Getting resourced - Policy, funding and planning

The home of the future will be full of things that are IP enabled – fridges, cooker, tablets, energy monitoring, mobile, home health hub, cctv, remote access control. What kind of kit you provide in the home becomes less crucial as individuals use their own devices, but rely on connectivity.

IP will transform the way information is provided and the speed information moves around. It offers a world of opportunity, but it is important to work with a provider who understands issues around resilience, connectivity, safety, privacy and reliability.

So in summary, why is IP good?

• It’s always on – it works 24 hrs a day seamlessly unlike analogue which requires dialling
• It handles voice and data on the same network – something not possible with traditional analogue telephony systems
• It’s fast – the data transmission speed is vastly improved and is virtually instantaneous
• It’s adaptable – you can access and create a whole host of new services previously unavailable combined to meet your particular requirements

A fundamental long standing concern for commissioners is that technology becomes obsolete as soon as it has been installed. It is important to address this so that you can recoup the capital expenditure and demonstrate value.

There are two elements to consider

• Plumbing (capital) - The fabric/infrastructure of the building – this is not likely to change rapidly and makes it a good value for money investment. For example Cat 6 cabling seems to have a fairly long timespan.
• Personalised technology (revenue) – equipment and services personalised to the individual, for example easy to use apps on tablets provided. This may be a device you already own, so connectivity to an existing infrastructure is key

So if we are designing and building technology-enabled housing for the future, it’s firmly about getting the plumbing right (the infrastructure) and not the gadgetry that you hang off it.

Flexibility in funding options is key here – a mix of leasing, capital, revenue and self-funders. If the idea is strong enough and the evidence is there to back you up, the money is found – so it comes around to making the business case.

Further work is needed to shape clarity around infrastructure/plumbing and the range of products and services personalised to the individual. For example it may not be essential that a particular service need to be available 24/7 - there are different levels.

What type of technologies are the components are we looking to put into these facilities going forward 

• The NHBC Foundation (opens new window) described the Connected Home basic features as
  • Home working
  • Voice and video telecommunications
  • Home entertainment
  • Smart meters and energy display devices
  • Basic lighting controls
  • Heating system controls
  • Automatic storage of locally generated energy
  • Assisted living
  • Fire and security systems
  • Low voltage DC outlets
• This survey report, Fast forward to digital care: Why digital tops housing providers' agenda (opens new window), highlights how retirement housing providers are looking to move from analogue to digital.

Useful information

• Connect Councils: A digital vision of local government in 2025 (opens new window)
  This report by NESTA outlines the opportunities that digital technologies offer local authorities to deliver better outcomes for residents, businesses and communities. It sets out a vision where council might be in 2025 and the extent to which digitalisations still needs to take place to transform their services, including reference to better networked care and support and access to information to enable people to self manage their conditions.
• The Impact of Analogue to Digital Migration on Technology Enabled Care
  This TSA paper provides a set of actions that will aid in the protection of services and service users as part of the digital switchover. The TSA is recommending that service providers take urgent action to review the impact on their older networked alarm services of the transition to digital telecommunications infrastructure across the UK. The paper highlights key action points, identifying how to mitigate against risk, what organisations should be testing and what next steps to take.

It’s important to put your technology infrastructure costings in, right at the outset as well as the more obvious ongoing connectivity costs. The capital funding pays for all the wiring and components and due to its longevity, will pay for itself over the lifespan of the building. You then potentially have a partner that takes on the management and maintenance and they take the full lifetime risk of the building. So it bridges the gap of obsolescence, and when it comes to replacement, tries to deal with the advances of technology but its driven largely by the structure of the deal from the start.

It makes sense to invest in the right plumbing/infrastructure, which is a small proportion of the overall cost, but we do understand that as a developer and a commissioner, public sector affordability is a barrier.

The strategy for your service should be to look at the ‘end-to-end’ service and work out the delivery model that is the most cost effective for your organisation. Buying individual ad hoc products and services from different organisations (eg service from one place, monitoring from another, response from another) could make it a costly exercise. Advice can be sought from providers.

