Technology and Care in 2022

We asked Esme Foxworthy-Bowers, our Facilitator in Scotland, to reflect on 2022. Esme’s Facilitator is in Glasgow, and aims to increase the use of technology in care at home services. She is reviewing and synthesising evidence to support the implementation of a new model developed by Scottish Care.

IMPACT Facilitators work within a local organisation, leading an evidence-informed change project. Through close collaboration, facilitators review the evidence, lead local change and evaluate the effectiveness of the changes that take place. In order to encourage replication across the social care sector, we will share our successful findings and outcomes with others.

What have been your highlights of 2022?

I’ve been working with Baillieston Community Care in Glasgow on technology implementation, with their care at home services. This is working alongside the Scottish Care project of ‘Care Technologists’. The role supports people to access care and helps them use technology as part of their everyday activities. To understand what has been working well or needs improvement, I’ve spoken to some of the people that the Baillieston Care Technologist has been working with. This has been one of my highlights. It has been great to be on the ground as staff and people who use the care-at-home service have learned more about technology.

Working with the Care Technologists has been another highlight for me. The team is so enthusiastic and has been doing fantastic information sharing with me! The project is allowing people who use care-at-home services and staff who provide support to identify the changes they would like to see, and to express their thoughts and opinions.

The number of opportunities for learning during this project has really impressed me. Scotland is currently working to develop a National Care Service. I’ve been in meetings where I have spoken about IMPACT’s work and the Facilitator project with individuals from the National Care Service working groups. The results will help them incorporate the practice knowledge and lived experience evidence into the development of the National Care Service. It would be incredible to see the work from this project used for such a large-scale re-design of care at home.

What have been the challenges this year?

At the beginning of my role, it was difficult to find information about previous technology projects or tests of change in the care at home sector. This prevented me from getting a grasp of what was already being done. I also needed to find out more about technology implementation. Initially, this was harder than I anticipated to navigate. A big part of my job is around evidence-based information ‘brokering’, and there isn’t a lot of information available or published at present.

How have your aspirations for the project/IMPACT changed?

I think now that the groundwork with Baillieston Community Care has been laid, my aspirations have shifted more toward plans for the Facilitator project itself. Personally, I love the information distribution aspect of this job. I want Baillieston Community Care to feel like they have more options, more knowledge, and are more enabled to explore technology in their service by the end of the pilot.

What have you learned so far?

So far, the gap between practice and research has been particularly emphasised. There is not a lot of large-scale research on technology in care at home, and services are often very stretched due to staff shortages and time.

A learning point for me was really emphasised by the equality, diversity and inclusion training that IMPACT staff attended in November 2022. This really highlighted the need for everyone in the system not to be viewed as cogs in a machine. I realised that everyone in a service has their own worries, lives, hopes and happiness to think about every day. I think this notion is consistent with the way that carers and people accessing care view technology. There is not one size that fits all and it is very individual. There is also a real worry that staff will be replaced by technology. Often this worry overshadows the potential for technology to complement care and support.

What are your hopes for next year?

I will be engaging more staff at Baillieston about IMPACT and the Facilitator project. I will also find out what kinds of technology would make a real difference. Through this, I hope I can bring an understanding of the background evidence for using technology in care at home in a way that acknowledges but takes steps to remove the fear that is sometimes present.

I am hopeful that this project can allow staff to work in ways that suit the needs of their role. They will begin to work with technology that’s suited to both them and the people accessing care. I hope the Facilitator project allows multiple organisations to understand their staff and the people that access care. Ultimately, enabling them to design ways of working that suit everyone.

What does success look like?

Success for me is ensuring that Baillieston’s hopes for this project are fulfilled. Baillieston Community Care is hoping to increase staff confidence with technology. They also want to develop case studies that can demonstrate what helps and hinders the use of technology in care at home services. This might identify the need for training in digital skills for example. By working with the Care Technologists this may encourage questions to them, which might alleviate some concerns or difficulties people face which they’re unsure about how to solve.

Conversely, it’s also becoming clear that part of success in a technological context is recognising hesitancy when using technology. Whilst there are benefits to assistive technology and information provision, digital access is about maintaining the right of people to say no to technology. Success in this context means that people benefit from technology if they choose it, and staff feels able to implement and use technology in care at home.

I think importantly, this success comes from the Facilitator contributing to evidence-based practice in this way. I am effectively distributing and encouraging the use of evidence-based practice.

