Having been working for years on various elements that make up the social care system of the future (yet without having completed any of them) it is beginning to look like we are in danger of having something we are proud enough of to open source (and make available as a SAAS product). Hurrah!
So we are starting to check our site (which has been in operation free of charge with friendly users for quite a while) meets requirements in areas that we have not been specifically focussing on. So today when the Sainsbury's Bank site got some poor publicity for getting an F in a security test we ran the same test on our hosted site. You can see below that we are doing OK (well - better than that - top marks!).
Our new site is up in the top tier - alongside Republican candidate for the presidential election Jeb Bush!
Hopefully it won't be too long before you can see what else we have been up to...
The internet is everyone’s shop window, and increasingly people are peering in through the small screens on their phones and tablets. This week Google started reporting in their search results whether sites were mobile-friendly or not. They also provided a tool to check whether sites meet the grade. You may be surprised by the results in the care sector. All four of the UK regulator websites fail the test. Most of the listings sites also fail.
Mobiles are increasingly used for internet access all over the world, and a recent (large) report from the International Telecommunications Union ranked the UK the fifth most tech-savvy country. The Google mobile-friendly test checks for a number of problems, including “Text too small to read” and “Links too close together”. In the table below sites that are deemed mobile friendly get a green tick. Sites that are not up to scratch (in a mobile sense) get a red cross for every failing. Kind of like a CQC inspection!
The results of our research (sorted by mobile-friendliness and importance, measured by Page Rank, with prices including VAT) are as follows:
So if you are a care provider and you have the time to enhance your listing on any of these sites you might want to consider saving your money.
Full disclosure: Better Care Guide, which appears second top in the table, is published by ReallyCare CIC. Care Opinion, which appears third in the table, have been helpful to ReallyCare CIC. But that isn't why they are near the top of the table. They are near the top of the table because Google put them there.
While every effort was made to ensure the accuracy of this data there may be some errors - please add a comment if you spot one, and it will be corrected (though no attempt will be made to keep it up to date over time). Likewise if you spot any significant omissions (sites which have ever had a Page Rank of 4 or above should all be included) please add a comment.
A homecare company (lets call them ACME Care) that I got chatting to at a conference recently get quite a lot of referrals from Continuing Health Care (which often means the service user has a terminal condition and isn't expected to live too long).
They told me that few months ago (in the middle of the financial year) they were referred a service user along with another company (who I will call OTHER Care). Each company was allocated a certain number of visits of a few hours per week. The service user found she had a very generous assessment, and after a couple of visits where their care workers were being asked to clean the windows (which were already clean) ACME care told the purchaser that there was over-provision and that they should cut back. CHC responded by taking 30 minutes off each ACME Care visit, and adding it to the OTHER Care visits (and presumably the windows were very clean indeed).
We have now moved on several months, and are approaching the end of the financial year. ACME has been referred another case from CHC. The service user is very sick, getting frequent home visits from a district nurse and must not be left on her own. In the periods where there is no homecare provision and no district nurse visiting she is looked after by her husband, who has significant health needs of his own, and has frequent appointments at the local surgery to have dressings renewed (though presumably renewing dressings is within the capabilities of the district nurse, who visits the house often).
Unfortunately there is not quite time for the husband to get to the surgery and back within a home care visit, and (remember) the service user must not be left on her own. ACME asked for a 15 minute extension to the visits on the days when the husband has to go to the surgery. The request was refused. The husband asked if the district nurse could change the dressings. The request was refused.
Apparently these sorts of things happen all the time...
Yesterday at a Kings Fund conference I attended a session entitled “Ensuring Excellence”, where one of the speakers was the National Programme Director of the LGA’s “Towards Excellence” program.
For me this is a huge shift from the current model, which you might call “Getting over a low bar” or “Avoiding starring in the next Panorama”.
Since the Care Quality Commission dropped the star rating scheme (and forgot to come up with a replacement) there has been very little incentive for a care provider to shine. In fact the only incentive I can think of is Pride (which is a deadly sin, surely). When the push to private provision was started we were told that the market would drive price down and quality up. I suspect it has done the former (though I don’t think the way public / independent sector hourly rates are compared is a level playing field), but I don’t think quality has improved as much as it has in other business sectors over the same period.
