Health and social care: how technology should stimulate fundamental change
Jos Creese, principal analyst at the Eduserv Executive Briefing Programme, says delivering integrated health and social care is so much more than a job for the IT team
You don’t have to look too far through the papers or listen to the radio for too long before you come across a story about the winter crisis which is gripping our health and social care services.
GP practices are struggling to meet demand; wait times in A&E are above the four hour threshold where safety becomes compromised; the lack of community care means patients in hospitals are blocking much needed beds. There is pressure on all sides.
The truth is that what we face is less of a winter crisis and more a structural crisis in the way health and social care is delivered in the UK. The current systems for health and social care simply aren’t set up in a way to give people the best care in a timely manner. The result is pressure falling unnecessarily on last resort safety nets of ambulance services, hospital beds and A&E.
Addressing this means tackling political, resourcing, and professional practice. Whilst it is imperative to use technology to modernise and deliver integrated care and to bring the NHS into the digital age - £4.2bn investment was announced last year – it won’t make a difference unless we address the pressing need for changes in culture and process.
Yes, we need to automate and modernise. But we can’t overlay technology solutions on practices which are no longer fit for purpose. Instead, technology should stimulate fundamental change in our care services and how we all use them.
So how do we go about delivering an integrated health and social care system we need?
First up, we need shift the emphasis away from the traditional gatekeepers for care – GPs, social workers and A&E – towards pharmacies, social prescribing, internet resources and community-support groups. This will go some way to allowing healthcare professionals to focus on delivering care rather than signposting and passing people on to right expert.
Second, we need to move away from seeing primary and secondary care providers as the default providers of care. We need to take a holistic view of an individual’s needs and take advantage of local non-clinical services as well as the more traditional ones. Again this would make better use of the health and social care resources we have and also encourage the emergence of new ones.
Of course this is hard: changes like this will require new governance overseeing integrated care locally and they require budgets to be pooled and used across a much wider range of services. Citizens will need to take more responsibility for their careand their own health and care data wherever possible.
This matters because research shows that the right care interventions made early on, reduce the long-term load on acute services, preventing social or health issues from becomingcritical and therefore more expensive to fix.
So what about the technology? I have talked about the structural changes we need first of all because that must guide our thinking around how IT needs to operate in order to support a modern and integrated care service in the future.
Starting from this perspective enables you to see the case for systems which focus on ‘care as a platform’. This involves open systems and open APIs for sharing across care specialist services, support groups and with citizens – safely and securely. It’s about citizens being able to see and amend data about themselves. It’s about identity mechanisms that are universal (such as the NHS number) and data formats reflecting the different types of data and their sensitivity. It’s about allowing data to be joined together as a resource for citizens, professionals and research.
For this to happen, we must bring national systems together locally through linked data, with national digital policy, standards and requirements defined for sharing care data and information. This is a job for the Government Digital Service (GDS), not just NHS Digital, because it spans much more than the NHS. We also need better digital skillsand knowledge among citizens, care professionals and the leaders and politicians in control of our health and social care policies.
Having investigated the issues around health and social care integration for two reports for the Eduserv Local Government Briefing Programme, it is clear that in different parts of the UK we are already making progress towards this vision of digitally-enabled integrated care.
There is a long way to go however, as much of this exists in islands of best practice and the focus is often very heavily biased on the NHS, and progress must accelerate. The main barrier to this is a single vision for a common digital architecture for all health and social care provision in the UK that allows local place-based implementation, designed around the service use.
We need to agree standards for open and linked data and systems, mandate principles and policies for distributed and shareable virtual care records and move towards common IT infrastructure across all health and social care agencies. This must be supported by a universal approach to security and identity management.
Evidence shows that progress comes fastest when digital and IT leaders work together across health and social care to unlock legacy blockers that lie in outdated culture, processes and technologies with the goal of achieving better clinical outcomes for people and communities. This is perhaps the starting point.
Jos Creese is principal analyst at the Eduserv Executive Briefing Programme which has published two in-depth reports on the challenges of health and social care integration. You can download copies of Health and Social care Integration – Confronting the Challenges (Part 1) and The Potential of Digital (Part 2) from here.