On 22nd June 2022, Public Policy Projects (PPP) hosted a roundtable entitled A Care System for the Future: Digital Opportunities and the Arrival of Caretech. The discussion saw PPP’s Social Care Network explore some of the challenges around digitising and integrating care, as well as the roles of government and the social care sector in facilitating the transformation towards a technology-driven, but person-led, social care system.
According to the government, only 40 per cent of social care providers have electronic care records, many of the remainder relying largely on paper records. The government, in its white paper, People at the Heart of Care¸ has committed investment upwards of £150 million to drive this figure up to 80 per cent, however the sector as a whole lags behind the NHS and systems in comparable countries in its use of administrative and assistive technology.
Following the establishment of integrated care systems, and given that public engagement with digital technologies is at an all-time high, there is now a unique opportunity to transform how technology is used to deliver social care.
Basic information – a right, not a privilege
The discussion began by acknowledging a fundamental problem of the current social care system – the lack of basic information sharing between care providers, those in receipt of care, and those family members or friends who want to oversee the care being provided.
Multiple participants were keen to stress that it should be considered a basic right for people to know who is entering their, or their loved one’s home, particularly when they are being billed for the service.
“There are a plethora of platforms out there but providers who implement them configure them differently.”
This is particularly important for those receiving domiciliary care, typically the elderly or those with disabilities. As one Network member explained, people should have a right to know “who will be my carer today, will they arrive on time, and if not, when will they arrive?”. The relatives of those receiving care also want to know “when did the carer arrive, what did they do, and how is my loved one?”
Different care providers have different electronic communications systems, if they have them at all, but it was commonly agreed that open communication between carers and families is not a typical feature of the various systems in place. There is also little interoperability between these systems. It was explained that “there are a plethora of platforms out there but providers who implement them configure them differently, in ways that make sense to them.”
Furthermore, where direct records do exist, they are often not completed until the end of the workday, so there is little scope to adapt to changes in care provision or the circumstances of those receiving care. It was discussed that, regardless of any innovations that are implemented, the government should “probably mandate a minimum level of data that care providers must ensure is available,” including who arrived to provide care, when they arrived, and what actions were taken.
Cultural and practical shifts
A common excuse for not implementing technology into social care, and especially adult social care, is that end users do not understand the technology, and therefore implementing it is not worth attempting.
However, it takes little imagination to conceptualise the benefits that technology could bring to those receiving care. As one member summarised, “assistive communications technology can make a massive difference for those with communication issues, for those with learning disabilities. It can completely open up the world and transform the quality of their lives.”
“We’ve got quite an undeveloped marketplace in terms of engaging older people with technology.”
On this subject, it was agreed that much of the technology that could make a real improvement to people receiving care does exist, for example, smartwatches, or Amazon’s Alexa. Increasing the care sector’s use and acceptance of such technologies will therefore require cultural shifts among end users and policy makers but also the market.
One participant noted that “we’ve got quite an undeveloped marketplace in terms of engaging older people with technology. We haven’t thought of it in the same kind of way as other countries about how you make tech accessible.” On solutions such as smartwatches, which can monitor vital signs and notify somebody about a noteworthy change, the same member commented that “the best way to market them seems to be to show a man in his twenties running in a forest, rather than somebody older, living independently at home who can use it to connect with family.”
“Personal budgets are a massive area where individuals can be facilitated to actually access technology.”
Many platforms currently in operation are also not designed with end-users in mind; as one participant noted, many elderly people “can struggle even with mobile phones,” while electronic records are often “badly presented – they have phone-sized screens to look at the data and it’s difficult for people to comprehend.”
The Network agreed that more must be done to provide the necessary technology, (tablet computers or voice activated technology) to those who need it, and there are mechanisms already in place to achieve this. “Personal budgets are a massive area where individuals can be facilitated to actually access technology,” commented one Network member.
The Network agreed that changes in attitudes towards technology should be encouraged among the general population; it was suggested that a public awareness campaign, as well as real efforts to ensure data security, should be undertaken to help people understand precisely why providing their data is important to help raise the standards and accountability of care. The experiences of the pandemic and the success of the NHS App were cited as proof that once people are sufficiently educated and can see the value of providing their data, gaining their informed consent is relatively easy.
Bridging the trust gap
The Network discussed how a general lack of trust over data sharing among patients and carers, as well as doubt that technology could produce any meaningful improvements to care, is also further hindering the adoption of technology in the care sector.
One network member shared their experience of this, explaining that “when Carers UK did a focus group on the use of technology by carers, they asked carers at the start of the focus group and 7 per cent said they were interested in exploring technology. By the time we explained what the technology could do we had over 70 per cent of the carers wanting to use it, so it was very much an education issue.”
“If we start recruiting staff at a senior level…that really understand [technology], we could transform the way in which we provide care.”
