Case Study: The BOLD-TC Project

Background

BOLD-TC (Better Outcomes for People with Learning Disabilities — Transforming Care) was a Phase 2 SBRI-funded project (just under £1m, commencing September 2015) led by Red Embedded Systems Ltd. It was commissioned through NHS England's SBRI Healthcare call and prompted by the Winterbourne View scandal and evidence of avoidable premature mortality in people with learning disabilities.

The project explicitly rejected one-size-fits-all approaches. People with learning disabilities have a uniquely wide range of communication needs, physical health needs, social circumstances and support arrangements. The platform approach enabled combinatorial interventions — bespoke combinations of technology components adapted to the individual.

Technology Platform

The BOLD-TC platform combined v-connect (multi-way video communication across TV, tablet, PC and smartphone); Lincus (Rescon Technologies — a Class 1 registered medical device for health and wellbeing data capture, storage and analytics featuring the RAVEN analytics engine); eHEF (digitised Health Equalities Framework profiles); physiological monitoring via Bluetooth; and Samsung SmartThings for ambient sensing (motion, door, temperature, power usage).

The Health Equalities Framework

The HEF is a 29-factor impact rating scale measuring how effectively services reduce exposure to, or mitigate the impact of, determinants of health inequality for people with learning disabilities. Endorsed by the Department of Health, NHS England, and Public Health England. The digitised eHEF, integrated with Lincus, created a continuous evidence record connecting care activity to outcomes — with anti-gaming design focused on outcomes rather than process.

Project Scale and Reach

164 people with learning disabilities supported. 48 social care providers and 61 healthcare providers engaged. 25 families connected. Deployments across 5 geographies: Sandwell, Kent, Devon, Bradford, and the Wirral. Policy alignment was assessed in four geographies against local Joint Strategic Needs Assessments — the technology could support between 9 and 15 of the identified outcomes in each geography.

Outcomes Evidence

Louise: "It has reduced my stress levels. I have more of a life now. I have got more confidence. I can talk to my boyfriend. I'm not lonely anymore." Emma: "I don't feel as anxious as I did before. I feel more confident when speaking to people. Knowing I have people to talk to encourages me to stay in my work placement."

Clinical: A new diagnosis of osteoarthritis in a person whose pain had previously manifested as challenging behaviour — the communication capability enabled them to describe the pain. The combination of v-connect + Lincus + eHEF created, in the words of evaluator Tom Dawson, "a multi-angle assessment of care delivery with no known precedent."

Key Conclusions

Commissioning must shift to outcomes across three classes: health care outcomes, social care outcomes, and social value outcomes. Families are a substantially underutilised resource and should be brought into commissioning models. A 12-month timescale is insufficient to demonstrate longitudinal outcomes. Ken Eason: "We have created a technological platform which can be used in all sorts of ways and we are exploring what value it has in different kinds of situations. To me, it is the epitome of the way to route appropriate technology into a complex variable situation."