What’s unique about your ‘technology in care’ project?

It’s become clear from my work so far that it is easy to assume that many social care organisations already have technology and technological skills. However, this is not necessarily the case. My hope is that confidence will increase in the future. To do this, I think we need to understand the needs, wants and fears of technology from staff and people accessing care at home.

I feel that there is a real opportunity for the Facilitator project to support this. In the future, I hope we will be able to help people in geographically different areas using technology (especially as social care provision can look very different in remote and rural areas).

Any highlights/stories/surprises you’d like to share?

A real surprise for me has been running focus groups. There have been some productive discussions about what is working and not working in terms of technology and implementation. There have also been success stories and practical knowledge sharing.

I also feel I’ve become a better ‘knowledge broker’. It has been great to experience people coming to me to ask if can share any research relating to technology implementation. This part of the Facilitator role has slotted very well into the social care setting and it feels as if I am providing a useful and relevant role. It is also great learning for the Facilitators of the future after the pilot year!

Direct Payments in 2022

We asked Marie Dunnion, our Facilitator in England, to reflect on 2022. Marie’s Facilitator takes place in Leicester and aims to identify the experiences of direct payments in black and minority ethnic communities.

IMPACT Facilitators work within a local organisation, leading an evidence-informed change project. Through close collaboration, facilitators review the evidence, lead local change and evaluate the effectiveness of the changes that take place. Successful findings and outcomes will then be shared with others for replication across the social care sector.

The Direct Payments Landscape

It feels almost unbelievable that 2022 is drawing to a close, as that means I have been an IMPACT Facilitator at Leicester City Council for almost six months! It seems a good half-way point to pause and reflect on what has been achieved in the first six months and what I wish to achieve over the remaining six months, with the project due for completion in June 2023.

I have become well-versed with the academic side of the project topic, especially as my project uniquely incorporates an academic literature review conducted by the wider IMPACT team. On the other hand, I have also been working hard to embed myself in the working life and culture of Leicester City Council, with an obvious focus on direct payments and learning about the various systems and processes in place. The Facilitator model has made it possible for me to function as a member of Leicester City Council staff, accessing the people and information necessary for me to understand the current direct payments landscape at Leicester City Council.

The Facilitator role has allowed me to explore the experiences of direct payments in Black and Minority Ethnic (BAME) communities, which is crucially what lies at the heart of my project. The highlight of my work has been speaking to people in Leicester’s BAME communities, actively listening to their stories of how direct payments are working for them and/or how the process could be improved. One challenge I have encountered has been finding people to speak to, which reflects the difficulty that Leicester City Council has experienced in obtaining feedback on Direct Payments from BAME communities. However, from those I have spoken to, a lot of what they have said corresponds to the academic literature; for example, they enjoy the improved control and flexibility that direct payments allow them to have over their own care package. This might include hiring a Personal Assistant (PA) who is a friend or family member or selecting a PA who they feel aligns with their ethnic, cultural, and religious values.

Looking Ahead

In 2023, I hope to further explore PA recruitment, especially as Leicester City Council have just launched a PA database, which will include comprehensive information about PAs, for example what languages they speak (relating to peoples’ cultural needs). As the literature has identified a gap in knowledge from the perspective of the PA’s experience, my aspirations are extending towards speaking to PAs where possible. I have also been made aware that some people in BAME communities simply do not know about direct payments, so it would be good to know why this may be and how awareness could be raised.

Since the beginning of my project, I have felt that ‘being successful’ by the end of my time with Leicester City Council will take the form of a collective account of direct payments, comprised of experiences from lots of different BAME communities and representing various areas of adult social care. To achieve this, I will continue to listen to peoples’ stories, such as the one Hashim Duale MBE told me when speaking of the Somali community as an oral society, and sharing the advice, “Give people information in the way that they can best digest that information.” He surprised me with the concept of talking leaflets in audio format – a simple but effective alternative to written materials. This is just one example of how peoples’ stories can be used to inform new practices within Leicester City Council; I’m looking forward to seeing how this and other evidence is implemented over time.

Decision aids and Dementia in Wales

We asked Leanne Taylor, our Facilitator in Wales, to reflect on 2022. Leanne’s Facilitator is in Ebbw Vale, Wales, and aims to introduce a decision-aid tool about support for family carers of people with dementia at end of life.

