Robots

Every few months, there is an article somewhere in the press getting excited about the potential for robots in social care. The latest is in the New Statesman: Automated assistance: how robots are changing social care. Samir Jeraj cites two examples of tech helping people to connect with services and notes the ethical challenges: Clenton Farquharson, who employs his own personal assistants and is Chair of the Think Local Act Personal programme for transforming social care, argues for “a rights-based approach”. “As well as accessibility and usability, manufacturers and providers should also be mindful of making assumptions about users’ needs… particularly for marginalised groups” who are “often not around the table”.

There is a long history of looking for quick fixes for the slow moving tragedy which is our current social care system. The National Audit Office today says that despite “substantial efforts from those across the sector to deliver these essential services in such challenging circumstances,” longstanding problems mean that “levels of unpaid care remain high, too many adults have unmet needs and forecasts predict growing demand for care. The lack of a long-term vision for care and short-term funding has hampered local authorities’ ability to innovate and plan for the long term, and constrained investment in accommodation and much-needed workforce development. In a vast and diverse social care market, the current accountability and oversight arrangements do not work.”

Below the attention-grabbing headline, the New Statesman article makes it clear that, in reality, robots are not currently changing social care. It gives two or three examples, the first of which is actually about tech connecting a sick school pupil to his lessons pre-pandemic, and then one small experiment using artificial intelligence to ‘chat’ to lonely care home residents about their interests, and an interesting academic research programme: the National Robotarium.

I’ve nothing against any of this: we are part of a government-backed consortium which is exploring how to combine machine learning, geospatial data mapping and grassroots community action using the Tribe application, and I feel hugely excited by the potential to combine tech and big data with community initiatives that until recently have been entirely offline and analogue.

It is worth, however, thinking hard about what problems we are trying to fix with technology. Many of the innovations grouped under the ‘robotics’ heading are more to do with AI-assisted social interaction than machines providing practical help. I am sure it is possible to create tech which will interact with isolated people in a life-like enough fashion to alleviate some of their loneliness. But why would we want to? As strengths-based models like Homeshare demonstrate, the best solution to a person’s loneliness, is to find another person who is either lonely themselves, or at least has spare social energy. Our Homeshare and Shared Lives teams and national networks are already exploring how tech can target, speed up and scale up those connections. As the NAO found, austerity hit social care hard, but as we’ve seen during the pandemic, there is now more than ever an abundance of caring and social capacity out there in our communities. The New Statesman reports that £34m is being invested in robotics research. When it arrives, the long-awaited social care Green Paper will need to demonstrate that level of ambition in scaling up the community-based innovations we already have in our sector: let’s get as excited about investing in people as we do about investing in robots.

How can we bring proven models to more people?

Ewan King, Chief Operating Officer at the Social Care Institute for Excellence wrote this blog for the Richmond Group of charities here. Here is an extract:

In January along with our partners Think Local Act Personal we launched the DHSC-funded Care Innovation Network.  Our goal is to answer this question: “How do we take proven person-centred models of care and support and bring them to more people?”

Locality leaders report that bringing the best to scale has perhaps been hindered for many reasons, in particular a short-term approach to funding, parochialism, lack of long-term planning – and regulatory barriers. But good initiatives have also failed to spread because statutory bodies have not always sufficiently engaged with others, especially the voluntary, community and social enterprise sector (VCSE) and citizens and communities.  More engagement would support both the establishment of more innovative forms of care, and also their growth and expansion.

Alex Fox, CEO of Shared Lives Plus, in his review of VCSE’s involvement in delivering care, bemoaned the sector’s often peripheral role.  He wrote: “Through drawing on people power as well as money, VCSE organisations are often uniquely able to offer support which looks at the whole person and whole family, thinking preventatively and whole-lifetime”. Moreover, VCSE organisations are increasingly creative in accessing resources such as social finance, and then applying different business models – such as franchising – to grow services.

The Care Innovation Network seeks an alternative route to growth of what works. In our network, we have many VCSE providers – like Shared Lives, Local Area Coordination and Stay up Late, so that they are part of the way forward from the outset. Working alongside us, applying co-production principles, are people with the experience of using services and their carers, so that solutions are well thought through, tested, and more likely to achieve the intended benefits of better experiences and outcomes.

Read more here. 

Government funds our innovation network

We’re excited to be part of a partnership led by the Social Care Institute for Excellence and the Think Local, Act Personal network, to help local areas scale innovative community-based approaches to social care. This builds on the partners work which has developed models and guides on how to take a whole-area, whole-system approach to innovation, getting away from endless small-scale, short-term pilots which lack ambition. In the current climate where budgets have been slashed and pressures are rising, the most inspiring areas are taking an all-or-nothing approach which recognises that, while initiatives may start small, there must always be a plan to move core resources into the models which work and away from those which don’t. (See Total Transformation, the Asset-Based Area and the family of community-based approaches launched at Social Care Future).

