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Transforming care and health through information and technology: Local Investment Programme – Interim Report

By Dr Adam Hoare

Local Government Association – Local Investment Programme

Local Government Association Local Investment Programme Interim Report

Local Investment Programme – Interim Evaluation Report

In 2017 the Local Government Association in collaboration with NHS Digital introduced the Local Investment Programme. The programme recognised that the imperative for local care services to transform has never been greater due to rising needs, citizen demands and expectations alongside sustained pressure on resources. Although technology will never be a replacement for the delivery of care it can, if used appropriately, support people to live at home for longer, enable professionals to work more effectively together and help commissioners target services where they have the greatest impact. The Local Investment Programme (LIP) supported transformation through one-off local investment funding of up to £50,000 for projects that seek to use information and technology to improve adult social care and health outcomes and deliver financial savings as well as supporting more resilient care services and in improving outcomes, including people’s experience of care.

The programme was underpinned by a number of key principles:

  • encouraging open and replicable approaches which enable other LAs to adopt digital ways of working
  • supporting innovation and new thinking within adult social care and health, assisting its digital maturity within a challenging financial environment
  • assisting cross-council or multi-agency use of information and technology
  • developing an evidence-base and tools to support ongoing local digital investment in adult social care and health.

It was expected that the outputs and learning from these projects would be reusable and replicable, enabling them to be shared and implemented widely across the sector.

Councils who were successful in their bids for funding received support from an external partner organisation to help evaluate benefits, capture learning and support dissemination to assist other local areas. Participating local authorities were required to actively support this work, over the course of the programme, including in the development of guidance and tools for the sector.

The Bayswater Institute and OPM Group (now Traverse) were successful in winning the opportunity to evaluate the 19 technology interventions funded by the programme. In April 2018 an interim report was produced capturing the learning on the ground as well as considering the programme itself.

 

Early Evaluation of the Organisational Implications of CSCW Systems

Evaluation of Computer Systems which Support Cooperative Work (CSCW)

Abstract:
Computer systems which support cooperative work will undoubtedly change the way people interact with one another in a working setting. In stimulating these changes, the CSCW system will be a force for organisational change. Over the past twenty years there has been a tradition of impact research, in which investigators have studied the impact computer-based information systems implemented within organisations have had upon those organisations. The results have been many and varied. Some studies show that computer systems lead to the centralisation of power, while others show decentralisation of power. At the level of the individual job there are studies which show the empowerment of the individual and the opposite: the creation of the “white collar assembly line.” A study from 1983 demonstrated both job enrichment and deskilling from two different computer systems in the same organisation. There is widespread agreement that there can be substantial change, but very little agreement on the form that it takes. We have argued elsewhere (Eason 1988) that the reason for these diverse results is that computer systems are not deterministic, and that they can be used to achieve many different organisational effects. There is an opportunity in the design and development process to plan the organisational outcomes and to achieve the impact that is desired by the members of the organisation.

Early Evaluation of the Organisational Implications of CSCW Systems Ken Eason

Springer Link to Article

Eason K.D. and Olphert C.W. (1996) Early evaluation of the organisational implications of CSCW Systems, In Thomas P. (ed) ‘CSCW Requirements and Evaluation, Springer-Verlag, London 75-89

Productivity? – Don’t Just Fund the Technology Phil! A response to the budget of the 22nd November 2017.

By Dr. Adam Hoare

The Organisation for Economic Co-operation and Development has downgraded its 2017 growth forecast for the UK to 1.5% from a 1.6% estimate made in September, making Britain the weakest economy in the G7. The office for budget responsibility had taken the rosy view that after 2008 UK productivity growth would return to previous levels of around 2% It has now admitted, after years of getting it wrong, that it is likely to sit around 1.3-1.5% until 2020. Last week’s budget reverberated with the recurring issue of low productivity growth. The solution presented was an industrial strategy. Something that had fallen out of favour as Government interference.

