Expertise is crucial when building anything you want to last. It is especially necessary when bringing new solutions like AI, to longstanding responsibilities such as care plan auditing. At Nourish we pride ourselves on the expertise our people bring to digital technology, and we guide ourselves with the expertise of the people we meet and trust in social care. People like Dr Antony Hall, who has spent decades at the coal face of care and support, both as a provider and a regulator.
During his ten-year tenure at the Care Quality Commission, including his role as Head of Inspection for London, Dr Hall authored the ‘Smiling Matters’ report. An insightful and incisive report that changed incisors and more for the better across the country. After leaving the CQC Dr Hall became the Director of Insights, Assurance and Governance at HC-One, as well as the nominated individual for 328 care homes. It was at this point that Dr Hall and Nourish first became acquainted. As he led the charge to implement Nourish at HC-One.
Since then, Dr Hall has worked alongside Nourish as a consultant, using his experience as both a provider and a regulator to shape our suite of digital solutions. Co-producing Confidence, Safety and Transparency with our product teams. Ensuring our functionality remains rooted in lived experience on both sides of the service.
We sat down to discuss satisfying the CQC, AI in social care and what makes Nourish Confidence different.
Section links
The view from both sides
The unique experience that shapes Dr Hall’s perspectives on social care and technology
Building Confidence
Dr Hall’s two-lens approach of balancing provider and regulator needs when developing AI for social care
Human after all
Why it’s crucial to include a ‘human in the loop’ when utilising AI tools in social care
Modern inspections require modern solutions
Aligning Confidence with the CQC’s increasingly observation led inspections
Augment or automate
How Nourish Confidence informs providers and frees up time for more impactful human interactions
Unique AI
What sets Social Care apart from other applications of AI and technology, and why having systems built specifically for the sector is so important
How has your experience shaped your perspective on and approach to care?
“I think I’m in a very privileged position that I could draw upon a vast amount of experience at the CQC. Particularly, I had the benefit of working at the CQC very closely with some incredible people. Such as Sir David Bean, who then took me to HC-One, as well as Professor Steve Field and Kate Terroni.
“That gave me a very unique perspective in the sense that I can see it from both sides, provider and regulator. I think that gives me an incredible perspective because in the caring environment, a lot of providers are always wondering how CQC functions and how it works.
“And often in CQC, they’re wondering how providers function with the tension of balancing commercial environments against delivering care!
“And, thanks to my experience, I can see it from both. Additionally, this experience helps me inform Nourish on how to build practical functionality that matches the needs of both providers and the CQC.”
How did this experience inform the development of Nourish Confidence?
“In a lot of different ways, focused primarily on how we can apply AI to social care challenges in a way that supports and satisfies both the CQC and the people utilising a service. We had several initial conversations about Confidence, we went into all kinds of realms about what it could and couldn’t do.
“I was coming at it from the provider perspective. Thinking, ‘this is what I really want this great piece of tech to do’. Particularly in the AI space around care plan auditing. For example, I remember Nourish’s Director of AI and Data, Sudha sending me a workbook of all the outputs from a trial of the AI care plan audit in Confidence.
“I took days to go through all the responses. I was doing it from two lenses. First from the provider lens and then from how I would view it as a CQC inspector. That was a really important piece of work to enable what Confidence has become. This two-lens approach is a hallmark of my work with Nourish.”
What does a CQC inspector want to see from a digital care plan auditing system like Confidence?
“I’ve always said regulation and CQC is about assurance. You’ve got to assure them that you know what you’re doing. A large part of that assurance comes out of auditing.
“Now, don’t get me wrong, I’m not saying you should be perfect. Auditing should not be about achieving a 100% pass rate. For example, if you’ve got RAG (red, amber, green) status reviews, you shouldn’t just be presenting a spreadsheet full of green to an inspector.
“Effective auditing should find the problems and remedy them. That’s what the CQC want to see. They don’t want to see that you’ve passed audits 100% because quite frankly, they don’t believe that.
“What they want to see is that you’ve identified the problem and you’ve rectified it. Or at least you are in the process of rectifying it.
“That’s what Nourish Confidence is about. Enabling providers to show their work to inspectors. Perfection is impossible, and not to mention quite suspicious. Whereas sharing your whole process, the mistakes, the omissions, the contradictions and crucially, the corrections, that’s the secret sauce. That shows safe, effective, responsive support from caring, well led teams.
“That’s what the key part of all the work we did with Confidence was. ‘Let’s create a product that can actually identify issues for the provider to take action on’.”
What if the provider disagrees with information surfaced by Nourish Confidence?
“If the provider then goes away and says, ‘well, actually, I don’t agree. I’ve got that right.’ That’s great!
“Because you’ve always got to ask yourself the question, ‘why does something else think that you’ve got it wrong?’ Which you then go and check.
“That’s the important element of Nourish Confidence. The ability to give providers the sense of ‘we think this is wrong’. Whether it’s an AI check or the way the insights give the information around the care plan auditing and actions. The system is designed to augment the role of people in a service, not automate them.
“Providers can utilise their own expertise when checking what they’re saying because something, whether it’s an AI tool or something else, thinks that it’s not quite right. Additionally, they can evidence their actions and provide this to their regulator.
“The AI tool can give you a far more complete coverage than you could achieve previously. You don’t have to agree with it, but it’s another lens on your service. Which means it another perspective and opportunity to improve the quality of care you provide.
“I think effective governance in care means bringing a lot of lenses in.”
Where do people come into the decision-making process?
“If you take, for example, the AI care plan auditing in Confidence. That should never replace a human being. That’s very important.