In retail, you can see very quickly whether you are doing a good job, because your customers exercise choice - both in coming into your store and (if they get inside) in filling their baskets. These decisions are being made all the time, and the retailers (and their consultants) measure and respond. The good retailers grow quite quickly (look at Tesco’s growth since Community Care Act in 1990) and the less well run fail (no shortage of data points here, unfortunately). Cast your mind back (if you are old enough) to 1990 and remember what super-market shopping was like: the lines that were carried, the quality of customer service, the car parking arrangements - I could go on. It is barely recognisable. I contend that the improvement is the market at work, in the way it was meant to work in care - but care has not moved on anything like as much.
The difference is that in retail the customers exercise their choice often - sometimes every day. In care the customers may make just one choice in a life-time. The only people who could buy care frequently enough to influence the market - the local authorities - have taken the decision, in the main, to make purchasing decisions once every 3 years, by going out to tender for block contracts or frameworks. Even where personalised budgets are available the service users are often strongly guided. Once a company has won a contract there is very little incentive to improve - they just need to defend. Not mess it up too badly.
This is failure by design.
I do hope that people with the word “Excellence” in their job title can sort it out. There is a finite number of years before I could be at the receiving end, and cultural change is very slow in government.
Note to Non Techies in Social Care:
Please read this post - if you think that you cannot make a contribution to an open source project you are wrong!
We have taken the decision that the time has come to open-source BetterCareGuide.org, which we have delayed for ages because, frankly, the code isn’t anything like as good as we would like (since it was the first app I wrote after a break of several years from programming, using a stack that was all new to me). But I have heard from many people that the code quality of a new open source product isn’t the important thing - a road map, a vision and a simple working product are. So I am taking the covers off the codebase in the hope that people will contribute and improve the code quality of BetterCareGuide while I concentrate on the easy stuff.
To provide a simple web site where the public can go to get information about UK care providers (though it should be equally applicable elsewhere) and the quality of care they deliver. The information and its presentation should be independent of any financial involvement with the providers. Small independent providers should not be discriminated against. The licencing prohibits the software from being operated by a for-profit organisation.
Road Map (bold items need significant input from non techies)
The pipe dream road map extends considerably further than this, but I will stop there for a while and see if anyone contributes with this bit.
So I have three requests:
We believe - passionately - in transparency, fairness and services that are of value to the community. We are trying to disrupt the Good Care Guide because we believe its model fails in the first two of these aims and the fact that there are several similar sites (and will be more) is a failing in trying to achieve the last objective. We are in a position where we can use new cloud services (which in low volumes are free to use) to be disruptive in an attempt to bring about our aims.
I don’t think anyone sensible these days would question the first two objectives, but I have heard that Shaun Gallagher, Director of Social Care Policy at DH, fears that having one site will stifle innovation, and that progress comes from competition.
His view is not uncommon - indeed it is widely held - but that doesn’t necessarily make it right, and I think he should consider the following:
We would welcome your comments on this.
The Good Care Guide, as many care providers know, costs £72 per year for a subscription. The two major benefits of subscription are that:
In order to subscribe you need agree to their draconian terms and conditions, which exclude:
“all and any losses, liabilities, claims, damages, expenses or costs (whether arising as a consequence of negligence or otherwise) arising in connection with…the inaccuracy, incompleteness or tardiness of any information supplied through the service”
We don’t think that this is fair on providers (particularly smaller providers) so we are launching a service that will let you know when someone comments on your business on the Good Care Guide site.
Our new version of BetterCareGuide.org launched today will send registered providers an email soon after a review of their business is posted on the Good Care Guide (as long as it remains possible - for obvious reasons we cannot offer any service level agreements) for FREE!*
If you are already subscribed to BetterCareGuide and set up to receive notifications of reviews then you don’t need to do anything (apart from tell other providers about this!). If you are a provider and want to know how to subscribe to the site then visit the guide for providers page.
If you are interested in why we are doing this please read this blog post.