This can also be partly attributed to a “massive skills gaps in the care workforce, both in the context of data analysis and the ability to install, support and maintain connection for people.” The government has committed at least £500 million over the next three years to help build out the digital skills of the social care workforce, a long-overdue and necessary step.
As is often the case, however, much of the change must begin at the top. It was agreed that “if we start recruiting staff at a senior level, to make technology and information and digital a real specialism within social care, and bring in the staff that really understand it, we could transform the way in which we provide care.”
Having digital and data expertise at a senior level will become increasingly essential as more technology is incorporated into the sector and the data it produces proliferates. A member of the Network’s Lived Experience Panel explained that any new care platforms will “create unimaginably large amounts of data that will need to be processed, shared appropriately, maintained, and kept safe and secure. It’s a Big Data problem for experts.”
The need for government guidance
It was also discussed that providers have valid cause for concern regarding investment in a technological solution that may not work as intended. One member shared their experience of a conversation with a care provider “who said they were fantastically excited about falls prevention technology that they’re introducing, but they’re absolutely terrified about what the consequences are if it doesn’t work.”
To address this, The Medicines and Healthcare Products Regulatory Agency could certainly assume a more prominent role, as once a solution is tested, approved and officially licensed, care providers need not fear making a needless investment into an unworkable or unnecessarily expensive technology.
Another feature of the current system is that there are “too many [technology] providers bombarding you, telling you their ‘innovative’ technology is the one to use, even if most of them replicate other systems and do nothing new.” The Network was keen to stress that this should not be seen as an attempt to stifle innovation, but to promote the development of new solutions, rather than simply replicating existing technology.
Much of this could be addressed by the provision of clear “guidelines regarding what technology is already there and what are the areas where innovation is required.” To this end, it was suggested that something like a Which? guide for existing technology should be made available.
One member then highlighted that such a guide does actually exist already, but a lack of awareness of it encapsulates the problem; “the Digital Health Alliance, working with Carers UK, did produce a guide specifically for technology for carers. Although the Department of Health and Social Care was extremely helpful in funding production of the guide, when it was time to get it on the side of buses so that people are made aware of its existence, they said ‘sorry, we can’t help’.” The Network called on the government to back up its words with actions to help raise public awareness of the beneficial role that technology could play across the health and care sectors.
A social care app
The Network discussed the creation of a single social care app, either akin to, or incorporated within, the NHS App, which was rolled out in 2019. Many of the problems identified by the Network could arguably be addressed in this way.
A major factor behind the success of the NHS App is the fact that it is a single, unified system. As one member explained, it has “28 million users because they’ve got a single system right the way across the NHS and people are buying into it. They are now integrating that with local individual services and that is forcing a significant amount of continuity and similarity between systems. We don’t have anything like that at all in the social care sector yet.”
Through a unified platform like the NHS App, all notes and communications about a patient can be logged and shared in real time, creating a single version of truth, and substantially improving standards of accountability. A single care app could also facilitate the open flow of communication between care providers and end users.
“Everything must be thought of in terms of the end user.”
Furthermore, the existence of a single, central social care app would ensure that any technology solutions that come to market are made compatible from conception, since the specifications and requirements would be a known quantity, rather than hopeful guesswork.
It was acknowledged that it could be “clunky to mandate standards from the top,” but the Network generally agreed that it probably represents the best hope for coherency across the care system. As one member elucidates, “there are myriad organisations in care, but if there was a ‘care app’, then the technology would have to fit into it, and [alignment] would happen organically.”
To ensure alignment with the needs of the sector, the involvement of the Association of Directors of Adult Social Services (ADASS) was encouraged by one participant, while consultation with the Society for Innovation Technology and Modernisation (SOCITM) was also proposed “to work on the IT side” of developing a care app.
Whichever bodies are involved, however, the Network was unified in its belief that “everything must be thought of in terms of the end user,” and close consultation with patient representatives will be essential to ensure that any solution can ultimately fulfil the needs of its end users.
Technology driven, person-led
Above all, this session was optimistic that the social care sector is heading in the right direction, but it still lags behind the NHS on the implementation of digital technology. Even if the sector achieves the government’s target of digitising 80 per cent of records by March 2024, efforts to modernise the sector must not lose momentum.
There are clear roles for government policy to ensure greater access to technology, clearer guidance for technology and care providers, and greater support for care providers and the workforce. The Network agrees that both the government and markets must also begin to lay the groundwork for cultural shifts that increase acceptance of digital technology, both among the public and the social care workforce.
The creation of a single app for social care that is accessible, facilitates the open flow of information and can incorporate modular technology would help address many of the issues with the present system identified by the Network and the User Experience Panel.
The consequences of the Covid-19 pandemic on health and care are lasting and innumerable. One of the more positive of these, however, was the necessary and overdue integration of technology, typified by the success of the NHS App. The Network believes that now is the time to seize the momentum and capitalise on the greater appreciation of the role that technology can have in health and care.