Essex County Council, Kent County Council and Suffolk County Council: COVID-19 virtual care

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.

The solution

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 1 – up to 3
• 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 bridge 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.

Lessons learned

• 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.

Contact

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