s important that the wraparound of support is carefully deployed in line with care home needs
- Homes with no COVID-19 cases want to strictly limit visitors in order to protect residents – taking time to build trust and agree that the Health Call Digital Care Home team were providing essential services in providing the kit and that training would then, in the long term, reduce the risk for the home.
- Digital skills of care staff - some staff have low skill and confidence levels and were therefore nervous of using the technology.
- Find creative and virtual ways to deliver training – the team utilised HEE training videos on using peripherals and developed its own training videos for using Health Call Digital Care Home on both the app and web portal.
- Keeping checking in on staff and providers when tech is deployed. It’s easy when new approaches / technologies are introduced to default to previous ways of working but regularly ‘touching base’ with providers keeps momentum up and encourage continued use of new technologies.
The COVID-19 pandemic has led the Government to take measures to encourage social isolation and slow the spread of the disease.
The three councils wanted to:
- Protect vulnerable service users from the risk of infection, support them to self-isolate, and make sure they continue to receive the care and support they need in the most effective way and as the number of available care workers reduces. This includes shielded individuals and high-risk people. Virtual visual check-in via video is a key part of this.
- Make it easy and safe for family members, neighbours and local community services to play their part in supporting people.
- Protect care workers from disease and infection risks.
- Ensure that care workers can continue to work and earn income while they are self-isolating. Virtual video check-in can be done from their own homes if they are self-isolating and will significantly increase productivity and capacity by avoiding unnecessary travel time.
- Stabilise the care sector as the workforce reduces through sickness and isolation.
Essex, Kent and Suffolk county councils made commitments early during the COVID-19 pandemic to utilise greater care technology to support communities and care providers. Whilst there is a wide-ranging market of care technology options available, the councils identified a locked-down tablet device (Alcove Video Carephone) to best suit their needs.
The video carephone allows care workers, family members and other approved services to be able to contact the recipient and vice versa through a video call.
The device is locked down and the system is a closed system, which is simple to use for vulnerable users – only approved responders who have access to the system can use the device. It also has a SIM card pre-installed so the recipient does not require WIFI. The tiles on the device include:
- formal care offer: care worker, day centre worker, community and voluntary services
- informal carer / family members: minimum of one – up to three
- technical support to aid with set up as well as ongoing technical support (provided by the supplier)
- help@Home service (for selected users only) to help with activities like shopping and obtaining medicines
Approved care workers and family members are given access to an app and portal to be able to make reciprocal video calls and also keep track of activity to ensure the recipient is managing during this difficult time.
The device, which is tablet sized and small enough to carry around the home, also has several additional functions which can be set up remotely including:
- reminders (such as medications, getting dressed, drinking fluids)
- video/virtual “eyes on” to see any changes in services users if they are symptomatic
- enable professionals to ask users about personal tasks (eg “have you applied your cream to your leg”
- texts to the device, for example “your carer is running late”.
Users can acknowledge completion of asks and carers or responders can be notified if users don’t respond to pop-up reminders.
The councils worked with the supplier to ensure a contactless delivery and support option. The device is delivered, without entering the home, to recipients together with operating instructions. Once the recipient has plugged in their device, they will be instructed to press the support button which will call the supplier’s Technical Support. The user is then talked through the process of setting up and any questions or concerns they have.
The expected impact
- The service will enable vulnerable residents to continue to receive care and support in the event that the number of available care workers reduces.
- The provision simultaneously offers an alternate method of care delivery that maximises care workforce productivity and may assist in maintaining a higher level of healthy care workers by enabling increased social distancing and protecting the care workers from disease and infection risks.
- It will also enable councils’ front-line services to better manage a dip in care capacity if the workforce reduces through sickness while service demands escalate.
- Where care workers are self-isolating, they will be able to continue to work and provide a service.
- Families and friends can be connected in order to reduce loneliness and isolation; this also has the potential to reduce dependence on formal, paid care and enable friends and family to be more involved in supporting their loved ones.
- Virtual video check-in can be done remotely and can increase productivity and capacity by eliminating travel time.
- By making it easy for a range of services and support to be provided through a single device, the device becomes a real and practical integrated care tool in people’s homes and helping to support people’s sense of control and independence.
How is the new approach being sustained?
- Leadership from proactive DASS, support from cabinet and strategic engagement have been key to ensuring the programmes have had the right resource and decision-making processes.
- The three councils have purchased 5,000 devices in total to roll-out to people across their respective counties in the next eight weeks.
- Priority groups include people who do not have access to mainstream technology. Service users with a higher care need are also being considered, if the Video Carephone will have a positive impact on reducing visits and contact:
- cohort: Older people; learning disabilities and autism; mental health; sensory
- broad range of commissioned services: domiciliary care; accommodation-based care (e.g. supported living and extra care); befriending and other community support services; discharge including reablement
- other people who live alone or are vulnerable in some way
- Mobilisation supported by bespoke business delivery team has been invaluable. Partnering with RETHINK partners helped bridged the needs of the councils, supplier and other key partners - including care providers - to activate the key enablers for delivery. This included: articulating business needs; co-ordinating selection of cohorts, designing benefits, governance, IG and contracting.