The costs for digital infrastructure and connectivity will potentially become another element of the service charge just like the provision of a lift.

Enhanced connectivity for residents also ensures that provider staff have all the required infrastructure to allow the benefits of mobile working such as immediate access to data and paperless working.

It is important to measure the return on investment not just in terms of a single provider but across the whole of the care system. In many cases this is around improving the broad social determinants of health as well as the gains to the individual users and providers.

Useful resource

• AKTIVE (Advancing Knowledge of Telecare for Independence and Vitality in later lifE: The evolving UK market for telecare (opens new window)
• Business case for digital investment (opens new window)

Useful evidence

• The value of digital inclusion (opens new window)
  This survey has estimated the value of digital inclusion for a new user as £1,064 per annum. This comes from having more confidence, making financial savings online, less boredom, opportunities to pursue hobbies, new job seeking skills, and a reduction in social isolation.

 

All this is easy in a new build situation; for example, M&E plans in general needs or specialised housing, but there are lots of refurbishments/remodelling, such as sheltered housing, taking place that are reusing wiring and replacing like with like. However, if it’s deemed the right thing to do, fundamentally the capital funding should be found.

If you are constructing a building, the capital cost for the right infrastructure is pretty minor, to do it afterwards is obviously more expensive.

In building refurbishment scenarios, it may be more cost effective to provide Wi-Fi to each dwelling rather than a direct Cat 6 cable connection.

Useful resource

• Is housing really ready to go digital? A manifesto for change (opens new window)
  This Housing Associations' Charitable Trust (HACT) report finds the UK housing sector to be stuck in a technology rut.

Customers are increasingly demanding access to digital services and we are at the advent of the digital enabled patient. However digital architecture as a requirement in local plans doesn’t exist – so why would directors include this in planning guidelines?

Whilst central government is backing off compulsory standards, Local Authorities now have the permission to adopt things in addition to access requirement in building regulations for new residential dwellings eg to Lifetime Homes Standards, HAPPI, wheelchair housing design. If the LA puts digital into their local plans, and as long as they have consulted with the sector those can be adopted locally over and above the building regulations

Currently, we are seeing three driving forces for including digital:

• Market shaping – the need to build housing that is “care ready” and provide a better offer to customers – current leadership is by private retirement housing developers
• Condition of the capital grant – where public grants are available, such as the HCA’s (or GLA in London) Affordable Housing Programmes, a minimum requirement, alongside expectations for a range of utilities, clean water etc. The recent NHS England learning disability housing capital grants received a great deal of bids including a range of assistive technology. There is a need to bring this learning together and share
• Planned care approach – providing support to existing people in the system but the need to find more efficient use of resources

Top tip

Adult social care directors should be having meaningful dialogue with their provider partners around their digital strategies to meet the infrastructure needs going forward. Most are operating in analogue and specifications are still coming out which include pull cords and speech modules. There is an ambition to move to digital and this resource should get the conversation going to link into future commissioning and procurement strategies. Investment decisions with the HCA and GLA might want to demonstrate that when the bid comes in you have information here that social services has talked to housing and there’s going to be good reasons to start shift the thinking. 

Good quality housing is all about making maintenance as easy as possible with the least disturbance to residents.

There is a need for good clear accessibility for maintenance, service ducts on the outside, make sure the design gives service struts on the corridor facing walls, so that electrics, wiring, heating and maintenance doesn’t disturb the residents.

In the digital world, there is also the ability to diagnose issues quicker and provide “over the air” fixes and software updates.

Digital technology has a key role to play in implementing the statutory requirements of the Care Act 2014 in particular how to provide choice, personalised and preventative care, market shaping and supporting carers.

