TAPPI Phase 2 - Q&A with Wiltshire Council

Six months after their recruitment as one of the six TAPPI testbeds, Wiltshire Council gives us an update on their project in this short Q&A.

What initial challenges are you facing and how are they / will they be addressed?

Challenges have included :

• Connectivity in a rural county - Wiltshire has areas of drop out and this has had to be considered for upgrading the testbed from analogue to digital, in preparation for the TAPPI pilot. Additional receivers had to be installed in communal areas and outside to ensure that residents had full connectivity when outside their room. 
• Social inclusion - Improved inclusion in communal activities and communities’ events was one of our initial discussions. At the testbed launch residents in the extra care setting said they had hoped for improved connectivity with family and friends and how to connect to the community and opportunities around them using smart tablets and smart phones. Wiltshire Council secured additional funding, as well as research into health and wellbeing apps, and apps to improve Activities in Daily Living (ADL): banking, shopping, GP appointments, Zoom, Facebook and a personal email. We are also hoping to secure and deliver skills training and ongoing workshops to support the resident in their digital know how and confidence.
• Interoperability - How different systems and platforms support each other to gather and report data. This is still an ongoing challenge and we have had to find new ways of working with current governance, new systems and reporting structure.
• Multiple wearables - Several digital care devices use wearables. For example a wrist band or lanyard to collect data from sensors and monitors or they can lend itself as an emergency call button. A person could have multiple digital care devices they have to wear if a person with various health concerns is assessed to need to wear various care technology. We have attempted to combine wrist bands, communicate, and clarify with the resident what wearable is for what monitor/ sensor however we are still learning and adapting.
• Design of TEC - As part of the testbed we are trialling new systems and care technology previously used in a clinical environment. We are engaging with the residents to understand the usability, functionality and how it makes them feel. This is being fed back to the TEC provider and influencing future designs and adaptations for different care markets.
• Communication - The need for effective collaboration and communication across staff, service users and care circle. Roll out dates have changed which has caused frustration for the staff and residents. The challenge is how to ensure the residents have enough information to prepare for care technology but not too much so they are waiting for it to be rolled out when inevitable there are delays for parts, connectivity concerns and training needs.

What specific technologies or solutions are you testing, and what outcomes do you hope to achieve?

• Digital Warden Call Systems | Smart Living Solutions Appello: We are testing its useability and functionality to improve virtual access to other flats in the extra care home, improve response time and effective daily monitoring.
• Hydracare Product - Hydracup | Aquarate: which monitors hydration to reduce falls and hospital admission.
• Various peripherals specific to the care need of the user.
• Strength-based assessment and use of different, need-led TEC. As part of the pilot, we have employed an occupational therapist to support new ways of working; researching TEC assessment and referral, process to order, record and monitor and reassessment.
• Access to the wider community virtually and in person using a tablet device to reduce loneliness.

We are also testing and validating assessments from a health perspective. Surveys and assessment include:

• The Barthel Index (BI) measures the extent to which somebody can function independently and has mobility in their activities of daily living (ADL) i.e. feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, chair transfer, ambulation and stair climbing.
• The Canadian Occupational Performance Measure (COPM), identifies issues of personal importance to the client and detects changes in a client’s self-perception of occupational performance over time.
• The Warwick – Edingburgh Mental Wellbeing scales were developed to enable the measuring of mental wellbeing in general population and the evalaution of projects, programmes and policies which aim to improve mental wellbeing. The 14-item scale WEMWBS has 5 response categories summarised to provide a single score. 

Have you been able to test any of the 10 principles developed during the first phase of TAPPI? Which ones and what results are you seeing?

Co-produced / Outcomes-focused – use of tablets and SMART phones to access the wider community, remotley speak to family and friends and find new ways to improve their confidence by using APPS to supoprt health and wellbeing, shopping, banking and booking GP appointments.

Choice-led – strength-based assessmements and new care technology outside the commissioned items.

Preventative – we hope to see results in this area by using the hydracup and accessing a reduction in hospital admissions. The SMART Living solution also is being tested to encourage daily notification, via the platform, from the resident to confirm how they are feeling.

What initial feedback have you had from tenants and staff as you begin implementation of the project?

Feedback from the Assistant Housing Manager: “Residents are using the smart living solution and have mastered certain aspects of it. It has helped their confidence as they feel connected to the carers and staff. Residents are still learning elements of the platform’s functionality, which will encourage them to be more sociable if they are less mobile. We do need to remind them to use all its functions. This is to be expected."

Staff with handsets find it very useful to improve the response time for an emergency call as the flat number pops on the handset which was not possible before. A care worker commented: “Better than the old analogue system as it tells us where the call is coming from and what flat so we can be more efficient and respond quicker. On the old system, if you missed the message you would have to wait for I to loop again to ensure you captured the full message. Better because it does the job.”

Feedback from Service User: “Now we use the digital smart living solution we have direct access and contact with the warden’s office, it gives us confidence. This was not possible before. I can also see who is at the door before opening, helps me to feel safe and given a choice as to open the door or not.”

Staff Co-production Champion: ‘”I am really looking forward to taking up this role. I believe one of the biggest issues is loneliness and you need to make a choice to make a physical connection, whether that be remotely or face to face. You can broaden your horizons with Technology Enabled Care and just be willing to learn. It will help you grow personally, and you can have a sense of achievement. I hope TEC is a benefit to all, I am happy to help you and will always make time.”

Lindsey Millen, Senior Commissioner, TEC Advisor, Wiltshire Council