LGSS Digital Blog
Service design for local government
Digital Business Analyst
The Social Care Digital Innovation Programme
The Local Government Association, in collaboration with NHS Digital, funded a 6 month discovery phase to help Cambridgeshire County Council answer the following question:
How can digital tools and technology enabled care (TEC) be used to increase the independence of adults with learning disabilities?
We spent the time researching with people, understanding their needs and pain and building prototypes in order to test and learn. We do this a lot in the LGSS Digital team and we were really excited to get stuck in!
We believe that Technology Enabled Care (TEC) could be a cost-effective way of providing services, but is currently being underutilised. There’s a huge range of TEC devices that are most commonly used to detect falls, provide panic buttons, plan routines or aid communication. The devices enable people to have more control over their lives and live independently for as long as possible.
A review of adult social care in Cambridgeshire in November 2017 showed that 24% of LD cases had opportunities where TEC could have been used but was not. The importance of TEC is forecast to grow, as social care requirements for people with LD in England are expected to increase by 14% by 2030.
Individuals with LD are given skills training for developing their independence at school and college. However many people still require ongoing support with travel and carrying out tasks independently both at home and in their communities. There’s a real opportunity for professionals to think creatively about a person’s support needs and explore how TEC could play in their lives, in place of more invasive and traditionally expensive options.
Here’s the perspective of a couple of people we met when undertaking the research:
During the day I work at a café, which I love. I know how to get there and I go every day.
I want to go to the shops on my own without my carer. I don’t want to get lost and I want someone to help me if I don’t know where to go.Jenny
I want to support Jenny to be more independent and go to the shops on her own. I want to ensure she feels safe and confident. There might be technology that can help with this, but I don’t know about it. I don’t know what’s out there and how current the information is.Ben
What did we do?
Co-production was key to the success of the project and so we invited people from across the organisation and community to come on the journey with us. We were joined by: the TEC team, Cambridgeshire Learning Disability Partnership (LDP), Commissioning, Transformation, Speak Out Council, Switch Now and TAG Bikes.
We talked to LOTS of people from across Cambridgeshire to understand their day to day life experiences. We wanted to understand what life is like in order to find the pain, problems and opportunities.
Research sprints: Held in May and June 2019. The first comprised five workshops with over 50 people and aimed to gather insights from a wide range of potential service users and to understand their high level needs. The second aimed to gain a deeper understanding of service user stories and engage further with professionals. This involved eight interviews with service users, social care workers and therapists, shadowing the TEC team and a survey of social workers.
What did we learn?
People don’t trust technology
“What if I break it?” – an adult with a learning disability
“What if it goes wrong?” – a parent
“What if it replaces my job?” – a social worker
People don’t trust technology
When people don’t fully understand the piece of technology, they are reluctant to use it especially if they are worried about it going wrong. Staff are wary of recommending devices if they aren’t confident or know enough about it themselves.
However we found that around 2/3 of the people with learning disabilities had access to a device and are confident using it! People use apps for travel (MyBusTrip) and weather.
The Slimming World app is used by many people with learning disabilities. This is because it: produces meal plans, shows calorie counts, has recipes and provides links to online shops.
Everyone's needs are unique
“I feel confident that we should have be using technology, but it is not always easy within LD to be very specific and we need recommendations to be broader” – a social worker
Everyone's needs are unique
Independence means very different things to different people!
We assumed there would be a gap in the market, our silver bullet, a problem everyone had that we could solve. This wasn’t the case!
We did identify core needs across the cohort around: feeling safe, feeling confident, memory, building routines and the need for clear instructions.
“The lack of information is a really poignant issue with TEC. We want to know what’s available and how available it is” – a social worker
The TEC team do a great job at showcasing new technology and this work needs more exposure.
There’s an assumption by social workers, and other professionals, that you need to ask for a specific device – rather than thinking about the need a piece of technology could support.
There are lots of resources available on the web about assistive devices, but it’s often quite hard to find and uses complex language for example “Augmentative and Alternative Communication Devices”…err, what?
Narrowing the problem statement
It was clear from the breadth of our insights that the original problem statement needed to be more specific. So, we held our own referendum (as that has always worked in the past…right?) and asked people to vote for the most important problem to solve. We had over 50 votes, and, with over 45% of the responses, the following statement won:
How might we show you how to find out more about technology that can help you and make sure you are happy and confident using that technology?
We were really happy with the result, especially as the winning statement could apply to anyone—not just people with LD, but the people who support them and within the organisation too. We had a good mix of respondents as well, with 80% coming from beyond the organisation.
Technology + knowledge = TECHknow!
The co-production group enthusiastically came together to draw out some ideas on how to meet our users’ needs. We had some AMAZING ideas and the group really liked the idea of a tool which could connect people to resources about technology. One that wasn’t as complex as marketplaces, would be specific to user’s own support needs and have links to local and national resources. We called it TECHknow!
TECHknow will provide an accessible introduction to marketplaces and resources. It will:
- Support people with LD and their support network to find the right information, in the right way, that is easy to digest
- Connect people to local and national resources
- Provide awareness of technology that can be used to support someone
- Remove the need to be specific about a particular device
- Provide an opportunity to ensure people live their lives with dignity
- Show real-life case studies and video demonstrations of technology in action in order to increase reassurance
- Be accessible and will, most definitely, move away from phrases such as “Augmentative and Alternative Communication devices”
In order to test whether TECHknow would be useful, we needed to make something tangible, to take out on the road and test with users. We wanted to receive feedback on the concept and idea itself, rather than the limitations of any prototyping tools we used and so it had to appear as real as possible. We built it in the Gov.UK prototyping kit.
The prototype was tested by over 60 users and we got some fantastic feedback from co-workers at Switch Now and attendees at the annual Speak Out Day event (attended by people with LD, carers, parents, commissioners, social workers and volunteers).
Some of the feedback we received:
- “Good idea”
- “The layout is simple and easy to understand”
- “The marketplace is so confusing, it’s hard to know what to look for and it’s not accessible. This solves that problem!”
- “I like the idea of a tool to guide people through it and provide access to the right resources.”
- “It accepts any names, even rude ones”*
* Winner of my “best tester” award!
You can test it yourself by visiting:
Username & password: nolimits
What did we learn?
Engagement with stakeholders was frequent and successful. We ensured that there were plenty of opportunities for stakeholders to engage, feedback and test the prototype. This ensured that the team kept the interests of the service users at the heart of their design.
Application of past learning: in the past we had really struggled to engage with people who work in social care due to their busy schedules. As such, we ensured that we planned meetings far in advance and shared our work if people weren’t able to make a session.
Broad scope: Starting with a wide problem statement allowed us to identify what was of most importance and value to our users. On reflection, had we started with a narrow problem statement, we would have struggled to explore the entire problem space.
Shout about it: The gallery of insights allowed us to share learning, not only with stakeholders, but with others interested in the project. We made sure it was shared, shared and shared again so that people knew what we were doing and why.
Accessible content: After the kick-off event, we received feedback that the materials used on the day were not considerate of people with learning disabilities. To address this, we attended Government Digital Service Accessibility training and sought advice from the Adult Learning team. This ensured we created accessible content from that point on and didn’t exclude anyone from our sessions.
We were amazed by the engagement we got from the people and places we visited. Everyone who spoke to us gave us a little bit of themselves and gave us insight into their world and for that we are so thankful.
If you would like to discuss the project or have a question, please do get in touch! My email address is firstname.lastname@example.org