At a recent edition of HTN Now we heard from Nick Weston, Chief Commercial Officer for Intelligent Lilli, along with their Chief Care Officer Fiona Brown, for a discussion on where and how to deploy care technology to positively impact the whole system.
Fiona began by acknowledging the current pressures facing the healthcare system, including growing demand from an ageing population, workforce recruitment and retention difficulties and the elective care wait list backlog.
“A recent CQC state of care report in October this year described the system as gridlocked,” Fiona commented. “They also questioned the capacity and stability of adult social care and how that is contributing to inequalities. It’s leaving people stuck in the wrong part of the system, whether they are people whose discharge has been delayed due to adult social care pressures or those waiting for operations who may be using primary or community services. All of this potentially leads to hidden harm for patients and contributes to the growing gap in the demand and delivery of services.”
The combined pressures facing the system “lead us to believe that perhaps we need to do something different,” Fiona said. “Lilli offers us an opportunity to do that.”
Taking a different approach
“At Lilli we’ve done some work and research into whole system impact,” Nick explained.
“When you deploy connecting care technology like Lilli, it’s not necessarily about health outcomes – we’re not measuring things like pulse rates, what we’re focusing on is how we can support people to live more independently. When you do that in a social care setting, there’s a much wider range of impact. You might call it the blast radius, or the ripple effect. What is the effect across the whole system?”
Nick shared a diagram, available to view at 7:57 on the video below, which shows a range of suggested impacts in social and health care that could be found from deploying the technology. For each sector, there are direct, indirect and population health impacts.
“There’s clearly a direct impact that can be seen in social care from deploying a technology solution,” Nick said. “One example could be being able to quickly arrange the right size care package for somebody. If you can do that, the impact into health might be that you create more bed availability, you get people out of hospital quicker because you can support them in the community.”
Then there are further effects on primary care, Nick explained, such as reducing the number of GP appointments and reducing pressure on the system overall.
What Lilli can do
Moving on to highlight how Intelligent Lilli can bring health and social care together and result in a wide range of these impacts, Nick said: “If you can demonstrate that technology can support a person in in their own home and highlight things that are happening and any changes that occur, then you are able to provide a safer and quicker discharge process. You’re able to support more patients to remain at home because you’re getting insight and data into how they are performing.
“One of the biggest complaints that we see focuses on the gap between health and social care. When social care picks up a person to be re-abled, they’re lacking evidence and insight into how that person had progressed to date. And that’s what our technology does – it supports the creation of that evidence basis. If you can send somebody home with a care package of three visits a day rather than four visits, because they’ve got a piece of technology that is going to support them to remain safe at home by providing the necessary evidence about how they are getting on, then you’re creating additional capacity within the system.”
Looking at some of the potential outcomes for social care that this technology use can bring, Nick continued: “Technology has a huge opportunity to assist with wait list reduction by identifying those most in need who are on the waitlist. By passively sitting in the background and collecting information about somebody, it can build evidence of baseline behaviours and identify those who are most in need.” This all ties into the ability to prevent unplanned care and a crisis from occurring, Nick added. By having that baseline of ‘normal’ behaviour, it means abnormal behaviours can be identified and people can be encouraged to take action early.
“Technology isn’t about replacing people,” Nick pointed out. “I want to emphasise that. This technology is about providing evidence to support people who are trained to make decisions – giving them the evidence to have the confidence to act. We talk to social workers who say that they face challenges from GPs or the police or neighbours, and they fear that they don’t have the evidence to stand up against the challenge. That’s the type of thing that Lilli can help with.”
On a similar note, it can support with CQC compliance. “It gives you the ability to show that you have reviewed all the people with this technology in place, because you can see on the dashboard that they are green and therefore they do not need an annual review.”
Looking to healthcare again, Nick said, “Hospital is a place where you go to be treated and then the best place for you to get better is at home. Being able to support a person at home through 24-hour monitoring is something that you simply couldn’t do with a human resource. It picks up little signs around deterioration and improvement and that is massively powerful. It leads to better health outcomes and fewer admissions, which means that people on the frontline have time given back to them to look after somebody else in more need.”