The announcements based on borrowing came thick and fast:

  • Digital skills and startup funding to reinvigorate the UK’s waning productivity.
  • £3 billion to cushion the landing of a potential hard Brexit, the chancellor said: “This Budget is about much more than Brexit. For the first time in decades Britain is genuinely at the forefront of this technological revolution. Not just in our universities and research institutes, but this time in the commercial development labs of our great companies, and on factory floors and business parks across this land. But we must invest to secure that bright future for Britain.”
  • Last year’s £23 billion National Productivity Investment Fund was to provide £31 billion in funding over six years, compared to the originally planned five. R&D to receive another £2.3 billion investment, under the government’s Industrial Strategy aim to ramp up R&D spending to 2.4% of GDP.
  • To double the number of tech startups founded in Britain with the goal to see one created every half an hour.
  • A £10 million Regulators’ Pioneers Fund to help regulators find new ways to bring emerging tech – AI and 5G – to market.
  • Tech City UK, to be rebranded as Tech Nation, a body with a remit to spend £21 million on developing the UK’s various startup hubs.
  • In a bid to tackle the UK’s stark digital skills gap, the chancellor also outlined fresh cash to retrain people and provide a greater focus on maths and computing for children and teenagers.

The idea of a strategy and a long list of funding opportunities for new technology seems to overlook some very important evidence. Figures for various IT projects (some of the figures originating from the National Audit Office no less) demonstrate a persistent gap between the projected benefits and the reality:

  • Child Support Agency – £500m estimated loss;
  • DEFRA Rural Repayments Agency – £130m estimated loss;
  • Inland Revenue NIHS – £3-4 billion estimated loss;
  • Magistrates Court LIBRA – £232 million estimated loss;
  • HM Prison Service C-NOMIS – £690 million estimated loss;
  • Fire and Rescue FiReControl – £469 million estimated loss;
  • NHS NPfIT – £20 billion estimated loss.

As we borrow money to fuel a technological “hail Mary pass,” it would seem a good time to think about why we fail to convert so many such passes to a touchdown. The Bayswater Institute has been extensively involved in embedding and evaluating digital technologies in health and social care over several decades. Over the last decade alone there have been hundreds of initiatives to improve productivity in care provision by elevating the use of technology to 21st century standards. Although there has not been an overall assessment of the impact of these initiatives the experience of care provision points to low impact from these initiatives. From seeing these projects from the inside, we have developed a level of understanding of why they struggle – and it is not the technology. Two things work against the use of technology in many of these scenarios:

  1. The technology does not exist in isolation it is part of a system that involves the people using it and the people receiving services. If it does not work for them it is not productive.
  2. Where there is an increase in productivity it usually means a single person can handle more work or the workforce can be reduced. This inevitably generates resistance.

Both of these challenges are rooted in social science and the interface between people and technology. Understanding these sociotechnical systems is essential in successfully capturing the benefits the technology can bring. Looking back over the announcements we cannot see where this is mentioned. Throwing money at the technology and expecting social transformation is an interesting approach but the evidence is – it has been done before and it will fail.

A third issue that recurs in productivity considerations. To know a system is more productive than it was before it must be measured in a meaningful way. This links back to point 1 above. If it works for the professional but not the citizen – it does not work. Hence, the outcomes of productivity must include social value and social impact otherwise public money is spent on making the system happy and the service recipient unhappy.

We spend much of our time providing summative evaluations of where the barriers and challenges are in technology projects that are trying to embed into practice. We have a special interest in formative evaluations of interventions where we can draw on our experience and anticipate some of the problems ahead of the development and have the opportunity to have an impact on the NAO estimated loss. If the focus remains on the technology and not the combined scoiotechnical system the return on investment is likely to be negative. The last thing that Phil wants.

Measuring and Evaluating – Introducing Imagine

How the Imagine Approach Captures Context and Leads to Sustainability

The Imagine approach is intended to assist organisations and communities of all kinds to improve their long-term sustainability. It provides a rapid means to:

  • Gain a clear understanding of the context in which the organisation or community finds itself and the challenges it faces.
  • Identify the main indicators which can be used to measure progress made in facing these challenges.
  • Assess the overall message of these indicators and thereby assess the current sustainability of the organisation or community.
  • Consider the current challenges, make scenarios of possible undesirable and desirable futures.
  • Assess progress made in either achieving or remaining clear of these futures in the light of current challenges.

Imagine requires the organisation to invest in no additional capital assets such as software or personnel. It is a facilitated workshop process in which a series of tools are applied to enable local decision makers to map their own context and model sustainable futures. In a series of four half day Imagine events, stakeholders from within the organisation or community come together with a facilitator to engage in the process. Imagine is Rapid, Participatory and Holistic It provides organisations and communities with empowering, evidence-based information … helping them to gain a clear insight into a sustainable future. Rich Pictures (such as seen at the top of the page) are used to map the initial context and amoeba diagrams provide an overview of how things were, are and (importantly) could be. Imagine is not Expert driven, Top down or Exclusive and full of technical language.

 

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