Industry voice: A modular approach to technology solutions supported by credible standards provides the way forward for a better integration of care, writes Tim Gregson, chief technology officer, local and regional government at Microsoft
The widespread integration of health and social care has become something of a holy grail, but it is also recognised as one of the most complex and difficult issues facing the public sector today.
Plenty of headlines have been generated in the national media by ‘bed blocking’ - when patients are medically fit to go home but are not discharged because they need ongoing or re-enablement care that has yet to be arranged. But there is a myriad of other problems that derive from the shortcomings in the exchange of information between the NHS, local authorities and other care providers.
As things stand, the system is not working, and the pressures on all sides are creating a sense of urgency around building one that does. But there is a sense that a 'grand plan' to provide all the solutions is not a good idea.
The issue formed the basis of a UKA Live discussion in which I recently took part with James Palmer, head of data and integration of the Social Care Programme at NHS Digital, Mark Golledge, care and health digital lead at the Local Government Association, and Richard Smith, interim director of technology enabled care at Essex County Council.
Everybody agreed with the wider consensus that digital technology will be at the centre of providing a more closely integrated care system, but also that this is a challenge with the legacy systems in use in most organisations. Historically, systems were designed to cope with specific demands that reflected a more siloed way of thinking, focused on the priorities of individual organisations rather than the more complex, but holistic, needs of individual patients.
Now there are signs of change for the better, especially with the development of integrated care record for some localities, cities and regions, but there is still a long way to go.
Three main requirements emerged from the discussion. One reflects a longstanding recognition in the NHS that information systems need to be able to follow patients across organisational boundaries. If someone living in Oxfordshire suffers a fall in Bournemouth the hospital needs access to details on their healthcare, but they could also benefit from access to crucial social care information.
Nobody is suggesting the creation of a big national system to provide this, but there is a need for clinicians, health and care workers to have access to key information on a patient.
Another priority is the need to include not just NHS bodies and local authorities, but all care providers: charities, the voluntary sector, and the commercial companies that provide many of the social care services on behalf of councils. It should also extend to less obvious organisations, such as fire services that carry out assessments on people’s homes, and public housing organisations that often liaise on special needs for individuals.
This would demand that professionals are able to extract information from even more systems, and produces an extra challenge in the fact that many smaller care providers – such as independent care homes – are not part of a strong digital infrastructure. Bringing them into the fold would makes some stiff demands around technology, culture and information governance.
The third requirement is that future systems should be able to accommodate the internet of things (IoT). There is a consensus that internet-connected sensors, monitors and alert systems will play a big part in supporting people at home and keeping them out of hospitals and care homes; but there is another major challenge in ensuring that the data they collect can be integrated into digital systems and shared when appropriate.
There is no silver bullet for this; we will move closer to integrated care through a procession of solutions for specific challenges, with some dead ends and failures along the way. A modular approach to integration, with solutions that can match the pressures on different organisations, is likely to be more effective than a grand plan.
But it will need the development of some rigorous core standards to provide the basis for integration. Some will apply to the technology to support the interoperability of systems – providing “a good handshake between the modules” – while others will be around information governance to protect the integrity of the data and provide privacy safeguards. And this will involve transparency around the use of data to help build public trust.
NHS Digital and the Local Government Association are both well placed, and apparently willing, to take leading roles in developing these standards. However, they know it should not be a top down effort, and want to work with organisations from across the spectrum to ensure the standards are viable and reflect the realities of delivering care.
Within this, it is necessary to ensure that the smaller organisations – those care homes and voluntary bodies with little digital infrastructure – are not shut out of the process. They are at the sharp end and need to be able to use the systems as well as any large organisation; and to deal with an information governance model that they find manageable.
It is also necessary to ensure that it is all focused on what the patient needs, not what works most easily for the organisation providing the care.
Elements of dialogue
There are other elements to progress. These include social care providers doing more to shape the dialogue than in the past; a need to work more actively with suppliers on shaping the market for social care IT; and recognising that, while technology can provide valuable support, the face-to-face conversations will always be an important part of the process.
It amounts to a massive challenge, but there is a sense that the two sides of the care sector, and the relevant sections of the IT industry, are closer together and speaking more of the same language than in the past. They are developing a series of common understandings on which to build a better, all round care system for our citizens.
This is just a taster of the observations and suggestions to emerge from the debate. You can view it in full below.