- Engagement of frontline workers and referrers requires a strategy tailored to the nuances of each organisation.
- Engagement of care providers: starting with ambitious providers looking to deliver a step change in care operating model for the longer term.
- Engagement of key partners – whole system / integrated care approach.
- Benefits tracking, research and realisation: to demonstrate impact now and for longer term.
- Culture change: rapid pace, need to follow-up.
- Case studies and impact – really demonstrating positive impact on people’s lives.
- Using services; users; patients; families and carers as advocates for sustaining the change.
- Early consideration of exit strategy and long-term planning for commissioning and funding models.
- Many providers are already using care technology to support service users and are very supportive of this approach. Co-produce with them to make the most of the opportunities and learning.
- Engaging care market providers early and with purpose is key to getting the right referrals happening; maintaining income levels and making it as easy as possible for them to engage is essential.
- The referrals process requires a high level of dedicated support depending on the context of each organisational design. Use of data; professional involvement and ensuring key people had responsibility for referrals was key.
- Culture change remains the biggest challenge. Assumptions about tech appetite of vulnerable groups persists and can slow down the referral process – particularly amongst social workers. Occupational therapists are often strong champions for tech.
- Having a dedicated communications team has been a major requirement to adapting to situations which can change on an hourly basis.
- Governance and decision making can take longer than planned – even where there is a fast track process in place. The processes are not designed for this kind of pace and use case. Care Act implications are resolvable but need to be considered.
- Getting to the people who are closest to the service user and enabling them to recommend people for receiving the technology is key; they have the best understanding of people’s needs and situation and are the best advocates for them and the technology.
- Focusing on the entry points for new services is a powerful way to embed technology into care and support plans from the outset e.g. hospital discharge, new care starts, social care front doors / call centres.
- Add legal representative to project team for data protection and contract.
- Create capacity for dedicated project manager and commissioning roles within organisation at the outset.
West Sussex County Council was in a unique position this spring. Its newly-commissioned care technology service was due to go live in May, so when COVID-19 hit early in the mobilisation of its new service, it was asked to look at how care technology could help its local health and care system to respond.
As all systems experienced nationally, the scientific modelling projected significant increase in demand over the peak pandemic period, therefore the four acute hospital trusts in West Sussex were expecting a significant increase in hospital discharges.
In March, the council was asked to consider how care technology could support fast and safe hospital discharge. This was against some tightrope walking of both working with their existing provider in the final seven weeks of their 10-year tenure as they navigated personal protective equipment (PPE) and other COVID-19 challenges whilst simultaneously mobilising a new provider and new contract.
- A range of options were initially considered including: video based care delivery; telecare check-in services; remote monitoring and the issuing of kit directly from hospital – essentially ‘telecare in a bag’ to reduce the risk of infection.
- Given the particular contractual position the council found themselves in - as well as the other challenges of COVID-19 – they settled upon a pragmatic solution which they managed to put in place by 14 April which was the scaling up of an existing initiative.
- The existing provider was already offering two of the four acute hospitals in West Sussex a telecare in a bag solution. A small same-day discharge option called Ownphone meant hospital staff could issue a handset with an emergency button to patients which could be linked to an emergency monitoring centre.
- This solution ensured that people could get home quickly but with support in place should this be needed.
- They scaled up to the other two acute trusts, ramped up the number of available devices and were able to deploy within 10 working days. The existing provider delivered it for 5 weeks, with the new provider taking over after that.
- The impact wasn’t what the council expected, because, like many others across the country, the expected high numbers of hospital discharges to patient’s own homes that they had prepared for didn’t materialise in the way that had been projected.
- The different patterns of discharge activity meant patients were indeed being discharged, but due to higher levels of dependence and acuity they needed input from community hospitals and care homes rather than going directly home.
- Although the patterns of activity were significantly different to what had been predicted some helpful working practices have been established.
- Culture change has been positively impacted, with additional professionals (with previously limited exposure to care technology) now aware of the benefits and keen to explore how to increase care technology use to support people retain their independence.
How is the new approach being sustained?
- The work to plan and create this additional care technology capacity has solidified and developed relationships across the system – across health and social care/acute and community. It has also accelerated exposure to and awareness of the wide range of benefits that care technology offers citizens, professionals and systems.
- The acute trusts want to continue the scaled-up offer, especially to support any potential future peaks in the pandemic.
- A blended model is in place which support people in receipt of care as well as those who wish to self-fund.
- Creating time and capacity to connect with the right stakeholders in a supportive/collaborative way was crucial. Getting the right information/data and quite simply having the head space to support revised business planning with two providers took additional resource and energy but was possible because the council took an agile and flexible approach.
- The nature of relationships with all stakeholders is fundamental. The way the council and providers collaborated through the challenges of COVID-19 supported a smooth transition between the outgoing and incoming providers, as they worked in partnership and supported each other throughout the situation.
- Developing a shared vision of the potential of care technology, creating the benefits modelling and tracking those benefits is the best way to bring on board those who are new to care technology approaches.