Tools to consume open data in Lancashire & South Cumbria Integrated Care System

Ian Singleton of Digital Co-production describes tools developed to use the standard data feed is used and benefits of the standard, including major cost savings.

Digital Co-Production Ltd worked with Lancashire & South Cumbria Integrated Care System – Healthier Lancashire and South Cumbria - to develop a set of frontline tools to consume Open Referral UK data. The tools were developed to enable robust trials and to accelerate adoption of the standard by both service providers and technology providers.

Challenges

The Integrated Care System across Lancashire & South Cumbria has recently delivered a pilot adoption of the Open Referral UK data standard. To help deliver the pilot and to help accelerate adoption of the standard, the programme identified requirements for development of the following tools:

• a multi-use “Service Finder” tool that allows different professionals to search across all service offers for the most appropriate services. This is aimed at key frontline workers, including Social Prescribing Link Workers, Early Help Professionals within Social care and locally commissioned third sector providers.
• a “Website Widget” for service providers to maintain information on their own Websites and in a digital catalogue as part of a single update process.
• a “Translator Module” to hold information and manage the updates into any required language, including easy read versions. The critical process was to maintain an automated tracking between changed original versions and the latest translated version – to avoid the English version and translated versions falling out of sync.

The process

Digital Co-Production Ltd was commissioned to co-design and develop these tools as Minimum Viable Products (MVP). The development was run as an AGILE project that lasted 4months to deliver the 3 products from November 2020 to March 2021. The final MVP products were trialled and tested by Social Prescribers, Children’s Social Care Early Help Officers and commissioned third sector providers (including Blackburn Age UK, Carers Services, substance abuse and food bank providers).

Delivering the prevention agenda

The starting point for the work was an initial set of requirements that had been captured during the Local Government Association (LGA) managed Loneliness work in 2019 – LGAs' report on Loneliness Pilots. The LGA was aware that adoption by technology providers and indeed by frontline workers may be slow and wanted to create a showcase of the capability enabled through Open Referral UK. The LGA had therefore commissioned an open-Source prototype tool that was developed and delivered by VidaVia Ltd. Digital Co-Production therefore took this open-Source product and developed a commercial offering of the Service Finder tool and added the Website Widget and the Translator Modules.

Co-development process

The co-development process consisted of 6 2-week sprints covering the 3 products. The process consisted of a set of online workshops that were run virtually using MIRO boards and PowerPoint online collaboration tools.

The workshops brought together a very broad set of stakeholders across Social Prescribing Link Workers, Early Help Prevention Officers, Adult and Young Carer Support workers, Substance abuse workers and many more. This provided the forum and opportunity to explore the broad range of use-cases for the data standard generally; and the specifics of the functionality of a tool to support them.

Attendance at the sessions was excellent with more than 40 people attending the workshops to provide feedback against their specific sets of requirements and preferences. The tools were commissioned by the Integrated Care System (ICS) to be given to all Service Providers to provide an incentive and a lever to ensure that they provide accurate information about their various service offers.

The model is that Service Providers can access and use the tools for all their employees, in return for meeting the defined levels of accuracy with regards to the information that they maintain. Where providers are asked to maintain data into a Directory that they cannot access (where they don’t have a compliant tool to consume the API), they will be less likely to engage positively.

The outputs agreed by the workshops were:

• The Service Finder tool should allow highly personalised and flexible searches; searches can be filtered based on client circumstances, availability, configurable pathways, configurable assessment questions, geography, type of service as well as specific eligibility such as age, gender or address for example
• The Service Finder tool can search across both traditional “human services” where there is 1 to 1 or group sessions, as well as searching for online and mobile phone / web app services
• The tool will allow the frontline workers to ‘txt’ clients through their preferred messenger tool e.g. WhatsApp or Facebook or SMS to view their shortlist/favourite service options in a browser. Alternatively, they can post the HTML of the shortlist/favourites into an email allowing clients to have a list of the appropriate services that were identified through the conversations.
• The tool will be responsive to mobile phone, tablet and PC versions to facilitate remote use as well as in the office. A future version will include an ability to create an account to work offline and remember preferences and shortlists.
• A Website Widget will allow Service Providers to be able to capture the information once and update both the central Digital Catalogue and their own website in a single process.
• A translation tool will allow ongoing management of translated versions to any specific language, including Easy Read, when the source version of the service information changes.

The image below is a screenshot of the Service Finder tool, both as a tablet and mobile phone version. For more screen shots and a demo, see the Digital Coproduction products page.

Further work with London Sport and the London Borough of Waltham Forest, now enables searches across both activity / sport groups (defined to the OpenActive data standard) as well as community groups defined to the Open Referral UK data standard. This will allow the development of a more holistic support plan for someone that perhaps can help manage both physical and mental health issues.

