What is your job role and what are your responsibilities?
I’m Information Systems Manager and I oversee IT projects that feed into social care services for Gateshead Council, and that’s both on the adult and children’s services side. I’m principally responsible for the CareFirst system. CareFirst is supplied by OLM Systems Ltd and CareFirst holds all the confidential, personal information about social care clients in Gateshead.
Whose idea was it to run the pilot study in your area and what were the series of events that led up to it?
We particularly wanted to look at doing something on the children’s services side and to look at two things really. One was a discussion between ourselves and the service area around looking at ways in which we could make efficiencies - for example, cut down on time social workers spent making assessments, that kind of thing, and also that may lead on eventually to whether we could contribute to physical savings in terms of costs of accommodation and so on.
Probably more importantly in my book was to improve the experience of workers who were having to record children’s information electronically, and grappling with the demands this placed upon them.
So I guess moving more into electronic working per se, but also adding a new dimension to that so that workers could start doing their assessments outside of the office and commit them straight to the electronic system without having to spend lots of time reproducing their handwritten notes and having them retyped and so on. We were looking for something that would help them become more mobile and flexible and improve their own and their clients’ experience of assessment working.
So how long did the pilot study last for or is it still going on?
We originally started it with seven workers and we chose those workers across a range of ability. So it wasn’t just the worker who was best at using a computer, it was a group chosen from across a broad spectrum of abilities.
We equipped them with DELL Latitude XT tablet PCs. We ran the pilot study for six months in total and we did an interim and then a final evaluation before deciding to roll out further tablets. So in children’s services overall we rolled out 53 tablets, which covered most front line workers.
Can you expand on what the beneficial effects have been to the user of this new technology, for example, what do you think the financial benefits might be in the long-term?
The financial savings are hard to quantify at the moment because we are still quite early on in the programme. What is clear though is that the mobile working is just part of a combination of measures that will realise savings, for example, in terms of moving staff out of particular accommodation. And we’re starting to see that now. We’re starting to see that we have the ability to close down some of the outlying offices and we now have a greater ability to hot-desk and move people around more.
For example, in the service area we’re moving some of those teams out to more centralised positions. It’s early days for that, but what we’re doing with several of the teams now, in both children’s and adult services, (mainly children’s services), is running out a programme of complete electronic working.
We’re using CareFirst to store some of the data that they use in their document management system scanning and they’re also using the mobile working in tandem so that we can help them redesign their work processes so that they completely govern all their information gathering and storage through the electronic system. It’s not exactly a new idea, but this will allow us to make the movement of staff and the establishment of staff much more flexible. It’s a work in progress.
What’s the difference between CareFirst and CareMobile?
The main social care information system for Gateshead Council is called CareFirst. CareFirst is a modular system and one of the modules within that system (‘CareMobile’) allows social workers to download electronic assessments and review forms and plans etc, complete them ‘offline’ on the tablet PC and then on reconnection to the network, upload the information straight back to the CareFirst database.
The CareMobile application client is installed straight on to the tablet PC and the main application sits on its own server. It basically links to the part of CareFirst (‘CareAssess’) that facilitates the construction of a range of types of electronic forms. The assessment worker downloads one or a number of these forms on to the CareMobile application on the tablet PC, according to what work they need to undertake that day.
The CareMobile application basically mimics the electronic forms in CareFirst. You can download as many forms that have already been commenced on as many clients as you like and then load them all up on to your tablet PC, which is then disconnected from the network and taken out to visits. Both the CareMobile application and the PC itself are fully encrypted for security. Should the tablet be lost or stolen, the information on it would be completely inaccessible.
You take them out so you can do as many visits as you want to in one day; record all the information on those pre-populated assessment or review forms or whatever they happen to be, then, when you’ve done that, you go back to base, you clip the tablet PC back into its docking station, you connect to the network and you upload the information straight back into CareFirst.
So what this allows you to do is to cut out all that ‘I’m going to go out and do an assessment today, I’m going to take a notepad with me, write reams and reams of notes, come back to the office, write them up on a piece of paper, hand them over to a typist, who gets it back to you a couple of days later, you correct it, give it back to the typist’ - it’s basically the ability to upload most of the data you need for an assessment back into CareFirst, and you also have the advantage of information from the database to pre-populate your forms in the first place.
We hear workers saying that in terms of completing an actual form, as a comparison between the electronic and the paper system, it can often save a good couple of hours from what they were previously having to do. And if you calculate how many forms social workers are having to fill in these days, it can be quite a considerable time saving. But also there’s another time saving in a sense of the process after completing an assessment.
From the social worker actually writing the form to then having it typed into the electronic system, corrected and authorised, there can sometimes be a saving of several days with this, depending on word processing backlogs etc., so the time savings can be quite considerable.
We are definitely finding that there are areas where this method of working works better than with others. We haven’t quite cracked it yet in terms of people rushing out to do child protection investigations; those kinds of things. It may be less effective in those kinds of arenas, but more effective in the teams doing the longer term work, the reviewing work.
I take it that this system allows for greater accuracy of note recording, in that the social workers are inputting their notes directly into the systems so that there isn’t the chance of them getting lost in translation further down the line if others are involved typing them up etc?
Yes, I think that’s true. The more times an account is reproduced the more it tends to change. For example, with social workers going out for a meeting with a fostered child, some of the workers have been able to take their tablet with them and go through the assessment face-to-face with the client.
