Digital Care Futures: Digital Shift and Connectivity

Digital Care Futures 3. Digital Shift and Connectivity

In this final episode of the Sustainable Care and TSA Digital Care Futures podcast, Kate Hamblin (University of Sheffield) and Tim Mulrey (TSA) spoke to guests from two local authorities that had explored how to promote digital connectivity and inclusion, and the implications for the ways they were using technology in adult social care.

our guests:

Ann Williams, Commissioner and Contract Manager, Liverpool City Council

Geoff Connell, Director of IMT & Chief Digital Officer,  Norfolk County Council

Sarah Rank, Head of Business and Technology for Adult Social Services, Norfolk County Council

James Bullion, Executive Director of Adult Social Services, Norfolk County Council

 

 

Learn more about Sustainable Care on our website: http://circle.group.shef.ac.uk/

---Intro/outro music: Ambient Cool by Sunsearcher is licensed under CC BY-SA 3.0 Gain/fade effects applied

Episode Transcript

(00:07):
Digital Care
Futures podcast series is a collaborationbetween Sustainable Care
Research Programme, funded by the Economicand Social Research Council
and the Technology Enabled CareStrategy Board, TSA
Industry and advisory bodyfor the UK tech sector.
For each podcast,we invite expert guests to explore with us
the challenges and opportunitiestechnology can bring to care and caring

(00:32):
. Hello.
Welcome to the thirdof our Sustainable Care Programme and Tech
Services Association podcast.
I'm joined todayby Tim Mulrey from the TSA
and we would like to talk todayabout the digital shift and connectivity.
Tim, would you mind talking a little bitmore about the technical side of this
for me, please?
Yeah, hi, Kate.
And thanks for the opportunity.

(00:53):
So the the digital shift
is where the major UKtelecommunications networks
such as Openreach Virginand within Openreach, BT, TalkTalk, etc.
are moving their networks
from analogue based to digital based.

(01:13):
So essentially there's about 15 million
Openreach customers, for example,in the UK who use landline telephony.
And at the moment a majority is analogue
and the plan is thatthose lines are going to be migrated
to digital lines by the end of 2025
and the plan is to kind of migratethose over

(01:36):
between now and then .
And what does this meanthen for local authority
commissioners of services or technologyand care services practically?
practically.
Obviously, it has an impact on
absolutely everyone in the UKthat uses landline technology.
So anyone who makes phone callsusing their home telephone

(01:57):
and that also impacts on things like
burglar alarms, fax machines,
anything that uses technology
or tone based technologyover an analogue service.
And that includes peoplewho have telecare alarm lines.
And currently there are about 1.8million people in the UK, predominantly

(02:19):
elderly and vulnerable peoplewho are uses of telecare in their homes.
And by what I mean users isthey will have, for example,
panic alarms or pendants, falls
detectors, door sensors, etc.,and they will use this
analogue landlinein order to alert their situation.

(02:44):
If they're having an emergency, it willit will send a message to a contact centre
at one of a number of contact centresin the UK using analogue
tones over an analogue landline.
And that's who predominatehas been affected by this.
So what needs to happen then?
So this analogue is no longer going
to functions of these systemsnow need to switch to digital.

(03:04):
What then the cost implications and thingslike that for these organisations.
It's alittle bit of a grey area at the moment,
so it's not to say that analogue systemswill not work on digital networks.
There has been a significantamount of testing
that has gone on, most of itin laboratory conditions,
and most of the products, analogue products

(03:25):
currently available in the UKwill work on digital networks.
But there's two caveats to that.
One of them is that these products
don't have a battery backup in themthat will will operate successfully.
So if there's a mains power failureat the moment, your analogue landline
will continue to work.
But in the New World Digital,it won't work because your router

(03:49):
doesn't work unless there's a backupbattery in place on the router.
So that's one thing to bear in mind.
And the other thing is
the products that have been tested,the analogue products
that have been tested on digital networksat the moment in those lab
conditions are exactly that labconditions, the real world.
There can be a lot of different elementsthat affect how successful

(04:10):
a telephone call is.
And the feedbackthat we've got from BT Virgin,
etcetera, saying thatwhilst it might work now successfully,
they can't guarantee thatin sort of two three years time.
So what the TSA were encouraginglocal authorities to think about is, okay,
what's the roadmap for the migrationof people away from analogue to digital

(04:34):
so that it lessensthe impact of that over time?
And as the TSA, you advising people
on particular approaches to that roadmapand particularly options they can take.
Yeah.
So obviously cost is
probably the number one reasonwhen we've spoken to our members
who are local authorities and housing

(04:57):
associations, charities, etc..
These replacement devices are not notcheap.
Also, some of them will incorporate thingslike SIM cards for backup
so that that means there's a revenue cost
as well as a capital costfor replacement of the devices.
And there's the additional installationcharges and everything like that.
So it's not it's not a low cost endeavourby any stretch of the imagination.

(05:22):
And what we're advising our members to do,really, is to kind of
look at what they've got installedat the moment where the risk areas are.
So if there's someonewho's particularly at need in need,
who might need to be lookedat more urgently than someone else,
then it's almost like prioritisethose individuals in order to

(05:43):
for a migration so that you canyou can stagger that over time
and also look at some of the benefitsthat can come from moving to digital ,
which might be, for example,you don't need to send an engineer out
to do some reprogramming work,
which happens quite a lot at the momentwith some of the analogue equipment.
If you've got digital, it might mean thatyou can make savings elsewhere.

(06:04):
So there may be a cost up front,but ultimately you might be able to then
recoup some of that cost by investing ina more accurate technology.
That's really interesting.
So in the Sustainable Care Programme,we did speak to commissioners of services
and technology enabled careservice providers and some we spoke
to were thinking quite ambitiouslyabout redesigning beyond

(06:26):
replacing like for like almostwith their digital products,
thinking about using other thingsand bringing Internet of things,
devices, mainstream devices and obvioulslythere are implications there around
standards and safety.
But then there werethe other end of the spectrum.
There are somethat were just feeling quite overwhelmed
about the prospect of havingto migrate everything potentially
and waiting for that governmentlevel roadmap or that government

(06:48):
or maybe a large scale investmentor something like that to help them,
or that perfect digital productthat just does it all
and has the same safety standardsand ticks that box.
And it was a bit difficult.
But then we also spoke to some authoritiesand we've got two guests here today
who have gone backand thought about the plumbing almost
because there are areas of the UK
where that ability to connectdigitally is still a challenge

(07:12):
and either because they're poorly servedby existing broadband
infrastructures or because maybe peopledon't have the ability
to afford access to reliable,good quality connectivity.
And so I'd like to welcome our guesttoday.
We've got Ann Williams,who's from Liverpool City
Council, who's going to hopefullytalk to us about what they've done

(07:34):
in Liverpool around this sortof fixing the plumbing first approach.
Hi Ann hi.
Thank you.
And thank you for the opportunityto talk today.
And we also have with us todayfrom Norfolk County Council Sarah Rank,
who's head of business and technologyand adult social services.
Geoff Connell, who is director of IMTand the Chief Digital Officer,

(07:54):
and James Bullion, who is the ExecutiveDirector of Adult Social Services.
who've also worked to promote connectivityacross Their local authority
and explore digital options for caretechnologies.
Welcome, everybody. Thanks, Kate.
Good to be here.
Hi there. Hello.
Ann if I start with you first,would you like to tell us a bit about what

(08:14):
you've been doing in Liverpool?
I know you've been part of a longongoing piece of work
and I'm sure there's been some changeswith COVID as well. Yeah, well
as you say we realised probably in 2016
the implications of the changesthat were going to be needed.
The mainstream and market leaderswithin the existing tech world had already
introducing some kind of GSM units wherethere was actually SIM cards going in.

