Necessity is the mother of ingenuity

This article was first published in The MJ

Plato allegedly wrote, ‘our need will be the real creator’ which has been moulded over time into the English proverb, ‘necessity is the mother of invention’.

As the UK’s public sector responded to the COVID pandemic in 2020, local authorities played a critical role in meeting the extra call on already stretched services. One of the weapons in their armoury was technology and its use showed how they could respond and think in different ways and that ‘necessity became the mother of ingenuity’.

Hampshire CC, for example, co-developed with its care technology partner, PA Consulting and its Argenti programme, an Amazon Web Services (AWS) Connect based solution to support the most vulnerable on its shielded list. In just seven days, a solution (known as the Wellbeing Automated Service, or WACS for short) using automated services and artificial intelligence (AI) to supplement familiar technology such as the telephone, was developed to help the council prioritise those who needed help the most. Automated calls were made to those shielding. The AI then determined whether someone needed help urgently based on their responses to a small number of questions. Once live, over 53,000 people were contacted via more than 200,000 calls. Critically 4,000 residents with urgent needs accessed medication and emergency food supplies. Hampshire CC estimated it would have taken 280 days for their traditional contact centre to make these calls – the system was able to make them as fast as the council was able to respond to the responses.

Given that the technology had helped solve an immediate problem, it would have been easy to have stopped there. However, that ingenuity is now part of ‘business as usual’ for Hampshire’s Adults’ Health and Care Directorate.

Hampshire CC is now focusing its efforts on those requiring their statutory annual care package reviews. Like many authorities, they have a backlog that needs addressing to reduce the pressures on the council but also the wider health economy.

In response, Hampshire CC is now adopting the same core AWS technologies to help with the reviews process, to complete care reviews in the required timeframes. Unsurprisingly, this has been labelled the Reviews Automated Call Services (RACS).

Under this system, a service user or their representative receives a phone call, SMS text message, email or letter with guidance, a phone number to call and/or a link to an online form asking three to four key questions. Importantly each service user is approached in the most appropriate way for them. Depending on the responses to the questions posed, if there are no changes or issues, then this will be recorded as a review on their records. Any reviews where an issue is identified, or if the person wants to speak to a social worker, they will be allocated a traditional appointment.

The solution, which has been piloted with a group of twenty people living with learning disabilities (LD), has shown great results.

Within just three weeks, approximately 50% of those contacted used the service, with web being the preferred form of communication. Just three individuals needed a face-to-face review. And 100 per cent of those who responded to the request for feedback said they would use it again with comments such as, ‘Nervous to begin with; when completing it found it to be straight forward and stress-free’ and, ‘Always a nervous experience with reviews. But found it nice and easy to follow’ received.

How to adopt ingenuity as business as usual

There are three key lessons to draw from Hampshire CC’s experience.

Think big, start small, scale fast

In responding to the pandemic, WACS was developed knowing that the numbers on the shielding list were growing month on month. The first week piloted the solution with just seven test calls, which increased to 20 per day, then to 20 per hour to eventually 2,500 per day resulting in over 200,000 calls. For RACS, the initial pilot was conducted with the LD cohort, but the council has clear plans to adopt it more widely in 2023. This will involve different cohorts, notably those with physical disabilities and older people, before making it the mainstream approach in LD (approximately 120 individuals). The plan is to have all main care groups using the automated service by May 2023, starting with the 14,000 individuals who are currently receiving a technology enabled care service.

Co-design is essential

Co-design should not only involve social workers, service users and their carers but also a variety of different disciplines such as wider operational, data analytical, communications, legal and social media staff. In developing both WACS and RACS, feedback from service users has been critical to continuous improvement within the solution.

Always ask, what next?

Finally, getting ingenuity right means recognising that it is never over and done with. This makes it essential always to keep an eye on what’s next. This ensures solutions don’t just serve one purpose and if developed correctly can rapidly be adapted to meet other challenges. For Hampshire this meant that a process invented out of necessity in the pandemic could quickly and easily be refined to automate the reviews process.

Technology was being used by Hampshire and other local authorities before the pandemic; the Covid experience led to an acceleration of new technology not before deployed. As we emerge from the COVID pandemic, there now exists a very real opportunity for local authorities to use this technology in a transformative way to deliver care to their residents in new ways.