- 03 February 2020
- 45 min read
How we can use technology and digital care-planning in care homes and hospitals
In his latest podcast - Episode 10 - Liam talks with Richard Macintyre about technology in care going beyond simply putting paper on a screen. Richard is an experienced quality management professional in care and a consultant.
Topics covered in this podcast
I'm always on the lookout for values-based leaders in social care to interview those who are making a significant contribution to the sector through their work. They're not always the loudest, they don't always have the strongest profile or the strongest online presence. But the more I meet these interesting characters, the more I'm starting to identify patterns of how they describe themselves and their work. And that's helping me to pin to more genuine movers and shakers in the sector. Richard Macintyre proved to be just that, a really fascinating guy combining nursing community health quality and more recently technology. He's a great teacher. I found him really easy to listen to. Apologies where some way through the interview we moved from a video call to recording the call on a mobile phone. I don't think it detracts from the overall quality of the interview, but I just thought I'd give you a heads up there. Without any further ado, I really hope you enjoy this. Richard Macintyre.
Hello everyone. This is Liam Palmer from the Care Quality podcast, Meet The Leaders And Innovators. I'm delighted to welcome Richard Macintyre to this particular episode. Richard is an experienced quality management professional in care and a consultant, and at this present time he has an interest in [CareTech 00:02:44], which he's going to explain a bit later, so a very warm welcome to you Richard.
Thank you very much, Liam. It's good to be invited to take part in this podcast, and I've really been looking forward to giving my view on my journey and also how technology can assist older people particularly, which is one of my interests.
3.04 Changing the dynamic of medicalizing old age
Right, so we've got a little structure, haven't we, Richard just to capture some of your stories, some of your insights, particularly wanting to draw out points about how providers can improve quality, what's out there, and also in some ways to come across how you became the professional you are and where your interests have been drawn from. And I think we've got the makings of a really good story here. So do you want me to start the, Richard, with what you're doing now and what's important to you right now in terms of working in social care?
Yes, thank you. The last three and a half years I've been working for a charity called Friends Of The Elderly, and I was doing a range of products to set up their quality and innovation team there, which included health and safety, learning and development and also quality itself. So that has been a really interesting journey.
And since then, I've set up my own as an innovation, health and social care consultant and I've been working in the digital space with a number of organizations, assisting them with technology, having used my experience over the last three and a half years and also before to assist people. Because as we know, only 22% of the health and social care sector particularly, not the NHS so much, are actually using digital technology to the full. And so that's very important. I mean, we've got something like 5.4 million older people aged 75 plus, and a 1.6 million 85 plus, and that's from Age UK figures. And that number is increasing, as we know, with the demographics.
And so it's important that we use tech to actually help older people to be independent and not be risk averse. So we're going to end up with over 500,000 people being 90 plus, and normally speaking we associate aging with incapacity, and also we medicalize that.
And I think that we need to take away that and actually change that whole dynamic, change that around. It's also about independence more than anything else, and about fulfillment in older life. So that's where I come from. And my journey started when I was a care assistant. I worked in a couple of nursing homes in the south coast.
And you'd have thought that my experience, which wasn't particularly good at that time, would have totally put me off wanting to work in this sector, but it didn't, because one of the things I thoroughly enjoyed was the interaction with the people that I was caring for. And we're talking some time ago now when people who had dementia were actually locked into their chairs and given medication like [lanarol 00:06:04] and Largactil to control them in a way, and I didn't know any different then. I was working in that sector, I was doing what I was told and then I went on to do my resident nurse training and completed that and went on to do several other clinical qualifications in orthopedics and community services, and spent time, about 12 years, in the health service. And then I suddenly discovered something called the social care by the fact that Norman Warner was the director of social services within Kent County Council and there was some piloting going on before the Community Care Act came out. And the Community Care Act of course was delayed for 12 months before that came in.
I did something called home care, which some people may remember, which then translated into changing a home help service into a care service, which was about change management. And that's something else that I have an interest in. It's about change management and making sure that we're getting the very best service to older people. And then I worked for a number of organizations in the charitable sector. So I worked at the Royal British Legion industries at Aylesford, which has just celebrated their hundredth birthday, looking after veterans and working with a number of groups that were homeless in London, and with the [Cosworth Stole Foundation 00:00:07:26], partner to something called the [Ex Service Action On Homelessness 00:07:31] and did really great work up there with others, and back at the ranch, also supporting families who had a range of mental health due to service experience and children who might have learning disabilities. So a whole range of stuff that we did and that supported people better, and before that funding went into mainstream funding within the local authority, which was great fun.
