The Highland Marketing advisory board discussed social care and technology a year into the Covid-19 pandemic. Three years on, there has been progress and set-backs, leaving plenty of questions for an incoming government.
The Highland Marketing advisory board last discussed adult social care in April 2021; a year into the Covid-19 crisis that had demonstrated its value – while highlighting some of its challenges.
The sector had gone into the pandemic facing a chronic shortage of funding and staff, while the Covid-19 response highlighted that care homes and domiciliary providers lacked wi-fi, electronic health records, effective communications, and monitoring technology.
Not enough of the vision thing
When Boris Johnson took over as prime minister, he promised to “fix” the crisis in social care “once and for all.” In December 2021, as his government reluctantly prepared for its third lockdown, it issued a ten-year “vision” for the sector.
‘People at the Heart of Care’ came with a headline pledge that people would no longer need to sell their houses to fund their care, and that £1.5 billion would be invested in housing, workforce and technology. Two years on, the Commons’ public accounts committee found this has fallen well short of a fix.
Days before the advisory board revisited its discussion of social care and technology, the PAC warned the promised funding had been scaled right back and the government no-longer has a roadmap, milestones or targets for the sector after March 2025.
Meanwhile, adult social care now accounts for as much as 70p in every pound of council funding, pushing an increasing number towards bankruptcy. Brexit has not helped vacancy rates, which have reached 152,000. Providers are struggling with the cost of fuel, heating and food. Yet, almost inevitably, demand continues to rise.
Digital social care records: two thirds of the way there
There have been some positives in the past three years. Integrated working is still on the agenda, even if progress has been slow, with NHS England and integrated care systems focused on finances and waiting lists.
The government has launched a plan to develop the domestic care workforce, with a new, accredited qualification, and a career structure with defined job roles. And there has been some progress on digital.
In fact, Claire Smout, head of digital skills at Skills for Care, told the advisory board that the £100 million ‘People at the Heart of Care’ earmarked for digital skills and technology is one of the few pots of funding that have not been raided and are still being spent.
The money has gone into three areas, starting with digital social care records. Smout said Care Quality Commission figures suggest “about 67% of care companies now have a digital social care record of some sort.”
Money has also gone into ‘digital readiness’ such as wi-fi provision, cyber security, digital skills and training, and into care tech pilots, ranging from using AI to help with scheduling, to installing Alexa and other voice-activated devices in people’s homes.
Data and interoperability standards
Even so, there’s a lot left to do. There are 18,000 social care providers in England, and while there are some large chains, many are small and simply cannot afford technology. “We’ve got small providers who cannot afford to put the infrastructure in place for digital social care records,” Smout said.
“They struggle to find investment for the wi-fi, or the tablets, never mind the licences. So, over the next two to three years, there’s likely to be a cross-over where we have some care providers that are paper-based and some that have moved on electronically.”
At the same time, the CQC doesn’t have a definition for digital social care record, so it’s not clear what systems that 67% of providers have deployed. Smout’s colleague and advisory board member Jane Brightman said an assurance framework has been developed to address this and drive-up quality.
This will be issued against a background of policy activity to address data quality and interoperability. An updated Care Data Matters strategy has been issued to make sure data can be captured once and used many times.
While, days after the advisory board meeting, the DHSC issued a prior information notice for an interoperability platform and services to share data with health providers and shared care records.
Strategies to recruit, retain, and upskill the workforce
On the training and skills front, Skills for Care has been commissioned to develop a Digital Skills Framework for its sector. Smout said it covers seven areas, ranging from ethics to cyber security and data management.
Each area sets out the skills that anybody working in social care should have, while another sets out the skills that those in more senior positions require. The framework has a learning and development framework attached to it, with a free e-learning platform holding videos and other resources, and a database of training providers.