We’ve already had a large number of applications from local areas and from innovative support models and we’ll be building on the 2,000-strong TLAP Building Community Capacity network, which brings together activists, entrepreneurs and organisations working in this space.

Government backing for this initiative is a promising sign that, despite the delays in publishing the Green Paper, the Dept Health and Social Care recognises the need for radical thinking and inspiration for our sector, which is under unprecedented pressure.

Better than we have ever known

I took part in a panel at a NESTA event yesterday, for finalists in two of their Innovation in Giving prizes, one for innovation in tackling the challenges facing older people and the other for innovation in tackling waste in the food industry.

As usual in a room full of entrepreneurs, I felt inadequate to give advice. I’ve huge respect for anyone who is willing to take an idea and base their lives – and livelihood – around making it happen. I’m envious of their confidence and of the rewards which can come when you are willing to take that kind of risk and cope with living with doubt and uncertainty whilst you are on that journey. The Cabinet Office Minister Nick Hurd was also on the panel, having launched a new programme for social action with NESTA last week.

I spoke on innovation in ageing and suggested that innovation is needed to fix three problems:

  • the formal care systems being cut to the bone and cannot in any case fix isolation, loneliness and exclusion
  • informal care is becoming less sustainable, with people who support each other under increasing pressure
  • the relationship between these two systems is dysfunctional.

So the innovations needed to fix our broken care system may also involve fixing something broken in our communities. I argued that  whilst we hear much about the need to integrate different kinds of service, we must go further, integrating and aligning service responses with the contributions people with long term conditions want to make themselves and with the informal, unpaid caring provided by their families, friends and communities.

Innovation in ageing was also the subject of a major NESTA report launched yesterday, called Five Hours a Day, in reference to the fact that life expectancy is increasing at a rate of five hours a day. This is often seen a massive problem, but the NESTA report shows how it can also be a massive strength and source of innovation. Shared Lives and Homeshare feature in the report, as does the work of our colleagues at Tyze (www.tyze.org) who we are supporting to bring Tyze Personal Networks to the UK.

The NESTA report highlights five aspects of systemic change:

  • Social places: mobilising vibrant, socially–engaged neighbourhoods.
  • People powered health: bringing the social into the medical.
  • Purposeful work: new employment models for the second half of life.
  • Plan for life: creating a sense of opportunity about the second half of life.
  • Living room: enabling older people to live where they want with friendships and support.

The report is full of examples of what’s already happening around the world to make those changes. Its message is very well summed up by this great quote from Psychologist, Dr. Laura Carstensen:

“Societies with millions of talented, emotionally stable (older) citizens who are healthier and better educated than any generations before them, armed with knowledge of the practical matters of life, and motivated to solve the big issues; can be better societies than we have ever known.”

The report is here: http://www.nesta.org.uk/home1/assets/features/five_hours_a_day

Geekworks

Tris Brown, our communications and media guru, guest blogs from a session exploring how digital creativity and design thinking could come together with people with social care related problems to solve.

Ever wondered what would happen if the world of geekdom met up with the world of adult social care?  I accept this is not something anyone stays up late at night thinking about – except a man called Max Zadow.  Founder of Digital Creativity in Disability and physically disabled himself, Max is a self-confessed Geek and has long been interested in what would happen if people from the two different cultures came together to identify problem areas in adult social care in which technology could provide a novel solution.

One cold Friday at Liverpool’s Science Park, several members of a local social care team commissioners, social workers and managers came together with disabled people in a room full of entrepreneurs, coders, social media experts and industrial designers.

First order of the day was to identify some problem areas which the room could discuss and apply their mental prowess to.  There were five such areas, but two – transport and common data standards for records – quickly fell by the wayside.  Transport was seen as too big an issue for those present to do anything about, and strangely the group discussing common data standards felt they had ‘solved’ the problem within 5 minutes, but implementation involved significantly more people than were in the room so, after a quick agreement to set up a consortium, coffee and cake, the group disbanded and joined other groups. (By the way, although the issue of common data standards sounds really boring, the care homes present estimate that they spend millions every year just coping with the fact that every resident the care for may arrive with a referral in a different format to everyone else’s)  

That leaves three final groups – Solving Part D; home visitation schedule changes; and the problem of how those using personal budgets are made aware of which services are available.