8.00 Using innovation and technology to help older people retain independence
But my main interest is about how we can use innovation and technology to help older people retain independence. And that's really quite an important part of what we do. And we've been doing some work at Friends Of The Elderly in that area and I think it's quite exciting, because it means that some of the work that we've been doing has, within care homes that we're piloting, we reduced the number of falls in one particular home by over 55%. if you think about that and how that translates on to hospital admissions and how to keep people not only safer, we know that from research that has been done, that if somebody has a fall, even at home then they lose confidence and the recovery time each time they fall is actually less. And so then in the end they become very incapacitated and need more care. So it's a really exciting time.
And at the same time at night we've reduced chest infections by 22% down to nothing, which is quite amazing, using this acoustic technology in this particular home that was doing some piloting. And for those with dementia, we've actually reduced episodes of challenging behavior down to nothing. And hospital admissions have reduced by something like 20%, and that is just in one area. So if you scale that up across an organization, you could imagine, well, how not only does that keep people independent, but also it retains the organization, and their relatives how much better they're being looked after. It frees time up for staff because they're not having to be disturbed at night, but also for the organization it keeps those beds full. And that's something that's a bit of a challenge these days because we know that all the care homes are closing due to staffing levels and also not being able to retain registered nurses.
Richard, could I just ask you something?
Yeah, yeah, is that all right? So do you want to maybe explain, I'm thinking for people that don't have any tech at all and you've made some points and some statistics there, which just sound amazing. I'm thinking of, so, some providers are a little bit traditional in their thinking. "We've got paper, we've got this, we've got that, we've got very clear protocols. We've got policies, we've got computers. What more do we need?" Yeah. "How on earth can these results be achieved? We already know what we're doing. We're the professionals." Do you want to maybe explain in some way how one technology applied can actually get these incredible results? Because it seems hard to believe. Yeah, I know it's true, but it's hard to believe for the people that aren't too cognizant of what technology can do.
So if we think about using technology in care home settings, for example, if we're using electronic care planning, what does that actually mean to providers and how can that help? Well, it means several things. It means that all the data that you're collecting is actually in electronic format. So it's digital format, which means it's retrievable very quickly. It's produced in real time. And it's also using national tools. So for example, people in the sector will know things about the MUST tool which is used to detail somebody's nutrition and hydration, and news about the [Forwards 00:11:47] System that they'd be using and there's various ones of those. And there are others that will be used. And later on what will happen is that we'll forget about those particular brand names. What will happen is that, like the [Waterlow Scale 00:00:12:09] and other things for pressure ulcer assessments, we'll be using national tools where the technology will actually take over and machine learning will actually do that for us and give us early warnings.
And that's a real liberating stance for care providers, in so much as what they're actually providing now. And the other good thing about it is that, what we've discovered is that it not only liberates staff time, so allows them to spend more time with residents who need the time and not filling paperwork in, which is great, but also saves time in terms of staffing, so you can deploy staff better for those people that need it most. And a good example there is how we've done the acoustic monitoring at night. We reduce the number of checks at night. The three-hourly checks are down to almost half because those people that would normally have that three-hourly check will be using acoustic monitoring to monitor how they are. So in other words, staff can listen in to what they call "audio clips", and if there's a something that they're not happy about, they can go and check up on the person and make sure they're okay.
13.14 Two examples of technology helping elderly care
And I can give a very good example of that. There was a lady who was experiencing a heart attack. She had the monitoring box in her room. The staff immediately heard what was going on. They immediately rushed to her room, started CPR. They then called the paramedics. She was then immediately taken to hospital after immediate treatment by the paramedics. She spent two days in hospital and then returned to the care home. Now normally speaking, if she'd had a normal call system where the she'd have had to have summoned help, that may not have happened. And I think one of the things, not only has it returned her to the care home where she enjoys living, but her relatives are really, really very happy with that, naturally speaking, because their loved one, their mother, their loved one has been saved by the use of technology. So that's just one example of how technology can help in this incidence, I think that's-
That's a brilliant example. Yeah.
