Thursday 28 March 2013

Holly Lodge Design: the challenges!

Due to the specialist nature of the design, the whole design project team: mcch’s housing team, architect, designers and the contractor, encountered challenges from day one. They worked closely with the support teams, families and specialists, asking many questions in order to really understand what needed to be achieved.  This design project team met on a regular basis to build up an understanding of the likely triggers, scenarios and behaviours of the prospective tenants so that they could develop a building specification which would ensure that the ultimate design would meet the needs of the known individuals and would aid and enhance how they would be supported and also keep the support team safe. They met with the support teams and families over many months and also visited other schemes to understand what was and wasn’t working well in those environments. They spent hours researching and sourcing materials to ensure they found exactly what they wanted to create the right environment.  As the support teams are not “techies” they have also had a steep learning curve understanding some of what is possible from a technical point of view. Ideas have had to be turned into reality, so team work and good communication across the whole project has been vital from the outset. 

on site in March 2013

Balance has been a recurring theme throughout the design and build. We wanted to create homes and not environments that were clinical. When visiting some other schemes we noticed they often appeared sparse and institutional. We knew that many of the materials that they had to use for practical and safety purposes would not help with this aim, so they counteracted some of this with curved walls, mood lighting and colour which, overall, created a softer and more homely ambiance. Mcch were also mindful about getting the balance right when it came to ‘future-proofing’ the properties. Although they wanted to provide for the individuals known to be moving in, they did not want to create anything too bespoke so that the properties could not be useful to future tenants. One of the ways they have achieved this is by constructing non structural walls which can be moved without affecting the overall construction.

Curved non structural internal walls will help to reduce incidents of self harming and generally soften the environment.

Long term maintenance costs have also been considered all the way through the design and build as mcch do not want their tenants to have to pay high service charges. Designing with this in mind, such as super insulating the properties, low energy lighting to name but a few,  has enabled mcch to keep these costs to a minimum. To reduce disruption to the tenants when repairs and maintenance are due, most services are accessible from outside. For example, there is external access to kitchen sinks, wcs, baths and wash-hand basins in case of blockages or problems with the supplies. Underfloor heating controls and isolation switches for the electrics are in the external cupboards. 

External access to services reduces disruption to tenants

The scheme will achieve Code 3 for sustainable construction (Code is a single national standard to guide industry in the design and construction of sustainable homes. Rating range from 1 -6).

The Secured by Design officer is very interested in the scheme and mcch and the design team are working with them as some of the principles are somewhat different to a general needs development.  The SBD awards consider the standards of physical security and use of natural surveillance and defensible space and acknowledge high levels of security and safety at awarded sites. Having to balance security with safety for tenants, staff and the local community, is proving to be a challenge for the SBD officer as they too have to understand how the scheme will be run.


Monday 18 March 2013

People, Personalisation and Telecare

Last month I spoke, on behalf of the Housing & Support Alliance, at Sitra’s Annual conference and agreed to blog my presentation, so here goes!

The title of the conference was Innovating for Efficiency. Although Telecare can and does bring efficiencies, the theme of my presentation was about the role of people in Telecare. I have seen and heard enough to know that if we want efficiencies (monetary or otherwise) from telecare then we have to pay special attention to the roles of people within that process. So, my emphasis was very much on practical issues; the realities of frontline practice, and the importance of the relationship between people and technology. 


As this is a blog you don’t get the benefit of the anecdotes, but the presentation is available online, more about the conference can be accessed here, and you can, of course, contact me if you would like some training!

I spoke about a number of the keys barriers to Telecare working efficiently and being taken up more widely. These include:

  • Pinpointing desired outcomes
  • Ensuring assessments are relevant and personalised
  • Lack of understanding about what equipment is available and how it can be used
  • Fears around staff roles, responsibilities and changes to the way people are supported, including fear of social isolation
  • Lack of training and ongoing support
Desired Outcomes
Firstly we need to decide what it is that we actually want to achieve. That sounds obvious and simple, but so many people are given equipment because it is available or practitioners are being told to include equipment within assessments but with no clear idea about what they want to achieve.

