Transforming home care for the elderly through a collaborative digital platform
In 2016 we launched the ShareLab Fund with a call for ideas that made use of collaborative digital platforms to create social impact. We selected eight pioneers who we’ve been working with closely over the last year. Now the process is coming to a close and we’re starting to review the progress made and the lessons learnt. We’re going to be publishing updates as they come along and hope to be able to collate our findings into a formal set of observations and recommendations some time in the spring.
There is a pressing need for innovation to avert a developing crisis in care for older people. An ageing population, the rising cost of providing quality care, massive reductions in local authority funding and an undervalued workforce are all creating enormous pressures on current operating models for care. And as every family will be affected by the challenges of our ageing society, innovations in this field that can work at scale could have a far-reaching impact.
TrustonTap is an online introductory service that helps older people to live independently for longer by matching people looking for care with local self-employed carers. It does this via a marketplace platform. Their application to the ShareLab Fund has enabled Nesta to understand more about how collaborative platforms can offer alternative operating models for care.
By working with TrustonTap we’ve been able to explore how platform technology can help people to build trusting relationships directly, enabling more consistent, personal care and to consider what effect that might have on quality of care. We can also see the impact that cost savings make on the take-home wage of the carers and how that might affect the long term prospects of caring as a more valued role.
We’ve been keen to explore some of the underlying issues too. Commercial platform businesses have been established for long enough for some of the downsides to have become apparent. Questions over the nature of the worker/platform relationship, over customer safety and the responsibility of the platform provider all become more urgent when the platform provides a service to vulnerable people.
The ShareLab grant has supported TrustonTap to develop further automation of their back office systems and the underlying marketplace platform. This includes incorporating personal budgets and Local Authority referrals into the system to ensure the service can be accessed by those in receipt of financial support as well as those who can book their own care privately. Improved methods for recruitment of carers and safeguarding processes have been put in place and the service expanded.
The Oxfordshire based business was conceived just over two years ago by William Cotton and Nick Grant who met while working on other businesses focusing on care of the elderly. We asked William and Nick to share the following discussion to give a bit more insight into the work they’ve been doing and what they’ve learnt over the last year.
Nick Grant, co-founder: So, William, what’s your background and what lead you to set up TrustonTap?
William Cotton, founder & CEO: Having spent 23 years with Boots running their Health & International Division, I left to to set up an assistive technology business called Canary Care, which is a home monitoring solution for older adults. Whilst being involved with this, I saw first-hand the severe lack of good, affordable and transparent home care and how hard it has become for people to access care whenever they want it.
So, I thought that there must be a better way of delivering home care and that was how TrustonTap came about.
How does TrustonTap differ from a more traditional domiciliary care company?
Unlike some of the more traditional care agencies we have invested heavily in technology to ensure that we can deliver a care service at a lower cost whilst also making sure that our handpicked team of trusted carers are paid at a good rate for the brilliant work they do. We have developed an online marketplace targeted at older consumers and their families so that they get the support and care to help them live independently in their own homes. Also unlike traditional care agencies, TrustonTap carers spend a minimum of one hour during a visit, giving the necessary time for close relationships to develop.
Our platform gives members access to the best possible information about the individuals who can give them care and support - such as profiles, ratings and photos. At the same time, we vet all our trusted carers and enable secure booking and payments via the site.
TrustonTap aggregates the supply of carers to give older customers and their families choice, transparency and consistency. We enable the same carer to build a customer relationship unlike traditional agencies which have their carers on a rota, meaning customers have different carers coming on each visit.
How does TrustonTap recruit new carers?
With the scale of the carer applicants we have received in Oxfordshire alone (over 1000), we need a very efficient process to review and filter potential TapTeam carers and to manage the significant amounts of data on each carer.
We have designed a completely new back office/ CRM system for carer applicants which allows us to manage the process efficiently and effectively:
- Registration: Applicants fill out an online joining form (20 questions)
- We conduct initial telephone interviews with them
- Applicants fill out an application form (c. 60 questions) and conduct a more in-depth interview with our carer recruitment manager. Those that we wish to list on the platform complete a joining form (c. 80 questions) and upload certificates, identity documents and photos. The platform has an automatic alert built in which notifies us if a certificate is due for renewal.
