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Using grassroots innovation to fix our care system

Alex Khaldi Alex Khaldi

The provision of social care presents a huge challenge for society. More and more people will need care in future – but current approaches to commissioning and delivering care are already creaking under the pressure.

Across the sector, there are pockets of innovation as local authorities, social entrepreneurs and technology entrepreneurs try to find new ways to meet demand and improve the quality of care people receive. But moving beyond pilots can be hard going. Established systems, ingrained culture and hard-to-shift mindsets are just some of the barriers to the transformational change that’s needed.

In the third roundtable of our caring society programme, people from across the public and private sectors came together to try to understand what needs to change to enable innovation to flourish and create new models for how we care for each other as a society.

Let’s rethink care models around relationships, not transactions

Despite widespread public debate, much of the care system still operates on a ‘time and task’ model. Employed under this model, carers must view their work almost as a transaction and have little opportunity to develop and deliver people-focused care.

A different way of employing and organising carers – such as the neighbourhood care model used by Dutch homecare organisation Buurtzorg – can provide much better outcomes. Under Buurtzorg’s innovative model, carers are organised as self-managed teams and have the freedom to work with clients to understand how best to meet their needs.

The point isn’t whether you can do a care visit in 15 minutes or an hour. The point is that carers on the frontline need to be able to exercise some freedom and responsibility to make a relationship with the people that they’re supporting.

Brendan Martin, Managing Director, Buurtzorg Britain & Ireland and Public World

 I think we need to think more creatively about everybody in the system and how we support independence. That means getting away from the traditional commissioning procurement model. Accountability is really important. We're trying to encourage professional responsibility – trusting people to know their job and get on and do it.

Sarah McClinton – Director of Adult Social Care, London Borough of Camden

 The way services are currently commissioned can be so damaging. You can have people working towards developing a vitally important service and their plans are blown sky high because the tender's gone somewhere else. We need to think carefully about which services local authorities need to keep for themselves, because tendering is actually unsuitable for some complex-needs services.

Professor June Thoburn, Emeritus Professor of Social Work, University of East Anglia

Balancing control and safety is fundamental

Giving carers the freedom to develop people-focused solutions rather than execute prescribed tasks raises complex issues around safety and control. The ideal is to create an environment where committed carers with the right qualifications can exercise their professional autonomy and their intrinsic motivation to do their jobs well. But how do you protect vulnerable people from situations where this ideal scenario doesn’t play out? It’s a paradox that’s not easy to resolve.

Control is a factor we’ve got to think about. There’s a strong link from authority through to control through to safety. And we have to think about how we channel that positively so that it doesn’t stop innovation.

Paul Najsarek, Chief Executive, Ealing Council

Taking the learning from the Buurtzorg model of community nursing recently tested in Lambeth. Lambeth Adult Social Care is testing how we allow Social workers to self-manage their work. We are piloting experienced social workers can sign off work themselves. When we look at the data on how many are actually doing this, it’s not as many as we hoped. They want assurance that this process protects them – it’s as if they’ve forgotten how to be self-regulating professionals.

Richard Outram, Acting Director for Adult Social Care, London Borough of Lambeth

Technology can simultaneously enable autonomy and ensure safeguarding. The digital care service developed by Alcove, for example, incorporates not just in-home sensors to monitor patients, a wearable assistance device, and smartphone and tablet apps. It also incorporates digital tools to monitor the activity of care workers.

If someone works in a supermarket and is handing out cashback at the till, there will be a camera monitoring what they do. But with personal care appointments, it’s quite possible that a carer will turn up that the client has never met before – and they are left to their own devices in a vulnerable person’s home. New technology solutions can help provide the protection vulnerable people need.

Hellen Bowey, CEO, Alcove 

Technology will be essential to tackle carer shortages

With two million more care workers required in the UK by 2024, local authorities and individuals may find they have no choice but to turn to technology for the support they need. But while telecare solutions can help family, friends, carers and local authority professionals keep an eye on vulnerable people living independently, they are not a solution in themselves. The human component is still vital.