It doesn’t work in all situations, but I think what that’s produced is a real feeling of inclusion amongst clients and they’ve actually been able to contribute some of the text themselves. And similarly in meetings they’ve been quite useful, being able to reproduce minutes of meetings, in the meeting itself and people signing up to that, so there are instances where that ability to instantaneously be able to produce a record can give greater accuracy and credibility.
That can’t work in every situation - there are some high-pressure situations that social workers get into, where we haven’t quite got there; it’s been a steep learning curve for some social workers.
There are various input tools, which come with the tablets - there’s the mouse, obviously, the keyboard too and also the electronic pens. The tablet PC looks a bit like an Etch-a-Sketch in a way - you can fold the screen down so that it becomes part of your tablet and there’s a programme on the screen, which allows you to write text and then converts your handwriting directly into text.
We’re got quite a few of the social workers using these now, but it does take a bit of mastering. Some prefer the keyboard, but many like the pens after practising the technique. It has high accuracy, this technology, and has proven itself to be really useful for workers.
From the patient / client perspective - how have they reacted to the new technology / process? Are they comfortable with the changes?
Well, some have been so comfortable to the extent that they’ve actually enjoyed the experience, especially in the less pressurised cases. The key to this is making a judgement with several factors informing that judgement.
The instances I’ve mentioned, where clients fed back that they felt included, they could see the information that was being written about them directly on the screen and they could make suggestions - it’s very different from seeing someone’s set of notes in a notepad.
They can make their own amendments this way and there have been instances where this has been a really positive experience for people. There have been other times, and such is the nature of social work, where you may be in a much more tense situation and the tablet PC sitting there might be perceived by some as being a bit of a barrier, so you have to make your judgement from case to case, and social workers are able to do that.
There are some areas you go to as a social worker where you might not want to take a tablet PC at all actually, but those aren’t necessarily the norm.
Is this the only system of its type or did Gateshead City Council choose CareMobile because it had a good reputation?
There are various ways of doing mobile working; probably one of the most well known is the digital pen and paper method, where you take out a piece of specially impregnated paper, which picks up a person’s notes made by a computerised pen and stores them - you dock it again with the system to transfer the information across.
We decided that the advantage of the CareMobile method was that it was an offline method, so you don’t have to be connected to the network, (like Windows Briefcase in a way) - you upload it and it immediately updates the database. That offline method was critical to us because of the geography of Gateshead means it is difficult to maintain a signal.
But the main thing was the combination of CareMobile and the tablet PC as well because you’re really giving the worker a PC that they can take anywhere. So they can work from home with it, they can work in a client’s house; they can work at different bases, so it gives them complete flexibility really. Pen and paper only really allows you to do one thing - it allows you to complete an assessment.
But with a tablet PC you can do all your other work as well - complete your word documents, complete your case notes; you could do an awful lot of different functions with your tablet PC. You can connect to the network somewhere else, other than just at your base; there are just so many possibilities, and that has been very attractive for workers.
Talking about the workers, how do they find learning to use the technology; do most of them take to it fairly easily?
Yes; well, the CareMobile programme is extremely easy to use, which was also an attraction. We haven’t got all the workers using it yet, because I think moving children’s services workers on to electronic working is a challenge probably for most authorities. It’s kind of a revolution - or maybe more evolution than revolution!
The tablet PCs - they’ve actually taken to, probably better than their desktop PCs, in many ways. I think the reason for that is they’ve kind of invested more in them.
Rolling out the tablet PCs has actually up-skilled workers including those that I wouldn’t have expected to have developed as far as they have. Sometimes a worker has to do a bit of work at home or in another place and it allows them to do that so they have a little bit more of an investment, a mental investment in using the technology.
And the digital pen technology on the tablets has been quite interesting for some of them as well and they’ve found that mastering that has allowed them a lot of other possibilities in terms of recording and speed of recording. So we’ve had extremely positive feedback on the tablet PCs themselves. It’s been pretty much universally positive.
We’ve had a few glitches where maybe the network hasn’t been so good, but those are pretty much the exception to the rule. There are more problems with needing to update the network, that kind of thing, rather than problems with the software itself. All these things are not without their teething problems and bugs, which must always be remembered I think. We’ve come through those and we now have a stable set-up, which is working quite well.
Were there any particular problems you encountered, such as software issues and so on?
I think in the early versions of CareMobile we came across software bugs which had to be ironed out and we have updated the software with successive releases. Even with the tablet PCs, we had some set-up issues with some of them. As we’ve developed more expertise around the tablet PCs, we’ve overcome those.
We’ve made suggestions to OLM about the development of the CareMobile programme to make it even more user-friendly and to make it more feature-rich and also to include some developments which we must have to be able to roll out the tablet PCs more widely, because we’re hoping now to roll out those tablet PCs to adult services. We’ve already rolled out a small number of them as a bit of a pilot and we’re looking to progress that further.
What are your future plans for using this technology - do you intend to roll it out to most of your field workers in due course?
Yes, there may be more rollout as long as funding is available of course. It’s quite an exciting time technologically I suppose in terms of what’s coming forward. There’s certainly a great future for mobile working, just in terms of the flexibility it gives people. It gives them the ability to work smarter.
There’s always a need to improve systems and that’s pretty unarguable. And there’s a lot of frustration around electronic systems as well and that comes across loud and clear from social care. I think the way forward is to give workers easy-to-use tools to work more smartly, more flexibly and more reliably.