(08:37):
And increasingly we're finding some peopledidn't have a landline,
so they only had mobile phone.
So there was already a market.
There was, I think, a lot of colleaguesand as a commissioner
of adult social serviceswho commissions the Telecare services,
I think a lot of my colleaguesacross the country thought,
oh, we just carry on using these devices,not realising the philosophy.

(08:59):
Internal protocols which devices are usingare also time limited.
So very quickly, I've had to learn a lotabout the telecommunications world
and I could see that having our own 5Gnetwork was an option
so that we could havesome control over the costs.
The costs are actuallyI think at the moment I'm signing off
every month about £16,000 for aSIM card costs,

(09:22):
and that's roughlyfor about two and a half thousand devices.
I've got 10,000 connections.
So when the rest go to SIM cards,that really becomes a prohibitive cost.
So we've started to look athow we could have some kinds of control
over those costs.
And as I say, the 5G technology offersthe opportunity for a private network.

(09:42):
So we're working initiallyin one of the poorest wards In the country
and we're able to provide accessto the latest technologies.
And we're looking on how we can transfer
our telecareservices with the new generation
and different types of technology.
One of the aspirations,of course, is to help
people who've got their own technology.
So if you've already got a Google Hubor an Amazon Alexa or an Echo,

(10:07):
whatever, you've gotthat we can work with that technology
together rather than having to for usto come along and put something specific
in which many people feel can bequite stigmatising for older people.
And there's a whole new generationof technology.
I've seen some pretty smart stuffthat using radar technology
can actually monitor when people fall andraise an alarm without anyone wearing it.

(10:32):
And one of those versions,it looks like everything in the
it has everything in the back base,but it looks like a vase.
So it looks like a vase of dried flowersor silk flowers.
And a lot of people,even the elderly people who we share it
to would much prefer
having something like that than a big boxin the corner of their room.
And they don't want to
have to wear anythingso they don't have to wear a pendant, etc.

(10:55):
They can just talk to itlike they might in an Alexa app.
And there's a lot,there's things like that,
but there's a whole world out therethat we're hoping to try and work with.
And you've done quite a lot of pilotsrelated to adult social
care with new bits of kitusing this mesh network.
Do you want to talk about some of those?
Yeah, some of the the biggest successes
we've had is with the PAMAN device,

(11:18):
which can be which can be usedwith a 4G dongle as well because it was
we recognised it was so goodif you haven't got 5G around.
But actually it's a service which goesdirect through to pharmacy assistants
who can actually help bring up.
They ring up the person, watch the person,take the tablets out of the box
and actually watch them swallow.
You can have a conversation with them tomake sure that they're taking the tablets

(11:41):
and they can monitor people's healthas they're pharmacists.
And so if you get a relationshipwith them,
they can have conversationsabout how they're feeling.
Have they got any concerns about whatthe medication is, any side effects?
And they can pick those things up.
And in particular, on the 5Gwith it's low latency and very big
broad bandwidth, you can have veryhigh quality video calls.

(12:04):
Also inour care homes, we're looking to have this
and we know that some speechtherapists want to use the 5G network
because sometimes on a 4G set up oreven on broadband, it can get pixelated.
And it's hard actually to do a diagnosticand swallowing diagnoses.
So there's a quite a lot of new services

(12:25):
that we can put in using our 5G network.
And we're quite excitedthat the integrated care systems,
which is going to be the new NHS model,
where we'll be working more closelytogether with to integrate health
and social care,
a lot of the new technologies actuallyhave a benefit to those organisations.
For example, the PAMAN device,which I just talked about,

(12:47):
the benefits to the health serviceare actually significantly higher
than to our local social serviceswith the local services.
Social services,we actually save money on the carers hours
and it's not just the money.
We're actually struggling to find carersto deliver the care
with all the much publicised issuesaround the care sector.
But it also means that
the medication wastage and the medicationadherence has been such that it saves

(13:10):
those significant amounts of cash,which is the Holy Grail at the moment,
because it's that we don't usually
save cash, but it's cost avoidancethat we normally make.
But we've actually managed to save cash
for the CCG on their medication bill.
And unfortunately, as Brexit Brexitbites, the actual supply of medication
isn't as strong as it wasa couple of years ago in this country.

(13:33):
So these things can really helpin a lot of these ways.
And I think there's a whole loadof new tech which are available
tech enabled deviceswhich will have a really big part to play
as we go forward.
And I think it's these new types of devices that we need to start working with.
And then during the COVID
pandemic, you have to explore new waysof delivering the service.

(13:56):
Or did you bring new bits of kit? Really,
because some of the other placeswe've spoken to,
Loacal Authorities and care providersdid sort of well.
Although the pandemic was terrible.
They did feel they sort of acceleratedthings for them around technology.
Yeah.
Yeah, it did massively.
And so there's moreand more consultations.

(14:16):
Our own social workers are doing moreremote consultations, and that's where
we find that our 5G and our aspirationsof being able to provide it to free to
everybody will mean thatthose who can afford a decent connectivity
to thosewho can't afford a decent connectivity
so that they can haveremote consultations, or whether it's
with the GP or someone from the councilor a social worker, whatever.

(14:38):
They're not disadvantagedand they can actually benefit from it
because that's one of the things we found,particularly with education .
There's a lot of children that even thoughthere might be broadband in the House,
by the time you've got mum and dad workingfrom home trying to do school full time
when there wasn't enoughbandwidth was a real problem.
All the data was eaten up quicklyand there wasn't any time for Netflix

(15:00):
or the match.
So there's lots of big issues aroundand actually how
we can get connectivitythat worked efficiently and affordable.
So that's really what we're trying to dois to make sure that we lessen
the digital divide and start tacklingsome of the health inequalities.
Yes, it is a widerpiece of work, isn't it?
There other
implications of being
digitally excludedbeyond health and social care

(15:23):
along the way of what challengesif you faced?
Well, we actually faced
an initial anti 5G sentimentbecause of a lot of misinformation
going around,particularly in the first lockdown.
And obviously, 5G was spreadingcoronavirus according to some.
There was all sorts of misinformationand false science going around,
and it was a big issue up here broadly.

