Help to Care Mobile App: Supporting care workers and carers to identify and prevent deterioration

Kent and Medway STP have developed a mobile app to support care workers and carers to access information to help them to deliver great quality care. In line with the local care agenda, we wanted to support people to stay as independent and healthy as possible within their own homes. Care workers and carers interact with the people they care for on a regular basis making them ideally placed to identify the small changes which can be the early signs of a problem.

The app is intended as a portable quick reference guide to support those who provide care to know what to look out for and what to do if they do notice the signs of deterioration, encouraging appropriate, timely referrals to NHS, social care and voluntary sector services. We knew from user research that both of these user groups are really pushed for time, so the app had to support them to find information and make decisions quickly on the go.

Given our aim to support people across Kent and Medway provide great quality care, we wanted to ensure the advice the app gave aligned with NICE resources. Each advice and guidance article is mapped to the relevant NICE guidance or quality standard. The app supports users to care in line with relevant NICE guidance and standards without having to access the internet or navigate to them.

Given the national context of the shortage of care workers and the growing demand for services the app also aims to support new people joining the workforce to quickly learn the basics and feel competent to care. We also have more people living with multiple long-term conditions which the app also supports. In the long term, our aim is for the app to support carers and care workers all over the country.

The Help to Care project was inspired by the Stop Look Care booklet created by Brighton and Hove CCG. Knowing that the project was addressing national issues, we wanted to build upon the success of the Stop Look Care booklet and make it an accessible resource for everyone living in Kent and Medway.

The app was designed to be free because we wanted to support consistency of practice that wasn’t dependent on commissioning decisions or budgets. We weren’t aiming to compete with or replace existing training but to complement existing practise. Whilst the care certificate is the professional standard, completion isn’t mandatory which can lead to inconsistent training standards.

In Kent only 21% of workers have completed the care certificate (Adult Social Care Workforce Data Set) and only 50% hold a relevant qualification. Similar challenges exist for unpaid carers, with only 9% reporting that they had received training as part of their caring role (NHS Digital 2018).

Stakeholders and potential users were consulted at several stages of the project. The project was initiated by a scoping workshop in July 2018 where key stakeholders were invited to attend. This helped to determine the key features of the baseline product. During product development, the app was again presented to a both a user group and a stakeholder group. Once the product was published, further engagement work was conducted.

Following publication in April 2019, further engagement and testing took place including focus groups with carers, social services teams, public representatives. The app was also presented at care provider forums and an informal qualitative study with a domiciliary care provider.

This crucial feedback enabled key changes the product before the app was officially launched. Changes included:

• The name was adapted from Help 4 Carers to Help to Care as carers reported the act of ‘caring’ was more universal and relatable than the title of ‘carer’ and better reflected the app as a self-management tool.
• The carers support guide was created, and the services section enhanced to support carers to self-identity and understand the support that was available, both locally and nationally.
• The feedback from carers has informed the development roadmap for the app. According to the 2011 Census there were 176,810 unpaid carers in Kent and Medway. Carers UK have estimated that the number of carers are likely to have increased by about 35% nationally. This also may not account for the number of hidden carers who do not recognised the invaluable support they may be giving to friends and family. Printing booklets for the entirety of this potential user base could have cost around £500,000 without considering distribution costs or issuing new versions. The app presented a scalable solution with the initial build costing less than 10% of this figure. It has also been much more sustainable as annual hosting and maintenance costs have been around 1% of the cost of printing.
• There are another 43,500 jobs in care across Kent and Medway with over 30,000 of these providing direct care to residents. Additionally, there are over 528,000 people living with long term conditions across Kent and Medway, that could be supported to manage their own condition using the app.

The project was initiated by the workforce lead within South Kent Coast CCG who developed a digital Stop Look Care e-book. The vision of bringing the product to the whole of Kent and Medway in a scalable solution was more challenging. Gaining consensus between the 8 CCGs to support the project and agree content standards was difficult. In order to gain traction, the support of Kent and Medway STP was sought. This also enabled the product to be transferred to the Design and Learning Centre within Kent County Council to support with the governance. The initial build of this app including development, testing and project management was delivered by NEL CSU for c£30,000. NHS Vanguard funding and Kent and Medway STP Local Care workstream has facilitated project delivery.

An advantage of the project dovetailing with Brighton and Hove’s project was that the topics for inclusion and the relevant NICE guidance had already been implemented. This made it much easier to ensure the guidance included on the app aligned with NICE with a strong evidence base of value within a social care setting. When new topics were proposed, such as Carers’ Support, we were able to identify the relevant guidance and included this within the governance documents. The purpose of this is to ensure the content can be reviewed in tandem with changes to national guidance.

