REDEFINING CARE DELIVERY THROUGH DIGITALISATION

INTERVIEW

Transforming care delivery through digitalisation

Through the development of its care management software, Nourish Care is helping to support the rollout of digitalisation throughout the care sector. NR Times meets its founder Nuno Almeida, and discovers his unrelenting commitment to achieving the best possible person-centred care, and Nourish’s role in empowering care teams to deliver that

INTERVIEW

Despite being a co-founder of a hugely successful multi-national business, Nuno Almeida did not find happiness in that. Rather than being motivated by the many rewards associated with continuing to grow such a venture, which worked in defence and weapons systems, he realised he wanted to take a different course. “I was with that business for ten years and we grew it from four people to 350, working across four continents. Everyone was delighted with that journey, but somehow I wasn’t,” recalls Nuno. “I was waking in the morning and feeling dread, I knew there was a misalignment between my work and values. Coming from Portugal, where 95 per cent of people are Catholic, those values exist strongly and rub off on you whether you want them to or not. “Working in this business I wasn’t feeling I was going to be proud of my life achievements. I wanted to build a company where the values completely align with what I was trying to achieve.” And from that realisation, and the brave decision to sell his stake in the business at the ideal time in 2007 - “as Lehmann Brothers was collapsing, but before everyone realised there was a big crisis” - came the foundations of Nourish Care, a care management software provider committed to delivering better standards to care providers, to enable them to better support the individuals in their care, through transforming their paper-based records into efficient digital systems. Since launching its platform in 2015, Nourish now works with over 1,600 care providers in the UK, serving over 30,000 people, and has just taken its first steps into international roll-out by moving into South Africa. More products are in the planning for the next two to three years as Nourish looks to support even more aspects of the sector, as well as expansion into new areas of healthcare where the company already supports a significant number of mental health hospitals, and with recent examples community and maternity care. And in building Nourish, Nuno has become a highly respected voice in care and the vital role digitalisation has to play, being appointed as an advisor to the All Party Parliamentary Group on adult social care, as well as being a founding member of the Care Software Providers Association (CASPA), an independent voice on software in care. And while Nourish was an established operator in digital

INTERVIEW

care well before the COVID-19 pandemic hit, its impact and the resultant realisation from across the healthcare sector of how vital a role digitalisation, supported by data and analytics, can play has seen even more care providers turn to Nourish. It also strengthened its links with the NHS, with Nourish being one of only two software providers to be assured by NHSX for its DSCR (Digital Social Care Records) Digital Purchasing System (DPS) at launch, supporting its goal of all social care providers having access to a digital social care record by 2024. “We are demonstrating time and time again that if we design a digital framework that is centred around the person, we can use this platform in any health or social care setting. We can augment the ability a company already has to deliver better care,” says Nuno. “For a care worker, an eight hour shift might be seven hours of joy in spending the time in delivering the care, but an hour of dread in writing up all the notes. “Through paperwork, they are gathering so much information but doing so little with that information to improve the quality of care. “If a person feels their job is becoming more possible, then that gives them another lease of life. They can have that cup of tea and sit down for a break, they can spend more time looking in the eyes of the people they are supporting.” Committed to delivering a solution to enable the creation of digital-led quality care, Nuno laid the foundations of his new venture in 2011 while looking into how his data science expertise, experience of running a successful business and focus on quality care could combine. “Social care was not the obvious focus at first, but it turned out that the sector was more amendable to innovation, they move faster and are willing to try new things - trying to do this in the NHS would have been very hard,” he recalls. “I volunteered in care homes and community services to see the true picture, and I came to understand that the main driver of the pressure on care teams was how much paperwork there is in delivering care. “The thought process was, if we could pull this off elegantly, we could reduce the burden of having to record all that information and bring the information alive digitally to improve care. “Care workers could be more empowered to deliver the best possible care, and they are even more able to put the focus for care delivery on the person and what is important for them.” And while its clients are routinely making cost savings through the implementation of efficient new softwarebased systems, Nuno is adamant that quality of care, rather than the financials, is the crux of Nourish’s offering. “That is how we market Nourish, rather than ‘This will save you X pounds on the balance sheet’. I remember very vividly how opinionated I was on this at first when we launched. It’s not about presenting a cost saving, it’s about helping to empower care teams,” he says. “We’re relentless in that focus on quality rather than how much it will save on the bottom line, that has never felt like the reason we exist, but I firmly believe that if you concentrate on the quality of care, then the financial aspects will stack up.” Nuno’s dedication to the quality of care stems, at least in part, from his background, and now extends throughout the entire Nourish team. He recalls growing up near a psychiatric hospital and a farm manned by people with both physical and learning disabilities - “I was lucky to grow up in this context and to see what I regarded as normal - these people were just human beings - but I later realised how that shaped me,” he says. “Computer scientists and care workers are among the clusters of professions which have a wide gap between