(15:46):
No, we haven't had
much opposition to it.
One of our biggest problems
now is actually getting the nodeson the lampposts
because of the international microchipshortage worldwide.
So we're actually being held up
in the supplies as quickly as we canget them on our lampposts, really.
When I started to workat some of the primary schools

(16:06):
to make sure all the childrenwho receive free school meals
can access good connectivity
so that they can make surethat even though schools are back
and there is an expectation of quitea lot of catching up to do
and there's all sorts of thingsto do at home.
And the realisation
that families that kind of fourto sit around the table in the evening
and help the kids with their homeworkon some kind of electrical

(16:27):
electronic deviceare going to do better in life than those
whose parents don't have that abilityto provide that kind of thing.
So what we're trying to donow is trying to help everybody.
And what we've foundis that we're actually configuring
the devices that that we give to people.
So, for example,
if a social worker does an assessment,we're configuring what device we need.

(16:50):
So it's already on our 5G network.
So they don't have tothey just plug it in.
They don't have to search for a networkand get onto it.
All that's been done
and there's a
real concern about using complete I.T.
networks.
And if the electric goes downand we all know ourselves,
we have occasionally to reboot,even just our television networks,

(17:12):
whatever, when they freeze,
when you have to switch it all offand then reboot it all.
And sometimesyou have to resource the network.
And if that's involving your telecare,then that becomes a real issue.
So we're hopeful that webecause of the monitoring our own network,
we can use the service level agreementswhich are much higher
than is normal in the phone industry,
that we can have a four hour SLA guaranteeto sort something out.

(17:35):
So if we get an alarm to say that Mrs.
James, on Sheild Roadhas no longer got connection,
that problems come through quicklyand then we can ring her up and say,
Have you got a problem?
Have you unplugged it, what's happened?
And then we can get out therequite quickly.
Obviously something like a mains cableor a power supply from the mains.
Some flooding like that might take longer,but we're there quicker

(17:56):
because of the current mobile phoneservice level agreements,
and we can provide all thatbecause we're doing it ourselves.
I think that's an important themethat's come up in the research is,
you know, it's quite somethingto focus on technology.
In this case, we thought we'd havethe digital connectivity job done,
but you need ongoing level of supportand service for people particularly

(18:17):
to sometimes engage with bits of kitand things that are quite unfamiliar.
And Tim, if you had any questions.
Yeah.
I mean, you know, I thinkfor the likes of Liverpool and Norfolk,
really, really pushing the boundariesand that's and that's
great to hear,I've spent some time up in Liverpool
with Ann just just learningmore about what, you know some of the real

(18:38):
really great use casesthat are going on up there
and the 5G network that Ann's describedI mean, you know, it's great
in terms of addressingsome of those key issues
that we're hearing from the rest of,you know, our members in the UK around.
How do we copewith the cost of various networks?

(18:59):
How do we ensure that
the connectivitybecause as you know, across the UK there's
a really wide variety of of availabilityof cellular networks and things like that.
So, so providing that I guess that local
kind of private serviceif you like, is really, really
important from a not only a

(19:20):
cost perspective, but probably a networkavailability perspective as well.
And I think from a from a question to AnnI guess is, is
could you see,I guess more life critical services
moving on to that networkover over a period of time.
Yeah.
We're working very closely

(19:41):
with our colleagues in health,as you know, Tim in Liverpool,
we're going to get a new hospitaland hopefully it'll be opening next year,
but it'll have 100 bedsless than our current one and there hasn't
been any eveningwhere there's been 100 empty beds.
So there's going to be a real pressureon that new hospital.
And one of the aspirations that we've gotis that when people would normally

(20:01):
be monitored through A&E.
After that, if
they don't know what typ e of bedthey're going to need,
then they could go home with a Docobo
And the latest Docobo versionwhich we're working with on
with those guys is for a new 5G versionbecause it can have far more of it
functions, better video.
The patients will be able to be dischargedwith some kind of device

(20:24):
that will be configured into our network
and it could be monitoredby the hospital .
And they can watch to see how things areso that the sort of vision that they have
from the health side of thingsand if people they feel
that people are deteriorating,they can go and bring them in.
back again,
we're working with some GP surgeriesand we're putting

(20:44):
so our 5G model into that and you can get
an MRI scan downloaded very quickly.
And as a countrywe don't use our MRI scans
for anything other than specialist peoplelooking at them.
But actually quite a lot of the GP'swould be interested to see
and would like to have a copy of that sothey can see what the actual issues are.

(21:05):
There's a quite a lot of opportunityto make sure with us that the service
level agreements are required,but I think it's always been a risk.
So you won't be discharged
with something if somebody thinks thatyou have got to have a serious incident,
but those things can be picked up quicklyand you'll be able to be discharged
with the device rather than tryingto find a bed for you for 48 hours.

(21:26):
And there's more
and more sensor technology being developedfor things like urine infections.
And quite a lot of elderly peopleget admitted into hospital
because of a urine infection, causingconfusion and causing falling.
So if we can pick that up quickly,then we can alert
the GP and get antibiotics around quickly.
So we're using AI to monitorwounds on leg ulcers, etc.

(21:49):
and there's quite a lot of high tech,high tech stuff that we can offer.
We are also trying a haptic vest,
which is a vestthat goes over your clothes.
So if you're visiting family,if you're if you are in a care home,
your family can actually overthe telephone in a conversation.
During a conversation,they can give you a squeeze

(22:12):
and it can feel like you're getting a hugif you're in the care home.
I know it's a bit of a novelty, butthere's lots of people are talking about
the opportunities that we can have to havethis sort of things almost mainstream.
And we're also very keen to be in controlof our own data as an organisation
and in the sense of a lot of differentexisting Telecare services

(22:34):
collect a lot of data,but it's never really used intelligently.
So yes, it shows how many times
somebody has pressed the buttonand things like that,
but it doesn't go into the granular detailabout what that means.
So what what is the trigger? Why is Mrs.
Jones suddenly pressing the buttona lot more?
And is the care package adequateor does she need something else?

(22:55):
Now, it's hard to get that information,
but if we can automate that and throughthe collection of the data using it,
we feel going forwardwe'll be able to offer a better quality
service against an ever decreasing budget.
That's really interesting, actually.
And the pointI was going to touch on then,

(23:15):
as we've had these conversationsaround the UK as part of the sort of TSA
and try to understand what our membersare are looking for, we've
we've foundthat particularly during the pandemic,
there was in some areasa bit of a growth around families
wanting some of the traditionally,I guess, reactive
telecare services to actually takeon more of a proactive approach.

(23:39):
So that might be,
you know, can you give Nan a callevery day or every week or whatever?
Just keep an eye on itbecause obviously the things
we've had to do in the pastwe've not been able to do.
And then in a lot of casesthat's then continued.
People have really seenthe benefit of more proactivity.
And I thinkfrom what you're describing there

(24:00):
with that level of datathat you would have access to and across
a range of things, it'd be interestingto see whether it's something that
I guess your organisation could provideor support, where you could actually
be more proactive and preventativeas well as anything else really.
Well, yeah,because we've got a joint contract
with the CCG and hopefully we'll continuewith the idea.

