Virtual Support Provider for vulnerable service users

OVERVIEW

To develop and implement a virtual support provider to help people with learning disabilities live more independently, with a dual focus on supporting people to address their employability and better manage their mental health and wellbeing in light of COVID-19.

This project was brought to the Social Care Digital Innovation Accelerator by the London Borough of Barking & Dagenham (LBBD) with a supporting statement that highlights the need for a solution to support both people with learning disabilities and councils across the country:

“The provision of outcomes focused support that helps those with learning disabilities to secure employment and/or manage their health and wellbeing and reintegrate back into social settings post COVID-19 – in a cost effective way – will be a key challenge nationally.”

Stephan Liebrecht, Operational Director, Adults Care and Support – LBBD

There are 1.5 million people living with a learning disability in the UK, all of whom will have experienced significant adjustments to their lives as a result of social distancing regulations. Vulnerable individuals may be experiencing feelings of loneliness, depression and anxiety that councils, partners and the wider community will need to support them to manage, and which may prevent them from continuing to achieve their expected outcomes.

Additionally – prior to the COVID-19 outbreak – the national view confirms that less than a quarter (17%) of individuals with learning disabilities as their main health condition were in employment (Briefing Paper to Parliament, No 7540 Jan 2020) and just 6% of adults with a learning disability known to their local authority in England are in paid work (NHS Digital, 2018).

CO-FUNDERS

SUPPORTED BY

DELIVERY PARTNER

CURRENT VIRTUAL SUPPORT OFFERING: AUTONOME AT HOME

AutonoMe is an established virtual support provider already working with 300+ service users across the UK. A video driven app with evaluation, feedback and assessment capabilities, the virtual support offers consistent content covering four areas of the Care Act; cooking, cleaning, personal hygiene and safety in the home.

With around 70% of people with learning disabilities owning smart technology and COVID-19 presenting challenges in terms of face to face support, AutonoMe combines technology with a real world approach. Alongside the app, there is a detailed screening process to identify the right people that will benefit from virtual support, as well as a local liaison officer who supports both providers and local authorities to track usage, celebrate success and better support service users not only to enable progress, but also adapt their EHCP and wider support to be more reflective.

Interest in this project outstripped the places that councils could take and as such we took a cohort of local authorities and service users alongside the collaborative project (more detail on that below) and were able to work with councils to roll out AutonoMe At Home and then bring the new employability content online (AutonoMe At Work.)

COLLABORATIVE PROJECT DESCRIPTION: AUTONOME AT WORK

The collaborative project focused on further developing and implementing a virtual support provider within five, diverse local authority areas. Building upon a proven solution, support will initially be provided to 10 service users in each local authority area – 50 service users in total. This will allow a small, focused cohort to familiarise themselves with the technology and, once comfortable, help co-design and develop it further to reflect their needs.

Service users were able to access the instructional videos and advice via a mobile app, provide information on how they are feeling and feedback on services. The provider will then work closely with users, the local authority and employers to develop content to support those engaged around health and wellbeing, as well as help them prepare in terms of their employability in the hope of actively moving into employment in due course.

Additional co-design and development was undertaken to enable support to be provided to service users to manage their health, wellbeing and mental health including anxiety seen as particularly important post COVID-19 – all of which resulted in an ‘AutonoMe At Work’ product.

In addition to the virtual provision, the provider will support frontline staff, the council and employer(s) including, but not limited to, training, development of personalised outcome plans, monitoring and evaluation. In light of the challenges presented by COVID-19, this was provided virtually throughout the project.

BUSINESS CASE

On top of years of funding reductions, local authority budgets are and will continue to be under additional strain due to COVID-19 challenges. According to the Local Government Association, over the past 10 years councils across England have had their budgets reduced by 60% whilst the cost of supporting people has increased.

This is particularly stark for learning disability services; the average cost per service user in LBBD is expected to increase from £38,902 to £49,279 between 2017 to 2025, an increase of 26% (London Councils, 2019).

In tandem with the technology, the project will produce a robust business case and establish a benefits management framework. At a high level it expects to demonstrate value and measure benefits by considering:

Service insight – AutonoMe enables access to rich information about the support individuals receive, their interests and desired outcomes and pattern of usage. This can inform service and commissioning decisions but also be monitored at an aggregate level to enable benefits to be measured
Support provided – the number of hours of support received by each individual and changes over time can be monitored to assess the impact the digital technology is having on a service users’ independence and thus the number of hours of support they require
Cost – the financial package costs can be reviewed against the baseline position and past trends to understand the impact and extent to which service users are being supported to live more independently
Feedback– feedback from service users, carers and support workers can provide qualitative information about the experience of using virtual provision
Reported outcomes – the outcomes achieved by individuals and the time taken to learn a new skill can be monitored via the service user database
Employability & Employment – the number of service users supported to prepare and sustain employment can be compared against the 2019/20 average

CURRENT EVIDENCE

Based on the evidence from the application of AutonoMe to date in a home setting, there is the potential to realise immediate and ongoing savings by reducing the number of support hours required per week – and we needed to keep in mind face-to-face support was limited/impossible in light of COVID-19.

Evidence to date demonstrated that service users had reduced their reliance on traditional support by at least two hours a week. It is also important to note that typically only 8% of the learning disability population had needs beyond the scope of AutonoMe’s service. Additionally recent OFCOM research shows that ownership of smart devices across this cohort was around 70%.

Even if the provision remained at just 10 service users per authority this would have offered a per council saving of £15,600 – £17,368 each year – notwithstanding the economic benefits employability/employment would have brought both the individual, the council and the wider community (which this project sought to uncover).

Whilst the intention was to roll the service out to as many service users as could benefit from the approach, even just delivering this support to 50 users in each authority setting would have saved £78,000 – £86,840 per authority per year.

As an example – in LBBD there were 760 individuals with a learning disability receiving a commissioned package of support from the council. A further 70 individuals will transition from Children’s services in 2021/22. Supporting these individuals to live independently with the most cost effective package of support was fundamental to the council’s financial sustainability.

As such in LBBD alone there were 534 service users who would have benefitted from the outlined approach in 2021/22. The time saving of 2 hours per week per user would have saved 55,590 support hours. Working at the lower end of the hourly support pay scale, Autonome had the potential to deliver an £833,851 saving to LBBD per year (using a £15 p/h support rate), before employability/ employment support considerations.

CO-DESIGN APPROACH

The six local authorities above helped to co-design a virtual support provider for people with learning disabilities around both mental health and wellbeing, as well as employability.

Each local authority provided subject matter expertise from a range of professionals as well as service users:

Project lead
Learning disabilities service representative
Employment pathway representative
Senior/Lead Social Worker

Each partner co-funded the development and match funding of £70,000 for this project, provided by NHS Digital, via the Local Government Association’s Social Care Digital Innovation Accelerator 2020/21.

Local authority partners also provided input into the business model and license fee to ensure a sustainable and equitable approach to pricing.

This project was independently assessed by the Institute of Public Care.