Marketing shaping is activity to understand your local market of care providers and stimulate a diverse range of care and support services to ensure that people and their carers have choice over how their needs are met and that they are able to achieve the things that are important to them. The Care Act 2014 (opens new window) sets out the law around market development in adult social care. It enshrines in legislation duties and responsibilities for market-related issues which include ensuring care is maintained where provider fails financially and services cease. Technology has a role to play in identifying and safeguarding a wide range of individuals.

The Spring budget (2017) brought about much needed cash injection albeit a short-term measure. It is recognised that a long-term, sustainable solution must be found for funding adult social care, and work on a forthcoming Green paper must include funding for appropriate technology in order to ensure thousands of older and disabled people and their families get personal and dignified support.

As funding is reduced and dependency levels increase, prevention is getting squeezed. So this is another way of delivering a prevention service. For example, carers and personal assistants may be ensuring that a person is properly nourished, but if the fridge tells you it hasn’t been opened all day this could be a cause for concern.

Domiciliary care/flexi-care contracts should consider the use of technology in the home and the Transforming Care Programme, moving people with Learning disability from long stay to supported housing, has seen the use of technology as a vital component to independence.

Useful resources

• Digital telephone switchover (opens new window)
  This Research Briefing, available on the House of Commons Library, addresses frequently asked questions about the switch of landline phones to digital services.
• Exploring how technology can be truly integrated into adult social care
  Not enough local authorities or care providers are using available technology within social care to keep people safe, happy and healthy at home, according to the final report of an ADASS/TSA Commission exploring the issue. Launched at the 2021 ITEC conference, the Commission found pockets of best practice but concluded that projects are rarely joined up and turned into intelligence to prevent people reaching a crisis. It is calling on Government to fund a two-year programme of 10 social care innovation projects to begin the process of normalising the use of digital within social care.
• Telecare stakeholder action plan: Preparations for the analogue to digital switchover
  This Department of Health and Social Care action plan describes a range of actions for telecommunications providers, service commissioners and providers (including housing), alarm receiving centres, equipment suppliers and manufacturers, ahead of digital switchover by December 2025.
• UK Digital Strategy (opens new window)
  Digital technologies and data are already helping to achieve the ambitions of Personalised Health and Care 2020 and a paperless NHS and the government will invest £4.2 billion over the next five years in areas such as electronic patient records, apps and wearable devices, telehealth and assistive technologies
• NHS England: Next steps on the NHS Five Year Forward View - Harnessing technology and innovation (opens new window) 
• Housing White paper (opens new window)
  ‘Fixing our broken housing market’ section on technology page 40 - In line with the Government’s strong commitment to achieving full fibre connectivity, we are consulting on requiring local authorities to have planning policies setting out how high quality digital infrastructure will be delivered in their area.
• The LGA housing commission final report Building our homes, communities and future (opens new window) 

The digital agenda forms a central part of the NHS’s Sustainability and Transformation Plans (opens new window) (STPs) and the NHS 2020 vision. The Integrated Better Care Fund and STPs needs to get housing round the table in the delivery of better health and care services. For example, to reduce placements in residential care, improve delivery of home care, avoid hospital admissions or readmissions, enable reablement/intermediate care.

The potential of digital is being recognised throughout the UK, with Informed Health and Care: a digital health and social care strategy for Wales (opens new window), Northern Ireland’s Health and Social Care Board’s eHealth and Care Strategy (opens new window) and Scotland’s Digital Future (opens new window) paper all setting out plans for the increased use of digital technologies in health and social care services.

And in the East of England, the Adult Social Care Digital Network has published a report, Emerging and developing work to digitally enable care across the East that shares useful practice and raise awareness about ongoing work in the digital field.

Examples of practice

Halton Housing Trust is providing a broadband package and a cheap tablet too all. They are going out on a limb to provide the right infrastructure.

Home Group’s ambition is that 90% of our customer interaction to be digital. Making the digital experience so much better and accessible so it’s a channel of choice. We recognise that there will be a number in supported housing who can’t or won’t be able to. This will drive us to make sure the homes have the infrastructure to meet this need.