(24:23):
We want to move in We can see of howwe can be seen as health on social care.
So the GP,
so get the details of the social careand what's happening at that level.
So although our GP's inthe city can prescribe tele care
that they can give them a prescriptionand look at the full monitor
of whateverit seems that there's a high risk of.
But actually the GPthat doesn't know what's happened,

(24:46):
so they might not hear backfor another 18 months
when the social worker contacts themand says that Mrs.
Jones is now calling 17 times a daywith the really extreme cases
and we would like you to be involvedagain, but sometimes that's too late.
So we like trying to understandwhat that data means,
and I think it will be a couple of yearsbefore we can actually start

(25:09):
to use the data intelligently , butat least we now know what we want to know.
Whereas at the moment
we're currently reporting just churns outreports that are fairly standard.
You know, how many calls were made aroundthe TSA standards and that's great.
But I think the world has now moved onand I think we want a lot
more granular detailsto make really informed decisions.

(25:31):
So I just wanted to ask you just to finishup almost this is what lessons
you learnt along the way that you wouldpass on to another commissioner.
I think what we need to dois think what you want,
not what the industry can provide.
I think that'swhat a lot of people are waiting for.
As you said in your introductionthat there are some people who just think

(25:51):
that they will be
and that the industry
will reactand they will be set out something
it might be slightly differentthan what they've got now,
but actually the world has moved onand I think that we need to.
In some instances,
I'm working with some of the big guys,various big players in this area.
I think the World Health
Organisation recognises the biggestindustry in the world is farming

(26:13):
and the second biggest industryin the world is health and social care.
So the big tech companiessee this as a big market.
But but I think what we need to dois to try and get there
quite quickly and tell them what we wantrather than waiting for them
to develop things for us to fit aroundhow to make that work in our system.
And I think there's a willingness andan openness of people to work together.

(26:37):
And I think that that'swhere we need to work
with the likes of TSA because I thinkthey can speak on behalf of us.
So rather than somebody having to speak tohowever many
local authorities there are, I thinksomething like 142 different authorities,
that there would be one voicethat shared all of our concerns
because we all have the same concerns,whether it's the more rural

(26:58):
or the very urban city council areaslike ourselves.
The issues are the same and there arethere are a rising number
of elderly people.
There aren't enough paid carersto look after them and
so the technology can helpresolve some of those issues.
It will never replace completelythe 1 to 1 care.
That's not what it's there for.
But we can help people live independentlyand longer in their own homes

(27:21):
and have a better quality of life.
What I
don't want to do is make surethat the technology creates a dependency
that makes themtotally locked in their own premises
because they don't feel safeunless they're near a box .
So then they become totally insularand really almost institutionalised
in their own home.
So we want to get past that.
And some people have saidit'll be a generational thing

(27:44):
before the next generationwill be able to cope with it.
But I disagree with that.
As you said, the COVID pandemic has meantthat an awful lot of people
and there are now a lot of 90 year oldwho will have regular
Zoom meetings with various family memberswho have gotten over
some of their reluctance and they're notrelatively happy to use the technology.

(28:05):
I think the GP face to faceconsultation is still an issue
but there's still an awfullot of people who are happy to have
that face to face interview
the consultation via phone or
device and the like I'm looking at now.
And for their consultation,I think a lot of people would be happy
to have that consultation with a lot of,as I said earlier, a speech therapist

(28:28):
or some other clinician,occupational therapy or whatever
that can take place over the technology.
So I think the world is changingor even has already changed.
Thank you, Ann, that was a classy way
to round it off on a positive note.
Yes. Thank you.
That was really interesting.
I'd like to bring in NorfolkCounty Council's experiences of how

(28:50):
they've also explored waysto improve connectivity locally.
Sarah, Geoff and James,can you tell listeners about you
the work you've done in Norfolk aroundconnectivity and how it's facilitated
the use of technologyin adult social care?
Anyone who wants to come in first, butit'd be great to hear your experiences.
I'm proudto say that over the last six years or so,
we've taken superfast broadbandcoverage for 42% to 96%.

(29:15):
So, you know, big advances.
And we are literally putting hundredsof millions into gigabit
fibre deployment now.
So super, superfast 28 megabits persecond, up to 1000 megabits per second.
So really futureproofing that infrastructure
and that's moving forward at pace.
We're also working very hardto improve mobile coverage for the county,

(29:36):
although that's a bit trickybecause we can't directly engage
in the way we do with fibreinfrastructure.
Also super excitedabout the rollout of our
LoRaWAN IOT innovation or sensor networkwhere we've gone
from nothing to almost ubiquitous coveragein just two years.
And I think that's an exciting technologyfor delivering
care services into the futureand enabling innovation.

(29:59):
Can I come in tag as well please, Kate,and say this sounds an obvious point, but
it's really important to have a strategyactually in adult social services.
So it's not
so that common across local authoritiesto have something that looks ahead
for 3 to 5 years about how you might
make the best use of technologyin integrated care settings,

(30:21):
or make the use of data between healthcare and housing organisations,
and to do some work building the capacityin your workforce so they understand
the issues that are the potentialand have got a conversation piece to have
with the people who are using social care.
It's simple enough to say,but actually building that strategy

(30:42):
and having a bit of a bit of a runwaythat builds on what Geoff talked about
in terms of the infrastructureis the first step and it's so important
and we've been at this nowfor a few years.
So we've got both the strategyand the ambition, but we've also got
a bit of a track record on some thingsthat we've tried out that are working,
which then gives you more confidenceto move on

(31:02):
and try new things or to collaboratewith others on new ideas.
Thank you.
This whole systems approach
is really interestingand in terms of what is working, have you.
Are there any examples of where
you've deployed technologiesusing these networks in adult social care?
So our strategy overthe last few years has been around
the citizen,the provider and the workforce.

(31:24):
And certainly for the citizen,we've got a really good assistive
technology service in placeand we've been deploying not not only
analogue but also digital solutionsand what we have within that.
So we've had the peripherals around that.
So thinking around the the wrist worn falldetectors, some of the smoke alarms

(31:45):
and the sensors, the door exit alarms.
And what we've recently developed issomething called NATaLI which is our own.
Now we're going to get the acronym now,and I've got to remember what that is.
So, Geoff I just need you to remind methe Norfolk Assistive
Technologyand Living Independently project
and it's using sensors,

(32:07):
the IOT network, automated intelligenceand dashboards
all in combination to understandwhen people are living a lifestyle
which is as it should be,
you know, regular patterns of behaviour,in which case
we don't get involved at all .We don't need to.
But it does allow us to flag outchanges to behaviours that might require

(32:27):
early intervention and is an exciting new
technological approach that we're takingusing a free to use network,
but enabling us to redesignthe ways that we support
people living in their own homesand just coming back on that.
Kate So it's really,really good use of the LoRaWAN
and enabling us to to trialthat and to trial.

(32:49):
We're currently looking at a couple
of our housing and care schemesand how we could use that data
and how we could help help those citizenswithin the so really exciting times.
And we did publish as a region,we published
a number of innovations
that authorities have put in placeover the COVID period.