IF A PERSON FEELS THEIR JOB IS BECOMING MORE POSSIBLE, THEN THAT GIVES THEM ANOTHER LEASE OF LIFE. THEY CAN HAVE THAT CUP OF TEA AND SIT DOWN FOR A BREAK, THEY CAN SPEND MORE TIME LOOKING IN THE EYES OF THE PEOPLE THEY ARE SUPPORTING.

INTERVIEW

THERE HAS BEEN A SERIOUS AND FUNDAMENTAL SHIFT IN THE ENTIRE SECTOR AND WE CAN’T POSTPONE IT ANYMORE. WITH ONE OF OUR CLIENTS, THE CEO SAID THAT NOURISH WAS THE THIRD MOST IMPORTANT THING IN HIS OPERATION AFTER FOOD AND PPE.

them, but no such thing exists here. “We always ensure we attract care workers into the business, and more than 50 per cent of our team have social or healthcare delivery experience. “If you are creating something which is going to be exactly what our clients need, it cannot be just technology-led.” After years of investment of time and resource into the creation of a system suited to the exact needs of care providers, Nourish, like countless other digital business, was suddenly supported in the cause it had long championed with the onset of the COVID-19 pandemic. “The entire system realised how essential it can be to access good quality data when hit by a crisis,” says Nuno. “COVID allowed us to see a lot more value in how digital care could benefit whole organisations, and collaboration is really essential in taking that forward. “In many cases the digital platform was non existent, but in this crisis environment it became very apparent that all of a sudden CCGs, the NHS, realised they cannot ignore the fact that social care providers are paper-based because it is such an important topic. The complete focus went onto accelerating the option of digital-based systems in social care.” Over the past year, the level of care provider engagement with digital care planning has risen from around 33 per cent to 40 per cent - while still a long way to go, Nuno is encouraged. “There has been a serious and fundamental shift in the entire sector and we can’t postpone it anymore,” he says. “With one of our clients, the CEO said that Nourish was the third most important thing in his operation after food and PPE. In terms of endorsement, I’ve never heard anything as strong as that, but digital was really showing its value amidst huge pressure. “Operators were seeing in the first lockdown how much more easily they could audit remotely, they could organise support digitally and it would show up at the entrance to the building with all the support they need, without the need for any phone calls. “The goal for NHSX, alongside the CQC, is that we want to see a fully digitised sector by the end of 2024. “We can be as cynical as we want about that, but even if we fail by two years it will still be a spectacular transformation across a very complex sector. We are talking about a wide range of care services, from specialist physiotherapists to complex care providers and everything in between.” Nourish is committed to playing an increasing role in that push towards digitalisation, with big plans of its own to fuel its growth. “We believe we have the best in breed when it comes to planning and co-ordinating person-led care and to be able to demonstrate that in a multitude of settings is really important. We are also able to support adjacent markets care services as long as we can do it with exceptional quality, as we have been demonstrating with numerous mental health hospitals, and more recently in maternity services,” says Nuno. “We do receive enquiries from overseas and have rolled out into South Africa and are now looking at other markets. It’s a fantastic demonstration that the impact we have seen in the UK can also help different care pathways around the world. “Data science will be a big topic for us over the coming years and we will continue to invest in engagement facilities for circles of care, which will lead to new products in the next two to three years. “Our goal has always been to empower families, care workers and care teams to deliver the best possible care, and we will always do all we can to achieve that.”

THERAPY

Setting a new standard for neurorehabilitation

When it first opened its doors in March 2020, the Inspire Neurocare team had no idea about the following year's challenges. As the rest of the UK went into lockdown, Inspire Neurocare was faced with the task of launching a highquality complex care service whilst also ensuring the safety and wellbeing of people living with significant underlying health issues and its new staff team.

