Antoine Tooley, founder of Total Care Manager, shares his personal & professional experience of technology in complex care.
Depending on where you work, complex care is either the most interesting, or least interesting part of the care sector.
For policymakers, it’s probably the latter.
It only accounts for around 25% of the sector. This support is divided between hospitals, personal budgets, and mainstream care providers – who are mostly preoccupied with dementia care.
The people concerned, meanwhile, are spread out thinly across electoral boundaries. Complex care may be a £10bn market segment, but it comprises relatively few people in each local authority with very expensive support packages. Unlike with Britain’s ageing population, no one constituency has enough people with complex needs for them to register on the radar of policymakers.
For similar reasons, it’s a minor consideration for most technology companies.
When my brother suffered a stroke 20 years ago, as a family, we started looking around for care management software that could support high-risk ventilated care in a family home. There were care platforms, for sure, but nothing really suitable for our needs. So, I learned how to code and built it myself.
That prototype evolved into what is now Total Care Manager. It’s been an exciting time bringing this software platform to market over the past 2 years, co-creating with early clients, and learning about providers’ experiences with various pieces of technology.
It’s an honour to now be joining the National Care Forum’s partner community. By way of saying “hello”, I wanted to share what I hope will be some useful observations from my dual perspective as a care professional and a technology vendor – and hopefully catch the attention of any providers who might have a need for our complex care software in their organisations.
What’s different about complex care?
Technology firms, by their nature, do not build for edge-cases. In order to scale affordably, a technology company will seek to solve the common needs of the largest share of the market. Then, in order to keep growing, they continue to develop around those most common needs.
As a result, all the major care platforms available in the UK work well for the core use-cases of high-volume dementia care. They also solve a lot of the other needs of a care business which don’t change much from one company to the next: HR, payroll, recruitment etc., and as a result, most care providers find it convenient to run their business on one of these ‘all-in-one’ platforms.
The trouble, of course, is that in the care sector, ‘edge’ cases are ubiquitous. Support needs are as varied as people. Conditions are found in every imaginable combination, and many supported people will see their needs change or accumulate over time.
And so, we’ve consistently found that when a provider has been using a mainstream care platform for more than 2 or 3 years, they’ll say the same thing: “it works OK, we just wish we had better for complex care”.
It’s worth taking a moment to consider what makes complex care different. This would typically comprise some of the following:
- high staff ratios
- larger budgets
- greater financial complexity, and a greater share of Individual Service Funds (ISFs)
- higher risks for supported people, care professionals and care businesses
- greater instances of multimorbidity
- a higher proportion of nursing activities relative to care activities
- greater use of controlled drugs
- greater emphasis on attainment, including through frameworks such as positive behaviour support (PBS)
- vastly greater data volumes, with far more support being planned and reported on.
I don’t need to preach to the care community; clearly, helping to feed, wash and change an elderly person is an entirely different prospect to working with people who may need to be restrained, people who rely on life-supporting machinery, or people whose support plan involves the work of developing life skills.
This is coming to the fore now because progressively more providers are moving into complex care and rightly considering whether they have the tools for the job.
Naturally, most businesses will consider the larger budgets to be desirable, and over time, there are more of these packages available. Advances in medical science, combined with a government push to reduce hospital occupancy in favour of community care, have seen support requests for working-age adults increasing at twice the pace of those for people over 65.
So as the makeup of Britain’s care and support ecosystem evolves, technology approaches that originated nearly 30 years ago are beginning to show strain.
The limitations of legacy tech in the care sector
Of course, few care businesses can easily replace their existing technology, and so I am not campaigning for all of Britain’s providers to tear up their contracts. Most existing care tech does quite a good job for most care businesses.
But nor should the client of any company, tech firm or otherwise, be expected to sit and wait for changes that are holding their businesses back, potentially causing other problems downstream or even putting people at risk.
We recently met with the head of a complex care division of a large, national care provider, who were using one of the best-known care tech platforms in the market. In the space of a 30-minute conversation, we calculated that this one service, with 15 supported individuals, was losing £50,000 in back-office time every year, working around the limitations of their legacy technology.
We’ve spoken to multiple providers who have requests outstanding with their care tech providers for months or even years, waiting for them to adjust the technology to the nature of their business or to individuals’ support needs.
