A national perspective on information and technology in adult social care

Challenge and opportunities

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Major challenges facing health and care system• Ageing population

• Over the next 20 years, proportion of population aged 85+ is set to more than double• Rising numbers of people with multiple long term conditions

• People with LTCs accounts for 70% of all health and care spending• As of 2011 – 52% of over 65s had a limiting long-term health condition or disability – a rise of

50% in the decade since 2001 • Over the next 30 years the number of people living with dementia is set to double

• Public services are under financial pressure• Funding gap from rising demand set to be £30bn by 2021 (Nuffield/ NHS) • LGA projecting a funding gap for local government of £16.5bn by 2020 (largely because of rise in

social care costs)• Pressures on services

• Over the 5 years to 2013, the number of over 80s attending A&E rose by 65%• NAO suggest 20% of emergency admissions are for existing conditions that primary, community

or social care could manage.

DH – Leading the nation’s health and care

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Sup

port

ed

Sup

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…and around 6 million people caring for a friend or

family member.

…around 400,000 people in residential

care, 56% of whom are state-supported

…around 1.1 million people receiving care at

home, 80% of whom are state-supported

…1.5 million people employed in the care

and support workforce

Social care impacts on a large number of people across England

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48 per cent of men and 51 per cent of women will need domiciliary

care only

33 per cent of men and 15 per cent of women will never need formal

care

19 per cent of men and 34 per cent of women

will need residential care

Older people are the core user of acute

hospital care - 60% of admissions, 65% of bed

days and 70% of emergency readmissions.

72% of recipients of social care services are

older people, accounting for 56% of expenditure on adult social care.

Three quarters of people aged over 65 willneed care and support in their later years

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To tackle these challenges, there is a wide rangeof policy initiatives across health and care…• Care Act – delivering the most significant change in the legal framework, funding and

provision of adult social care for over 50 years• Integration – Better Care Fund and Pioneers accelerating joint working and new models of

care between primary, acute, community and social care • Personalisation – increasingly putting the citizen at the heart of the system, in control of

their health and their care and support• Quality – seeking continuous improvement in the quality and experience of health and care

services, including greater transparency and use of data (MyNHS transparency hub)• Prevention – exploring ways to reconfigure services to manage increasing demand better

across health and care

Plus local authorities are also:• Delivering wider policy policies - e.g. children’s services, troubled families, • Undertaking wider transformation programmes to drive efficiencies and manage pressures

Information and technology can be a key enabler of change

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Investment in technology and information

is a key enabler….• Help put the citizen and communities at the heart of the system, support design

and delivery of services which really meets individual and carer needs and support self-care

• Support information to be more easily shared across multi-disciplinary team, and with citizens themselves, to improve the quality and experience of care

• Deliver new systems which integrate data and records held by different organisations to improve care packages and enable early and more effective interventions

• Drive continuous improvement through increased transparency and participation in our health and care system, and supporting sector-led improvement

• Help support new delivery models to develop and process improvements to increase efficiency, reduced delay, elimination of duplication and offer more cost effective services

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…but we know our current infrastructure,processes and practices prove a challenge

We need to clearly understand the levels of intervention and insure alignment:•What must happen nationally? Once for all?•Where do we need collaboration and agreement across the system? •Where can local innovation flourish?•How can we support cultural change?

Roadmap for change

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Our national priorities

DH – Leading the nation’s health and care

1. Focus on delivery of the core social care national programmes and influencing broader national policy where appropriate

2. Working in partnership with other national and local agencies to develop the underpinning work that will enable future change and progress across the whole system

3. Supporting complimentary initiatives in which DH Social Care has strong interest but does not have the direct levers

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Integration & interoperability -

Pioneers

Information Governance

Transparency & Comparative Data

Del

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iorit

y pr

ogra

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es

Economic case Citizen-focussed technology

Market development

Achi

evin

g br

oade

r str

ateg

ic

obje

ctive

s Current state

Target future state

Capability & leadership

Integration & interoperability -

Standards

Integration & interoperability – IDCR

& Tech Fund

Care Act implementation Our national work programme focused on two broad areas – 1) delivery of key programmes, and 2) how we can start to develop a wider consensus around investment and change in this area?

