A local authority operates a 24/7 physical responder service for around 5,000 registered residents, using in-home alarm monitoring to coordinate or provide response when alerts are triggered. The service is largely reactive, with responders attending residents in their homes to help manage risk and support independent living. It also provides out-of-hours monitoring and response for sheltered housing tenants and delivers the Council’s emergency repairs service.

The service was paused to new referrals due to capacity and scope challenges. Risk-management changes introduced during this period were perceived to have increased operating and financial pressures, including longer time spent in residents’ homes and wider impacts on ambulance, emergency, and urgent care services.

The challenge was to redefine the service’s operating parameters to improve safety, efficiency and sustainability, while supporting a shift towards more proactive, digitally enabled telecare and building on existing health and care partnerships.

The purpose of the review was to establish a clear understanding of the current service, identify options for future delivery, and assess the potential impact of each option for the Council, the Independent Care Alliance, the Integrated Care Board and residents.

Caja worked collaboratively with the councils officers and partners across the wider care and health system to review the existing Technology Enabled Care (TEC) operating model. The work developed a shared, evidence-based understanding of how services operated in practice, including the role of responders and the monitoring function, how technology supported decision-making, and how effectively current arrangements enabled residents to live safely at home.

A key part of the discovery phase focused on people, roles, skills, and ways of working. Through structured engagement with frontline staff and managers, Caja explored how responsibilities were allocated, how assessments and responses were prioritised, and how consistently decisions were made. This highlighted cultural factors such as reliance on reactive working, variation in assessment practice, and the impact of manual processes on staff capacity, confidence, and consistency. Skills gaps and capacity constraints were also identified, alongside opportunities to better align roles, training, and technology.

Building on this insight, Caja supported the Council to develop and appraise a structured set of future operating model options. Clear assessment criteria were co-designed, reflecting resident outcomes, workforce impact, sustainability, deliverability, and alignment with the Council’s TEC Strategy.

The below options showed a progression from reactive to more proactive and predictive models:

Market analysis across public and private providers informed the recommendations.

Engagement confirmed the responder service was highly valued, leading to a transformation approach focused on optimising the service through improved digital tools, clearer roles, standardised assessments, and stronger referral pathways.

A benefits model using Monte Carlo simulation supported investment decisions by assessing best, worst and most likely scenarios based on the costs of falls and long-lies in the over-65 population.

Caja was able to present a fully comprehensive report that:

The report has provided the detailed basis for an executive summary to be presented to the Boards of the Local Authority and the Integrated Care system.