Benefits

There are three broad types of benefit, which rely upon the adoption of the data standard generally across the ICS, as well as using similar tools to be able to search across all services (hyper-local, regional and national delivery; and across traditional “human services” web / phone-app and online services).

Delivering the prevention agenda

Adopting the standard and enabling frontline workers (and citizens themselves) to search across all available local, national, online and mobile phone-app services underpins the broad ambitions for population health management / prevention. This is not solely about signposting to third sector services but creating a more joined-up capability to find appropriate statutory and non-statutory support for people to prevent their needs from escalating. Without a reliable and accurate set of all service offers, then the ambition for people to find their own or being helped to find appropriate local support is unrealistic and hence the targeted impact on better health and care outcomes (and reduced demand) will not materialise.

A more efficient system

The business case (awaiting publication) across Healthier Lancashire and South Cumbria demonstrates that there are annual efficiencies in excess of £1 million per annum. This is driven by a model where there is a single record of each service, rather than many dozens of records. On average each “service” is being updated / maintained in 20 separate mini-directories, thus saving 19 sets of administrative processes.

The efficiency above is an administrative saving relating to a reduced effort by multiple organisations to maintain their own list of what services are available. More importantly, the Service Finder tool will deliver up to 25% increased capacity across frontline workers. Currently frontline workers invest significant effort researching appropriate services for people they are supporting; they often also visit and engage with local groups to build their own network and awareness of local services. Service Finder that is searching a wider Directory (or Data Lake or Digital Catalogue) of this information will save this time. The estimate through the original LGA loneliness projects was that as much of 25% of their time is invested into doing this research; this not only saves time, but also allows a far wider set of referral services – as a single brain can only perhaps remember 30 services in total.

A better customer experience

Lastly, the tools also deliver an improved experience for clients / customers. The tool allows frontline workers to co-produce the search process by getting the client to choose the circumstance terms, locality, times of the week etc that would suit them for attending a community group or service. This will improve their experience and also increase the likelihood that they will attend. The process is less time consuming, but most importantly the process removes two key frustrations expressed by citizens.

Firstly, that they are sometimes signposted through multiple organisations who claim to offer support, but who only offer a signposting role; thus, a citizen can sometimes be signposted through multiple organisations and still end up without appropriate support. The tool and the standard ensure that services are listed that are specific groups/services and times, rather than organisations.

Secondly, another frustration is that information can be inaccurate and hence people are referred to services that do not operate anymore or have changed times or location. Having a single version of the information increases the likelihood that the information will be accurate.

Stimulate the market

An additional benefit sought was to gently disrupt the market and persuade other mainstream technology providers to adopt the standard where they may see a risk of losing market share to generic but OR UK compliant service finder tools.

Lessons Learned

The learning below relates both to the core function of the tools, but also more broadly to the challenges that remain for Open Referral UK.

Nervous Providers

Providers are sometimes nervous about a model that makes their service information visible alongside similar competing offers; they would prefer a model where people visit only their own website to avoid any sense of competition. Similarly, providers have always tended to capture and promote information about their organisation rather than their service offers. The Open Referral UK model is built on the assumption that customers wish to find detailed information about actual service offers (time, location and eligibility for example), rather than general information about organisations that might be able to help. Greater focus on the actual customer experience will resolve this dilemma and help shape how Open Referral UK and adoption of the standard is shaped in future.

Shared Taxonomies

There is a need to create a shared set of taxonomies (the tags that are used). Without shared taxonomies, then the join-up across health, social care and broader community services will remain undeliverable (as each separate agency will insist on their own preferred language / tags).

Rather focus on own website

Some frontline workers prefer to rely on their own web research rather than searching a maintained list of all services. There are a number of factors at play such as lack of trust, angst over their own role/value and simple worker preference (sometimes a preference to work with paper-flyers rather than digital records); these may need to be resolved to deliver the real benefits of Open Referral UK.

Self-care

The work to date has not considered the business case and user-case for direct citizen access to search for services and self-refer to local community support services. A reliance solely on paid employees who help people find support is financially unsustainable; the subsequent phase of work for Digital Coproduction is to develop a self-service module (which would include a model where family members take on an advocate role for a vulnerable person).

Demand driven

It is demand at the front-end that creates the momentum and will underpin success; service providers and technology providers will adopt the standard and the defined process where they see that this is becoming widely used. It is therefore about understanding and then meeting the need for how and when and why people (either frontline workers or citizens themselves) need access to accurate information about local community (or national online) services that is the key.

Focus on outcomes

The greatest success can be achieved where the vision and alignment exists between technical and operational leaders. It is a focus on outcomes – such as ensuring that vulnerable people can identify and attend appropriate support offers - that helps drive this, with an underlying message that adopting data standards and adopting efficient digital ways of working are important factors in delivering those better outcomes.