Is the social care sector innovative enough? | Legal Thinking Podcast

This week we speak to leading thinkers in social care innovation, to find out why social care is ripe for innovation and what might be holding it back.

Thanks to our guests:

• Sophie Chester-Glyn, Director at CoProduce Care CIC
• David Collins, Data and Integrations Product Manager, Person Centred Software
• Mei-Ling Huang, Partner in Health & Social Care, RWK Goodman

Make sure to check out our recent 'Emerging from the Storm' report into the changing landscape of the Social Care sector.

Thanks very much for joining us David, Sophie and Mei. I guess the first question about innovation in the care sector is you know how important it is. So what is the importance of innovation in the social care sector, is it necessary and if so, why?

David Collins: I believe it is hugely important, but it has to go hand in hand with timeliness so we as technologists and software vendors and hardware vendors and the like can be very much on it when it comes to innovation and trying to be a couple of steps ahead as to what the sector needs. However those who work in the sector have to be ready for this so we should go and release something that is all singing and all dancing using the latest AI an things like that but the sector won’t be ready and we will end up with something that actually may even set things back a couple of years because people will have been scared of the technology that came through. I believe that people within the sector have what I call DQ so we will have an IQ and EQ and I think they have this digital version of that as to how ready we are and how mature we are towards accepting that.

Let’s maybe move on to Sophie then.

Sophie Chester-Glyn: Yes I mean it is a really good question. I feel like I want to roll back a little bit when I am thinking about innovation and really understand like what do we mean by innovation because some people will say the word in modern times we think technology but when we actually look at the definition of innovation I had a little gander at the good old trusted Oxford Dictionary and it mentions a new method idea of produce or product being innovative is thinking about new methods and it uses the example of innovative designs or innovation such as helping unemployed people getting to work. So when I think about innovation I like to think a lot about what we do every day. Those small paces close to home where we are doing things differently in our daily lives and I think that social care is actually a hub of innovation when you see, especially through the pandemic thinking of how it had to just, it was on its own the regulator wasn’t going in, care staff were having very little training understanding of what Covid was at the time and they just had to kick start a way of working in a different way, safety of infection control and I think that is where my idea of innovation really comes from and in thinking about how important it is it is vital in terms of making sure that the people we look after are safe and are comfortable and a great resource for ideas of innovation both in terms of technology and working differently is I think Local Act Personal website they have a directory of some incredible examples. Something called compassionate neighbours where there is an organisation that sort of co-ordinates neighbours in a local area to work together to look after people who need support and lots of ones like that so I would like to think about the other ideas and concepts of innovation that are already going on teasing those out as well but yes I mean it is vital to go forward I think with supporting people.

Yes and if anything like you mentioned the pandemic really showed the importance of innovation and Mai what are your thoughts on that.

Mei-Ling Huang: I think innovation is critical for the survival of the sector. I think we all have to move with the times and you cannot really pretend change isn’t happening and Sophie’s example of the pandemic forcing changes, forcing innovation is a really good example of that. I think another example of that is the lack of staffing that we have at the moment. We have got 160,000 vacancies in the sector and that lack of personnel is definitely going to force us to innovate and continue to force us to innovate and we are seeing that in other countries who are ahead of us on that like Japan and China where the working age population is very low and you know frankly somebody has got to take care of people. So there isn’t really an alternative to innovation in one way shape or form and part of the answer probably has to be money and part of the answer has to be more people but other parts of the answer probably lie in the realms of tech and our ways of thinking about the delivery of care and as Sophie was alluding to you know changing the way you think about what you are doing on a day to day basis but the short answer in terms of why it is important is that we have to do something because right now we have got this system under very significant pressure and that I think will force us to change.

So, in terms of the innovations that we are seeing now you know a large part of the push is towards digitalising social care so in terms of tech David what are your predictions for the direction of travel over the next five years’ or five to ten years’? And have you got any predictions for 20 years’ time, if you are going to be bold?

