This year, I travelled across the UK to have a first-hand account of innovative ways of providing care and support to people in order to help them to live their best lives. SCIE is dedicated to both learning more about innovation in the social care sector and sharing best practices. In September, I was joined by my colleague Helen Broad in traveling to Manchester to meet with YOURmeds, a company that has excelled in medication management. We visited a woman who uses the device as well as speaking to the local authorities and NHS organisations to learn more about their experiences using YOURmeds and scaling this innovative practice. The YOURmeds system uses a device, filled by the user’s local pharmacy, to manage medication. The device has a screen and numbered pillboxes that are large enough for those who have difficulty with their sight. It emits a noise when it is time for the user to take their medication and tells the user on the screen which pillbox to open. If the medication was never accessed, a notification is sent to the user’s preferred contact person such as family member or care worker for them to remind the device user to take their medication. At the end of the prescription, it is easy to see which medication was taken, or not, and can better help the user’s medical team determine the efficacy of their drug protocol.
When I met with the YOURmeds user, she shared that the device greatly improved her quality of life. It helped her manage her medication and prevent unnecessary visits from care workers disrupting her daily routine. It had also reduced her medication, as regular medication had got some aspects of her condition under control. She would encourage others to use this device.
I also met with both health and social care teams from Manchester and Stoke-on-Trent who use YOURmeds. They felt that the use of YOURmeds greatly helped both their constituency and their bottom line as they now did not need to send as many care workers to people’s homes to ensure that medication was being taken. However, despite being used in a city as large as Greater Manchester it is currently only reaching between 30 – 40 people. When we asked why the device is not being used more widely given its success, it was reported that funding for medication management falls into a grey area. Medication is normally funded by the NHS. However, ensuring people take their medication falls to social care workers. This system is an example of the importance of further joining up NHS and social care programming as both are needed to help people live fulfilled and independent lives.
YOURmeds is simple in its innovation which is part of its appeal. Not every innovation needs to have a ‘wow’ factor, sometimes it’s the smaller actions that can make the greatest change in someone’s lived experience. This is a simple but effective solution to medication management. It would be worth further investigation of the barriers as to why this has not been taken up more widely. There is some concern by users that they will lose personal contact if they do not have a care worker checking in on their medication. I believe this should be looked into further as that personal connection is important. However, I wonder if reducing the number of short personal contacts could lead the way to more meaningful interactions in the long-term since care workers might not be as thinly stretched to address medication uptake as well as all other responsibilities.
I greatly enjoyed my time in Manchester speaking with people with lived experience with the YOURmeds device and local authorities’ experiences in supplying them. I look forward to going on more site visits in the future to learn more about innovative products and programmes across the UK.
SCIE is always looking for new and innovative ways of providing the best social care and support to people to enable them to live their best lives. With this in mind my colleague Vikrant and I recently visited a dementia care home in Leeds, a part of Orchard Care Homes, where they are using Artificial Intelligence (AI) to support a new way of providing dementia care in a number of their new homes. Paisley Lodge in Armley, Leeds, is one of these care homes. Here they have transformed the downstairs section of the care home into what they call a ‘reconnect community’. Housing between 18 and 20 residents who have typically been hard to place due to their so called ‘challenging behaviour’ – a term banned in Orchard Care Homes, along with many other terms they consider to be degrading, labelling or de-humanising, such as toileting. Such particularly offensive words seem reserved to the care sector, so I was very pleased to see them removed from this care home. Crucially, the behaviours referred to are in general not presenting anymore. The residents are treated with dignity and respect both in the language being used and the care they are receiving. One of the ways they are achieving success in reducing such behaviour and improved residents’ expeirence is by using an application supported by artificial intelligence to assess a persons level of pain (Paincheck). This application that all staff are trained in uses facial recognition to identify where someone who is unable to communicate may be in pain, in order to get the right medication or treatment for their pain. At the same time, they have managed to reduce reliance on psychotropic medication, typically used in care homes or hospitals for people living with dementia to counteract behaviours such as ‘wandering’, frustration or aggression.
The Reconnect Communities, modelled on care usually provided for people with autism, have a significantly higher staff ratio and a higher standard of training than a traditional dementia care home. The effects of their whole approach are immediately evident, every single person was meaningfully occupied, either with social activities or a ‘job’ that they had selected for themselves. For example, the laundry is not a locked room, residents are welcome to come in and put their washing in, hang the washing out or fold some laundry. There’s a workshop, unlocked, where residents can go in and do some painting, woodwork or something else that interests them. The garden is open for gardening, growing fruit and veg when the weather allows. All these activities safe in the knowledge that there are always staff around with time to support.
Paisley Lodge has an upstairs care home run on the traditional model of care with a separate pricing and referral process (albeit still using Paincheck). I asked one of the staff what the differences were from her perspective. She was very animated in the difference telling me she didn’t like working upstairs, she gave me an example of a lady who was prone to wandering and could be aggressive, upstairs she had to be ‘managed’, sat back down or maybe even ignored if staff were busy; downstairs a lady with similar needs was observed quietly and different staff would intervene to distract, look out for any problems, help the person to communicate their needs and become occupied more usefully – meaning this kind of behaviour was rarely a problem.