It is. And the other example I can give, a very good example, is when there was gentleman who was being checked regularly every three hours. And because the care home he was in was quite an old building, every time the staff opened the door, it woke him up. But what he did, he faked being asleep. So he made out that he was asleep and he wasn't. And so during the day, he wasn't particularly well, because he was woken up at night.
As soon as the acoustic monitoring box was there and he wasn't being disturbed every three hours, he had a better night and also was able to then have a better day. And the upshot was that one of the incidents was that he actually, when he wasn't asleep, he got up to go to the toilet and had a fall, where with the acoustic monitoring system in place, the staff could hear something and went to his room and assisted him to the toilet. So it was a double edge sword for him. It improved his quality of life and also it saved the lady's life basically. So they're just two examples about how technology can help in that incident.
16.33 Digitizing the care setting isn't simply putting paper structures on a screen
Brilliant. I'm not adding anything to what you said, but just keeping in mind, I'm trying to put across to providers who haven't embraced technology yet, why some of these applications are really significant. Because, I mean, before I knew about some of these applications, I thought of digital care planning as really just paper put on a screen, which to be fair, some of them worked like that 5, 10 years ago. But what you're talking about, the examples you've given, is where the applications are so well designed, they're actually leading to better health outcomes. They're leading to interventions that wouldn't happen otherwise. And I think that's maybe lost in as much as people don't realize that the technology out there can actually help you to run your care home better, no questions asked, to actually [crosstalk 00:16:34].
Yes, and I think you make a very good point there, because when I started out on the journey of digitalization, one of the things I was doing was actually reviewing the care plans that the organization I was working for was using. And it was such a large document that in fact it took staff forever to complete it. And so what I did, I formed a review group and we reduced the amount of paperwork we had and then invited in the tech company to start to digitalize that. Now that doesn't mean to say they're going to take the paper product and reproduce it on a screen. What they were doing was taking the main headings or the evidence from it, and putting it into a digital format, which is what they did.
And that was the basis of moving forward. And that was a bit of a development program that we had that has worked very well and has been enhanced ever since. And I think the other thing to remember with the providers is that they need to make sure that any digital platform they have has a legacy. In other words, it's not what I call ceilings, in other words, once you've got the product, you can't go any further with that, you can't expand it, it doesn't interact with other systems. It must interact with other systems. And certainly the acoustic monitoring system that I've used and the digital care-planning system, they talk to each other, they're part of the same system, you'll be pleased to hear, they're on the same app, and that's quite important.
I think impact of this stuff is just... When you really think it through, like you talked about reducing falls, capturing a heart attack while it's actually going on. I mean, compared to what we've got right now, which is primarily paper, and like you said for night checks, checking every one to three hours according to the protocols in the home, it's just significantly better. I think it's so exciting. I mean, I do apologize because I asked you a question while you were explaining your background a bit. So I don't want to miss any goodies that you had for us when you were explaining. Are you able to go back to where you were?
Yes. So yeah, so I've been working in the sector for about 35 years within various different organizations, some in housing-related support, some in care, some in quality, but I have a particular interest in older people, particularly those who have a mental health condition such as dementia, and also how systems can help with that and improve people's lives and the quality of it, which is quite important to me, about outcomes for people living in the community or actually in a care setting. And also because we know that that society, puts certain pressures on us. In fact older people are viewed as associated with frailty, incapacity, and we've medicalized that, and also a loss of independence, when in fact it's very much the difference. It's a third age. University for example, the way that empowerment and decision-making and action over their lives is quite important, about positive risk-taking also.
And we know that, just touching on tech, we know that people who use Telecare, for example, feel much safer by that, that sits in the background and reduces the admission to hospital. But also it's important that older people are viewed as involvement in their local community, that they have personhood, as Kit would often use to say, that they lead comfortable lives and that there's proper management of chronic conditions when they arise so that people can improve and enjoy the quality of life which they have. And some of the other things that I see as very important with older people in community settings is about reducing the isolation and depression that associates with that.