“The framework has been developed with the sector,” Smout stressed. “It’s very interactive, and it’s not designed to sit there, gathering dust.” Nor is it being developed in isolation from other workforce initiatives. The DHSC is working on a strategy for digital, data and technology (DDaT) staff.
While Skills for Care has been tasked by its sector with developing an adult social care workforce strategy, as the government has not commissioned one.
Brightman said the strategy, which should be published in July, will cover one-to-five years and five to 15 years, so it can address immediate challenges – such as the collapse in apprenticeships – and longer-term ones – like creating new digital roles to support new ways of working.
How far will the money stretch?
With all this going on, it’s clear the digitisation of social care still has some way to go. And advisory board members questioned whether there is the money to do it.
Neil Perry, a consultant and former acute trust chief information officer, noted that £100 million is just 5% of the money the NHS is putting into its frontline digitisation programme to implement and upgrade electronic patient records.
“The breadth of social care, the number of places in which it works, it can’t be any simpler than the NHS, surely?” he mused. “So, the question is: how is that £100 million going to stretch?”
“The positive is that social care is a greenfield,” Brightman said. “We haven’t got some of the structural problems with technology that the NHS has got. “We’re not years down the line with long, unwieldy contracts with our suppliers.”
Having said that, she acknowledged that with 18,000 providers to cover, the government has effectively said: “we can’t do all of it” and: “we can only put a little bit in.” And that will run out at the end of the three-year spending review period next March.
Finding drivers for adoption
Andy Kinnear, another consultant who formerly worked for an NHS commissioning support unit, admired how far that “little bit” had been stretched. “You’re getting these dreadfully meagre crumbs off the table, so the fact that you are still smiling and so positive is an incredible achievement,” he said.
But in the absence of funding, he wondered what other drivers are available. Smout said a lot of impetus will come from the Care Quality Commission, which has issued guidance suggesting providers will need to adopt digital social care records to remain ‘good’ or ‘outstanding’; and instructing them to complete the Data Security Protection Toolkit.
Skills for Care is also looking at how it can drive the skills and training agenda by building these into other frameworks. “The new care qualification, for example, will be available for new staff, so how can we make sure digital skills are embedded into that – and into some of the other mandatory training that people have to do?” she asked.
Finding solutions, engaging policy makers
Both Brightman and Smout stressed that finding practical solutions is essential to keep ministers and Treasury officials on board. “What I have learned is that the government just doesn’t listen if we go in cap in hand, saying social care is a nightmare, and you need to fund this, this and this,” Brightman said. “So, what we’re trying to do is come up with positive solutions they can work with.”
James Norman, a former acute trust CIO who now works on the supplier side, accepted the point, but wondered if things would change with a change of government. “What about Labour,” he asked: “Do they give any indication of funding this?”
Brightman said the party seems to be interested in a National Care Service, but its immediate priorities are likely to be a new offer on pay, to attract and retain more staff, and further investment in digital.
On top of everything else discussed, Kinnear suggested the party should look for ways to commission new, digital models of care and to put care tech into the hands of users, so they can access some of the self-serve functions that have become common in banking, shopping, and other sectors.
“Health has been slow and clumsy to move in that direction, but there must be opportunities to rethink social care in the same way,” he argued. Brightman and Smout said some councils are already talking about a “frank conversation with citizens” about how to share responsibility for health and social care.
Time to tackle funding
Whatever Labour decides on structure, workforce and digital, it will need to address funding. After all, Ian Hogan, CIO at a community and mental health trust pointed out, social care is an investment.
A failing social care sector leads to delayed discharges from hospital, makes it harder for people to return to the workforce, and means people live less full lives than they could. Or, as he summed up: “Poor social care leads to poor healthcare, which has a direct, knock on effect on all of us.”
David Hancock, a consultant who previously worked for major EPR and SCR companies, agreed. “In 2015, [former NHS chief executive] Simon Stevens said that if he had more money, he would put it into social care,” he said. “It didn’t happen then – but it needs to happen now.”
