Background
Increasingly, technology is being used by health and social care practitioners with the aim of enhancing the wellbeing of care home residents and people drawing on home care. BLMK ICB received funding to implement two technologies (Robopets and PainChek) across a range of different community-based care settings with people living with dementia or a learning disability, experiencing some of the following challenges:
- Communication difficulty
- Symptoms of cognitive impairment
- Low mood/ anxiety
- Behaviours that are causing concern
The use of the technologies was anticipated to support people to live independently, improve quality of life, reduce avoidable hospital admissions/ readmissions and improve care quality and safety.
Robopets are robotic companions, in the form of cat, dog or bird, with sensors that respond to touch, sound and movement and mimic realistic behaviours such as purring, barking, head turning and tail wagging They are designed to provide a calming influence, give people greater independence and confidence, and improve mental health and wellbeing. Robopets are intended to be companions for older adults, people living on their own, or anyone who is unable to have a pet of their own. They are becoming commonplace in the UK care system, as well as being purchased by private individuals, with the aim of reducing loneliness and anxiety among at-risk older people.
PainChek is a digital pain assessment tool used via a smartphone that uses AI to detect pain through facial expressions and guides carers through a questionnaire to give a pain score for individuals who are unable to communicate this themselves. PainChek is a validated AI device with evidence of concurrent validity, inter-rater agreement, and internal consistency, indicating it to be a safe and reliable tool to identify pain in the cohort identified within this project. PainChek is intended to support effective medication use for those who are unable to verbalise pain and as a result risk being left in discomfort or distress, which could also lead to behaviours that cause concern such as increased agitation.
This study was one of 8 projects nationally to have received funding through the Adult Social Care Technology Fund. This evaluation, in conjunction with the other projects, will help inform spread and scale of technology implementation within adult social care in England.
The University of Hertfordshire (UH) was the evaluation partner for this project. The evaluation aimed to understand the acceptability, usability, cost-effectiveness and impacts of PainChek and Robopets as implemented and adopted in BLMK care homes and as part of the domiciliary care offer, to inform the development of an evidence-based plan for scale and spread across BLMK ICB.
Project Aims
- This project aimed to understand the technology implementation processes and outcomes, including adoption, acceptability, usability, and sustainability of PainChek and Robopets;
- Assessed the effectiveness of the technologies against the intended benefits, including outcomes for those receiving the intervention, their families and staff involved in their care;
- Estimated the resource use and cost changes associated with the adoption of the implemented technologies.
Project Activity
The evaluation used a mixed-methods approach with quantitative and qualitative data collected at key touch points during the implementation of the technologies. Emphasis was on an overarching knowledge mobilisation approach whereby relationships with key stakeholders were established at the outset and drawn on throughout the project to help determine required data collection and analysis, as well as to ensure buy-in to the evaluation across the Integrated Care System (ICS) and ensure the usefulness of findings.
The evaluation consisted of 4 overlapping work packages (WP) with data collection and analysis underpinned by the NASSS framework, which is an evidence-based technology implementation and evaluation framework.
Work Package 1: the pre-implementation set-up, establishing governance arrangements, and scoping exercises to understand the current context and initial requirements for implementation. Activities included:
- Rapid evidence review;
- Document analysis;
- Logic model development through stakeholder workshops.
Work Package 2: encompassed the qualitative data collection and analyses, focused on the impact of the technologies on the experiences and outcomes of service users, carers, and staff; and the collection of quality-of-life data using Adult Social Care Outcomes Toolkit (ASCOT) questionnaires. It was concerned with identifying the challenges and enablers to implementation in the specific social care settings (i.e. domiciliary care and care homes). WP2 included the following data collection methods:
- Focus groups;
- Interviews;
- Observations of the technologies in use;
- Review of care notes;
- ASCOT self-completion and proxy-completion questionnaires.
Work Package 3: comprised the quantitative and cost-consequence analysis to estimate the resource use and cost changes associated with the adoption of the implemented technologies. The primary quantitative analysis adopted a pre-post design, with observation at baseline and follow-up to analyse benefits based on administrative data that can be collected both prospectively and retrospectively. The selection of outcomes has been guided by the findings from WP1 and included, for example, changes in: effective prescribing, levels of pain, hospital admissions, safeguarding incidents and incidences of concerning behaviours.
Work Package 4: included knowledge mobilisation activities and dissemination. A knowledge mobilisation approach enables sense-checking with stakeholders and a continuous feedback loop throughout the project. This involved, for example, the logic model workshops in WP1 to ensure there is a mutual understanding and organising vision for the technology implementation and evaluation. Throughout there was commitment to meaningful involvement of public members and those assumed to benefit from the implementation of these new technologies. Two knowledge mobilisation workshops were held at midpoint (March 2025) and at the end of year two (February 2026) to present draft findings and get feedback from attendees on recommendations.
Impacts, Outputs and plans for dissemination
Key findings
The project saw mixed engagement and adoption with some excellent examples of how the technology can make a positive different to service users and staff when it is fully embedded into practice. Evidence suggests there is a role for technologies in promoting quality of life. However, adoption of technologies was seen to differ across providers. Additionally we learnt that ‘simple’ technologies still require training and other preparatory and ongoing work to support appropriate adoption and uptake. Positive experiences reported did not always correspond with long-term commitments to adopt technology, raising questions about sustainability when funding ends.
Across both technologies, success depended on contextual factors that are challenged by the delivery approach in short-term, target-driven pilots. These included:
- having a clear understanding of individual needs;
- strong care provider leadership and openness to change;
- staff culture and digital readiness;
- integration with existing policies and good care practices;
- wider system support;
- and the financial capacity to invest and plan for sustainability.
All dissemination activity will be conducted in collaboration with experts by experience (e.g. through co-presenting and co-authoring), including:
- Academic papers
- Reports for funders developed with BLMK ICB including reports for care providers and their service users
- Presentations at Academic and Practitioner Conferences including Alzheimer’s Europe and NHS ConfedExpo 2026
- Creative outputs, such as infographics for the Theory’s of Change developed through this work
Who was involved?
- Professor Kathryn Almack (PI)
- Dr Jenni Lynch
- Dr Alison Tingle, Research Fellow, University of Hertfordshire
- Dr Krystal Warmoth
- Dr Melanie Hadley, Associate Professor, University of Hertfordshire
- Dr Jane Fry, Senior Research Fellow, University of Hertfordshire
- Dr Chris Sampson, Consultant Health Economist, Office of Health Economics
- Health Innovation East
- Bedfordshire, Luton and Milton Keynes Integrated Care Board
Contact
ARCOffice@cpft.nhs.uk
Project SALLT08
Project MH57
Project PEDHSC47
Project SALLT07
Project SALLT02
Project SALLT06