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With a collective funding gap of more than £3bn for 2019/20, local authorities across the UK have been looking at assistive technologies ranging from collaborative robots to voice assistants to support delivery of adult social care services and reduce pressure on resources.
Although the Department for Health and Social Care (DHSC) has pushed an agenda of using innovative approaches to increase independence and self-care for people living with complex conditions, while improving the circumstances of carers, an overarching strategy for care in the UK is yet to be created.
A long-awaited adult social care green paper is expected to tackle many of the issues and provide a blueprint for the future of care, but the DHSC’s bandwidth has been consumed by Brexit and the green paper, which was supposed to have been delivered in the summer of 2017, has been delayed at least six times over the past 18 months.
“We have been fighting for political oxygen to get the green paper published, but we will keep fighting to get it out there,” health secretary Caroline Dinenage told sector professionals at the Residential and Home Care Show in London in June 2019.
“But I don’t think it’s a spoiler to say technology features prominently [in the green paper]. Technology is a means to not only diagnose or detect warning signs, but also to connect families, friends and communities within a wider web of care and support.”
While the UK’s care system awaits an overhaul, the requirements of the country’s 5.3 million people aged over 75 have to be catered for. These demands, coupled with increasingly tight budgets, are presenting a significant challenge to councils, according to David Rees, head of local government services at PA Consulting.
“Local authorities are largely dependent on central government funding and since the coalition government at the turn of the decade, that has been hugely compressed,” he said. “Added to that, there is a strong demographic pull, with more of us living longer with more complex needs.
“There is huge pressure on the social care system, with less money going in and more demand for services, with limited ability to supply. There has to be other ways of looking at this issue – and by using technology where appropriate, we can try to lift the burden on the system.”
Rees added: “We are completely appreciative of the fact that technology can’t do everything – it can’t put you to bed, wash you clean or give you a hug, but it can do other things, which then allows the most valuable resource – social workers, occupational therapists, carers – to do other things for you that are also hugely important.”
Potential of collaborative robots
PA Consulting-led Argenti Care Technology Partnership has been working with UK local authorities to use new tools to tackle issues in social care provision. Its largest client, Hampshire County Council, currently has more than 10,000 people using technology-enabled care, and generated £8m in savings in the first five years of its care transformation strategy.
“We found that technology has been enabling lots of people to live safely, well and independently without the need for other forms of support,” said Graham Allen, director of adult health and care at Hampshire County Council. “Technology been absolutely integral to us in terms of supporting people with the outcomes that they want to achieve.”
“I am particularly excited about the opportunities around robotics in care and we hope to be trialling cobots in a range of settings – both for people with limited mobility and for carers who are supporting those patients,” said Allen.
Graham Allen, Hampshire County Council
Designed to operate alongside people or with human input, wearable cobot models such as the devices to be trialled in Hampshire can help people who need care in areas such as rehabilitation for walking and caregivers with tasks such as lifting patients.
Further robotic applications in care, which are also being considered by Hampshire County Council, can support tasks around social assistance, for example sensing people’s vital signs such as blood pressure and monitoring falls, with the technology integrated with emergency calls or remote monitoring systems.
As well as its work with Hampshire Council, PA Consulting is also working with the Isle of Wight, the Local Government Association and NHS Digital on a trial assessing the need for cobots by informal carers, such as spouses or family members.
In the trial, areas of consideration include defining how the technology would work in an everyday setting, discussing how buying and hiring of devices would work in practice with equipment providers, as well as legislative and regulatory details.
Evolving voice technology
DHSC considers Hampshire County Council a leading light in the adoption of assistive tech, with the council having previous successes in care innovation, notably the roll-out of voice assistant technology to help patients manage diabetes, depression and other chronic conditions.
Some 50 Amazon Echo devices were rolled out across Hampshire, with bespoke skills developed for tasks including setting specific routines for people who need prompts to cook, drink and take medication, writing online shopping lists used by carers to shop for housebound users, and adjusting thermostats so that bed-bound users can control their environment.
A bespoke skill, dubbed My Carer, has also been developed. This establishes a secure connection, via an IT network, to care workers in a central office and enables remote communication between staff, who could place reminders on the device for their colleagues or the service user to access.
The council now plans to involve social workers, carers and people needing care to evolve application of the technology and understand how Echo can be expanded and integrated into the wider care system, with functionality such as removing the need for carers to register their visits, thus freeing up more time to care for users.
