Good care is non intrusive, non patronising, dignified. Why is it that technology for care so often fails to grasp this?

Digital Health and Digital Social Care — Where the Opportunity Lies

Much has been said across Europe about the impact of austerity policies on the role of the welfare state. The sustainability of social services is at stake, with commissioning bodies facing cuts to budgets while they are expected to serve an ever growing population living with long term conditions and age related frailty.

Although the welfare state is a relatively new phenomenon, care for people living with frailty has historically been provided by third sector organisations. Prior to the 20th century, life expectancy was much shorter and the “needy” or “poor” were supported by almshouses or local trusts run by local church or state elites. Provision was highly asymmetric, and people were expected to abide by the social norms of those charities. Pension schemes were introduced in the beginning of the 20th century across most of the western world, and later the state has intervened to level the support landscape and create coherent support to people with frailty.

Today’s social sector is more complex than ever. In addition to public sector support, there is a maze of social enterprises, not-for profit organisations and impact-focused for profit companies.

This landscape is changing, and this change is being accelerated by two catalysts: further cuts to public spending, and the baby boomer generation hitting retirement age. This creates two important supply and demand mismatches in the sector: demand for modern assistive products, and need to better care planning and coordination.

Assistive Products

On one hand there is a supply chain that has been shaped by public sector procurement requirements, and these requirements consist primarily of compliance with health and safety regulations at minimum cost. Resulting products are usually highly stigmatising, and give no choice to the person using them but to be stuck with some hospital-like piece of equipment. They can choose these products in any finish, as long as their preference is beige plastic. The baby boomer generation will be buying the products directly. And this is a generation that grew up with the power of choice. Product designers who are mindful of this gap can open one of many existing catalogues of assistive products, take their pick, and start redesigning.

Care Planning Frameworks

On the other hand, there is an urgent need to rethink care in the community, shifting from care-by-the-hour structures to outcomes focused contracting, where care providers are paid to ensure an outcome is met. Good care providers will try to achieve this outcome with a clever mix of technology, engagement with family, and application of rehabilitation rather than continuous support, which can result in higher operational margins, and better experience for people receiving care and their families.

Care in the community, designed around outcomes, making use of the best tools available, has the potential to bring sustainability back to the sector, whilst reducing hospital admissions, prolonging independent life at home, and ensuring all resources from both informal and formal carers are put to good use in achieving outcomes that are truly important for people who need a helping hand.

At Nourish we are doing just this. We empower product developers to deliver a bigger impact by integrating devices into a bigger picture allowing them to fit into the right context — a wearable device is not only a step counter but also an activity trend monitor to assess potential loss of mobility — or the data from a glycaemia monitor being automatically assessed and used to alert a carer if values show a rise in risk of an acute episode taking place.

But we are doing this in a truly outcome based, person centred approach, that takes into account the need for better care management — much needed by care providers — self-management by the person and the family, and the use of technology where fit for purpose, underpinning formal and informal care interventions, both institutional or in the community.

We may not be able to solve the care crisis altogether, but providers and communities using our products certainly feel the difference when it comes to dealing with complex care planning, recording and reporting, where carers save very significant time on compliance tasks, managers and families have more confidence in the care provided, and providers are able to give reassurance in a time effective manner to CQC and contract monitoring teams of the quality of care being delivered.

And in its role of monitor and regulator, the welfare state can use these approaches to assist with a fresh look at its role: one of supporting those who cannot get support by other means, of empowering people to self-manage, and supporting families and communities to gain more resilience.

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