So if you only speak to an older person in your street to 10 minutes when you meet them, it might be once a week or twice a week, that will reduce their isolation of the whole of that week, because they may not speak to anybody else. And so I think it's part of personhood that we need to reach out and view aging and the journey that we're on as a positive rather than a negative, because we're all going to get there in the end. But I may be talking alone here, but that's how I view it. And I think we've got a wealth of experience in the people that we support in our local communities that needs to be embraced.
No, I mean it's fantastically put, Richard. I wouldn't expect anything less from you, to be fair, but listening to you, there's echoes of Dr. Keren Wilson, the founder of the retirement village movement in the US, and she had a very similar set of values in terms of what you talked about. In terms of moving away from the pure medicalization model and seeing the whole person, actually work out how we can help people to take risks, and a more positive model of aging, in a nutshell. And you've got some really broad experience that's formed that view. Can you put that jigsaw together a little bit? Because I remember when we talked first, prior to the interview, there seemed to be a natural... Because you did some stuff for council and some stuff for commissioning, some stuff for home care and some stuff for nursing, and then a move into quality. And it looked like in retrospect, almost a 360 degree view of learning about how healthcare is delivered, where the gaps are. Do you want to explain that a little bit more? Because I think you put it really well.
22.45 How we're using tech to improve independence and positive risk-taking
Yes. Yeah. And I think also that, yes, I think the third part of this jigsaw for me, apart from how we're using tech to improve independence and positive risk-taking, is about how staff knew that as well. Because we know that for example, I was listening to a very good Sky webinar on the 9th of the month, 9th of December, that Sky were doing about social workers and the use of technology and how the health digital capability framework is going to be adjusted for social work training. Because they discovered that not all social workers can do, for example, Word "track changes", they might use a phone or whatever, and there's a need to make sure that everyone's on board with that.
And also the ethics that go along with professionals using this type of framework, which is just quite important. So the digital capability framework, that is, and how that's linked to the technology space. So we know also that people like Google's DeepMind that I've been involved in, how that's being... DeepMind is part of Google and they've been doing some excellent work with the Royal Free hospital with for example, kidney conditions, kidney transplant conditions, and how analytical work that we have been doing more so in the residential nursing sector, how that's coming from the NHS and how that framework is helping. Because the more analytical stuff that we use, we can then help people remain independent longer. And as I said earlier, just by using technology at night, how we've maintained people's independence and wellbeing during the daytime. Because I do honestly believe that, particularly people who have dementia-type conditions, if you have a good night's sleep, you'll have a good day. And that's what we'd be improving.
We've been capturing data on that and that's very important as well. So there are three sides to this, and as I said, we know that people that wear sensor monitorings in a Kent study, 94 users felt more reassured, out of 100 people that the trials that they were using, because they felt safer using that sort of technology. But the less intrusive it is, because not everyone wants to wear a bracelet, let's face it, the less intrusive it is that maintains people's independence, the better. And I think that's quite important. So they're just examples, really, about how we've done that.
Yeah, that's absolutely brilliantly put. And you've explained that some of the technology is about helping people to stay at home and be safer. Telecare reference really-
Yeah, and there are companies out there that I've been involved in who are using technology as a basis of their home care service. For example, there's one in London that I've been involved in there for a while. And they're using things like Alexa. We know if you watch the television that some of those things are reminding people to take their medication now, and there's quite a good advert now on the television where the gentleman wants to play a particular tune when his male carer comes round. I mean that type of stuff, I think is fantastic, and those simple technologies that we use at home can be applied to all sorts of situations, not only for older people, but for people who have a disability generally speaking. And that's where it all comes from, really. So the future is bright, in my view, for technology and how it can be applied within the care setting.
Yeah, massively. And I think you've got a unique voice there, Richard, with your community-based experience, experience covering mental health, seeing the whole landscape, I suppose, for older people. My background is more with residential homes, but I think it's really helpful to look at it as a continuum. And so whether people are staying at home, whether they're at a residential home, technology intelligently applied can actually improve people's qualities of life, like you said, give a sense of reassurance, it gives a sense of wellbeing and safety. And I think they're really, really positive messages. It's not technology for its own sake, is it? It's technology in order to get better life outcomes for older people, isn't it?