You can’t replace carers with technology, but you can augment care. So what we’re trying now is augmenting two hours in a care visit with 24/7 home monitoring.

Devika Wood, Co-founder & Chief Development Officer, Vida

Similarly, assistive technology also has the potential to make a big difference for people who need help, but robots cannot replace human interaction and kindness completely.

There’s an interesting bed that will change itself into a wheelchair, so rather than waiting for a carer to get you up in the morning, you can just press a button. There’s also a system that helps people feed themselves. These both have the potential to be empowering for individuals. But I'm very much against the idea of replacing human care with robot companions. I can't see that as a good way to go.

Amanda Sharkey, Senior Lecturer, University of Sheffield

It can still be a challenge for entrepreneurs and private companies to talk to councils about how technology can help meet future demand for care. Many technology businesses say if they try to talk to social care commissioners about digital, they are often pushed back.

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We need more flexibility around employment models

Traditional employment models can get in the way of matching demand with capacity and can hinder efforts to deliver more personal, relationship-based care. CQC rules, for example, prevent agencies from using self-employed carers, even though agencies often need to use a mix of contract types to get the flexibility they need.

Homecare innovator Vida uses a mixed employment model in conjunction with bespoke software to create and manage personalised care packages for different clients. Vida’s algorithms find the best match between available carers and the needs of individual clients – enabling the company simultaneously to promote a personalised service and to make best use of carer capacity.

I believe the only way to manage a disparate workforce effectively, and with the ability to scale, is through algorithms. Vida’s algorithms help us minimise the time our carers spend travelling, so we use capacity much better. That’s vital to helping us meet a key challenge – a growing shortage of carers.

Devika Wood, Co-founder & Chief Development Officer, Vida

How can we create the conditions for innovation?

In local authorities, there’s rarely time and resource available to think about innovation in the system and understand what the pipeline innovation in the local area might look like. What’s more, local authorities can be hampered in their desire to innovate and be creative around the care services they provide simply by the nature of the systems within which they exist.

What I've been struck by is that when I meet people who are commissioning their own care, from state resources, that's where I see the greatest levels of creative disruption. These people buy things that we can’t buy because our discretion is fettered by regulation.

Glen Garrod, Executive Director of Adult Care, Lincolnshire County Council

There’s also a more specific challenge about discussing and envisioning innovation. There’s no  language or taxonomy for thinking about innovation and the social care system. No way of describing what good looks like in terms of councils providing the conditions for innovation. 

Money still matters

All too often the debate around the future of social care comes down to the need to meet growing demand in the context of limited resources. Our Caring Society series aims to open the debate up – but there are still financial components working against innovation.

In a situation where our biggest source of income is going down, we are all hampered in our ability to raise tax locally, one way or another, to invest in the public care system. 

Paul Najsarek, CEO Ealing Council

One challenge is that it can take time to realise benefits from new approaches – and local authorities facing budget restrictions don’t have the luxury of waiting for several budget rounds before innovation yields results.

On a connected note, it can be difficult for local authorities to capture the savings from investments they make. For example, the impact of setting up and funding self-managed teams may be seen in a reduction in hospital admissions or a fall in demand for GP appointments. When no benefits accrue to the local authority, there’s little financial incentive for them to try a new approach.

Why we should be optimists

Our debate reveals the complex challenges around how to innovate and create a caring society. But it also highlights commitment, vision and energy on the part of those taking part in the conversation. Forward-thinking authorities are working hard to rethink their care models, while social and technology entrepreneurs are developing solutions with the potential to improve the quality of care for millions. This is no time to be pessimists. Let’s look to the future with optimism.

If you wish to be involved with our caring society project, please contact Alex Khaldi, or join the conversation on Twitter at #ACaringSociety.

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