Spot trouble before it happens.

Part 8 of 10 in our TEC Pathways series, following the journey from first plan to proven outcomes.

The same data, a different job

The last two articles lived in the moment after something had gone wrong. An alarm was raised, someone at the Alarm Receiving Centre answered it, and the right help was sent, climbing the escalation ladder no higher than the situation needed. That is reactive care done well, and it matters enormously, but it shares one limitation with even the best ambulance service in the world, which is that it only starts working once the person is already on the floor.

Back at step 5 we said that the data flowing out of a home becomes three things, alerts that say act now, trends that say something is changing, and reports that give people evidence for decisions. Alerts have had two whole articles to themselves. This step belongs to the other two, and it is where technology enabled care stops being a faster way of reacting to a crisis and starts becoming a way of seeing one coming.

The quiet drift

Very few crises arrive without warning. They arrive without anyone noticing the warning, which is a different thing altogether. In the weeks before a fall or an unplanned admission there is nearly always a quiet drift away from the pattern that is normal for that person. The kettle goes on a little later each morning, the trips to the bathroom at night become more frequent, the front door opens less often than it used to, and the hours spent in the chair grow longer while the movement around the rest of the home thins out.

None of those is an alarm, and any one of them on its own means almost nothing, because everybody has an off week. Laid side by side over a month, though, they tell a story that a good service can read, and they tell it while there is still time to do something gentle about it. A phone call, a visit from someone the person knows, a medication review or a word with the GP costs very little today. The fall, the ambulance, the hospital bed and the care package that follow if nobody notices cost a great deal more, and they cost the person most of all.

This only works because of what was learned at the kitchen table at step 3. A trend is a departure from normal, and normal is personal. A man who has always risen at 5 is not deteriorating because he is up before dawn, and a woman who has never cooked a hot lunch in her life is not at risk because the oven stays cold. The service that took the trouble to understand a life is the only one that can tell the difference between a habit and a warning.

Stepped up, or safely down

Change-of-need reporting is usually described as a way of spotting people who need more support, and it certainly does that. What gets far less attention is that it works just as well in the other direction, and that may be where some of its greatest value sits.

Care packages have a well-known habit of only ever growing. Someone comes home from hospital with 4 visits a day, which is exactly right for the first fortnight, and 18 months later the 4 visits are still in place because nobody has had the evidence or the confidence to reduce them. When the data shows a person back in their own routine, up and about, cooking, sleeping well and getting out of the house, a reviewer can step support down safely and with a clear conscience, knowing that the same sensors will flag it quickly if the judgement turns out to be wrong.

That is a better outcome for the person, who gets their independence back rather than having care done to them indefinitely, and it releases capacity for someone else on a waiting list who needs those visits today. It is also, to be plain about it, one of the more substantial savings in the whole pathway, and one that arrives with nobody being worse off for it.

The home speaks too

The same logic applies to the building. Temperature and humidity readings that mean little as individual numbers become an early warning once they are watched over time, because damp and mould announce themselves in the data long before they appear on the wall. A bedroom where the humidity has climbed steadily for 6 weeks is a repair worth booking now, while it is still a ventilation fix, and not in the spring when it has become a health hazard, a complaint and a much larger bill.

Housing providers will recognise the stakes immediately. Awaab's Law has put firm legal timescales on how quickly damp and mould hazards must be investigated and put right, and a landlord who can see trouble forming has a considerable advantage over one who waits for the tenant to report it, particularly given how many tenants never do. A home that sits at 12 degrees through January tells you something about the boiler and something about the household budget, and both deserve a conversation before the cold does its damage.

As we said back at step 3, the person and the property are very often looked after by the same small set of sensors. This is the step where that decision pays its dividend, with one stream of information keeping homes safe and healthy and the people inside them well.

The service in the mirror

There is a third kind of report that belongs at this step, and it is the one services are least keen to commission, because its subject is the service itself. Every call and every action was logged at step 6, and every response and its outcome was recorded at step 7, which means the evidence is already sitting there. How quickly are alarms being answered, and does that hold up at 3 in the morning on a bank holiday? How often does reassurance on the call resolve things, and how long does the mobile response team really take to arrive? Which devices keep dropping offline, which generate alerts that turn out to be nothing, and which homes have gone suspiciously silent?

A service that reports faithfully on the people it looks after but never turns the same lens on itself is only telling half the truth. The organisations that improve fastest are the ones that look at these figures regularly, without defensiveness, and treat a poor number as something to fix and never as something to bury.

A report nobody reads is just a louder spreadsheet

All of this comes with a warning, because the sector is not short of dashboards. It is short of people who have been given the time, the responsibility and the authority to act on what the dashboards say. Insight that lands in an inbox nobody owns is not insight at all, it is data with better graphics.

So the discipline at this step is as much about people as it is about software. Each report needs a named person who receives it and an agreed rhythm for looking at it, written in plain English and built around exceptions so that the 3 households who need attention this week are not buried beneath the 300 who are fine. Above all, each one needs a clear answer to the question of what happens next and who does it. A trend that nobody acts on until after the fall was never prevention, it was just a very detailed record of a missed opportunity.

Prevention beats crisis

The economics of this step are simple enough to fit on the back of an envelope. The difficulty is that prevention is invisible. The fall that never happened sends no invoice, the admission that was avoided appears in nobody's statistics, and the mould that never grew generates no complaint for anyone to resolve. Success at this step looks exactly like nothing happening, which makes it very easy to undervalue and very easy to cut.

That is precisely why the baseline taken at step 1 matters so much. It is the only honest way of counting the things that did not happen, by comparing what is going on now with what was going on before. Programmes that skipped that work find themselves at this stage with a strong feeling that things are better and no means of proving it, and a feeling has never yet survived a budget round.

A trend acted on today costs a fraction of tomorrow's emergency.

Where the series goes next

The next article in this series follows that insight into the rooms where decisions get made, the care reviews, the repairs programmes and the commissioning meetings, and makes the case that every one of them should be settled on evidence rather than assumption.

If you are planning a technology enabled care service and the data it gathers only ever gets looked at after something has gone wrong, 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. 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.