27.17 Using technology to audit
Yes. And I think the other bit about is I've been doing some work with one major company about auditing using technology audit and how that links to, particularly in the world that you would know, in terms of the CQC regulations and how that links to the P lines of inquiry, the KLOEs, and how they can use technology to audit and make sure that you are compliant and how that looks in terms of what are possibly where your inspection will go on the five domains, and how that can be used across the whole group of care homes or care settings. And I think that's quite exciting as well. And in the new year I'm hoping to do a round of regional meetings with this particular organization, to bring together health professionals, to show how we can use tech to actually help with their mock inspections and also with the audit process.
And we know from my own experience how technology has reduced the time and expense when you have to do a quality audit. In other words, before, the quality manager would pitch up at the care home after making an announcement that he was coming or she was coming, they would carry out an audit and then write the report up and then publish it. Now, some of that work can be done off-site at home by going into a dashboard, checking that and then going to site to check that what they see on the screen is actually what's happening in reality. And we've reduced the number of days by over half by doing it this way. And that's quite exciting in terms of...
And getting back to digital care planning, it's not always about saving time and saving staffing. It's about the quality of the outputs that you get from digital systems which is most important, but at the same time being very mindful that if you put rubbish into a system you'll get rubbish out. And that's a management issue. But if you're using audio, for example, if you've got somebody who English isn't their first language, they may have poor writing skills. And so you need to make sure that if they are tapping in stuff into their handset or their handheld devices, that they know that the spell-check is there for them. Or they can speak into the system, which will then input it into the person's care plan. But the positive side of that is that if you have somebody ring up and say, "How's my mother today?" they can instantly look in real time and see how that person is by looking at that device rather than having to go to the main office to look at the data. So there's some real benefits I see in going digital.
And I mean I think you've covered it, but I'm just trying to think about people that are not familiar with using IT platforms apart from running finance or whatever. So for the one that would say, "We've got a brilliantly designed paper care plan. Everyone uses it. It's used properly, it's fit for purpose. We don't need computers to do this." How would you explain the benefits of moving to a well-designed digital care system?
Yeah, I think some of it might be about taking that leap of faith actually. And for me there wasn't a problem with that because we started out doing a pilot. So I think I would say to organizations, your paper systems are probably all right. They're okay, they're compliant. If the regulator's been in and seen them, that's fine. But you might actually want to make it easier for archiving, and easier for access, and easier when you're off site, to have everything on a digital platform so that you could actually see it yourself. So if you're concerned about a particular person's condition, you can actually tap into the care planning and see things on a dashboard and see where your trends are as well. So if your concern's about falls, if your concern's about meds errors, if your concern's about hydration, nutrition, that's all available to you as a manager of that home or as a regional director.
If you've got a large group or even a small group of, say, four or five care homes, you can actually see straight away and you can then target that home and discuss with your team about how you're going to offset that. So you might want to set some KPIs, for example. You might want to say that you want to make sure everyone has so many liters of fluid a day or something. You might want to set those up to [inaudible 00:32:09]. You can do that on a digital platform. You'd have trouble doing that with a paper- driven system. Now you might talk about it, but I think it's the analytical side that I find quite exciting. The trends that you might see, for example. If you know that everyone is falling at a certain time of the day or for example if you've got people who are having some sun-downing syndrome because they're getting tired at the end of the day and they've got a dementia-type condition, it might be that you need to alter your staffing patterns to meet that need.
It might be that if people are awake early in the morning, it might be due to the fact that perhaps the kitchen staff come in and all start planking around that's waking people up. You might not know that unless you have an acoustic monitoring system that might pick those sorts of noises up. That's what we've discovered in one of the homes that I was involved in. And so we altered the staffing patterns to meet the needs of those restaurants because at the end of the day, it's their home. It's a place that we work, it's their home. So it's about monitoring and being able to do that.
It might be that you want to monitor what your night staff are doing, and the digital systems will make your whole home much more transparent. And so there's no hiding places for staff that you may have some concerns about. Now you might trust everybody, but it's nice to be able to check on occasion without perhaps having to go to sites, if you can listen in to see what actually what is happening to make sure that staff are being monitored and carrying out their jobs that you're paying them for. And they are an important resource, aren't they? But also if you, for example, had some complaints coming in or you were doing any investigation, I've used the system to assist in that process, and it's quite interesting when what people tell you or what you actually find on the system don't always meet in the middle. And then that is intel that you can use in your investigation and to mitigate complaints that may come in.