“It’s another lens though, and it will spot things quicker than a human being. For example, if you’ve entered three different weights in the same plan that don’t match. Or you’ve created some wording in one part of a care plan and somewhere else it seems to contradict it. That’s the power of AI to pick that out through logic and its algorithm. But a human being is the only way that can match the sentiment and the person centeredness of a care plan. The two should work hand in hand.
“Fundamentally, the action always comes from the human. Confidence can spot the issues, but it will never tell you how to fix them. Because that’s what the provider does best. It’s one of the most exciting things about Confidence, the potential to change how providers work. It gives them more time to fix issues because they don’t have to spend as much finding them in the first place.
“Confidence offers another lens to give assurance and clarity to you as the provider and sharing that with your regulator.”
When you say good governance is about having multiple lenses, does that speak to the idea of championing lived experience more when the CQC is looking to inspect?
“Absolutely, the new CQC inspection methodology is going to be about 80% based on observation. They’re training the inspectors at the moment on it. And that’s what it should be, because that’s what actually matters.
“That’s why the tools, whether it’s Safety or Confidence or Better Care, they must underpin that to enable the care staff to demonstrate how good they are at care. Those systems in themselves are not the drivers for those human interactions. But they provide the foundation upon which that human interaction can then develop.
“It’s absolutely vital because as an inspector, you typically would place yourself somewhere in the home. Whether it’s the corner of a lounge or a dining room or a corridor and just sit and see what happens. Even in outstanding homes, the amount of human interaction can be very, very low. It’s stark sometimes and really surprising.
“It doesn’t matter how good all your systems are, you’ve got to support those human interactions.
“But if the systems that underpin your care delivery are poor and clunky and take a lot of manual intervention. Whether that’s paper or digital. Then you’re not going to get that human interaction.
“But if you’ve got a really good seamless ecosystem, which Nourish is, underpinning that as the foundation, it enables the staff to have that time to focus on those relationships.”
How does Nourish Confidence utilise AI to support care professionals care plan auditing as opposed to automating them?
“I hate attending conferences recently and hearing people talking about using AI to save on staff payroll bills. It’s a standard selling point of AI and we see it everywhere. If you’re a leader of an organisation the decision is generally, ‘I’ll pay for an enterprise license for Claude, how many staff can I save?’
“We can’t do that in care because we will lose that intrinsic, human interaction aspect of the service. What we actually need is AI to free us and our team’s time up.
“That’s what confidence does. It frees the staff time up because the interface is so easy and the insights from it are so immediate and transparent. You don’t have to spend hours using Power BI to scrape the data off and work out what it means. It tells you and you can get immediate assurance from the auditing.
“Confidence can turn care plan auditing through 90 degrees. Instead of finding and fixing all of the issues in one care plan, it allows your team to fix all of the most important issues across all your care plans.
“This means you no longer have the inspector picking up the care plan that hasn’t been audited for six months. Additionally, you can show an inspector ‘look at all of the contradictions that carried clinical risk that we found and fixed in the last month’.
“This unlocks a deeper understanding of the challenges your service is facing. You can get insights into a specific home or organisation wide issues that you can fix the root cause of. Such as negative language or contradictions. It can help you to prevent care plan issues existing in the first place.
“That’s the power of something like Nourish Confidence.”
Why do you think it’s so important that Nourish Confidence’s AI powered care plan auditing is built specifically for social care, and that it’s insulated within our sector?
“I think that’s really important!
“Obviously all AI and other tools are developing at pace. But we’re seeing, particularly in the AI world, the dominance of certain providers. Your Anthropics and Open AIs and so on.
“This is reflected in care systems too. We’re seeing a lot of providers coming into the market who are not care specific. They’re trying to go into health and social care, such as Apple.
“The problem they’ve got is they don’t understand our sector. And you’ve got to understand this is a highly regulated sector. Admittedly, the CQC has had its ups and downs over the past few years but we’re still a highly regulated sector. In the sense of there’s a lot of regulation out there.
“You have to understand that to build effective technology for providers. In my role sales people are constantly trying to sell me stuff. One of them came to me recently and said ‘I can save you X amount of staff’.
“And I’m going, ‘well, what about the CQC regulation around there must be adequate and skilled and competent staff to meet residents’ needs? To which they said, ‘what regulation?’
“That’s the problem. Whereas if I had that conversation with Carrie Taylor, (Nourish Care’s Clinical Safety Officer) she’d know that instantly.
“It’s important that you understand working in a care home is different. There’s a similar challenge in hospitals. We are human beings looking after human beings. That’s a really interesting dynamic, because you’ve got emotions, you’ve got reactions.”
How does that reality define the role of technology as a whole in social care settings?
“It’s definitive, or at least it should be.
“Imagine a 19 year old carer who is being punched or spat on or abused and called names, all the names under the sun by somebody who’s expressing some distressed behaviours. Controlling those reactions is really difficult and it takes special people.
“You have to be able to deal with really challenging situations. What’s important then is you have the systems underneath that enable you to learn from these occurrences. Whether that’s care plan auditing, incident management or rostering. I’ve had this example many times where a carer has been punched or spat at. Both professionally and personally.
“What’s important is that you understand what’s happened, and you learn from it. You then learn about how you can manage those behaviours for that resident. But you can also coach and support the member of staff. Show them how to support differently in the future, around the individual needs of that resident.
“Asking important questions like; ‘What triggered that behaviour?’
“The right system can help you connect those different experiences and data points. To get the best perspective of the person supported. And in turn inform the best way to work with them.
“Nourish is a fantastic ecosystem for linking together different information points and experiences in care and support settings. Whether it’s Safety, Better Care or Confidence. It gives you that foundation to then get on with delivering proper care.”
