Starting at the right end of digital care: Place-based and citizen centric care is a task for GDS and NHS Digital

Jos Creese, independent digital consultant and principal Analyst for Eduserv, says that technology should promote fundamental change in our care services – and argues that this is the responsibility of everyone from local providers to central government. 

Technology isn’t just booking appointments online, says Jos Creese – Photo credit: Flickr, Till Westermayer, CC BY 2.0

We read daily about the issues with our health and social care services – staff over-worked, budgets insufficient to cope with demand and services on the brink of collapse – especially in these winter months.

The government is promoting the importance of digital care services, with £4.2bn announced in 2016 to be spent bringing the NHS into the digital age.

A future of paper-free, kite-marked health and social care apps, digital records, ‘click and collect’ prescriptions, booking appointments on-line, free Wi-Fi in hospitals and citizens having access to their personal data and records that they can control and edit, wherever they are, shared with care professionals.

“It is about so much more than being able to book an appointment online.”

Yet as with any digital programme, it is less about the technology than it is about cultural and process change – and nowhere is that more evident than in a move to digital health and social care.

Where I live, outside Winchester (apparently, the best place to live in the UK), you can’t get to see a GP for weeks unless you have an urgent medical need, because they are over-stretched and seeing a group practice nurse instead is not allowed.

Our A&E service is bursting at the seams because there are no out of hours GP services anymore – again except for emergencies, and then they just send you to A&E anyway. Currently, many people go to their GPs and A&E who really don’t need to, or because a problem has become a crisis. The same is true for social care services.

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Although digital care must include automating and modernising administration, these technology solutions must not be used to mask practices that are inefficient and not fit for purpose.

Rather, the opportunity of technology should promote fundamental change in our care services and how we all use them. It is about so much more than being able to book an appointment online.

First of all, creating an integrated care service with a sensible triage system that starts with the most local and lowest cost support – not always with the GP, social worker, ambulance service or A&E, but with community support groups, pharmacies, and internet resources.

That means new attitudes to and methods for managing risk – our GPs do not always have to be gate-keepers to care services to protect our well-being.

Then we need a network of care services and support groups in an area, so a holistic view can be taken. This should include ‘social prescribing’: whereby patients with social, emotional or practical needs can be referred to a range of local, non-clinical services that are often provided by the voluntary and community sector, rather than depending (often repeatedly) on primary and secondary care services.

Care as a platform

These changes are complex and fundamental. They require new governance overseeing integrated care locally, not just administered nationally.

They require budgets to be pooled and used across a much wider range of services. And they need citizens to be allowed to take more responsibility for their care (or have help to do so) wherever possible.

If we can get this right, care interventions can be made quicker, more easily, at the right time and much more efficiently, reducing the burden on acute services.

Currently too many people end up needing expensive social and health care specialists support, because they don’t know where else to go, because the system demands it or because interventions were left too late and social or health issues have become critical.

“Together, we can unlock legacy blockers that lie in outdated culture, processes and technologies.”

Starting from this perspective enables you to see a different picture of design of ‘care as a platform’.

It’s about open systems and open Application Programming Interfaces for sharing across care specialist services, support groups and with citizens – safely and securely.

It’s about citizens being able to see and amend (where appropriate) data about them, including from wearable technology.

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.

Single vision for digital architecture

National systems need to be brought together locally through linked data, with national digital policy, standards and requirements defined for sharing data and information. This is something the Government Digital Service needs to take on, not just NHS Digital, because it spans much more than the NHS.

It also needs consideration of digital skills – for citizens, care professionals and the leaders and politicians in control of our health and social care policies.

There are some great examples of digitally-enabled integrated care already happening across the UK, although often in islands of best practice.

Sustainability and Transformation Plans are being developed to help to capture the opportunities that digital offers, including Local Digital Roadmaps – although the slant is often too heavily NHS biased.

What is lacking is a single vision of 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.

That should cover, for example, standards for open and linked data and systems, mandated principles and policies for distributed and shareable virtual care records, common IT infrastructure across all health and social care agencies, and universal security and identity management.

With digital and IT leaders working together across health and social care, and with the totality of resources we already have, we can unlock legacy blockers that lie in outdated culture, processes and technologies and, as a result, make a better case for investment in our front line acute services.


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