34.52 Transparency - technology gives relatives transparent access to see the care being provided
Yeah, superb. I think you've put that exceptionally well, Richard, so thank you. I think it's been a really, really useful conversation in helping to break down by talking about those two applications, the acoustic monitoring, the digital care planning, what does it actually mean to people running the facilities and why, as you said, it's worth taking a leap of faith, because it brings new perspectives on your operation that you don't have now. It's that information in real time. It's the historical data, as you said. It's the patterns that you can easily access, which you simply can't today. They don't exist, do they? Because they're on bits of paper somewhere.
Yeah. And the other thing about it is that if you have a digital system, just getting back to that question you asked me, if you have a portal for relatives to tap into, with limited access because you wouldn't show them everything, they can see for themselves about how their loved one, their mother, their father, their aunt or their uncle, whatever, their friends sometimes, how they are, and be reassured that they are actually having a meaningful and enjoyable day, which I've had evidence of. And that's quite reassuring because often the case is that people that are nearest worry more than those that are furthest away.
Yes. Yeah. Yeah. Absolutely. No, that's extremely clear. Okay. Well I think we've had a really enlightening conversation. Is there anything else that you want to say to providers who are thinking about stepping into the unknown with digital? Is there anything else you want to add about technology for the listeners?
Yes. Right, yes. Yes. The first thing is to research the market well, because there are companies out there who have been around a little while who I feel will probably exit the market at some time. Make sure that you have a list of things that you want to have in your system. Don't overfill your expectations. And the other thing is that it's a cultural change you're going to be going through with your staff teams, and so you need to make sure that you appoint a digital champion, and you need a lead person in the organization that's going to drive this through.
So you need somebody at a senior level who's going to champion with the company that you're going to engage with to actually implement the system. And that selling and telling and getting everyone on board is critical to the whole thing working properly. I've come across some companies recently who are using systems I know well out there, and they've admitted that they're not being fully exploited because the person who was doing the selling of it is not fully signed up or they've left, and I think you do need somebody who is a champion for that.
37.05 The NHS Social Digital Care Pathways Grant
The other thing is there are government grants out there to help do that and I've used those, for example there's the NHS Social Digital Care Pathways Grant, which is available and they've just closed that and I've had access to some of that money to help companies with that. So if it's about finance, and it doesn't always have to cost a great deal, but if it's about finance, there are funds available, but you just need to be aware and actually make sure you tap into those.
But the most important thing is that it's a cultural change. It's a management-led system. It's getting everybody on board. It's getting your staff team on board and making sure that the company support the digital journey that you're going to be having to bring you up to speed. And I know when I was doing this piece of work some two years ago now, must have been three years ago now, I went to various companies that were using it, and the staff told me they wouldn't go back to the paper products. Once they've used digital systems, they don't normally want to go back.
Well I think that says it all, doesn't it? Excellent. Excellent. All right, Richard, it's been an absolute pleasure. I think we've really got a helpful introduction to a couple of relevant applications out there and I think you've explained it extremely well, what it means, how to implement, how to talk to people who are not yet pro-technology. So I just want to thank you very much for your time. It's really been a pleasure, and wishing you a lovely evening and thanks again.
Thanks. Thanks, Liam. Thank you very much.
So there you have it. A really interesting interview with Richard Macintyre. How did you find it? I wonder what stood out for you? What I really liked when I listened back to this interview with Richard was how grounded he was and how non-salesy he was in presenting some of these technologies. It's really refreshing, isn't it, to hear about innovation without a sales pitch.
What I also really liked was how clearly Richard explained things, how he could take complicated concepts and break them down into everyday language. I think this is a real barrier to getting the message of some of the excellent applications in technology that already exists out in the marketplace, and I think Richard's voice an approach here really helps with that. I wanted to use this technology to have an opportunity to share some of these key applications. They are out there in the marketplace. There are some great case studies out there. It's just so much of social care doesn't realize how good the tech is now, so I thought it'd be nice to use this platform in some small way to help senior decision-makers in social care connect with the progress being made in tech. If any of you have got any questions for Richard, you can find him on LinkedIn. He's more than happy to sign post, and thanks very much.