(33:10):
And NATALI is one of the areasthat we submitted.
So really excited about that
Do you want to say a little bitabout what you're doing with providers
and the workforce because I think again,it's the whole system is
it's making sure that everyoneis taking on this journey really.
So from the providerswe did a couple of years ago,
so this is pre-COVID,we did a questionnaire

(33:32):
with all of our residential providersand trying to find out
what works for them andwhat would they like to see in the future.
And some of the their main concernswas around the connectivity.
And as Geoff has talked about already.
We've made some real inroads with that.
And then other areaswas around the electronic record

(33:53):
and then looking at some of thosethose video conferencing.
So with pre-COVID,we talked about trialing
video conferencing with a hospitalin a care home, too.
Rather than having a patienthaving to go in
for an appointment,we could do that virtually
to save the impact on the patientand obviously on the wards as well.

(34:16):
So so that was something we were aboutto trial but obviously cope with, then
hit it all.
So it's something we're now trying toto move on and develop.
So there was that there was a,as I say, the care record
and then thinking aroundhow sensors can help.
So how can we helpwith some of the assistive technology?
So not necessarily puttingassistive technology into care homes,

(34:39):
but thinking about how we can help themand how we can support them.
So so we're really at the early stage now.
We've, we've just updated our strategyand we had a
we've got a five year strategythat we've now put into place,
which is the key areas around those aroundfixing those issues.
Six, fixing those basics, as we called it.
So we've already started on that journey.

(35:01):
We can really move that forward
and then join in up that systemsto how we all work together
and whether that's health,social care providers across the board.
So thinking around the shared care recordand thinking about other opportunities,
the virtual wardsand what we can do there.
Then in the moment.
So what are we doing right now?

(35:21):
What opportunities are available to usand how can we really expand
that and really buildon some of those technologies out there?
So we've got thatthe analogue switch off in 2025.
So what can we be doing now to be movingtowards that and being ready for that?
The video tech really buildingon the video technology we've piloted.

(35:42):
We've been very lucky
in piloting alcove the alcove devicewith our day care providers.
So what can we do with that now?
Can we move that on further andand really roll that out
to maybe home care providers?
Is there something there
rather than a home care providerhaving to go out and visit,
could we do something virtually I exceptit's not going to work for everybody.
But is that something we couldthen explore?

(36:04):
And then the other areasis thinking around that digital inclusion
and again working with our providersaround that digital inclusion.
And then
the last thing is around the workforceand what are we doing with the workforce?
And Geoff, I don't know if you want tojust to pick up on what we've achieved
certainly over the last 12 months,because, again, we've moved mountains.

(36:25):
Some of the things we wanted to dopre-COVID actually, that has given
us, COVID has given us the opportunityto move things on much quicker.
So, Geoff I don't know ifyou want to pick up on that.
Yeah, I
think COVID has really actedas an accelerator for us.
I don't think it changed
too much in our strategy,but it really moved it along a pace.

(36:45):
So we had a smarterworking programme already.
Which was it trying to ensurethat our social workers, in particular
all staff and in particular socialworkers, were able to work from anywhere
that they had the right kit, the rightconnectivity, the right software,
and crucially, the right skills to be ableto work any time, any place, anywhere .
And what I think has happenedthrough COVID is almost overnight

(37:08):
that went from being a proportionof the workforce to pretty much everybody.
And I think we've learnt a lot throughnecessity about effective ways to engage
with our clients, residents, patients,you know, whatever context we see them in.
And I think that's been really helpfulto us in many ways because what we can do
now as the pandemic eases,we move back to hybrid

(37:31):
working and immersivetechnologies in our meeting rooms
is we can keep hold of the bestof that practise, you know, video
where it makes sense, but face to facewhere that makes sense as well.
So really I think the key for usnow is to get the best of both worlds.
And my roleas the provider of the technology is
to make sure that we've gotthe right tools to be able to be agile

(37:53):
and change our ways of working to reflectthe data that we see in the needs
that we see from the communities we serve.
Can I add
an issue about the professional workforceand just thinking about
the job content of social workersor nurses or OTs?
So there's something about our strategywhich we are learning
as we going that actually technology.

(38:16):
It's not just about placing itin the relatively simple situations.
Our strategy what what is teaching usis that in really quite complex situations
like personality disorderor autism or dementia,
that there's a huge potentialof trying to use these tools
as an aid to professional practise

(38:36):
as well as obviouslyto meet people's needs, which is the core
the core outcomethat we're trying to achieve.
But the examples ofand Sarah might need to help me
with the names of these,but in the moment or brain in hand,
the sort of the conceptual toolsthat help people
with strong emotions settleor breaking down tasks

(38:59):
so that people who are experiencingdementia can still be kept on track.
And part of the reason for saying thisabout how how well it can interface
with a professional practise issueis that actually
we have a bit of a workforcecrisis building in social care.
We I think we have a needfor about 600,000 more people

(39:20):
working in social care over the nextsort of five , seven years
and they're just not coming actually.
I mean, I think we all realisethat competition for jobs and people's
preferences mean that we're always goingto see our workforce as relatively scarce.
So the more that technology can addto that equation and make working lives

(39:40):
easier as well as better outcomesfor people is a crucial dimension of
how got to think about these strategiesreally.
So constantly learningabout how your professional model works,
how technology adds to that,where it doesn't add value
as well and not,you know, not getting bogged down in
that is really importantpart of the process for us.

(40:00):
Can I just add to that?
I would certainly agree with Jamesthat we can't get enough
social workerseven if we had an unlimited budget.
The people just aren't out there.
So I think it's really importantthat we use technology
to free up our existing workforce,
to do the things that are most valuable,the things that they most want to do.
So using intelligent automation,things like robotic process

(40:22):
automation to take away the drudgery,to take away the administration
and free them up to do what they dobest to enable them to to work with
with the patients and clientsand residents and to intervene earlier.
That's another crucial opportunity thathopefully we can free them up to to do.
If we can use technologyfor automation effectively.

(40:44):
Yeah.
Just picking up on that point.
I think that's a really valid,valid point.
And thinking around technologyisn't a one size fits all.
It's an enabler. It's to help.
So I know we've had concerns raisedbefore.
Well,are you going to put technology? What?
I want that face to face contact.
I want to see that person.
That isn'tthe case is around helping and enabling

(41:06):
all of our social care practiseto be able to to deliver the services.
But as James and Geoff have both said,if technology can help, then let's use it.
And one of the thingswe had a conversation
Geoffand I were involved in a conversation
at the beginning of the weekwith a colleague from Shropshire
who's been doingquite a lot of work around data analysis.

(41:28):
And it was really interestingto hear his take in.
Actually, we as an authorityand I guess every other authority
he has got oodles of data.
We're really, really data rich.
What are we trying to solve?
What is the problem we're trying to solve
and what are the questionsthat we need to be asking to then
help us do some of those predictions,some of those early modelings?

(41:49):
And as James has said,we've got a depleting workforce
and trying to attract social workersinto the profession.
How can technology help with thatand can some of that data
analytics helpand can we be doing more with that?
So I think we're justconstantly moving forward.
And what really excites me withthe technology is it doesn't sit still.

(42:10):
This is somethingall the time being developed.
One thing with COVID that I thinkhas been a bit of a hindrance.
We haven't been able to get outand go and see.
So I've been to a lot of technologyconferences
and it's great because you go alongand I've been on to the autism bus,
have been on to the dementia busand you can think, Wow,
that would be greatif we did that in Norfolk.
Let's go out there. Let's go and do that.