After the initial build the project required an FTE Project Officer to manage the product. Securing this resource has ensured the product remains relevant and up to date in terms of content and facilitates ongoing promotion of the app into the delivery phase.

What our users thought:

“I absolutely love the app. It's easy to use, informative and signposts for further help. Great for carers, support workers, in fact, as a parent, would love it” Care Provider Training Manager

“I loved every bit of it especially the articles and trainings section, the navigation and font choice is superb as I read through with ease. I wish there was more content.” Social Care Worker

“It’s packed with information that’s readable and useful … the contents are attractively signposted, and it's is easy to navigate and use. The hyperlinks throughout to specialist services are particularly useful” Resident and Volunteer

The app has met is main objective of creating an app for care workers and carers which supports them to provide quality care. As part of the formative evaluation of the product, a domiciliary care provider piloted the app to help test its effectiveness. After 2-4 weeks of using the app, interviews were conducted with the staff to understand the impacts of implementation.

During the pilot study several interventions were enacted which prevented unnecessary treatment / admissions.

• Skin Damage. The pressure sores assessment tool was used to assess the red skin she observed on a client. The app prompted her to call the clients GP to book an appointment. This resulted in the early diagnosis of cellulitis which was treated without complication at home.
• Catheter Care. The catheter care guide was used to improve knowledge and resulted in more regular cleaning, reducing the client’s risk of infection.
• Mental Health. The mental health guide was used to increase confidence to facilitate a conversation with a client that was presenting with a low mood which would otherwise not have taken place. During the conversation, the Mental Health Services section was used to pass on some relevant numbers. Access to these services supported the client to get the advice and support needed and her mood improved.Despite being experienced, the staff interviewed reported the app made them feel more confident and reassured them they were deliver good quality care. Managers within the care services felt Help to Care supported them to create common standards and expectations across the workforce and encouraged staff to respond appropriately to changes in their clients.
• An unexpected finding was that the app was seen to have benefit for those living with long-term conditions because it supports self-management. During engagement activities a carer who had recently been diagnosed with type 2 diabetes highlighted the value of the app for him to manage his own condition and changes to his health. The potential of the app to support clients using inhalers was also identified. In one instance the app could have prevented, phone calls to a supervisor, 111 and the client’s GP as well as a GP appointment, demonstrating a clear efficiency saving.
• In all three examples the care worker felt that without the information, they wouldn’t have sought support from a manager or health care professional in such a timely manner, if at all, supporting lower level interventions and more efficient responses to changes in care needs.

The pilot has demonstrated the diverse ways in which the Help to Care app creates efficiency within the health and social care system and supports carers and care workers to follow NICE guidance. Following this successful pilot, the app was publicly launched on 11^th May jointly by the Kent and Medway STP, Kent County Council and Medway Council.

User testing demonstrated that some people, whilst confident to use apps, didn’t have digital skills to download it without support and would search via the internet, so we added some content and support videos to our website to support people navigating online. We’re also linking in with other projects to support digital skills and access as this is a barrier to using the app.

Every guide gives people the opportunity to let us know if it was useful or not. Our guide on continence pads has been voted most useful so far. Other popular articles include carers’ support, catheter care and the skin damage tool.

Taking an agile approach to project management has been key to enabling success. Some of the more complex features, such as a directory of services and integration with e-learning content, haven’t been able to develop as quickly and are dependent on other pieces of work. In order to overcome this challenge, the decision was made to launch in two phases. Phase one would be a baseline product which achieve the product aims of information and once the product was established, phase two will see the development of more complex features. The benefit of this approach means it is much easier to be user focused during the development phase.

However, there were some delays caused by early publication. Upon wider consultation, it became apparent that the name of the product was causing confusion about the intended audience of the and that it could bring wider benefit that originally anticipated. Having a publicly available app has been challenging for evaluation, for example we haven’t been able to baseline data before people start using the product.

Some of the biggest areas for benefits include the domiciliary care workforce, where workers are generally working alone with limited resources, and unpaid carers who again are providing care with limited support. These groups are very difficult to target as they cannot be captured through place-based evaluation. By delivering the app through the local authority it was possible to target both audiences through pre-existing relationships and build on existing forums.

The Help to Care project enables broad system improvement. By being developed a system level, it was possible to ensure all of the potential benefactors were considered alongside product development. The operational board has representation from social care and health (including local care, workforce and digital leads within the STP).

Further resources:

Help to Care promotional video 

Help to Care website