Case Study: Nourish Transparency and The Orders of Saint John Care Trust

When care providers look for funding they can feel like a broken record. In a sector often overlooked and rarely understood the debate to establish the value, and justify the cost of social care is well worn and, quite frankly, out of style. The NHS’s recently published Long Term Plan is an ambitious vision of community-led support. One that social care can, and indeed must, play a definitive role in. In order to do this social care providers need a dependency tool that can accurately reflect the care requirements and costs of the people they support. Especially in a health and care context where the needs of people drawing on support are growing more complex.  

At Nourish Care we are working with our users to develop such a tool, which we call Nourish Transparency. We are building Transparency to accurately assess care needs at a granular, personal level and provide a detailed breakdown of the support each person using a service requires. Giving care providers the ability to tie these costs to their own rates and the information to back up their funding requests.

We spoke to Caroline Alford, Central Operations Director for The Orders of St John Care Trust (OSJCT), about why Nourish Transparency is required, and the benefits it will bring for care providers. We also spoke to Paul Skuse, Product Manager at Nourish and a former Registered Manager of Adults & Children’s services, with over 17 years of direct social care experience, to discuss how Transparency works in action. So care providers can move past the old dependency song and dance, and change the score for their communities. 

“I have worked in care for almost 33 years at this point,” explained Caroline. “So I have plenty of firsthand experience of the challenges that we all have on being able to evidence all elements of the care we provide to our residents. Which at times is difficult and can be very time-consuming. As a result, we can find ourselves under-funded, unable to demonstrate the full extent of the care we are delivering and the resources required to sustain it. 

“Resident’s needs are changing so much and the proportion of those with higher needs has grown substantially. At OSJCT we see the dependency of the residents moving into our homes is changing rapidly. They are typically arriving with higher dependency needs, such as requiring more medication or having more frailty. Which often means they need more than one carer to support them. We need to be able to demonstrate that to ensure we are being funded accordingly. 

“That’s why everyone at OSJCT is so excited about Nourish Transparency! Having been involved in the building of Transparency I truly believe that this I going to be a game changer. It provides the functionality to support us to evidence the care each of our residents needs. As well as the right staffing required to meet those needs. Ultimately giving us the tools to highlight what the true cost of care is.” 

Nourish Transparency was created to answer a specific challenge: 
How can we design a product that: 

“It all starts with a simple assessment,” explained Paul Skuse, Nourish Transparency Product Manager. “The assessor records common activities within clear, easy-to-understand groups, making often difficult conversations about care and support more intuitive. It’s quick to complete, but incredibly powerful when combined with the Nourish platform.  

“Once the assessment is complete, staff continue supporting people as usual, recording as they go in Nourish. Nourish Transparency runs in the background, continuously tracking against that baseline to show how care and support activities align with, or diverge from, assessed needs. The activities in the assessment are connected to the daily timeline. Which means managers have a dynamic, objective view of whether a person’s package of care truly meets their needs or requires review. 

“Nourish has always been at the forefront of using data in powerful ways, and Nourish Transparency follows that lead. Assessment data flows directly into live views of staffing requirements and a view comparing cost of care to agreed funding. Helping your team prioritise cases for review and make informed choices that put your organisation on sustainable footing. 

“At its core, Nourish Transparency is a simple idea: assess people’s needs based on the care and support they actually receive every day. Then use that insight to continuously improve quality, efficiency, and outcomes to make care better for everyone. Fundamentally, showing it’s working throughout the process. Removing the reliance on ‘black box’ scoring or impersonal algorithms.” 

“The point of assessment is where it all begins,” said Caroline. “Nourish Transparency gives us the tools to able to understand the whole care needs of the potential resident. So we can be confident in our ability to provide the care they need. Whilst also ensuring our operational sustainability to continuously provide care to all residents within each care setting.  

“The platform enables us to more easily keep track of our residents needs as they evolve as well. So instead of doing full reviews several times throughout the year to see if the residents needs are being met, this system will allow us to review changes more easily as we are seeing the resident needs are increasing. It also helps us determine between when these changes are long lasting or when it is a short term change. Such as a recent illness or an infection. 

“This continuation of care is supported by the overviews and reports Nourish Transparency builds. So that you can clearly see the average time care takes. This will really help ensure our care plans are developed based on the support needed. With Nourish Transparency we are not just cover personal care or daily living tasks. The system is very person centred, so it capture the resident’s social and emotional needs as well. 

“Crucially, this level of insight into the needs of our community also gives us a clear understanding of the staffing levels we need.” 

“Like many providers we often find that the care assessments we undertake, or the reassessments we request from local authorities, are rejected based on lack of evidence to show the level of care that is needed,” said Caroline. “The way Nourish Transparency is being developed it captures time taken for tasks to be carried out. This helps us clearly demonstrate the true cost of care to our Local Authority. 

“For example, in our services we often struggle to really evidence the time that is taken to give reassurance to residents. Specially those who are often walking around the home with a purpose looking for someone who is no longer in their life. These events can often happen more than five times a day. To more than one resident. It is critical to our residents wellbeing for us to give them the time and assurance needed.  

“Evidencing this in care plans can be difficult and time consuming based on the frequency of these events. Nourish Transparency will help us capture these and build a clear story of each residents individualised needs.  

“We see that Nourish  Transparency will give us the evidence we need to be able to demonstrate the outstanding care we give. Helping us justify a fair price for the care we deliver to the Local Authority.” 

“Each year when annual reviews take place or following a reassessment we often get asked by residents, family members etc. for a breakdown of what their fees covers. Nourish Transparency will help with both of these scenario’s as we will have clear timelines on their care needs. As well as the support we provide on a daily basis.” 

“A tool like Nourish Transparency means that we can get more help to truly identify individual needs and preferences,” explained Caroline. “So we can build a package specifically for them. This builds on everyone’s desire to treat everyone who uses our service as an individual, and move us away from the reductive ‘dependency scores’ of the past.”