Proof, not promises.

Part 10 of 10 in our TEC Pathways series, following the journey from first plan to proven outcomes.

Back to where we started

The very first article in this series made one simple claim, that if success is not defined before go-live, it cannot be measured after it. Nine steps later, this is the moment that claim pays off. The baseline was taken, the measures were agreed, and a method for putting social value into pounds was chosen before anyone ordered a single device. Everything since then, the map of the place, the conversation at the kitchen table, the connections, the data, the answered alarms, the proportionate responses, the early warnings and the decisions made on evidence, has been building towards one question. Did it work?

The tenth step answers that question, and the word that matters most in it is continuously. This is not the evaluation report that arrives at the end of a programme. It is a habit that runs alongside the service for as long as the service runs, measuring what is happening against what was happening on day one, and feeding what it finds straight back into planning.

Why once is never enough

Most technology enabled care programmes are evaluated once, usually late, and usually because someone has asked whether the funding should continue. By then the evaluation is being asked to prove a case rather than test one, and the people reading it can tell. As we said in the first article, a figure agreed before go-live is evidence, while the same figure assembled 18 months later is advocacy.

Measuring continuously changes the job the numbers do. Instead of a verdict delivered once the money has been spent, they become a steering wheel. A service that looks at its results every quarter can see that one type of device is sitting unused in drawers, that one rung of the response ladder is carrying far more than its share, or that one neighbourhood is getting far less benefit than the rest, and it can put those things right while there is still time for it to matter.

Financial impact, counted honestly

The financial case is the one most boards ask about first, and it deserves to be made carefully. The savings from a good pathway are real. They come from the cost of care avoided or reduced, hospital admissions and ambulance callouts that never happened, moves into residential care delayed by months or years, and maintenance bills cut because damp and failing heating were caught early.

The difficulty, as we said at step 8, is that prevention is invisible. The fall that never happened sends no invoice. The only honest way to count it is against the baseline, comparing what is happening now with what was happening before, in the same service and among the same kind of people. That also means resisting the temptation to count the same saving twice, or to claim every good outcome for the technology when a skilled carer or a helpful neighbour played their part. Modest figures that stand up to scrutiny will always serve a programme better than impressive ones that do not.

People outcomes, asked and not assumed

The second measure is the one that matters most to the people the service exists for. It covers outcomes against the care plan, independence maintained, falls and harm reduced, changes in need caught earlier, and the reassurance that families and carers feel when they know someone is looking out for the person they love.

Some of that can be read from the data, but a good deal of it cannot, and this is where the promise made at step 3 comes due. Back at the kitchen table we said that the person and their family would be heard at the start and heard again at the end. Step 10 is that second conversation. Asking people what has actually changed in their lives, in their own words, is not a soft extra to be added if there is time. It is the only way to know whether the technology made life better or simply made it more monitored.

The same goes for the place. At step 2 we mapped need, strengths and gaps street by street, and those maps can now show outcomes in the same way, place by place. GIS of the kind our trusted partner Colligo Labs specialises in turns a single average for a whole council area into a picture of where the pathway is working well and where it is not, which is exactly what the next round of planning needs.

Social impact, in pounds

The third measure is the one that too many programmes leave out, because it seems hard to put a value on wellbeing. It is not as hard as it looks, provided the method was chosen at the start. HACT's UK Social Value Bank and the HM Treasury Green Book approach used by our trusted partner Colligo Labs both allow social impact to be expressed in pounds in ways that funders, auditors and elected members recognise.

That covers the wellbeing improvements people experience, the public costs avoided across the NHS, emergency services and residential care, the reduced strain on unpaid carers, and the value of safer, healthier homes and communities. Put alongside the financial savings and the people outcomes, it completes a picture that no single measure could give on its own, and it speaks the language that decides whether a service is renewed, extended or copied elsewhere.

Fed straight back into planning

The last part of this step is the one that turns a line into a circle. What the measurement finds does not go into a report and onto a shelf. It goes back to step 1, where it becomes the new baseline, and back to step 9, where it shapes the next round of decisions about who gets what, where and why.

That is why we have never thought of this as a ten-step project with a finish line. A pathway that measures honestly and plans again from what it learns gets a little better every time it goes round. One that measures once, celebrates and moves on tends to stand still, however good its first year looked.

Measured once, it is a report. Measured continuously, it is a service that keeps getting better.

The whole pathway, on two pages

Over ten articles we have followed technology enabled care from the first plan to proven outcomes, one step at a time. Plan, place, person, connect and gather on the first page, then answer, respond, report, decide and measure on the second, with every step tracing back to the baseline set on day one.

We have drawn the full pathway as a single talk-through diagram, two A3 pages that set out every step, what happens at it and the rule that holds it together. If it would help your own planning, or a conversation with your board, just ask and we will send you a copy.

If you are planning a technology enabled care service, reviewing one, or trying to prove that one is working, that is exactly the conversation we help with. We are independent, we work across the whole market, and we work for you, not for any vendor. Thank you for reading the series, and get in touch, we can help you.

Harry MacLean is the Founder and Managing Director of Creating Better, a strategic business advisory with a specialist care technology practice. He has spent his career making complicated things simpler and broken things better, and he has not finished yet.