Fifteen months on, the service – just revealed as a finalist for Complex Care Provider of the Year in the Health Investor Awards 2021 – reflects on its approach and plans for the future.

Over the last year, Inspire Neurocare Worcester successfully provided care for individuals living with complex neurological needs, and the team continues to welcome new residents as the service enters its second year of operation. The 43-bed service, which includes an independent living apartment, is characterised by contemporary décor and open plan living. Taking every care to ensure accessibility, assistive technology and the ability to make personal choices was built into the design. Pull-down cabinets and adjustable height kitchen worktops, large, spacious therapy bathrooms with hoists and wide corridors and doorways throughout the service allow people to maintain and develop independence. Ensuite bedrooms are over twice the usual size in such services. Each is fully soundproofed and has independently controlled underfloor heating, so people can set up their living space just as they would in their own home. Service Manager Marc Russell said, "At Inspire, we place no limits on what people can achieve - the team never define people by their age or diagnosis. Over the last year, we supported many individuals to achieve life-changing outcomes, despite the challenges of Covid-19. From the beginning of the pandemic, ahead of Government lockdown, we proactively engaged with care commissioners and national regulatory bodies to ensure we could safely welcome residents to our new service. Our Enhanced Infection Control Pledge, increased protocols and continued commitment to protecting the people we support meant that we were the first choice for individuals and families requiring quality complex care in the Midlands."

Innovating for independence following a brain haemorrhage Jay, aged 74, came to Inspire for a period of rehabilitation following a subarachnoid haemorrhage, further complicated by hydrocephalus in late 2020. On arrival into the service, Jay was experiencing problems with her balance, had left side weakness and found mobilising very difficult. She was unable to stand without support from the team members and a walking frame. The team worked with Jay and her family to create a rehabilitation plan to increase her independence. With physiotherapy focusing on restoring Jay's balance and increasing her confidence, she can now walk independently using a frame. Life Skills Facilitators also worked with Jay under the direction of the therapy team, using an innovative mobile app called Clock Yourself to improve her balance and mobility and increase her confidence outside of the physiotherapy gym. Jay is continuing to work with the therapy team as discharge planning gets underway. "I'm thankful that I'm still alive – it's down to the wonderful surgeons, and of course, the rehabilitation at Inspire, which has been fantastic. When I came here, I was on my back. I couldn't walk. I couldn't sit up, couldn't do anything. And here I am now – walking with my frame. The progress has been fantastic. The staff here are wonderful, so patient, and so caring. Those who saw me when I first came in – they say, what a transformation! I'm being taken home by the Occupational Therapist next week for a visit to make sure everything is in place for when I return home and if there are any other exercises I need to do because I want to live on my own. I want to be strong enough, and well enough and capable of continuing to look after myself, hopefully for another decade at least!"

THERAPY

Developing an outstanding team Director of Clinical Excellence, Michelle Kudhail and Service Manager Marc Russell welcomed outstanding colleagues to the team over the last year, including Consultant in Rehabilitation Medicine, Dr Damon Hoad. Dr Hoad brings a wealth of experience in neurological rehabilitation to Inspire Neurocare, working for the service in addition to his roles within the NHS and Warwick University. Neuropsychologist Dr Victoria Baxter is joined in the interdisciplinary team by a neuro physiotherapist, a neuro occupational therapist and a speech & language therapist. The Clinical Lead manages Inspire's nurses, who are trained to very high clinical standards. Specialist nurses ensure that the service can meet patients' very complex care needs, from ventilated care and tracheostomy management, seizure management, and peg nutrition to bowel management and catheterisation.

Expanding with confidence Close partnership working with care commissioners influenced every element of Inspire Neurocare Worcester, from design and build to service development. This commitment to work in close collaboration with commissioners and stakeholders continues post-launch in Worcester and is ongoing in other parts of the country, with new developments coming soon to Basingstoke and Southampton. Work on these two new state-of-the-art services starts on-site in late 2021 and early 2022, intending to welcome residents from 2023. Reflecting on the year, Director of Clinical Excellence Michelle Kudhail said, "In an unprecedented year, Inspire Neurocare has thrived against the odds. After opening our first service amidst the challenges of the first wave of COVID-19, we have now firmly established ourselves as a leading provider of quality complex care and rehabilitation for adults. “The planned Inspire Neurocare services for Southampton and Basingstoke will allow us to achieve more for many individuals, in hopefully far less challenging circumstances for launch, and we are exploring options around the use of innovative technology to enhance therapy provision and increase intensity of practice to supplement what we already offer. “The future looks bright for Inspire, and I'm incredibly proud of the team for everything we have so far achieved together."

