Earlier this year, Eddie Copeland announced LOTI’s intention to launch the Local Authority Sandbox (LAS) – a physical, dedicated, and collaborative space where LOTI boroughs and their partners can experiment with the latest innovation methods to explore and solve complex challenges.

Our overall aim is to make participants feel energised and inspired to take action collaboratively in solving these thorny, decade-long systemic challenges.

The LAS would allow boroughs to bring these challenges to life through simulations, performances of processes, user journeys, highlighting pain points and potential opportunities for solutions. In addition, this dynamic problem-solving approach and related design activities would enable the development of solutions that are grounded on the users’ actual needs, as opposed to, perceived experiences and needs.

Testing the LAS concept in a meaningful but cost effective way

The LAS concept is London’s and probably UK’s first example of its kind and as such there’s limited evidence for how this would work in practice or any lessons learned. Given the upfront investment needed to set this up as a permanent offer to our LOTI members, and the untested assumptions around it, we’re taking the more precautionary approach of testing this, initially on a small scale, with the view to learning, iterating and improving its future design and delivery.

In order to make best use of the public’s money, in a low-risk, high reward approach, we’re planning to test our hypothesis and related assumptions by prototyping the LAS in a cost effective but meaningful way. This approach will help us learn about what works from a design, resource and capacity angle including the types of skills that might be needed to deliver it well. It also provides an opportunity to test a completely different way of working to help solve some of London’s biggest challenges.

Focusing on adult social care

It’s fair to say there’s no shortage of big challenges in London (or any other big city for that matter), be it climate change and related ambitions around net zero, or social housing and social care.

Adult social care is one of five biggest areas of local government spend and with a forecasted £200m overspend in the 23/24 financial year, I’m sure you can see it easily represents one of the most significant pressure points in local authority budgets. Therefore, our focus for test this LAS will be adult social care.

By focusing on adult social care, this would also build on our lessons from the pilots we ran as part of our New Service Models Innovation Fund, where we developed a data platform for frontline workers and tested a co-operative service approach to delivering high quality home care.

A risk managed rather than risk free approach

We’re conscious that the very experimental nature of this and any other innovative approach means that there’s always an inherent element of risk. We’ve grounded its design on deep engagement with our partners which include the boroughs, London ADASS (Association of Directors of Adult Social Care), the Local Government Association, Digital Social Care, London sub-regional NHS Trusts, the Department for Health and Social Care, the Health Innovation Network, etc.

We’re managing risks by exploring the system and its associated challenges in a separate space, which means that there are neither pressures nor risks associated with frontline service delivery.

This approach is completely risk-free when it comes to borough or health services budgets, because the LOTI funding is covering this collaborative experiment – doing this as a borough or health organisation would be cost-prohibitive or at the very least incredibly onerous.

Overview of the LAS in adult social care

The LAS in adult social care consists of three phases:

1. Launch of the LAS: Immersive Day
2. Design Sprint
3. Showcase of prototypes

1.Launch of the LAS: Immersive Day

Since LOTI began, we’ve run hundreds of workshops, and innovation days, which have involved process and journey mapping, exhibitions of solutions etc. What we’re doing differently this time at the Immersive Day is to bring the additional dimension of – human emotion. We will use live performances to immerse the audience in the stories and journeys of two individuals as they navigate the health and care system in London.

Whilst the event will be fun and creative, we’ve incorporated thematic breakout rooms which will seek to involve participants in unpicking issues, exploring opportunities together and ultimately we’ll end the day with tangible ideas we then take forward to a design sprint.

Using our user research findings to inform the day

We spoke with directors of adult social care, service leads and managers, and staff members working in adult social care across seven boroughs in London. Over the course of the many conversations, we narrowed in on some key challenges we might address:

• ‘The Discharge Challenge’
  At first glance, this sounds like a pain point that sits within hospitals and healthcare. And while it is something that many health colleagues are working hard on addressing, we have seen that it has a close cause-and-effect relationship with adult social care. For example, delays in discharges are often caused by slowdowns in care placements, and conversely, delayed discharges could mean increased care needs for those whose conditions worsen from staying in hospital too long.
• ‘The Prevention Challenge’
  While talking to staff in adult social care teams, we found that while the transition from hospital to a care setting is an issue, many boroughs have traced it upstream to when patients are admitted into hospital in the first place. Insufficient or inaccessible community care or increased social isolation can mean that the health conditions that people are experiencing often escalate to a point of needed hospitalisation. This was seen as another challenge area that might be addressed through a sandbox-style approach.
• ‘The Referral Challenge’
  Many people we interviewed spoke to us about the front door of adult social care. There is already brilliant work being done in this space in some London boroughs, but as we dug deeper, we uncovered other challenges staff were dealing with within local authority teams that exacerbated the issue of the front door and need to be solved for the front door solutions to have real impact.

Taking a systems and user-led approach
We absolutely recognise the challenges associated with taking such a broad view but underpinning this is the fact that although operating in silos, the different parts of the system are most certainly connected when it comes to a resident’s experience. A systems approach can help us to surface the main challenges across the different services and identify solutions that address the root cause of problems rather than treating the symptoms. The other reason for doing this is because our own user research has revealed that the challenges are well known and documented with each part of the system, but what’s missing is an interconnected understanding of challenges.

Therefore, we pieced together the different components, people, pain points and challenges we had heard along the way and came up with our understanding of the system as it is. Starting from a person living in their home, we mapped out some possible journeys they take through healthcare, into care settings and through continued social care support. The image you see below is a simplified, joined up depiction of the whole system as we understand it.

2. Design sprint 
Having identified a longlist of potential opportunities at the launch event, we’ll then invite participants to get involved in developing prototype solutions for 3 – 5 shortlisted project ideas.

We’re developing a set of criteria we’ll use to assess the shortlisted opportunities which will likely include things like desirability, feasibility and viability as well as – where can LOTI make the greatest impact and what’s of most benefit to our boroughs.

3. Showcasing the prototyped solutions
Having developed 3 – 5 prototypes by the end of the design sprint, the idea is to then showcase these potential solutions to boroughs, adult social care and health partners. We’re still developing our approach for this phase, but our aim is to identify how we might support boroughs in further developing or testing created prototypes or perhaps even adopting prototypes.

How you can get involved and participate?

If you’re a frontline worker in a local authority, health organisation or care home who has experience of working either within or across community care, hospital admissions/discharge, care homes and adult social care then we’d love for you to be involved throughout or just the launch event, please get in touch.

If you’re a supplier who has or is developing technology, data or other (e.g. service or people oriented) solutions in this space then please also get in touch with us about coming to the launch event.

If you have any suggestions or are aware of other similar initiatives either in the UK or aborad, please get in touch.