Infrastructure and systems

The ADASS Perspective

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The Care Act is part of a wider agenda and must be seen in context

Care Act – delivering the most significant change in the legal framework, funding and provision of adult social care for 50 years

Integration – Better Care Fund and Pioneers accelerating joint working and new models of care. Technology Fund supporting capacity building across sector, with a focus on interoperability.

Personalisation – increasingly putting the citizen at the heart of the system, in control of their care and support

Prevention – exploring ways to reconfigure services to manage increasing demand

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Current Position

•Systems designed with the provider/ commissioner in mind, not end-user

•Too many paper based processes in health and social care

•Risk averse cultures leads to little information shared between professionals or systems

•Traditional market model, with small number of suppliers focusing on council back office systems

•Use of apps under-developed at a time of innovation

Future Position

•User at the heart of the system, with the same level of customer service/ interaction as in other areas of life

•ASC professionals and providers embracing technology as a key part of getting the job done

•A fully joined up information ecosystem within health and care, including other critical agencies

•Use of big data: effective prediction (through analytics) and prevention (pre-emptive interventions)

•Dynamic market, open to innovation

The Care Act in a Digital World

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Recent Stocktake of Authorities

Areas of Concern Workforce Communications Affordability Informatics

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Care Act Cross-Cutting Themes

Scale:

1. Large number of self‐funders coming into the system

2. Much higher volume of data and information stored for longer

3. Case for replacing any manual systems with technology and investment in online assessment Need for reduced admin burden e.g. pre‐population of data

Personalisation

1. Online information and assessment

2. Improved links to advice and care records

National consistency

1. Eligibility criteria

2. Deferred payments

New functions1. Funding reforms2. DPACross Boundary Working1. Technology supporting information flows

across agenciesInformation Governance1. Implications for data sharing, consent

models, access to data and applications and services across networks.

Transparency1. Being open and transparent about rules,

processes and outcomesInformatics Skills1. Training and support for workforce

developmentLeadership & cultural change1. Supporting transformational change

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In terms of Informatics

For 2015/16

• Case recording• Managing Deferred Payment

Administration • Provision of online information

and advice.• ADASS confident this is on

track, though there is some uncertainty in cases where local authorities may be in the middle of changing or upgrading their systems.

For 2016/17

• How data flows across health and social care system to the benefit of the individual and the professionals

• Need to develop an IT and informatics service that supports drive to person-centred care, portability and optimum system efficiency.

• This will come with a cost – particularly in terms of systems being compatible both within and between local authorities.

DH – Leading the nation’s health and care

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We should head towards a world of:1. Fully automated business

processes 2. User portals transacting online3. On-line assessments, reviews

and transactions4. On-line access to health and

social care record5. Joined up health and care

ecosystem including independent sector transferring data seamlessly

6. User in charge of their data7. Wider use of bespoke apps to

encourage self-care

Need to be brave and take the opportunity

Engagement with suppliers

Developing a target ‘future state’ in social care informatics

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Where are we headed?

Improved citizen outcomes and experience, the transparency agenda, integration across service domains, enabling citizen participation

Transparency

Transactions

Participation

Interoperability and trust

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Demand = Opportunity?

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Opportunity = Benefits?

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Numerous challenges

across services within local government and the community

across service domains – NHS, local government, social care, public health, voluntary sector

• Identity management• Information standards –

data and formats/ protocols • Common terminology and

definitions• Open architecture and APIs• Customer focus• Communications

infrastructure and culture• Creating benefits case for

investment

• Identity management• Information standards –

data and formats/ protocols • Common terminology and

definitions• Open architecture and APIs• Customer focus• Communications

infrastructure and culture• Creating benefits case for

investment

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Social care informatics scoping project

Information Standards• Benefits case and supporting narrative for LAs• Identifying enabling ‘foundation’ standards for system• Identifying and analysis of priorities and timelines• Implementing optimal approach for standards development,

adoption and implementation

Client Level data• Benefits case for primary and secondary use• Opportunities for alignment of activities• IG challenges – developing IG toolkit and guidance

Quick wins – building on Care Act implementation, Pioneers work, sharing assets across health and care, enabling interoperability with ‘essential’ infrastructure

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We need your help!

To develop and establish in more detail and at a local level:

• What is the target state for information and IT enablement and what are the steps along the way that we must prioritise – what would success look like for citizens and how must we change to deliver?

• For each organisation; where we are now and what must we do first, second . . . and so on

• To develop a social care/local government digital maturity road map and index that embraces variation and innovation