(42:31):
And so for me, looking forwardto some of these reopenings again
to go and have a look at what is availableand then bring it back
to our commissioners and say, right, look,this would be great to either work
with the provider on this or workwith our workforce on this,
but to see what else isis there and currently available.

(42:51):
Tim, did
you want to comein and reflect on anything at this point?
Yeah.
I think it's you know, from my perspectiveand you know, I've said this earlier
in the podcast that, you know,when you look at Liverpool and Norfolk
and some of the leading authorities.
From a tech point of view,they really are pushing the boundaries.
And it's it's really refreshing to hear,I guess, some of the use cases

(43:15):
that have been discussed.
So I spendprobably the majority of my time
trying to work with authoritiesand it tends to be,
you know,focussed on the more traditional areas
because ultimately that's,
you know, there's 1.7, 1.8 millionpeople in the UK that rely on this stuff.
It's, it's, it's life critical
and inevitablythat's where the majority of my time sits.

(43:38):
It's, you know, around
some of the things
that were talked about early aroundsmoke detectors and fall sensors
and things like that, because ultimatelywe've got to make sure that they work.
But we've also got an eye on the futureas well.
As has been mentioned,the analogue to digital change
and a lot of the technology is changingand it's really great to hear

(43:58):
that Norfolk are pushing those boundaries,looking at new ways of working,
if you like.
You know, particularlywhen I when I think about LoRaWAN and how
that's being deployed at the moment,as you've said, around
monitoring activities of daily living,predictive and preventative,
you know, a lot of technology in the UK atthe moment is deployed
at the end of the scalewhere people are already

(44:20):
kind of at that criticalsort of area of their lives.
But actually if we can start to pushthat further back in the lifecycle,
we can start to help people withtechnology before they get to the stage.
And and it will help them stay out of
whether that's more formal support or,you know, those type of areas as well.
So it's it'sit's really great to hear about that.

(44:43):
And obviously, from an infrastructurepoint of view, how that's been pushed
because particularly in some way I rural,you know, with a lot of our members
Herefordshire has been mentionedNorfolk again where mobile coverage
is very patchy and a lot of thethe technology, the digital technology
at the moment, it does rely onon a reasonable mobile signal.

(45:06):
And that's really a challenge that we'regiving to our tech supply members.
And so using those alternative methodsof connectivity,
whether that's broadbandor whether that's, you know, LoRaWAN
or some other method of getting out there,that's that's really important
for the future.
So, yeah, that'sthat's really where I'm coming from

(45:28):
and what my, my kind of pleaI guess, to Norfolk and everyone else is,
please pass on those good case studies
where you've done somethingand it's worked really well.
It's part of our role is to,I guess, spread that that good news
amongst our other members becauseultimately we rely on the vanguards here
to kind of go and learn the lessons,make the mistakes and get it right.

(45:52):
So then to then pass on tosome of our other members who are either,
you know, not as far down the line,you know, from our perspective.
Can I just chip in and say I
think partnership working is crucial here,
whether that's us working with mobilenetwork operators to share access
to our tall buildings and fire towersand things like that, or

(46:14):
employing a full time highways memberstaff as we do to pave the way and help
in terms of way leavesand just take away all those barriers
to deploying infrastructure right throughto the other end of the spectrum where
it's back pooling and sharing datafor an operator appropriate uses
both operational and strategic analytical.

(46:35):
We've got the Norfolk Office of DataAnalytics that we've created
jointly between Norfolk County Council,the NHS Police and the districts
trying to pull data to answer those wickedquestions, those place based questions
through to the more prosaicbut equally important shared care record
we're working on.

(46:55):
Because actually there'sso many great practical examples
about how we can deliver bettercare, cheaper care, faster care
just by sharing some key informationacross the different entities.
And I have to say,COVID has been helpful in that respect.
It's it's caused peopleto work more closely together.
The coping notices have enabled us toto share data

(47:17):
with with more pace and less bureaucracy.
So I do think we're we're movingin the right direction in terms
of pooling that intelligenceand working effectively together.
And hopefully we'll keep that up.
I want to pick up on what
Tim has said about the need for learningand for passing learning on
and on the kind of building of a movement,I suppose really around this.

(47:41):
And but it leads me to think as wellthat we're at a particular
time for adult social care,which is a government
thinking deeply about reformand where it wants to go with the model.
And we can expect,I think, a couple of white papers
before the end of December 21.
So one on integration and another oneon social care reform itself.

(48:03):
And as I understand it,both of those white papers
want to have chapters on technology.
So there's a key national moment hereabout what framework and expectations
can we set at right across Englandin local authorities, amongst providers
and crucially in the relationship
between the NHS and local governmentabout technology.

(48:24):
And my expectationis that there absolutely
ought to be room for getting the basicsright, right across the pace,
but also for innovationand for incentivising that innovation.
I mean, I don't underestimatethe amount of work that Geoff has done
that Sarah does that our partnersdo in bringing about our strategy
and then working on it over a five yearperiod.

(48:46):
Actually, there are resourcesthat are needed to do that.
There's a business case in doing itbecause it leads to more efficiencies
and in some cases financial savings,
but some national resource in this space,some incentives
seem to me to be a really important partof how you spread the learning
and how you create a big expectation about

(49:10):
national action, national supportfor this stuff,
because we're
trying to convince the public here as wellas convince ourselves and the government
definitely got a role to play in that,it seems to me.
This is something that's come upin earlier podcasts around sort of
promoting innovation and making sure thatthat promotion is sustainable.
So often, you know, pilotfunding comes to an end

(49:31):
and that pilot comes to an endand it doesn't get scaled up or spread
necessarily in what could perhaps be.
I just want to pick up on something around
the sort of shared learningand it's something that's come up during
this project is around there's
examples of good practise out there,but sometimes this sort of missing pieces,

(49:51):
the honest discussionsabout where things haven't gone as planned
or the challengesthat organisations face along the way.
And I think that's really important.
Part of the learning process for otherlocal authorities who might be considering
taking a particular approachto understand, okay, this,
this is where you can get to.
But along the way
these are some of the potential pitfallsor booby traps you might come across.

(50:14):
This is how you navigate them.
So I wondered if along your journeyyou also faced challenges- Ann
from Liverpool
has spoken about some of the challengesthey face from their mesh network.
Have you encountered issues along the way?
Aside from COVID, of course,which has been an accelerator
but you know,it has also been devastating.
Yeah, I'm happy to come in on that.

(50:35):
So we've got two pilotsrunning at the moment, one
with Alcove and one with Brian in hand.
The alcove one, I have to say, has gone,I'd say really smoothly.
It really hit is gone off the ground.
And everybody's been really keenand we've got some brilliant examples
of how it's helped help people.
And we're at that stage where we're goingto be then seeing him with is project.

