Digital transformation in social care: the key ingredient to effective integration?

By - Integrated Care Journal
Digital transformation in social care: the key ingredient to effective integration?

Nuno Almeida, Chief Executive of Nourish Care and member of the APPG on Adult Social Care, stresses the importance of creating a digital thread to link care services with the wider healthcare sector.  

Integration between health and social care services has been an aspiration for over a decade. However, integration means very different things to different people across communities of GPs, CCGs, local authorities, or even the very people receiving care and support.

The renewed drive for health and social care integration, as recently described in the Government’s whitepaper, has already started. We are seeing a clear acceleration of activities that promote system thinking – be it in the context of Integrated Care Systems (ICS), or in the context of shared care records, where NHSx has set the ambitious goal for the whole of the NHS to have shared care records in place by the end of 20212. But there are also concerns about how this process frames integration as something that happens from the commissioning bodies’ points of view.

Discussions around integration are primarily taking place between the NHS and local authorities. Yet, the vast majority of care provided in social care is done so through a wide array of sources of support: unpaid carers, personal assistants, home care and care home providers. These carers are largely employed by one of over 20,000 care providers across the UK. Although approximately half of all paid care is commissioned by local authorities or NHS CCGs, the other half is paid for privately, with no commissioner’s involvement.

Care providers need to be invited to be part of these discussions – integration will not be achieved by having the NHS and Local Authorities designing processes and dictating them to providers.

Securing the sector’s seat at the table

The focal point for integration needs to be each and every one of us, as people, sometimes as patients. Shared Care Records are not focussed on enabling an individual to understand their care or decide about the shape of their care. Social Care providers suffer from the same problem – a lot is being decided about how they will fit into an integrated system, how they should be managing personal health and care information, without them being at the table.

NHS providers tend to assume that most roadblocks to integration will be solved by sharing GP notes and hospital discharge summaries with registered managers; at an extreme we often see care homes being offered access to NHS systems. As much as this can be helpful, if we disregard the vast quantity of information that exists about an individual in social care, we are closing the door on improving healthcare’s ability to serve each person better, closing the door on avoiding unnecessary appointments, and closing the door on providing a risk stratified approach to healthcare to people who rely on social care services.

Nowhere is the asymmetry of volume of information between social care and health greater than in a specialist dementia nursing home. Between records of personal care, assessments, observations, nutrition, episodes of continence, tissue viability, mobility, activities and socialising, it is not unusual for a care team to create 40 records per day for a single person – the status held for each person is near real-time. A GP system will hold a small number of records per appointment and is as up to date as the last appointment (which can be several months old). Recently we have seen remote monitoring systems being deployed in nursing homes where NHS teams become able to monitor patients in care homes rather than in hospital. These systems duplicate the effort done by care workers in care homes who are recording observations in their existing systems, and then introducing the same observations in NHS remote monitoring systems.

In this context we need to assert three points:

  • Social Care providers hold vast quantities of very valuable high-quality data, which can drive improvement and efficiencies in the context of integration.

  • People’s experience of health and social care can improve if health providers gain access to social care data.

  • It is to everyone’s benefit that all social care providers adopt digital platforms for care management – and this will drive improvement across the entire system.

Information management and reporting is a significant part of the workload of any care team. More than 60 per cent of care teams across the UK still collect information on paper3. Digital transformation of social care can change the paradigm of what is meant by integration.

There are some fundamental principles that can enable large scale transformation, and rapid delivery of benefits for both Social Care and NHS.

Ensuring all care providers become digitally enabled

This is a cornerstone for accessing the benefits of digital across the sector and could create a similar trajectory to what happened with the uptake of GP digital systems in the 1980’s. Digital care planning and care pathway management can unleash a range of benefits for care providers, deliver immediate improvements in safety and quality of care and open the door to more personalised care, where each person can be involved in shaping their own pathway.

Digital platforms can support personalisation, coordination of circles of care, and enable individuals to take as little or as much control as they are prepared to take. Ultimately, they enable the transition from the current commissioning model to modern models of co-creation and continuous innovation in care planning. This requires investment in ongoing programmes such as the enrolment of care providers in the Data Security and Protection Toolkit (DSPT) so that providers meet good data security standards, and investment in programmes such as the Joining Up Care programme, within the NHSx portfolio4.

The impact of a digitally enabled care team is widely recognised with a large number case studies and research initiatives as, for example, on care worker engagement.

Driving interoperability across the system

So that digital transformation of care providers can result in improvements to other parts of the system, new systems adopted as well as those already existing within the NHS and local authorities need to evolve towards full interoperability. It’s essential that genuine interoperability is made a requirement - avoiding a situation where a care provider is locked down by a single supplier - open standards need to be encouraged within social care and between social care and health.

Interoperability will enable integration of data across the system. This will result in better transparency and easier access to data for commissioners and regulators, increased capacity for remote monitoring, avoidance of hospital admissions and GP visits for health providers and truly integrated risk driven community care. Achieving this requires a significant drive behind the definition of standards and adoption of standards. Such efforts are already underway, coordinated by both the PRSB, InterOpen, with an overarching strategy being defined by NHSx and sector contributions, such as those from Digital Social Care, part of the Care Providers Alliance.

Ensure we are driving towards choice and independence 

Having the right digital infrastructure allows each person and their family to access services, self-help, and to retain control. This is true of assistive devices that support the person with daily activities, as well as digital tools that enable family members to coordinate in supporting the person both with their activities or in using health and social care services. But above all, these tools allow people to control their own life: giving them the ability to write their care plans, their advanced decisions and helps support them in remaining independent and healthy for as long as possible.

Investment in technology in social care is investment in the infrastructure that will enable social care to integrate with other services, enabling integration to happen around each of us when we need support.

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