Of course the final one is of particular interest to Shared Lives Plus whose micro-enterprise members who always face the challenge of letting people know their service exists to be used.

The Part D problem was brought to life with a passionate plea from a care home provider who is regularly given a bonus for taking a resident on a Friday night and then fined on Wednesday when Panel disapproves of the placement.  But the real Eureka moment came when Continue reading

Demand and supply

Here’s a third and final blog off the back of this week’s King’s Fund discussion about innovation in healthcare.

I’ve argued on a number of occasions that we have focused too much on trying to adjust demand within social care -by giving people personal budgets and Direct Payments with which they could, in theory, demand the service of their choice – at the expense of thinking about supply. Without developing diversity of supply, it turns out that people only have the same old choice of services to spend their personal budgets on, and that problem gets worse as supply organisations find it easier to compete on price than on personalisation of their offer and the market consolidates into fewer, larger organisations.

In conversation with colleagues in healthcare innovation, it was suggested that if social care’s innovation problem is that we focus too much on demand and not enough on supply, perhaps the main barrier to innovation in the NHS is focusing too much on supply – new contracts, payment by results, innovation in medicines and procedures – and not nearly enough about demand. We are all ‘patients’ and ‘consumers’ when we step into the realm of the NHS, which talks about things like increasing our level of ‘compliance’ with treatment regimes.

Could we bring together social care’s progress on thinking about demand, and the NHS’s progress on streamlining supply?

Eco-systems, not machines

Here’s another reflection arising from this week’s King’s Fund discussion about innovation in healthcare – they must have had good coffee.

Whenever we talk about innovation, ther e is a tendency for us to be talking about innovative interventions and projects – shiny new ways of doing a task, or shiny new bits of kit. Another way of thinking about innovation is to think of innovation in systems  – in the way that those tasks and bits of kit work together. A system can be innovative without any new tools. A system which is has all the new tools, but hasn’t worked out how to use them together,  can be chaotic rather than innovative. Sometimes getting rid of bits of kit which didn’t really turn out to add much value, actually improves things.  One way I heard this put recently was that we should be thinking about systems design in terms of developing a healthier eco-system,  rather than thinking up a more impressive machine.

Innovating out the humanity?

I was at the King’s Fund (health think tank) yesterday for a discussion about innovation in the NHS. It’s always interesting to be part of a discussion about healthcare. Partly because I am always the least knowledgeable person in the room when it comes to all kinds of crucial technical points – tariffs, CQUINs and all the other bits of jargon which bamboozle non-NHS folk like me. And partly because I never fail to be shocked by the difference between the cultures of the NHS and social care.

Both sectors talk constantly about the need for integration. And yet we can barely talk the same language. We don’t even appear to share all of the same goals.

An interesting point in Richard Bohmers’s opening presentation at the session, which was a review of innovation in the NHS, included a throwaway point which seemed to me worth some deep thought.

Richard noted that there are tensions in healthcare innovation – between for instance, trying to give people increasingly specialised responses, but also wanting to people to experience one, integrated NHS, not several different organisations. The tension he noted which struck a particular chord with me was the tension between greater efficiency, which can mean things like automated and hi-tech interventions, and our desire to be supported by people who care -in the common sense of the word – not just people who are efficient at caring tasks. Is innovation in the NHS antithetic to compassion? Have we innovated the caring out of the NHS? And if so, how do we make use of technology and whizzy systems thinking in health care provision, but also bring the humanity back in? Interested in your thoughts – a couple more ruminations from this discussion to follow later in the week.

Five questions with one answer.

On Friday, a group of senior leaders from council social services departments got together with colleagues from the Department of Health team writing the social care White Paper due later in the Spring. Sue Bott from Disability Rights UK and I did our best to keep order in a passionate debate about how to tackle a question as old as social care: what role should the state play in helping people to help themselves and each other? Peter Hay, this year’s ADASS President and social services Director for Birmingham, opened and closed the discussion and outlined a situation common to lots of areas: demand for services increasing whilst budgets shrink, coupled with recognition that even the best services cannot meet some of the most pressing needs, like isolation or exclusion from community life or employment opportunities.

I felt privileged to listen to the risks which local leaders are taking to turn a dysfunctional system on its head: it’s so very easy to panic and take a short term view when faced with a crisis in funding, but there are places around the country who have refused that easy option. There will soon be an open call for examples of citizen-led approaches to care and support, to which I’d encourage anyone with knowledge of promising local work to respond. But in the meantime, by way of processing some of what I heard and hopefully widening the debate, this blog and one or two following will set out some of the questions we kept returning to.

My first observation is that Continue reading