And for all the technological progress in the care sector, paper is proving difficult to get rid of. While some celebrate the milestone of 80% adoption of Digital Social Care Records (DSCR), still 8,000 care businesses – supporting 10% of the UK’s supported population – are stuck on paper notes. Others may be using Excel-based systems, which lend some benefit as digital workarounds, but are a major cybersecurity risk, consume nearly as much team time as paper, and lend no benefits in insights that can improve service delivery, safety and care outcomes.
Terrifyingly, people with learning disabilities are twice as likely to suffer an avoidable death compared to the general population. This problem has a lot of contributing factors, but a recent paper published by Aston University found that one major challenge was communication across the complex care ecosystem, and making sure that stakeholders in person’s support have the right data to hand.
A quick look at the DSCR figures shows that small providers are far less likely to have moved onto care planning software. In our experience, these are more likely to be complex care specialists, rehabilitation facilities, supported living sites and ‘micro-providers’ who support the most vulnerable people in society. Many, as my family and I found with my brother’s support needs, found the available technology simply wasn’t up to scratch.
Nor is this problem limited to the care side of the business; in many cases, providers’ financial management approaches are unfit for purpose.
Ross Barrie of Andor Cards, a prepaid cards and management platform, gives the example of an 80-bed residential care home where he managed to deliver annual savings of approximately £170,000 to a by moving their cash-based resident money management processes into their SaaS-based system. This cut workload across cash handling, paperwork, manual reconciliation, invoicing and auditing, and allowed more staff budget to be shifted towards supporting residents.
Ross said, “The cash savings are crucial but there’s more to it than that. Having the right tech in place means that everyone – the provider, the residents’ family, etc. – can see exactly where the money is going and know that resources are being used efficiently. It’s about reinforcing trust, letting the tech take care of the money so that people can focus on the care.”
Neither legacy technology providers not support providers are to blame for the challenges the sector is now experiencing; rather, the role they’ve played in the rapid digitalisation of this sector is laudable. Without this baseline of transformation, many of the problems the sector is now seeking to solve may have remained prohibitively out of reach.
Nor can any tech platform realistically propose to be all things to all clients; it’s simply not a viable way to run a technology business.
Yet as complex care occupies a greater share of the landscape, and as technology nears the point of ubiquity, the need to get the right tech into the right corners of the care sector is becoming impossible to ignore.
Building a care tech stack around your needs
In many industries, companies now widely integrate best-in-class software from different vendors to achieve the best possible setup for their business.
One of the most obvious examples of this in action is Sona, a workforce management vendor which doesn’t offer care planning software, and yet in only a few years has become a leading technology vendor to the care sector. Other widely-used tools in the workforce management category include Worforce.com, Alpaka and various others.
Similarly, compliance has now evolved into its own software category. Radar Healthcare, CQS and InvictIQ all offer dedicated compliance platforms, while Care Research’s technology helps providers collect the data they need for CQC audits.
Each of these solutions has its strengths and specialisms. The point is, for a decade or more, all these capabilities have been offered by mainstream care management platforms – yet care providers are motivated to shop around and integrate new solutions that make their businesses work better.
A lot of providers we speak to, particularly those shopping around for their first care tech, say they don’t want multiple contracts with multiple technology suppliers. This is understandable; “going digital” can be a leap in and of itself, and no technology stack is ever set in stone. It’s best to get something that works and build from there.
But larger or more mature care businesses, especially those with retained IT support, should be periodically looking at their technology setup, listing their top five challenges, and shortlisting the fastest ways to solve each one.
In many cases, acquiring new tech will be the way to go.
Improve your complex care setup with Total Care Manager
If you’re interested in better technology for complex care, get in touch with Total Care Manager and we’ll gladly see how we can help.
Our system combines the clinical precision and safety of hospital systems, with the holistic support valued by people living with long-term conditions, helping to plan activities, hobbies, support goals and outcomes.
Care professionals, meanwhile, value our user-friendly design. We can train up care professionals in just 30 minutes, and our modern, intuitive app design makes support planning a breeze.
We provide a very effective standalone solution for small care providers and self-directed support. For larger providers, we can integrate easily with your existing technology to help you gain greater capabilities around complex care.
Thanks to our modern system design, you can easily connect your existing tech – such as case management, payroll and HR software – via our secure API. This allows you to quickly upgrade your care planning capabilities, with minimal disruption to the wider organisation.
Visit TotalCareManager.com or contact us here to find out more.