David Collins: I probably wouldn’t go so far as to be bold, I mean we saw a pandemic creep up on us quite quickly so I try and avoid 20, but in the next five to ten I think we can start to do some very clever stuff about where we take information from. So an example of this would be around, say in a care home setting or even in a domiciliary setting people want to be able to get to live with us much independence as they can and we need to be very aware that people are people and we need to give them their space, time and independence. Technology can help support that by providing fees of data on their general wellbeing on say for example whether someone has had a fall or whether someone is moving around a location in a way which is predictable and understandable, whether they are taking their medication say from a medications pot that can track whether or not it has been opened. Taking all of that information and then further using it to understand individuals needs and predict when something untoward may happen. Over the next five to ten years I can see us working more and more towards a predictive model and an intelligent model of care to help support individuals as least intrusively as possible. But it is going to take a lot of work to get there and I think the push towards digitising with the ICS is starting to provide the funding to bring care homes in particular to the digital space is really going to help because you can only do that level of prediction and level of analysis once you have the absolute volume and velocity of data coming through into the data models to start then predicting what it is people need.

And obviously like you said Sophie innovation isn’t always about tech you no sometimes it is about just working more efficiently or trying to find a different way of doing things. You mentioned you know some community support for staffing in the sector but what innovations do you think need to be made in the sector in terms of staffing and staff training? Particularly with the levels of vacancies that are in the sector at the moment and have you heard any interesting developments that have already begun in this regard.

Sophie Chester-Glyn: I think with technology and supporting staffing it is really supporting them to do the work that they need to do on the ground. So almost taking away the monotony and the bind of paperwork which takes people away from what they really originally came into care to do which is to care for people. If you can help that part of someone’s job then you can help them help people in a physical sense do stuff that technology cannot do. So at the moment there is very popular the scheduling systems, the EMAR systems and once people get their head around them that there is a process of integrating that into people’s work streams which can be a bit challenging if people aren’t used to it, but once they get there from our experience it usually is such a revolutionary change to people’s working lives and it does free them up with a little bit more time to spend with people on the ground so those types of technology and also with making care a little bit different a little bit fun so I have seen at various conferences people advertising virtual reality headsets for training. I think that could be something that would be very helpful not only with costs in terms of training. I think that could be something that would be very helpful not only with costs in terms of training people but also making it feel a lot more real than giving people that vision of how they would safely support somebody. I have read somewhere that King’s College Hospital is currently taking part in a virtual reality pilot and that is in order to help people with understanding people’s mental health and diversity and inclusion training so people are starting to adapt these types of ways of doing things differently but I do wonder to what extent technology will potentially replace the need for staff that has always been the concern with people when they are embarking on new developments because obviously staffing is a major challenge at the moment so will some technology do that.

And Mei what do you think it will take to really get innovation going in the sector?

Mei-Ling Huang: Well I think it is obvious that there needs to be some money and people talk a lot about  money so I won’t focus too much on that but there needs to you, you know when any sector is undergoing change and new things are being developed there needs to be some funding behind it. I think there needs to be a change in people’s way of thinking there has to be a focus on innovation and a focus on change and when you have a problem to solve you need to be able to stop and think about it. You need to be able to take what we call the helicopter view so that means that when you are down in the weeds and Sophie alluded to the bind of paperwork there is no way that you will be able to get the big picture and think about doing things in a different way so you need to get the head space to be able to do that and the trouble at the moment is that everybody is just trying to survive so that is very difficult. I think we also need leadership and we need the provision of the right environment. I recently attended along with Dave something called the Care Innovation Hub which is being run now by the National Care Forum so Vic Rainer and her colleagues at NCF and the Care Innovation Hub brings together a lot of very bright people from the sector who want to facilitate change. So we have got providers, we have got managers, you have got carers, people who use services, people like Dave who work in the sector and also groups of mostly university students many of whom are post grads and feel like tech and medical science is in engineering and they held a hackathon which is an intensive weekend designed to enable people to develop new ideas very quickly and hopefully lead on to businesses that will foster change within the sector so what is nice about this is it gives ideas a chance to blossom and one of the top entries from a previous year attended to talk about how she has created a fully fledged business from her idea so what she does is she provides a matching service for care providers and carers that enables care providers to find carers who are culturally aligned with and have the language skills that match up with those of their clients and that was all borne out of a hackathon a couple of years ago and it shows how innovation can progress off the back of an idea when somebody takes the lead to create the right environment to nurture those ideas. So I think we need more head space and more room for the development of the ideas.