(50:58):
We got some funding through the SWhat do we do next with it?
Where do we go with it next?
And if we want to roll it out next,how are we going to fund that?
So we're at that stage with Alcove,
but I do feel thatit will be really easy to push forward
because just to say we've got verypositive experiences with brain in hand,
it's been a little bit different andI think that's been because of potentially

(51:20):
the commitment that we've been ableto give to that from our services.
And I think because everybody is so
under the kosh at the moment,there's so much going on,
it's been really hard to give that timeto really promote in that.
So I feel that hasn't goneas well as the alcove and I think
when you run into similar projectsat the same time, it's easy to compare

(51:44):
because if you do them at different timesand you think about How did that go?
What went well there?
But I think with it isI'm really comparing the two all the time.
I'm now trying to get underneath-So what can we do with this?
Because I believe in this productand I think it's a brilliant product
and we really need to start to promotethat and think about how we roll that out.

(52:05):
But we, we're not quite there.
So it is causing usan issue at the moment,
but that's something I want to reallytrying to get underneath to saying,
okay, so what's causing itnot to be as successful as Alcove?
I think if I could ask the questionas well around that is quite often we see
and it's interesting that you say thatand it's great that you've got again

(52:28):
to progressive solutions that
sometimes with an Alcoveor that type of product, it's almost like,
right, we've got a thousandof these devices, let's push them out
and but there's no real kind of, you know,established kind of need sometimes.
So it's almost like here some devices go
and then people are sat thereand they're going like, well,
I don't necessarily know what to doand they don't get so

(52:51):
so it's really interestingthat you've made that a success.
Whereas in my mind, I'm almost like, well,the brain enhanced
if that's that's less of a productis such more of a a service.
So I could almost
it surprises me that you you say thatyou know and that's and that's great.
And I wonder whether and I know that,
you know, working with Helen and peoplelike that, whereas with Alcove

(53:13):
they there is a lot of servicethat goes into that as well.
It's not just the product that supplies,but they actually give you the insight
as well.
And whether that's made a differencepotentially as well as to
why it's been a big success.
It's not just
what older devices say you go,but actually it's some insight as well.
But I think you're absolutely right, Tim.
I think looking back on that,Helen has been massively supportive

(53:35):
and we've worked closelywith Rethink Partners as well
and they've been really, really good inin helping us promote that
in some of our marketing,in some of the news stories.
So I think we've done itbetween the three of us.
So it's been Norfolk County Council,it's been Alcove and it's been ReThink
and I think because we've done itas a combined effort, that potentially

(53:55):
is why it's been so successful.
So I think that's a very good point.
My observation would be that technologyenabled change is comprised
generally of people processand technology,
and sometimes people have a budgetfor the technology
and forget the tech on its own doesn'tdo anything.
It's just an overhead.

(54:16):
So actually it's not underestimatingthe digital skills development
that will be needed.
In these initiatives
and also change management,you know, helping
people to see what's in it for themand for their customer.
Why should they do it?
And so I think the key is oftento have a well-rounded
project or programmeand wherever possible to be data driven.
One of the challengesI find around digital
inclusion is not having the numbers.

(54:39):
You know, we know that people'sexclusion can be caused by lack
of connectivity, lack kit, lack of skills,lack of awareness, lack of support.
In what proportion and where are they?
How many of them? What do they need?
And that's whatwe've been really working hard
on with our digital inclusionstrategy recently.
Also, the funding for this is oftenpiecemeal, as Sara touched on earlier.

(54:59):
It comes a little bit of capital here,a little bit there.
Maybe it comes at the last minute.
You have to have a project readyto roll at the drop of a hat.
But I'm a big fan of the principle thatif you can measure it, you can manage it.
I think we have got a wealth of dataand if we can articulate the business case
for some of these challenges, we'vegot a better opportunity to address it.

(55:20):
I think working collaborativelywith our communities of practise
through ADASS and through with LGA,we've got a really good opportunity
to use the evidence baseto create the business case
and to do somethingreally strategic off the back of that.
Yeah.
That's a really good point, Geoff.
And I think just just going back,thinking around the project, you're right,

(55:43):
all of a sudden we think there'ssome funding available or what can we do?
Can we can we meet those meetthose requirements?
Is that something we can go for?
And something that we're working on at
the momentis almost coming up with a wishlist.
So if money was no object,what would we want?
So then if all of a sudden the fundingcomes available, go through your list.
If that meets that criteria, let's beef itup, let's add to it,

(56:05):
and then we can do that, because I thinkif we can be prepared in that way,
I do think we miss out on opportunitiesbecause it is such a quick turnaround
and you've got to see it and then think,Oh, well, what could we do with that?
So I do think if we could have a wishlist, I think that would be really good.
The other thing I was just going to add,I did some work with Rethink and the LGA.

(56:26):
I think it was the beginning of last year.
So just before the pandemic where we werelooking at all of those things
and technologiesthat we've tried to implement,
the good and the bad and the uglyand doing a bit of that stuff.
A Let's have that sowe can share that with other authorities.
So if somebody is thinking about, well,I want to look at this particular project,
then share our experiencesso that people and it's not necessarily

(56:50):
going to be the same experience,but people could then learn from that.
So things haven't worked, learn from that.
So as I say, we did that piece of workand I have got a conversation
with Rethink later on today.
So I was going to just ask wherethat got to
because I think that we've really usefulto try and pick that up again
just to really as a help forfor other authorities as well.

(57:11):
I think that would be really great.
I mean, it's something that
from a TSA perspective,we spend quite a lot of time on.
It used to be regional surgerieswhen we were able to do more face
to face stuff,and it's obviously moved online now.
So it's less regional,but it is a case of getting a load
of commissioners and buyersin a room and saying, What are you doing?
What's worked well?

(57:32):
And almost collating all that informationso that, you know, we can try and help
support people, navigate peoplethrough those those difficult decisions.
And when a reflect on you knowwe're talking about lessons learnt here
some of the some of the other authorities
things that they've struggled within particular particularly during COVID is

(57:52):
developing really nice kind of servicesbut then
not been able to drive that culture changethrough that
the staff that are almost responsiblefor making those referrals in order
for spotting those opportunitiesand and that's been the really tough
I think it's been almost workingon the mindset of individuals.
But from a remote perspective, rather

(58:12):
than sometimes it's easierto have those conversations
on a face to face basis and constantlybe there supporting them through it.
And it's more difficult remotely.
So if I'm thinking about social workas it's how do they.
How do we get that sort of mindsetinto the the technology is is should be up
there for consideration alongsidethe more kind of formal care and support.

(58:32):
And it's a really tough thing to doand I don't know
if you've come across that as wellin the services that you're working with.
Yeah.
I think you're absolutely right, Tim.
I think and it's some and some and I thinkit's kind of the same in any,
any organisation.
You've got some that are really pro
technology and yes it would really helpand others that aren't.

(58:55):
So it is that cultural shifton bringing people along with this.
And I do think some of those use casesare really good
because when you can talk through and say,well, this was Mary,
this is what happened to Mary ,and as we've done with the alcove,
because it makes you sit and think,actually, wow, that's really good.
And we couldn't have even provided that,but technology can.
So I think it is about buildingon some of those.

