Tag Archives: Social Care

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Digital Engagement and Collaboration

Public Service to be saved by digital engagement?

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Using the Devon Local Authority area and demographic as a model, an assessment of this authorities annual social and economic benefits potential for public service digital engagement with citizens has currently reached a staggering value in excess of £2.4billion.

Realisation of these benefits will require the digital solution implemented achieving a true transformation of the current service delivery model, certainly one that services a more pro-active and well-being orientated approach to health and care requirements.

As the NHS England – Five Year Forward View strategy states “we now want to accelerate this way of working to more of the country, through partnerships of care providers and commissioners in an area (Sustainability and Transformation Partnerships).”

The key opportunity is the education and empowerment of the population through digital engagement solutions, the strategy goes onto offer;

“Working together with patients and the public, NHS commissioners and providers, as well as local authorities and other providers of health and care services, they will gain new powers and freedoms to plan how best to provide care, while taking on new responsibilities for improving the health and wellbeing of the population they cover.”

Critically however, digital engagement cannot only be about the NHS and it’s services, these are in essence after the fact and only engaged when you have a problem, the focus needs to shift to social care, and the up-front engagement that occurs with people with the potential to develop health concerns, the primary deliverable has to be about pro-active engagement that services better and more timely interventions and thus delivery of a wellbeing orientated focus.

Carers and Cross Service Collaboration is Key

Aiming for a family / carer orientated engagement approach at the core of any solution, implemented in a way that facilitates much improved cross service collaboration between public service functions, the Devon social and economic benefits to be obtained across service functions presently assessed at: health and social care unsurprisingly achieving the most significant benefit of circa £2.1bn, followed by Education at £151m, Criminal Justice at £100m and Welfare currently coming in at around £74m. With benefits research still underway it is very likely these values will grown by as much again.

A good proportion of these benefits would involve the realisation of cost savings and efficiency gains within each of these service sectors, and potentially at a scale that would make for a significant contribution on top of current sustainability and transformation plans. Given the maturity that exists in digital engagement technologies widely available today, perhaps the timeframe for achieving delivery of these benefits need not be too far away!

Troubled Families a Key Enabler

Whilst the NHS inevitably addresses requirements for improving use of systems and flow of information through the “Global Digital Exemplar” and further exploration and development of the “New Care Models” working with vanguard organisations and initiatives across the country. The more significant opportunity for transformation to a wellbeing orientated digital engagement approach is perhaps better defined by the Department of Communities and Local Government (DCLG), “Troubled Families” initiative (now in a second phase of delivery).

The fundamental differences between the NHS and DCLG approaches, is that the NHS is mostly geared to addressing issues once they have materialised, whereas local authority Social Care service provision in particular is being guided to becoming more pro-active in its engagement, through aspects such as the “Early Help” services targeted in schools to identify children at early stages of need for support, through to supporting adults to live independently and well.

The case for local authorities being the focal point for digital engagement with citizens is strong when you take into account that it is responsible for other key services that affect an individual’s wellbeing, such as education, housing, inclusivity in forms of transportation and access to digital services and other investments in local infrastructure to improve access to employment, all very significant in terms of servicing positive outcomes for individuals.

When we acknowledge that the issues and challenges the public service faces in trying to meet our needs are seldom caused by one single event or distinct set of parameters. We already acknowledge that deprivation and poverty are key issues affecting health and wellbeing, that poverty is also linked to crime, that mental health issues in adults affects the health and wellbeing of children, but that there is also a growing awareness of a significant gap in mental health support for children directly.

There is in fact a large body of work out there that has looked at cause and effect of different social dynamics and more importantly the benefits potential to be obtained from tackling negative social and wellbeing issues. Whilst some of this work warrants updating the models employed as a means of qualifying social and economic costs and thus potential in benefits remains good for today’s purposes.

Focus for Digitisation Strategy and Plans

The key to the client side digital engagement is to consider what can be utilised quickly to deliver benefits early, essentially adopting an agile and incremental approach to delivery. For example, much focus is being given to making patient medical records available and accessible online, but many struggle to appreciate what value is access to medical records going to achieve?

For those in the population that have an issue or pre-existing condition that perhaps is not being coped with or managed very well, wouldn’t just access to information and guidance that was more focused and capable of empowering the individual, and more importantly their personal care circle of family and friends to care better be a start.

