One benefit of working with the care technology (TEC) services in two-dozen local authorities, is that I get to see what works and what doesn’t. When it comes to service delivery, I commonly encounter three approaches:
- in-house, where everything is done by council staff, sometimes excluding specific elements like equipment installation or alert monitoring, which are commissioned in lots;
- phantom managed service, where one commissioned provider has what appears to be end-to-end responsibility but is either not commissioned or perhaps is unable to deliver some key aspects;
- true managed service, where one commissioned provider takes responsibility for everything.
When things work well, like in Barnet or the multi-award-winning Hampshire CC’s true managed service, TEC becomes a ‘first offer’ for people with care needs. In Hants, the last contract generated £9.8m in net savings and supported 16,000 people. Care practitioners became active advocates of technology. Robust evidence of outcomes drove the service forward and built the confidence to experiment with new technologies like Alexa and more complex cohorts, such as children.
Other delivery arrangements each have weaknesses that can lead to significant and prolonged negative impacts.
For example, without the scale to operate cost-effectively, in-house TEC teams can struggle to build a compelling case for the investment to grow. The time and capability needed for robust QA or benefits measurement are limited and innovative projects can peter out at the pilot stage. These are zombie TEC services, often persevering with a declining charged-for ‘button & box’ offer because there is neither the drive to transform nor the political appetite to exit the market.
The phantom managed service is typically delivered by a household name from the world of community equipment supply or manufacturing. I frequently observe that commissioners exclude from scope aspects that have a significant influence on sustainable success. For example, they may not explicitly require their provider to identify new target cohorts, to design new pathways that reduce demand elsewhere or to work with care practitioners to change referring behaviour. It can be unclear who is expected to introduce exciting new solutions like apps, particularly when these are not part of the provider’s standard product range. Crucially, responsibility for realising the savings achieved through TEC, so essential for unlocking investment for service development, can be absent from scope.
In Hampshire, commissioners were clear that all aspects were in scope for their newly awarded 5-year TEC contract, which went live on 1 Feb 2019. Hence the Council was able to select a provider with a strong track record not just in installing and monitoring today’s technology, but also in mainstreaming emerging solutions, leading service change and growth, and driving benefits from TEC.
The key is holistic commissioning and in the next blog in this series I will explore what that means in practice.
Steve Carefull is a social care expert with PA Consulting and Programme Director of Argenti. He is the holder of the TSA’s inaugural Individual TEC Leadership Award.