(59:18):
And again, going back to conferences,I, I know some of the
TSA conferences and listeningto some of those where it's happened.
There was a particular homecare providerwho talked about
some of the services,he had provided he was a home carer.
And if ever you wanted to go into thatprofession,
that was a time because he justit was so powerful

(59:42):
and you don't think about it, but
just thinking about his experiences,you just think, wow.
And that was a really good opportunityto listen to what others are doing.
And he certainly promoted that profession.
I'd like to have known whether many peoplesigned up to after that
because he was absolutely brilliant,really good.
We've definitely got a recording of it,so I'll dig it out and make sure it's

(01:00:05):
circulating on social media again.
I think
there's a balance, isn't there, between.
Having your experts.
I'm thinking of assistive technology now.
We've got a teamwho are deeply expert in this area.
But then you need the wider workforceto understand that
they're never going to be expert,but they need to understand enough of it
to spot the opportunitiesand sell the benefits .

(01:00:25):
I think it's the samewith digital inclusion as well.
I think all our staff are advocatesand that kind of emissaries,
if you like, for promoting
the opportunities that come frombeing connected and having digital skills.
And so it's making sure that people knowenough to be helpful,
but recognisingthat we can't all be experts in everything

(01:00:47):
. Just to add to what Geoff is sayingthere about this notion
that what is really powerfulis to get people to speak for themselves,
the people we're serving to just justdescribe what difference things have made.
And and not to forget that just becausewe're talking about this particular
area of our work is just like any other ,we get things out of kilter, misshapen,

(01:01:08):
and get them wrong in all kinds of areasof public service delivery.
And that's absolutely you know,it's in a way, it's absolutely fine that
you just need to learn from that, adaptwhat you're doing and move on.
And this is this is no different in a way.
And and it's ironic, isn't it?
We're now living in a timewhere just in time
and efficiencies are sort of slightlyfalling apart in the world

(01:01:30):
because we've had the shock to the systemthat we've had.
But it's reminded usthat a lot of innovation comes from trying
something and just deciding, actually,that didn't work.
And, you know, of course,that's that's how you progressed.
And so I really do think we need to showboth tolerance to stop getting it wrong
or on the issues not workingvery well and things not lining up ,

(01:01:53):
but also show a passionfor getting the stories out there,
because that seems to mewhat really motivates people to make it
make a difference, really.
And I think,
you know, I would say Norfolk,the focus on this itself has meant
that we've probably had some conversationsthat we wouldn't have had
because we've just created the energyand the willingness to try stuff out.
Really, I hope as director that spreadsthe innovation more generally.

(01:02:17):
I'm sure it must to some degree.
I totally agree, James.
And I
think even thinking around the assistivetechnology team, it's a brilliant team and
and they really get it and they do sharethat with the rest of the department.
But one of the other things we're lookingat the moment is a tech lending library.
So where people can go in

(01:02:37):
and lend bits of tech,if it works for them, absolutely great.
If it doesn't, they can take it back.
But it gives up, gives peoplethat chance to almost try before you buy.
So that's something we've just startedand but it'd be really,
really good to watchand to see how that then rolls out.
And if I could just add thatas part of a wider tech lending library,

(01:02:58):
so people can go toany of our libraries network
and they can borrow potentially a laptop,a Wi-Fi device, they can get
some advice and guidance, potentiallypick up assistive tech at the same time.
So it's a combinationof borrowing equipment,
but also getting that advice and supportat the same time that you need.

(01:03:19):
So as James said earlier,it's about agility.
It's about learning at pace.
And sometimes that means failing.
But what's the term fail forward,fail fast and they keep iterating.
I think increasinglythat is our new way of working.
Thank you.
There's been loads of fantasticadvice in there.
So for peoplethinking about exploring these issues
and I just wantedif you want to just summarise

(01:03:40):
your final thoughts for Commissioners,in terms of advice on how to move forward.
We need to move on, actually, from afrom a commissioning model
into much more of a collaborative wayof working
and in in the NHS in ICSsis that's what's happening now.
Innovation is coming from providerscoming together with commissioning
is coming together with partnersto bring expertise in

(01:04:02):
and just try and stuff out
and not really worryingabout the commercial was too much upfront.
I know that's easy for me to sayand difficult to do,
especiallyif you're doing things at scale.
But for the kind of thingswe're talking about, it's
probably quite safe to to almostnot take a commissioning approach
just to collaborate, try itand then move on to formal

(01:04:25):
commissioning if that's what is neededfor the next step.
And I hope in local governmentthat is the attitude
that also prevails alongsideworking with the NHS, how otherwise
I think people become very riskaverse to try and sort out.
I would agree with that.
I think it's about starting small,doing things, proof of a value, proof

(01:04:45):
of concept fast and then iteratingand scaling where you see that they work.
And I think if you do thatin collaboration with your partners
from the outset, then you've gota better chance of success than trying
to bring them in further down the linewhen you've done something on your own.
I really think as we do this,we really shouldn't forget inequalities
that such a strongtheme has emerged in the past year

(01:05:08):
about how disproportionatethe impact of poor outcomes
have been on protected groups or people
at risk of exclusion and so on.
So I think we have to take
a conscious step to think about that,not not just digital inclusion,
which is a kind of generic term,but I think targeted action

(01:05:28):
on areas of our geography that we knoware going to be suffering poor outcomes.
If I take Norfolk, I know thatsome of our urban areas in Great Yarmouth
and some groups of people,particularly black and minority ethnic
population and and
colleagues, they are at a disadvantage.
So we've actually got to use this agendato try and see if we can

(01:05:52):
create equalisation.
And if we don't, there will remaina sort of double disadvantage really once
you put digital exclusion over that overthe top of that ordinary inequality lens.
So I think it's very importantpart of the agenda for me.
I suppose that the the workwe're doing around data sharing, around
being able to link that acrossdifferent parts of your services

(01:06:13):
and even more broadly in the localauthority can help with that sort
of smart intelligenceon the particular inequalities
in the particular areasyou might need to focus your attention on.
Can I also add that we are reliant uponcentral government
and its agencies to help us providesome better
standards and interoperabilityaround digital identity

(01:06:36):
at the moment is difficultbecause everybody creates their own
digital identity solutions and triesto plug them in together.
I'd be really interested in how we couldhave a single sign on for the area
that combines the NHS digital identitywith a government
digital identity so that we can join upour services for our citizens.
I think digital and electronic data

(01:06:59):
interchange give us ways of reallyjoining up those services
and making them look much more coherentthan they might do physically.
But it is dependent upon thatthat standards
work and developing new capabilities.
Moving on from the,
dare I say,
the failures that we've seenwith verifying.

(01:07:20):
As a negative note to end on, isn't it?
You might want to editthat one somewhere else or remove it,
but it is an important digitalinfrastructure capability,
a foundation that we need to leverage,joined up local services.
And I think Geoff to add in intothe positive is really building
on the coping notices.
We've had an opportunity to be ableto really share that data where we failed

(01:07:43):
before, where we couldn't
perhaps share some of that informationand share that data.
And let's make sure we build on thatand we don't lose that good.
The good that that has broughtis that's a positive
to counteract the negative.
I'd like to thank all of our guestsfor joining the InternetMe
and Tim todayand really fascinating discussions.

(01:08:04):
And we hope that you will enjoy listeningto this podcast, Bye everyone!