Gloucestershire - Case Study

Gloucestershire County Council, in conjunction with its commissioning partners, the Gloucestershire Clinical Commissioning Group (GCCG), has implemented an innovative Electronic Call Monitoring (ECM) system designed for disability services (including mental health, physical and learning disabilities) from CM (now Access CM).  

While monitoring systems have been used within domiciliary care for well over a decade, Gloucestershire is the first authority in the country to extend the quality benefits and efficiency savings delivered by Electronic Call Monitoring to people with disabilities. 

This has been possible due to system developments that reflect the complexities of support in shared accommodation. The solution can monitor a range of different support types, including one-to-one support, shared support and waking nights. 

The system now delivers both significant cashable savings of up to £1 million per annum by paying Providers for the actual support delivered, and also ensures that Clients are getting the right care at the right time by a consistent Support Worker. 

Benefits at a glance

• More control over externally delivered care - pilot project identified 7-10% under-delivery of commissioned support. This time / money can now be reinvested in the service.
• Significant savings – paying for actual service delivery has already delivered savings of £1 million. 
• Increased visibility of actual service delivery – wealth of data bringing new levels of transparency in shared care and one-to-one situations. 
• Improved management information – business intelligence to ensure KPIs are met.
• Less administration – no need for form filling or timesheets.
• Reduced risk of support not taking place when planned - through effective use of real-time alerts.     

Drivers for change 

The well-publicised strain on social care budgets across the country has led to extensive creative thinking by the Gloucestershire Commissioning Partnership, in particular the commissioning practices adopted for externally provided community support. 

With increased demand on public services and an already stretched and reducing budget, the Council and CCG had to find new ways to deliver ‘more for less’, so that an increased number of people could receive the support they need.  

Community support services for adults with disabilities in the county has an annual budget of £22 million. Before implementing CM solutions, payment for services was made to each Provider upon receipt of a hard-copy invoice, with no way of confirming the level of support delivered.

Pilots confirm tangible benefits

The Council undertook two pilots to check proof of concept. These highlighted under-delivery of commissioned support in the region of 7-10%, confirming the potential to save money that could be re-invested in the service.   

Lessons learnt during the pilots informed the development of the product specification used in the subsequent tender process. Following a successful bid, CM was awarded the contract to provide monitoring as well as the powerful payment tool, CM Finance Manager. 

Bringing Providers along the journey 

The Council and CCG recognised that implementing a monitoring system would require behavioural change from Providers. They invited a small group to be involved in the pilots to ensure maximum understanding and collaboration.

This helped reduce apprehensions and gave Providers the opportunity early on to see how the new technology would complement and streamline working practices in both support delivery and administration. Providers had the chance to give feedback, which helped shape the final specification and included a user-friendly login procedure.  

Valuable service insight 

Using unique freephone numbers for each Support Worker and PINs to identify support locations and Clients, it is easy for the service to be recorded day and night. 

The Council and Providers now have a wealth of information including: 

• visit start / end / duration
• the Support Worker delivering support
• the Client receiving support
• continuity of Support Worker
• delivery of shared support
• assurance that Support Workers are awake during waking nights
• alerts if support does not take place when planned
• warnings if Support Workers feel vulnerable or at risk whilst on shift.

Financial benefits

ECM enables the Council to pay on the basis of actual support delivered, allowing a re-focus of any savings made into delivering additional support where needed. During the first 11 months of the phased implementation, savings in excess of £500,000 were achieved.

After the system was embedded and appropriately monitored, savings increased to £1 million and have maintained that level since that time. The Council and Clinical Commissioning Group believe ECM will continue to generate long-term savings.

Increased quality

Access CM delivers full service transparency to both the Council, CCG and Provider.  Providers can tailor the support they deliver based on individual Client need. The system is able to record continuity of Support Worker, which is crucial to a high-quality support provision, particularly in situations where a client has specific communication or behavioural needs. Being able to see which staff visit a Client most means the Provider can plan to ensure Clients are receiving the best possible support. 

All partners benefit from a suite of real-time alerts, which provide the safeguarding protection recommended by the Health and Safety Executive (HSE). These are a particularly important feature of the system and protect:

• vulnerable Clients (ensuring that their Support Workers turn up on time)
• Lone Workers working in the community (ensuring they get to their next call and home safely)
• staff providing support to Clients with behaviours that challenge (by providing them with a panic alarm, should they believe they are at risk).

The system has enabled Providers to change their working behaviours by prioritising safety, with the added peace of mind that they are meeting their duty of care obligations.

The quality indicators allow the Council and CCG to commission on both price and quality factors, rather than just price alone. CM has brought quality into the ‘value for money’ equation.

Less administration 

By reducing reliance on the previous paper-based system, Support Workers have changed their working practices in the way they record information (such as their attendance, as well as some Client information). As a result, there has been a significant reduction in administration time and staff now spend more of their valuable time delivering support to Clients, rather than filling out timesheets and forms. 

Improved management information 

CM (Access CM) has given Providers access to intelligence that can help them deliver a better service to Clients. Reports are readily available that show service delivery data such as visit punctuality, duration, over / under-delivery of support and more. 

The intelligence provided by the CM solutions have helped the Council and CCG to further inform working practices. For example, one of the available reports details visits that have been logged remotely; this may be for a number of reasons, such as the Support Worker being unable to enter the property or the visit being refused.

Since the implementation of ECM, the Council has been able to recognise trends and report them to the relevant social work team for investigation and resolution. Ultimately, this means that Clients are not going without the support needed and resources are not committed where support is no longer required; ECM allows these scenarios to be highlighted in a way that was not previously possible.

The Council has a dedicated ECM Officer, who is responsible for monitoring data against KPIs that have been included in Provider contracts. These KPI targets were agreed in conjunction with a Provider focus group and include items such as system usage compliance, staff punctuality and consistency.

The Officer is also responsible for ensuring the appropriate utilisation of this information by social work teams, to inform the assessment and support planning process, as well as aid in any safeguarding or quality investigations where appropriate.

Transparency of information for disabled people and family carers 

By involving Clients in the implementation of the system, the Council and CCG ensured that they would have a better understanding of the support they are entitled to, as well as increased transparency of the support that is commissioned. This knowledge-sharing had such a positive effect that the Council is extending the information that is available to citizens through further use of CM technology.  

Extending the system to monitor outcomes 

Gloucestershire County Council and the CCG remain committed to ensuring Clients receive the support they are entitled to, promoting long-term wellbeing and enabling them to stay in their homes for as long as possible. They will shortly be implementing CM’s Outcomes Module, which will provide vital information on Clients’ wellbeing and progress towards their social and health goals.  

The module uses data recorded from a wide range of assessment methodologies (such as STAR, ASCOT etc.) to determine a Client’s wellbeing and has been designed to demonstrate periods of decline. This will enable Providers to intervene while the episode is still happening, rather than when it has finished, which is often too late. It will allow Providers to tailor support around individuals’ needs, thereby improving their support journey and outcomes as a result.