We conduct the same verification checks as a traditional care agency - two written references (work), up to date DBS, telephone interview, two application forms, ID checks and finally a face to face induction before authorising their profiles.
The unique care model ensures that the handpicked team of carers keep about 80% of their client’s fee vs about 40% via a traditional care agency. This is extremely important as most carers in the sector are underpaid and undervalued.
Therefore, our carers are better motivated and able to deliver better quality and more consistent care to customers. Also because of the platform technology, TrustonTap can meet customer needs faster and more conveniently.
As all our carers are self-employed they retain the flexibility to manage other care jobs or they can continue to look after their children and families during the hours that full time employment would not allow them to.
This one minute video explains the business from the perspective Marietta, of one of our carers;
How do you keep your carers happy if you can’t find them any work?
As all our carers are experienced self-employed carers, most of them have other work or want to work flexible hours. However, one of our challenges is to balance supply and demand. This is one of our toughest challenges. We try to maintain the right balance by carrying out targeted marketing, i.e. if we have more carers in a certain area, we will only market to customers living in that area and vice versa.
What happens if a carer cannot turn up to an appointment?
If a TrustonTap carer is unable to make a care visit and is aware in advance, then they can go onto the platform and help their customer choose another suitable local carer. In the event of a customer not having a suitable replacement in an emergency, TrustonTap will notify a member of their family or neighbour.
However, TrustonTap encourages all its carers to connect with other carers in their local areas to be able to form friendships and to help each other if the situation arises. TrustonTap is also piloting a WhatsApp group for one of our areas in Oxfordshire.
Are all the customers using the platform self-funders?
Although most of our customers on the platform are private payers and may have a relative, who can make the initial contact via telephone or Webchat, we do have a growing number of customers coming to us on direct payments via the local authority. This is very good news as it opens up a much larger share of the market.
Why bother with local authority work if there is so much demand from the private market?
Whilst dealing with the local authority is much more complicated, the demand is huge with over 75% of the UK home care market being LA funded (£4bn versus £1bn). Currently local authorities are at crisis point and being able to provide them with high quality and affordable care is vitally important to ensure there is sufficient care provision.
What happens if there is a safeguarding issue?
We have a company safeguarding policy to inform all our employees of the steps required if there was a safeguarding concern. If TrustonTap Head office team or TapTeam carers become aware of any abusive or harmful incident, we will refer it to the Local Authority or to the police where criminal behaviour is suspected.
What is stopping the client and carer going direct and cutting out TrustonTap?
Whilst our platform is based on trust, we also believe that the ‘value add’ we offer will deter ‘back dooring’ for the small amount of commission gained.
So, what has been your main learning so far?
I think the main takeaway to date has been the huge value our customers place on having a direct relationship with their carer. They like the one to one relationship that develops over the one hour they are together rather than having a rota of different carers coming and going for 15 or 30 minutes at a time.
What would you do differently if you were starting again?
I think we probably underestimated the time it takes to develop relationships within the local authority and if we were to start over again, I would make sure we had earlier buy in from the key decision makers.
What would you change about the system you work within to make it easier for new ideas like yours to be implemented?
I think Local Authorities have their own way of doing things which they have been doing for years and if I was able to change anything I would like to them to be more nimble and more open to change. They can still be very archaic in their thinking which is a shame because there are huge opportunities within Local Authorities to take the initiative in fostering innovative start-ups.
So, William finally, what’s next for TrustonTap?
The feedback we have received to date has been exceptional and this has given us the confidence to grow the business across the region and to bring our service to many more people needing care at home. We started with a bold dream back in 2015, seeking to change the way we care for older people in our communities across Oxfordshire. Just over a year later, we are achieving that dream. We now have a brilliant team of around 100 trustworthy and motivated carers who are helping older and vulnerable people throughout the county and we look forward to helping many more people over the coming years across many other regions.