“Tools designed to add richness to the life of anyone who uses them are the kind of solutions we will be looking at”
Graham Allen, Hampshire County Council
Further enhancements to the council’s voice technology roll-out could include analysing data from devices to detect a potential decline in a person’s overall condition, adding more sensors to the Echo system, such as blood glucose monitors fitted to toilets to spot signs of infection, as well as artificial intelligence (AI) functionality, such as analysing changes in people’s speech patterns to detect depression or dementia.
According to Allen, the council sees itself in a process of shifting from being “a provider of technology to being a curator", finding ways of delivering services through consumer tools.
“We are all about the outcomes and don’t need to promote one particular device over another,” he said. “Tools designed to add richness to the life of anyone who uses them are the kind of solutions we will be increasingly looking at, whether they be based on apps or particular types of technology, such as voice-controlled devices.
“Alexa is now part of that menu of potential solutions to support people. It meets some needs, but not necessarily all – it’s not a panacea.”
According to Hampshire Council, 72% of the participants in its voice trial thought the voice-activated assistant would improve their daily routine. It helped relieve feelings of isolation for 62%, while 68% agreed it would help to maintain their independence while avoiding carer burnout.
As well as enhancing traditional care provision, another byproduct of using such devices is improving local authorities’ ability to optimise spend, said Allen.
“With the changing demographics, there simply aren’t enough workers in the care sector to do everything they seemed to be doing previously,” he said.
“There is also a disproportionate cost involved – whether it be a 15- or 30-minute call for somebody, it is more than the cost of an hour of care, because there are other costs, such as travel, to be considered.”
According to Allen, the value of using human carers to perform such functions is becoming increasingly unclear. “Short visits might reassure a service provider or a commissioner of somebody who is still alive and well, but it doesn’t add any richness to the life of the individual for somebody to be actually dashing in and dashing out,” he said.
In many cases, people also feel they are not getting value from their taxpayer contributions from such short visits, which are “less than enriching”, said Allen. “Because [citizens] make a contribution [towards social care provision], they might feel slightly short-changed.”
Driving cultural change
Local authorities want to introduce new technologies to optimise use of resources, but considerations around areas such as design are key to acceptance and effectiveness. According to research by Isle of Wight Council, innovations such as cobots are regarded more positively than robots in social care because they are seen as less likely to replace caregivers.
According to EY’s Consumer health survey, released in March 2019, individuals are interested in approaches to care beyond the traditional, such as voice assistants, and care providers believe such tools help in managing patient populations virtually. But the study also highlighted concerns among care providers around low-value data and increasing expectations and demand, driven by vast data inflows and burgeoning consumer devices.
But changing perceptions about the use of technology in care is by far the greatest challenge for councils looking to evolve their approaches to innovation, said Hampshire Council’s Allen.
“Our biggest obstacle is the cultural shift involved, not only within our workforce, but also in terms of what our population might expect in care delivery as they will probably start [the care process] by interacting with another person face to face,” he said.
“We have been absolutely cognizant of the challenges around making sure the workforce is both empowered and informed in technology-enabled care.”
Alexander De Carvalho, Public
Allen pointed out that the council has technology champions in its operational service to ensure staff are well supported for new tools as they are introduced.
“Cultural shift is only possible when you increase the confidence of people to use new technologies, advocate for them and celebrate successes,” he said. “The outcomes of the work we have been doing in that space, as well as feedback from staff, patients and carers, has been extremely positive.”
So there appears to be consensus around the need to drive further adoption of technology to ease the pressure on the UK care system. But Alexander de Carvalho, co-founder at govtech venture firm Public, said the country’s ageing population presents a serious challenge to the public sector’s social care provision, and new tools hold the promise of significant cost reduction, increased efficiency and delivery of care that is focused on citizens.
“Simple health economics bear out that we cannot continue with the analogue, traditional approaches we are currently pursuing,” said de Carvalho. “It is time for the public sector to embrace this innovation, think more about prevention and make Britain the centre of tech for elderly care.”
As local councils continue to struggle with limited budgets and ever-growing expectations from a mobile-centric citizen base, de Carvalho suggests technology holds the key to turning the mantra of “doing more for less” into reality across all stages of care, from citizen engagement to back-office processes.
“Councils need to start adopting these types of services, but more importantly, they need greater training and support to understand the fast-moving technology market,” he said.
“Fail to do this and our local services will fall behind. Achieve this and we can lead the world in a range of key global markets.”