Life Skills Facilitators Inspire Neurocare empowers its team members to excel, and with the Life Skills Facilitator (LSF) role is revolutionising the neurorehabilitation sector with an innovation that leads to outstanding patient outcomes. Enabling each person they support, LSFs increase people's capacity without limiting them. Under the guidance of clinicians and therapists, they administer medicine, carry out exercise and mobility programmes, sensory activities, orientation and memory tasks with communication aids and interactive equipment. LSFs facilitate daily tasks such as showering and choosing clothes, making a drink or meal, and taking an interest in people's lives, supporting them to continue or develop hobbies or social activities as much as possible. Their unique position sees Life Skills Facilitators working across nursing care, therapy, and wellbeing, allowing them to take a genuinely universal place in the lives of the people they support. Their work supporting occupational, physical, and speech and language therapy means therapeutic interventions are no longer confined to the gym or to a particular session with a therapist. With the individual's therapeutic goals and desired outcomes in mind every step of the way, Life Skills Facilitators amplify the rehabilitation process, facilitating and enabling daily living activities that increase people's independence, functional abilities, and confidence through every interaction, every day. Inspire Neurocare sees people achieve their rehabilitation goals more quickly through this continuous focus on reablement and independence.

Cooking and rehabilitation - a stroke survivor’s story

Craig Pankhurst, founder, A Stroke of Luck

There is nothing positive in having a stroke. But positive things can come from experiencing stroke. And one of the things which has helped my recovery is finding a place in the house where I feel relaxed, able to focus, and to try and be creative. And that room is the kitchen. I have always had an interest in food, mainly eating it of course, and have been fascinated by the creativity of chefs. I decided early in my rehabilitation that away from fitness and exercise, I needed something to focus my creative juices on to support the recovery journey from stroke. And with having zero talent in art and having a real appetite for food - terrible pun! - I knew the kitchen was going to be my place of solace. This month I will be celebrating my third anniversary of surviving my stroke by cooking a three-course dinner. As yet, I am undecided what the menu will be and how it will work out, but whatever the outcome, the process of cooking I thoroughly enjoy. Here, I share one of my favourite recipes with the readers of NR Times.

Strawberry Salad with Balsamic Glaze

July is the month of Wimbledon, and that is synonymous with strawberries and cream. So, I like to create summery dishes which range from easy to complex. This one in particular is very easy to do. And the key ingredient is sumptuous strawberries.

This dish is a perfect example of how fresh, in-season ingredients can combine to make a delicious dish in very little time. This strawberry salad uses under 10 ingredients, but it still has an incredible mix of textures and flavours. The peak-season berries are sweet and juicy, and a handful of soft summer basil adds a surprising fresh accent. Toss in a little cheese and diced avocado for richness, pecans for crunch, and a drizzle of tangy balsamic, and you have a mouth-watering summer meal. Best of all, it comes together in 15 minutes flat! A simple Caprese salad is the base of this dish but adding fresh strawberries to the basil tantalises the taste buds! You are in for a treat.

Recipe

¼ cup balsamic vinegar 1 cup sliced strawberries 1 cup halved cherry tomatoes 1 cup halved mini mozzarella balls 1 ripe avocado, pitted and diced ⅓ cup pecans, toasted ⅓ cup loosely packed basil, torn A drizzle of olive oil Sea salt and freshly ground black pepper 2 tbsp of lime juice 1 tsp soft brown sugar 2 loaves of bread, unsliced 2 tbsp of nut oil

Method

In a small saucepan, bring the balsamic vinegar to a high simmer over medium heat. Stir, then reduce the heat to low and simmer until the vinegar has thickened and reduced by half, about 8 to 10 minutes. Set aside to cool.

Place the strawberries, cherry tomatoes, mozzarella, avocado, pecans and basil in a shallow bowl or platter. Drizzle with olive oil, and season generously with salt and pepper. Gently toss. Drizzle with the reduced balsamic.

This is a wonderful summery salad when partnered with a glass of chilled white wine - an afternoon treat!

Good luck!