Well it sounds like there are green shoots of innovation coming through with things like the Care Innovation Hub and things like that but when obviously working day to day care providers have to work pretty closely with CQC guidelines. How does the relationship between regulation and new tech affect the progression of innovation in the sector. So that is a question for everyone so whoever wants to jump in on that one first?

Mei-Ling Huang: Can I just give an overview? First I think on the one hand in my view anyway, on the one hand regulation slows innovation down but on the other hand it speeds it up so regulation slows innovation down because the regulator is fundamentally risk averse and around five years ago CQC were talking about doing something called regulatory sandboxing which means that they would allow innovations to be tested in a safe controlled regulated environment so they talked a good game but I haven’t seen any of that happen personally. Maybe it is happening and I Just haven’t seen it. I haven’t heard anything further about that and I think that CQC’s aversion to risk makes it harder for providers to take chances and you need to take chances to innovate. I think there is a way for CQC to speed things up. They are actively behind in supporting the digitalisation of care records and things like that at least in principle and the way they are approaching things now supports that. They are using the information that they obtain about a service as the basis for going into inspect. They then look to see if you have dotted all the i’s and crossed all the t’s in terms of particular aspects of care and record keeping and they are taking a really quite microscopic view I think so that makes it important to have every I dotted and care providers basically have to have the electronic care systems to be able to cope with that kind of scrutiny and those electronic care systems also help with auditing which is required to a much higher standard these days by CQC. I think the problem is this all still falls down in places. There are a lot of different systems out there and two things happen with some frequency. One is that the inspector does not actually understand how to use your system and they misinterpret the data or they can’t find the data and they come to the wrong conclusion about it and the second problem that often occurs is when the service is transitioning into a new system and it is not complete yet or it is bedding in, then that effects the quality f what CQC view and can lead to criticisms by them. So I would say that CQC’s regulation of the sector is pushing towards digitalisation but otherwise their risk aversion probably slows things down in terms of innovation and CQC is not an organisation that is designed to be creative but then again you know most bureaucracies are not. Most regulators are not.

David Collins: And linking back to Sophie’s point earlier about innovation can come in the form of small changes we have noticed that our customers using our system will have gone through a regulatory inspection as normal but as a result of that there will be some feedback saying how do I find this information out. Normally we use the systems day to day. How do I get to that and we are then able to make small innovations to provide more contextual based information within the reports. So say for example someone is independent and you are looking at hygiene chart and the CQC inspect the hygiene chart and say why has Mr Smith not had a bath. Well actually he has, he does it himself he is more than capable but recording that information was key and that was an innovation change that helped us grow the system and helps us then further support the customers as feedback from their regulator.

Sophie Chester-Glyn: That is really interesting and I love these type of innovations and to show how things are, can be different in care provision but I was really interested with Mei’s comments actually because I rightly or wrongly have seen it quite different with the CQC. I have kind of noticed maybe they have not embedded it into their general inspection framework properly to be fair but I have definitely noticed that they seem to be talking about innovation a lot more, like they want to see more and in their reports they are very much in favour of people who are doing things differently. I definitely think it is very difficult to explain from on the ground. I have found people have found it difficult to sometimes get inspectors to get to understand how their tech or innovation is making a difference but I think that maybe it is a case of providers, even having an innovation policy that sets out really clearly this is what we are doing and this is the impact to the people that we support or to our staff and this is the positive difference it is making and then along with that having some feedback. So, any innovation that people put through I definitely feel it is a benefit if you can go back and do a survey monkey and get people, or just a questionnaire that people set out and say what do you think of us using EMARS. We did this with Teams or the electronic medication monitoring. We did this with Microsoft Teams we actually started trialling it back in 2018 and we found it very difficult to even get our Local Authority to have interest in what we are doing. Fast forward 2020 everyone is trying to jump on Microsoft Teams and using it but by that time it is embedded within our organisation so we, it is helpful for us because we have got a home care, we have got residential, we have got lots of different types of services. Not particularly large but it really helps as a communication tool some of the teams are using it as their communication record. We have been able to communicate really quickly to find people who have gone missing and it that has really helped the team work quicker and faster and I think it is just using those type of examples and embedding that in the PRI or the feedback to CQC to really help them understand the impact it is having on people that are being supported. I think that might be the change that hopefully makes a culture of CQC seeing how what you are doing and how you are using new innovation is beneficial to your services.