IMPACT Facilitators work within a local organisation, leading an evidence-informed change project. Through close collaboration, facilitators review the evidence, lead local change and evaluate the effectiveness of the changes that take place. Successful findings and outcomes will then be shared with others for replication across the social care sector.

What have been your highlights of 2022?

The developing relationship with the CARIAD (Care And Respect In Advanced Dementia) service within Hospice of the Valleys and the wider hospice has been a clear highlight for me. The rapport with the CARIAD service has been easy to form and they have been super welcoming of my role and my presence. It has been easy to ‘slot’ into the team and be treated like a fellow team member who is included in routine internal meetings and updates. They have always been willing to find dedicated time to discuss the project I am introducing to their service and the surrounding evidence base.

From the outset, it was clear to me that they wanted to be accommodating and supportive of the role. Cariad’s initial curiosity about the facilitator role and its purpose was encouraging and led to many insightful, unplanned, and in-depth ‘corridor’ discussions where I was able to gain deep learning about their aims, purpose, practice, challenges, and underlying values. My growing insight in this regard has allowed me to present my work and ideas in thoughtful and sensitive ways that are considerate of the service and its surrounding context.

What have been the challenges this year?

Untangling the knowledge exchange role has been important to understand what it means in the hospice setting and its value. On paper, it reads easily as “supporting the hospice and staff in their practice of carers of people living with dementia, nearing the end of life”. However, working in a setting where staff have a plethora of knowledge and past practice experience that guides their everyday practice, has meant I’ve been privy to a collective work ethic that is person-centered, bespoke, and dynamic, where practice and decisions occur “on your feet”. It’s therefore been a challenge to master the introduction of new and different knowledge in this context; doing so has meant encouraging a pressured and relatively small staff team to make time to reflect, think and plan new ways of working.

We are working with a specific decision aid too and in addition to scoping out how the tool would sit in other parts of the hospice, I, with the support of the CARIAD staff, am looking at how the tool can be used, presented, and re-framed to complement the service’s strong identity.

How have your aspirations for the project/IMPACT changed?

I am not sure that they have changed. When I started the role, I was excited about bringing lived experience, practice knowledge and research and evidence into closer contact and more explicit communion, and I am still very passionate about how the Facilitator model can support this process. If anything has changed for me, it has been about how I operationalise the project. Initially, I wanted to gain insight by encountering and supporting a range of staff members, carers, dialogues, and stories. However, the real-world pressures that carers and staff members experience mean that opportunities to reflect, analyse and participate in purposeful collective learning are thin. This means that I have needed to look for depth rather than quantity, where I capitalise on the rich and deep lessons present in the small number of case studies and discussions that my work is supporting, and where I can think about how these lessons can interact with my background research and reading to be made meaningful for the hospice and IMPACT.

What have you learned so far?

I have gained insight into the dementia and care setting in Wales, its strategic priorities and ways of working. I have also learnt about dementia, the challenges that carers confront, and the many national activities and interventions that are taking place to support these groups and tackle their challenges.

In terms of my practice, I have had to learn about and work with real-time experimentation and learning. I have needed to deal with the feeling of working with a model as it develops which is exciting but a little scary!

What are your hopes for next year?

From my perspective, it would be great for the staff teams and individuals I am working with to engage with the experience of trialing new evidence in practice. I am looking forward to seeing what comes of the process; the creativity that can be revealed and harnessed when reflecting on real-time learning and practice. I also hope that these experiences encourage ongoing curiosity and learning within the hospice, long after my tenure.

What does success look like?

My idea of success mirrors that of the hospice. While every voice in this knowledge-sharing process matters, the voices of those with lived experience need to be heard loudly and clearly, and in this case, that is the voice of carers. The Welsh Facilitator project will be successful if carers and staff feel that their needs, ideas, and challenges, have been engaged with, understood, and addressed as a result of this process.

What’s unique about your decision aids project?

This project and subject matter are unique because it is addressing end of life planning and care for people with dementia, which has not been considered extensively enough in Welsh and national policy. According to Hospice UK and others, generalist social care services tend to designate end-of-life planning and conversations to “specialist” palliative services, while really, this is a conversation that everyone should be engaging in. The piloting of an evidenced tool that is intended to support carers who are supporting people nearing the end of their lives, and talking about the tool with external, non-specialist services, is perhaps going someway to normalising end-of-life conversations.