* at least for the time being - we may need to introduce some charging at some point if the traffic increases too much and we don’t make enough from our pledgie, but if you sign up before that point the service will remain free
I had the idea for this blog post a few months ago, but (typically) didn't put pen to paper - or whatever the modern equivalent is. In the last couple of weeks I have been prodded twice - once by an excellent blog post entitled What makes residential care good? and today when I heard that one of the proposed "official" quality indicators for both residential and domiciliary care is a measurement of staff turnover.
My thinking is that staff turnover is a key indicator in all businesses, and that it would be beneficial to many groups if staff turnover figures were to be made public on every corporate website (at /staff-turnover.html perhaps). So far as I can see this would be in the interests of the business themselves, their customers and potential customers, their staff and their potential staff and even recruitment consultants (who would doubtless try and place people where the turnover was highest to maximise their profits). My proposed metric, which would be reported every quarter, would be "what percentage of the workforce of 3 months ago is still employed by you?".
As I say I have been thinking about it for quite a while and have discussed it with several people and so far nobody has come up with a reason not to do this. So I have taken a first step. Let's see if it will catch on....
Like everyone else involved with social care I watched Panorama (which showed hidden camera footage of abuse at a care home) the other night. I wanted to watch it live so I could time a couple of prepared tweets to pimp some new functionality on our BetterCareGuide web site, so I was also watching the #panorama twitter stream. I have been involved (albeit peripherally) in social care for many years and am no longer shocked by this sort of abuse. Saddened, perplexed, dismayed by my inability to find a quick fix – all of those, certainly. But as long as there are elderly or disabled people who need care, inequality (more of this later), cheap electronics and an audience, Panorama will have its regular care slot every 12-18 months.
So let's deal with the simple stuff:
This is massively outside my area of expertise (my Mastermind subject would be programming languages 1993-1996) but I think there are two fixes – one partial that can and should be implemented now, and one full, long term and almost certain (sadly) never to be implemented.
It is impossible - for the regulator, the management, service user relatives or anyone else apart from the service users (who are often not able to speak for themselves) and individual care workers – to fully monitor the way in which people are treated in their room in a residential home (and even harder in a domiciliary care setting). So the response should not be to throw more money at the problem, it should be to try to make monitoring unnecessary.
Make care workers feel like more than just cogs in the machine. I have long been in favour of stimulating the micro-provider end of the market simply because here care workers are closer to (or are) management. So management can more easily see how care is being delivered and care workers identify more with the business and its aims and ethos.
One of the problems with the care system in this country is that regulation and training are proportionately less of a burden for larger providers. In these businesses the distance between senior management and the coal face can be vast, both in terms of geography and levels of management. So you can end up with carers like we saw in Panorama – but you don't have to, and I have met senior managers who I think are doing the right thing to keep standards high in their organisations, but it is clear that the management of Forest Healthcare were not.
Safe in the knowledge that nobody on earth is going to read this far down, I can now get a little bit more controversial / speculative: Poor care exists in this country because of income inequality.
I just made this up, but I suspect there is something in it, and it isn't too big a jump from the research that has been done by Kate Pickett and Richard Wilkinson in The Spirit Level (or watch cute video introduction) to my unresearched guess. Perhaps they will include it as a case study in a sequel.
Last week the National Audit Office put out a document called "Implementing Transparency" part of which (8.2 - if you are interested) said that we need open data about social care “to support users in choosing how to spend personalised budgets”.
Tonight Panorama will give weight to that by showing that regulator data is sometimes a long way from current reality, whereas (as many a hotelier knows from TripAdvisor) data collected from the fickle public can mount up very quickly if something is wrong.
Open data is very important to me and I believe that transparency and openness in the long term increases performance and eventually open organisations will always benefit over those who hide their murky ill-doings. I also like playing with open data and this weekend I took part in Rewired State's National Hack the Government Day at the GDS offices in London. My hack (involving Met Office data) even won a prize, but my cup failed to completely run over as I never got to shake the hand of Mike Bracken who was meant to award the prizes (he didn't turn up).
Our comparison web site BetterCareGuide.org has a commitment to keeping its data open, but actually collecting data about social care providers is non trivial because:
Adult social care technology expert, open source advocate, cyclist, parent, volunteer teacher, former (very easy) world record holder and reluctant blogger.