With regards to supporting people with long-term conditions, “if you can prevent somebody with COPD or diabetes from going into hospital on a regular basis, you’re enabling their long-term conditions to be more stable and better managed.”
Case study
Next, Nick shared the case study of a 99-year-old named Edna who resides in sheltered accommodation. Edna receives social care support through three short visits a day from carers.
Having been in hospital a number of times over the last year with a range of issues stemming from falls, Edna’s family are concerned that she may need to move to residential care.
“Lilli was put in place to support Edna to be at home,” Nick explained. “Edna came home from hospital and she was still disorientated on that first night, so she got up in the middle of the night to make a drink. We’d worked with a partner organisation to set up a number of alerts around nighttime activity to support the discharge process. There is a third party who will go in as an emergency response service if needed. The alerts indicated that Edna had been wandering around for over an hour during the night and that she had opened the front door, so that information acted as a trigger.
“The third party resource visited Edna and found her lying on the floor, having fallen and pulled a door off its casters. She had only been there for 20 minutes. Essentially, the service enabled help to get to Edna when she needed it. Her care team weren’t due for another five hours and her red emergency button was in the drawer for safe keeping which is quite often the case. I think it’s fair to say that had she not been found at 3am when the care team went in, she would have been sent back to hospital which she had only just come home from. There would have been an assessment and they likely would have wanted to look into moving her to a residential facility.”
As it is, Nick added, Edna is still living at home and further hospital readmissions have been prevented due to the support she is receiving.
“Edna was telling up in the night on a regular basis, usually twice a night. When that became five times a night over a weekend, her social worker called her family. Her family made a GP appointment and the GP was able to provide antibiotics for an UTI. So that cleared up and she didn’t have to go into hospital, as had previously been the case.”
The perspective of the frontline worker
Nick noted that social care and health care training rarely includes any technology training. “We’ve got to make sure that these things are fun and interesting for people to use, and also that we demonstrate what is in it for them,” he said.
He shared another case study in the form of Hospital Discharge Social Worker Kate and her patient Roger.
“Roger had called an ambulance out five times in the last six months for incidents,” Nick said. “Kate identified him as somebody who we could support. She wanted additional insight, she wanted to understand the incidents leading up to him making those calls.
“So Lilli gathered basic data around things like movement, sustenance, bathroom usage. Kate was able to gain behavioural insight to what Roger was doing and the trends associated with it. She identified a couple of areas where she could advise Roger on behaviours that could be creating risk scenarios and put in additional levels of support. Rather than waiting for Roger to go into crisis, she was able to support him. She felt better knowing that she could access his data and she could also inform his family as to how he was doing. That improved the relationship with them as well.”
Lilli’s outcomes
Ultimately, Fiona concluded, technology such as Intelligent Lilli is able to reduce variation in care packages by supporting teams through continuous monitoring; ensure that people are discharged in a safe and timely manner; and share the view of an individual’s risk across health and social care teams.
She emphasised the need to manage an individual’s care proactively, “not just talking to the individuals and their families when they hit crisis but making sure that we can see what’s happening to them on a daily basis from the data that we get through from Lilli, to make sure that we can interact with them and intervene at an appropriate point in time.”
Fiona highlighted Intelligent Lilli’s direct outcomes (right size in packages of care, improvements in bed availability, safe discharge and reduction in hospital admissions) and their indirect outcomes (reduced ambulance requirements and reduced GP appointments, resulting in less pressure on the system overall).
Nick wrapped up the session by sharing information about Intelligent Lilli’s latest pilot scheme, which is taking applications from ICSs now. The pilot has to start in the next three months, will last for three months in total, and can involve up to 50 patients. It is intended to create a business case to support the procurement and roll out of Intelligent Lilli or similar technology at scale, with training and support provision for frontline teams. Nick can be emailed at nick.weston@intelligentlilli.com for more information.
At this point, Nick and Fiona took questions from the audience, available to watch from 32:28 below.