I felt quite uncomfortable at this ‘upstairs/ downstairs’ model and feel that to juxtapose the two care options within one building is especially unfair as many residents ‘upstairs’ would benefit from a Reconnect model but might not have been adequately referred or are unable to afford the fees. It is worth noting, though, that the ‘upstairs’ traditional dementia care model is providing a high standard version of the regular dementia care home model. Orchard Care homes have persuaded commissioners across the country to pay double the usual care home fee to place people in the reconnect communities, providing evidence and statistics to show the savings achieved reducing costs across the system in places such as frequent hospital visits, placement breakdown and medication. Not to mention the impact on the persons wellbeing and happiness which was the crucial takeaway for me.
I have long felt that we have age discrimination built into our care and commissioning model with younger people receiving exponentially larger care packages than older people. In my view, this is because we don’t value the emotional and social wellbeing of older people, the need for them to be meaningfully occupied in just the same way as younger adults. If the Orchard Care Home model was rolled out across all older people requiring care and support, it would come at a cost, but what might the savings be to other parts of the system, and isn’t this the kind of care we would all want for ourselves and our loved ones in older age? Taking a people-first approach to care homes and prioritising an experience for older people with dignity and respect is the standard social care should uphold.
During 2022, NHS Gloucestershire’s children and young people’s mental health services launched its digital support finder. Beth Gibbons explains how her team at NHS Gloucestershire created On Your Mind Glos to give young people more control of their care.
With the support of tech specialists, Made Tech and Mace and Menter, we have created a team of designers and technologists along with our NHS staff to research and build this new mental health tool. The work was commissioned rather than built in house because of the specialist skills and capabilities needed around service design and agile service delivery. The team worked with clinicians, frontline workers, children, young people and the local community to research user needs. We found that interaction with these specific groups was crucial to help us create a tool that truly worked for those it needed to. Mental health support practitioners, GPs, school nurses and mental health leads in schools were also included in the research to help us understand the specific problems that needed fixing.
A single source for local mental health support information
The online support finder on the dedicated website guides users through a series of questions to understand how they’re feeling and what support they might need. They’re then signposted to the most relevant service for their needs and given useful information about mental health.
The results are available to young people, their parents and carers via the website and SMS. Providing SMS access was an important element of the service as it needed to be accessible and secure for any child or young person to use, regardless of their access to a computer. Just three months after the initial launch, a round of user research revealed that young people like using the service, with more than 2,500 visiting the site.
Today, the support finder is an easier solution for young people to understand, find and access over 100 mental health support services and gives them more choice and control of their care. For health practitioners it provides accurate advice and helps them signpost to services.
It has since been launched in schools alongside a programme of mental health awareness and has reached around 10,000 young people. While it was developed for young people, it’s expected that professionals, parents and carers will use it too.
Largely driven by the pandemic, the social care sector in Wales has seen a fast-paced switch from face-to-face to digital forms of workforce training and development. To better understand the benefits and challenges of digital learning, Social Care Wales commissioned SCIE to undertake an evidence review and activities with staff to hear about their experiences. Amongst the issues discussed, digital literacy was one of the most common. Digital learning requires learners to operate devices and navigate through digital resources such as websites and learning applications. For staff that struggle with this, it can be a major barrier to digital learning. When we spoke to social care staff, they discussed two related issues:
Digital skills
The first issue is about digital skills themselves. The social care workforce in Wales is very diverse and includes people from different age groups and with all sorts of professional experience and skills. This means that, as in many sectors, some of the workforce requires specific training and support to develop digital skills to access digital learning resources.
Digital confidence
The second issue relates to how comfortable and confident staff members feel when using digital learning resources. While the two are related, we found that developing digital skills does not necessarily equate to developing digital confidence. Often, individuals use digital devices for everyday tasks such as shopping, using maps, and web searches, but still don’t feel confident when accessing digital learning. For some people, this is related to how the digital learning platforms they have tried using have been developed. Some platforms focus more on recording progress and performance than on how the staff feel and experience the resource. As a result, staff can be unsure about key tasks such as logging in and navigating through the resource. A negative experience can affect how the individual feels about the learning process and be as much of a barrier to digital learning as a lack of digital skills.
Understanding digital literacy as a twofold issue can help to create joined-up solutions to support the uptake and experience of digital learning. While basic digital skills can be supported with training and upskilling approaches, the development of confidence needs a tailored approach with, for example, coaching sessions to support staff to transfer digital skills they already have, and, most importantly, providing user-friendly resources and devices that staff find intuitive.
You can find out more about the impacts, benefits, and challenges of digital learning for the social care workforce, as well as our recommendations to guide future approaches to digital learning in Wales in our report below.