So, some outcomes may be:

  • create a safer environment
  • protect the building / environment
  • give someone greater control, independence and confidence
  • (Self) manage conditions
  • keep someone at home for longer (reduce hospital/care home stay/admission)
  • assist carers to provide more reliable support or less intrusive support
Personalisation and assessments
In terms of personalisation, we are all now familiar with the concept and, for the most part, we are providing support which is personalised to the individual in terms of their needs, wants and aspirations. However, I’m not convinced that we are doing this when we think about telecare.

Assessors need to spend time understanding the person’s needs and way of living. Think about how the individual and their staff will use the equipment. We will not achieve any efficiencies or decent outcomes if equipment doesn’t fit someone’s needs and lifestyle. Equipment should work with care arrangements to enhance support rather than replace it.

What equipment is available?
Almost anything you need or want!

There are many pieces of equipment with the same name that work differently so it’s important to ask questions, source from the whole of the market and remember that one size does not fit all!

On the powerpoint presentation I showed examples of three flood detectors: the first needs to get wet before it signals that there is a flood, the second signals that the water has reached the overflow in a sink or bath and the third signals that the water has reached the overflow and shuts off the water supply.

So, this is just one example to demonstrate that if you limit your procurement to one supplier, or individuals/staff are expected to purchase from a tick list or a catalogue without much explanation, then they could end up with something they don’t want, that doesn’t work properly in the given scenario or environment and certainly doesn’t do anything to increase efficiencies, confidence or provide good support.

Which System?
The same can be said for the system with which the equipment interfaces – panel, pager, mobile phone, website, call centre etc. If a carer needs to respond immediate (for example some is about to abscond and run into the middle of the road) then best to choose a system which provides an immediate response, such a pager for on-site staff, rather than a website based system that you are going to log into periodically! Sounds obvious, but again and again I have heard about or been asked to sort out systems which do not respond in a way which is appropriate to the circumstances. The biggest offenders are suppliers who insist that alerts need to be routed to the mobile phone of the carer in the same home! This costs the user money (mobile phone calls) when a system such as a DECT (cordless) phone or pager could do the same job with no on-going call costs.

Again, if we get this part of the assessment wrong at best we don’t make those efficiencies and at worst we could be putting people in danger.

Information and training
Technology should support the way people live or wish to live and be supported and not replace it, but clearly this isn’t happening in every case.

However, some change is inevitable, and change is scary. Individuals and staff will have to work with the equipment and become responsible for it in different ways. Processes will be needed to report activities, faults and for contingency arrangements in the case of equipment failure. So it will mean change and people need to be supported through that.

In many cases, people have been put off by the “failures” they have encountered. If the only encounter someone has with Telecare is not a good one then they are less likely to advocate for it or engage with it in the future. We need everyone in the process – individuals, their families and professionals to be confident about telecare and other equipment which assists otherwise we are not going to see efficiencies, good support or regular use of technology in the care sector. So, people need to:

  • Understand the intended outcomes and benefits
  • Understand how the equipment works – both its capabilities and limitation
  • Know what to do if it doesn’t work – and the consequences

Resource constraints can lead to training being overlooked or not considered important. Had there been sufficient training for the people I talked about at the conference, then I don’t think I would have had those scenarios to mention, as all, in their different ways, arose due to a lack of understanding in one form or another. Training around technology definitely needs to be considered as an “invest to save” area.

I talked a lot about failure at the conference. In fact, the right technology in the right place for the right reasons can be very effective and I wholeheartedly support the use of technology in these circumstances. I love gadgets and am always excited by the possibilities they can bring! There are many reports and good news case studies available already, so I wanted to provide a slightly different perspective. No figures, hard facts, citations or specific references (which probably annoyed some people) but hopefully experience and commonsense which illustrates that people are the key to success when we start thinking about introducing technology for the people who need some support or reviewing systems which are in place already.

I have been working with colleagues to produce an online Telecare Assessment Tool, which should be ready within the next few weeks (spring 2013). It enables individuals or staff to be guided through an assessment process by asking a number of questions about the potential user. It then suggests a number of pieces of equipment which can then be considered by real human beings before being purchased! It works on all platforms – apple, android, blackberry and pc. There will be a blog about it at some point......