Strategy before shopping: the question every TEC programme should be able to answer

Part 1 of 10 in our TEC Pathways series, following the journey from first plan to proven outcomes.

A year or so after any technology enabled care service goes live, somebody senior leans across a meeting table and asks whether it actually worked. It is a fair question, usually asked by the person who signed off the budget, and in far too many organisations it is followed by a silence that everyone in the room recognises. Not because the service is obviously failing, and not because anyone did their job badly, but because nobody agreed at the start what working would mean.

This article is the first in a series following the journey of technology enabled care from first plan to proven outcomes, step by step. It begins where every good programme should begin, which is nowhere near the technology.

The quiet room

It makes no difference whether that meeting room belongs to a health board, a local authority, a housing association or a charity, because the pattern repeats itself everywhere. The service costs were never baselined, so nobody can say whether money has been saved. The people outcomes were never defined, so nobody can say whether lives have improved in the ways that were hoped for. The social impact was never given a value in pounds, so the wider benefit to families, carers and communities, which is often the largest benefit of all, simply does not appear in any report.

The programme is not failing, exactly. It has become unmeasurable, and in the end that amounts to the same thing, because whatever sector you sit in, what you cannot prove you cannot fund for long. Budgets are under pressure everywhere, the analogue to digital switchover is forcing decisions onto timetables that nobody chose, and any service that cannot demonstrate its worth in the organisation's own terms will eventually find itself explaining its existence to someone holding a spreadsheet.

The frustrating part is that the fix costs nothing, takes a fraction of the time the procurement will take, and happens before a penny is spent on hardware.

Start with the organisation, not the technology

Every organisation delivering technology enabled care is different, and the differences matter more than the similarities. A housing association with ten thousand tenancies has different obligations, different funding flows and different definitions of success from a county council commissioning care at scale, and both differ again from a charity supporting a specific community. Before any conversation about sensors, platforms or suppliers, the organisation needs an honest account of itself: what kind of organisation it is, what service model it operates, what it wants to achieve, what it must deliver whether it wants to or not, and which pressures are bearing down on it, from budgets to regulation to the digital transition clock.

This sounds obvious written down. In practice it is the step most often skipped, because the technology is the exciting part and the organisational homework is not. Yet every decision that follows, from which peripherals suit which people to how responses are staffed and how reports are read, traces back to what the organisation is actually for.

Take the baseline while you still can

The second piece of work is a baseline, and the timing is everything, because a baseline can only be taken before the service changes. Once new technology goes live, the old picture is gone for good, and with it goes any hope of a before and after comparison.

Three things need to be captured as they stand today. The first is money: what the current service costs to run and what it achieves for that cost. The second is people: the outcomes the service currently delivers for the individuals it supports, honestly assessed rather than optimistically described. The third is social impact: the wider value the service creates, or fails to create, for families, carers and communities.

None of this needs to be perfect. It needs to be honest, documented and agreed, so that whatever the technology achieves later can be measured against something real.

Put a number on success, including the social part

The final piece is the one that separates programmes that survive scrutiny from programmes that do not: agreeing up front what success will be measured in.

Financial measures are the familiar territory, things like care costs avoided, hospital admissions prevented and residential placements delayed. People outcome measures take slightly more thought, because they need to reflect what matters to the individuals being supported rather than what happens to be easy to count. And then there is social impact, which is where most programmes go quiet, because putting a pound value on wellbeing feels uncomfortable until you realise that recognised, respected methods exist for doing exactly that.

HACT's Social Value Bank and the HM Treasury Green Book approach used by our trusted partner Colligo Labs both allow social impact to be monetised in ways that funders, auditors and elected members accept. The essential point is that the method is chosen now, at the planning stage, and not reverse-engineered eighteen months later when the funding question arrives and somebody needs the numbers to say something flattering.

A social value figure agreed before go-live is evidence. The same figure assembled afterwards is advocacy, and everyone reading it knows the difference.

The least glamorous step, and the one everything stands on

Strategy before shopping is not a slogan, it is a sequencing rule. If success is not defined before go-live, it cannot be measured after it, and every alert, every response and every report the service produces from that point on is only worth what it can be measured against.

Get this step right and the technology proves its worth in the organisation's own terms, in pounds, in outcomes and in social value, continuously and without argument. Skip it and the best that can be said at that meeting a year later is that the service seems to be going fine, which is not an answer that protects a budget.

The next article in this series moves one step along the journey, to the place and the community, and why understanding how a neighbourhood is actually working belongs before any conversation about an individual home.

If you are planning a technology enabled care service and the measures of success are still fuzzy, 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. He has spent his career making complicated things simpler and broken things better, and he has not finished yet. He has spent years watching health, social care and housing organisations try to navigate a technology market that was not always designed with their interests in mind, and developed some firm opinions, a lot of useful contacts and an apparently incurable interest in sensor technology along the way. He decided to do something about it. This is that something.