A Nottingham housing agency reinvented it’s services to create SMaRT – an innovative scheme using technology and response service to help people remain independent and well.
Since 2003 the Nottingham Community Housing Association (NCHA) has provided supported housing to a wide range of people, including people with a learning disabilities, mental health needs and drug and alcohol problems.
In 2002, the NCHA asked their residents what they wanted from the service. They found that many felt that the service wasn’t meeting their needs. They wanted access to support, but were not always happy with the way that support was provided.
One of the residents said “I would rather not have staff sleeping in the whole time. If I had staff there when I need them I wouldn’t be able to do my own things like I am doing now. Then I know that when I move on to a flat, I can do all that for myself”.
Other people, who didn’t have on-site support, said that scheduled visits from support workers weren’t always at the times they were wanted or needed.
The NCHA decided to have a rethink. How could they meet the needs of the people who used their services more efficiently?
They looked at the technology often used in services for older people: remote monitoring, help at the end of the phone or the press or a button, and rapid-response call-out. They then identified how they could use them in a different setting to provide more efficient and effective support.
“Why couldn’t this be adapted to work with a whole range of client groups?” says John Bartle, Head of Housing with Care and Support at NCHA.
So the SMaRT scheme was launched in November 2003. Staff no-longer sleep in the supported housing. Instead, a response centre was set up with staff on call round the clock. Residents can contact support staff by phone or via a ‘SMaRT box’ in their home.
Other technology is used where needed, such as an automatic medication dispenser which allows staff to remotely keep track of whether someone is taking the medicines they need. CCTV is installed to offer protection to those who may be at risk, such as for women who have experienced domestic violence.
SMaRT ensures that the right support to be there at the right time. John says “we can respond instantly by sending in our staff, and we have good relationships with the police, ambulance and fire service, out of hours NHS services so they can respond appropriately.”
Staff at the response centre deal with a wide range of issues.
“At a simple level it’s people locked out of their flat” says John. “They can contact us and we can talk them through what to do. It’s giving people the confidence and empowering them to know what do. At the opposite end of the spectrum someone may have got to the point where they want to take their own life. Basically we’re giving people a counselling session at three in the morning.”
It is also flexible, so the amount of support an individual receives can be tailored to the amount that they need.
“it’s an individual response – it can be stepped up or stepped down, instantly – the whole service is designed to be a response service,” John says.
The ability to respond rapidly, and the staff’s ability to think of creative solutions mean that they can often catch problems early. This can prevent more serious issues developing and avoid hospital admissions, intervention from the police or even a tenant losing their home. In the case of a woman who had escaped domestic violence, the service was able help at exactly the right time.
“Her partner had arrived at the house” says John, “and she was wavering with letting him in. She called SMaRT, where the staff had her records on file and were able to talk through the issues and how she was feeling. They talked her round and she managed to resist getting into a very dangerous situation.”
John emphasises he doesn’t think SMaRT is a “one size fits all” solution.
“One of the problems with the current commissioning process,” he says. “People prescribe how they want care delivered and order what they’ve always ordered. We prefer to have a conversation about how we can meet the needs in different ways. People talk about thinking outside the box – if you procure inside the box, you get an answer from inside the box.”
Summing up how things changed as a result of the SMaRT service, John says “It has inspired people to achieve things. The things we have always talked about, it’s actually delivering. People are inspired and confident to do things they never believed they could do before. It’s inspired us as professionals, and then we can inspire service users to achieve fantastic things. But we’ve only just started on a journey…we’ve still got a long way we can go.”