David Collins: We noticed that actually so through building system and getting our system into care providers over a course of time with the CQC reports being freely available we were able to search for any references to this and we noticed over a period of time it really started to pick up and obviously individual inspectors will have their own personal opinions around a system being used but on the whole we have noticed that over time the fact that they were seeing systems like ours in place as really helped the regulators get more on board with this shift to digital and understand and appreciate that actually it is there to support the workers to deliver the best care they can but also make the managers lives easier and then onwardly make the regulators lives easier in inspecting.

Okay, so I guess I will just run on to the last question which is if you had the power what would be on your wish list to help the sector move into a better future.

Sophie Chester-Glyn: How long have you got? Sitting with the innovation theme I just speak from experience. When we try to put new innovation in we found it very difficult to just say to managers right this is what we need to do go ahead and bring your teams along. What we were really lucky to have at the time and because we had the resources we had somebody in the organisation whose sole “res a detre” if you like was to help with technology whether it was the local laptop or it was with using Microsoft Teams or any other technology we were using and that really did lesson the pressure for managers to do everything they are doing on the ground plus trying to embed new innovation on the ground. So, I think if there could be some kind of support which providers and managers can draw from that is either commissioned centrally or by Local Authorities that everybody can draw from that one person who can come on site and support them with embedding innovation or even a pot of ring fenced funds that providers can go and use that to pilot their own new tech or their own way of working whether it is with community in a different way because that is all part of innovation as well and that they can use that whether it is grant funding so that that can personalised for the organisation. Because one thing we haven’t touched on is the fact that social care is so nuance so what might work in a care home won’t necessarily work in home care which might not work for people who are employing their own personal assistants. So having something that people can use and adapt for their own and personalise to their own services for innovation I think would really help from my point of view.

David Collins: I would actually echo that as well. There is a barrier to digital adoption and that barrier is time, fear and mostly it really and people need to support. People need support in understanding that it can be difficult but it is not an unclimbable mountain and having that support would be key. We try and provide as much support as possible and as much structure in demonstrating the journey to going digital as a provider there is only so much that we can do having that more on the ground support from peers and groups who have gone through that change already would be absolutely fantastic and I completely echo Sophie having that central resource to call off to get that support would be absolutely ideal.

Mei-Ling Huang: I would like to zoom out a little bit about this question I think. I think that one of the most important things we need is a change in mindset of the people who have the power to resource the system and specifically the people who have the power to make policy so we have got a lot of 40, 50, 60 year old MPs in parliament who need to think this is going to be me some day. How will I want to be cared for. We all are going to need support to one degree or another but I think many people do not seem to think that it will affect them and that idea that this is important for all of us needs to be internalised and our politicians need to be brave enough to put all of this above political point scoring and stop kicking the issues into the long grass. I think we are starting to see a shift in the recognition that the NHS is dependent on the adequate provision of social care to function properly and that is the beginning of a first step but now we need to see the follow through in terms of the provision of funding, the enablement of the sector to recruit enough staff to train the staff. To bring social care into the world of respected and recognised provisions like doctors and nurses and you know I think we need to applaud everyone in the sector all those leaders who have been trying to make the people in government see this stuff and recognise what needs to be done and it feels like a long hard slog in that respect but we are starting to detect a bit of change at least in terms of the recognition of the problems if not in terms of the solutions and the funding that is required to achieve the solutions. I would also like to see a regulatory framework that really recognises the value of innovation in the sector and you know we may be sort of slightly disagree about that but I think it is to some degree recognised through the award of outstanding ratings and digitalisation but right now CQC is almost fully focussed on the rooting out of risk as opposed to the recognition of good practice and innovation so I think they need to get fully behind the innovation you know push and recognise that it is not just about digitalisation and I would say the same for Local Authority and NHS commissioners. You know everybody is just trying to survive and I think we need to try to look beyond that. Then lastly I think we probably need more incubator type facilities, enterprises like the Care Innovation Hub we need more conversations about innovation and the space to do that in and more support for the development of ideas that come from both inside and outside the sector. So that is the big picture view anyway I think you know Sophie is right that lots of people are doing innovation on an every day sort of level but we need to have those bigger conversations to share those ideas and spread those things across the sector.

Great. Sophie, David and Mei thank you very much for your time.