In the first of our series of stories about customer-led successes, we look at the story of Hampshire County Council and Argenti, a venture from PA Consulting to bring technology into care services. They have brought a truly customer-led approach to the provision of crucial care services, an area not at the glamourous end of tech and under considerable pressure.
The burning need to do something different
It’s well known that the care sector in the UK is facing a crisis.
People are living for longer, with families spread across the country rather than staying in the small, tight-knit communities of the past. This is creating a gap in the support needed to help older people retain the independence they crave.
At the same time, council funding has steadily reduced since the financial crisis, with low salaries and difficult working conditions leading to a growing number of job vacancies nationwide.
Despite huge technological advances, the approaches taken in Social Care have stayed firmly in the past, with ‘the big red cord’ (that every visitor is afraid of accidentally pulling) being the go-to solution for those in need. It’s a wholly reactive service, providing no data or context to share or learn from, as well as being stigmatising for people needing care – a bright and visible reminder of their old age or disablement.
This has created a crunch moment in the industry, one which Hampshire County Council was experiencing first-hand, facing their own shortfall of 8,000 jobs in the next five years. It was clear to them that the traditional, conventional solutions could no longer provide the answer – and it needed immediate attention, with pain being felt by the people they cared for, the carers that worked with them and the organisation as a whole.
An outside-in approach
The established approach to solving this issue is more about the place than the person and their needs, in a market dominated by the manufacturers who make the kit, driven by high volume, low production cost and a push to sell what’s being made.
To find a new response to this situation, Hampshire County Council partnered with PA Consulting and the Argenti team, as well as other contributors such as Medvivo and Red Alert.
Their response was unusual. They started by taking a genuinely outside-in view of the situation. This meant beginning with the care need and understanding what would be useful to and appreciated by the person being cared for, the carers involved and the council. It meant being agnostic to the kit that currently existed or the manufacturers that made it.
In order to understand what the people at the heart of these services truly value, not their opinions on the current way things worked, meant taking the time to understand their routines: what they did on a daily basis; the challenges they face that are significant, and the small things too.
It also meant understanding the emotional side of care, with social isolation a growing concern. People often want and need rapid access to human company.
Only once it was clear what would be genuinely valuable did the team then look at the consumer technology available and how this could be useful in social care. This was a conscious choice, avoiding the default of stigmatising products designed solely for this narrow specialist market.
Bold new outside-in beliefs
This approach was possible because the senior team at Hampshire could see the long-term potential of this approach, for both them and the people in their care. They were ‘enlightened commissioners’, prepared to listen to the inconvenient truths that were being presented to them about the inadequacy of established approaches, and to act on them without having proof, at that time, that it would work.
This preparedness to act is unusual, but shared belief across an organisation that something like this will really work only comes from the action and successful outcomes that follow. We call these ‘moments of belief’ – like moments of truth.
The first significant moment of belief came from the top down, with Hampshire awarding the care contract to PA Consulting for five years without a fully specified plan to deliver, knowing that innovation would be required to learn the best set-up in the first year. This meant creating and committing to broad outcomes instead of focussing on specific KPIs because at this stage it was impossible to say what the most useful would have been. The wrong KPIs could ruin the work, whereas the broad outcomes could be set with confidence, making sure everyone was focussed on the most useful work.
The three outcomes set were:
Delivery of net savings with a minimum of £1.4m p.a.. (In practice achieved every year, culminating in £9.8m over the first five years)
Customer satisfaction, where 95% of users would recommend the services. (In practice achieved every year, with 98% on average)
Technology was contributing significantly to meeting care needs. (In practice 4 out 5 social workers who responded said this was “good” or “very good”)
This provided space for learning to happen and within six months establishing a balance of eight input and output KPIs gave teams ways of managing and improving the new, person-centred approaches.
Supporting this were a series of smaller moments of belief from the bottom up, as solutions were identified and piloted in the real world:
Providing users with an Amazon Echo device. This enabled immediate contact when help was required as well as a link to the outside world and information that might be needed. Crucially the device was provided earlier than usual to some users, before the ‘need’ was present. This looks expensive – a traditional approach would have withheld the expensive support until the need was greater. But providing it early allowed people to get used to the approach when they were feeling well, building the capabilities into their lives as habits. This meant they stayed healthier for longer and therefore independent for longer too. This outcome is clearly better for them but it is also better for the council, the savings in out-of-home care dwarfing the additional costs in providing support at an earlier stage.
The ‘Brain in Hand’ app for people with Autism. This smartphone app records users’ calendars, reminds them of tasks important to them and includes specific plans in place to help them solve problems they may encounter. This enabled the council to help prevent common issues by notifying users with specific reminders (such as remembering to turn the taps off after washing up, preventing the kitchen from being flooded).
Operation Magnet. Working alongside the police to resolve the issue of people with dementia leaving their home and needing to be found by using GPS, or a sensor on the door that activates a familiar voice suggesting they stay indoors if the person was leaving the house at an unusual time.
Each of these were managed outside-in leaps of faith. The initial financial outlay is definite, the commercial benefit is not, but there is a bigger picture customer-led view that these technologies will help people remain independent for longer and a more independent person is not just happier but also costs less overall.
The success of this outside-in approach has been impressive, creating value for users and the council.
Five years into the partnership, over 10,000 people are receiving telecare as part of their mainstream care package. And feedback shows that users are hugely satisfied. with 98% of service users stating they would recommend the service, and four out of five social care professionals stating the approach was “good” or “very good” at delivering care outcomes.
In addition, from the users on the Amazon Alexa pilot:
72% believe using a voice-activated assistant improved their daily routine
62% believe it reduced their feeling of social isolation
68% believe it helped to maintain their independence
Commercially, the initiative has been a success, too. Argenti has created a £9.8m net saving for the Council in addition to costs saved in other departments that are often unseen. For example, each call-out the police make to locate a missing dementia sufferer costs an average of £6,000, a need now vastly reduced due to Operation Magnet.
As a result the PA Consulting & Hampshire Argenti partnership has been extended for another five years to 2024. And it’s growing further, too, with new partnerships now in place with Barnet, Essex, and Barking & Dagenham councils.