Presently, Carers UK has approximately 6.5million registered carers*, and NHS England have identified 1.4 million unpaired carers providing fifty or more hours of unpaid care per week that they wish to better reach out to with engagement solutions, but are they right, is there only that many that care?

There are in fact over 40 million people aged between 16 and 74 years, many of whom have older parents or children under the age of 16 they care about, isn’t it this whole group that the public service solutions need to be setting themselves up to engage digitally with? We all care don’t we?

Conclusion

There is massive potential for social and economic benefits to be obtained by improved public engagement using digital technologies and tools, from a health, care and wellbeing perspective where services are under immense resource and funding pressures, this engagement and delivery of benefits cannot come too soon.

Critically however, whilst there is investment being made, most of it is presently being targeted at addressing shortcomings in inter-organisation information workflows and operational systems integration, which beneficial and therefore worth doing, but by comparison very little investment is being made on the wider opportunity that is direct digital engagement with citizens.

The key to securing the massive benefits potential that exists can only be achieved with a true citizen centric focus on their needs, and the subsequent servicing of this need with a digital engagement solution that services collaboration between carers, regardless of who these individuals are, or how they are funded, or who they work for.

Equally there is no reason why the solution cannot delivery short to medium term efficiency and cost saving benefits arising from better engagement of those with pre-existing long-term chronic conditions, whilst also and at the same time provide the framework for longer-term benefits from early help and intervention on children and adults with emerging issues. To establish a wellbeing orientation that over time benefits society through pro-active engagement that helps people to maintain healthier lifestyles.

Critically, if we are going to truly transform health, care and wellbeing for all and maximise the benefits to be obtained from a pro-active and wellbeing orientated solution, then maybe we need to move the focus from after the fact NHS and health, to local authorities and social care and what should be a pro-active and universal focus on concerns that have the greatest effect on citizens wellbeing and health!

Then and only then, will we see a transformed service delivering social and economic benefits of the scale mentioned at the outset of this article, which when extended beyond Devon and across the rest of the country would quickly amount to £10’s of billions for the UK economy.

* https://www.carersuk.org/news-and-campaigns/press-releases/facts-and-figures

** https://www.england.nhs.uk/commissioning/comm-carers/carer-facts/


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NHS Reform Bill 2012 and NHS Information Governance Toolkit

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There is plenty for those involved in putting version 9 of the NHS Information Governance Toolkit together to consider, here are my thoughts:

We cannot ignore that the country is about to embark on the most significant health and social care reforms ever seen since the inception of the health service, this in itself has huge ramifications from an information governance perspective.

Not least the proposal for health and social care integration to result in the convergence of health services and local authority services, with consideration being given across the country to facilitated this new arrangement in the form of a Social Enterprise, a semi-commercial entity (the same consideration is also being given to public health).

Information Governance Toolkit

Presently the IG Toolkit only provides (on a non-mandated basis) a guidance framework for social care delivery, which for the above perhaps needs to become mandated and merged with the existing primary care toolkit standard?

The next question will then be who will have oversight responsibility for these new social enterprises from a quality standards and information governance perspective, is it Care Quality Commission (CQC)?

The data that will be managed by this new non-public sector organisations, adult services, child health etc. arguably represents some of the most sensitive of all public sector data, mandating a strong and robust information governance standard going forward, is I feel one of the most important considerations to be addressed by the reforms.

We also have additional informatics (information sharing) and subsequent information governance challenges arising from the opening up of the healthcare market to “any willing provider”.

NHS Reform Bill 2012 Regulatory Assignment

NHS trusts and their information governance returns are presently used by both Monitor (at least for foundation trusts) and CQC (for all trusts) in the measure of capability, quality etc. the assessment of which can result in a trust losing its foundation status or fitness to practice licence.

The current reform proposals suggest Monitor will take on a role in oversight of the commercial “willing providers”, but there is no mention (at least that I have found) of CQC having any part to play with the fitness to practice licences.

The key of course, will be whether the IG Toolkit is extended to make provision for returns from “any willing providers” and if this will be mandated as it is with public sector trusts.

Finally and not least, GP Consortia, the IG Toolkit is presumably going to contain a set of requirements (a merger of current PCT and GP requirements) and again a mandate for these organisations to comply with?

Conclusion

To end with, the semi-commercialisation of NHS service provision through social enterprises and any willing provider I feel change the landscape sufficiently for perhaps the UK to adopt a more robust approach.

It is perhaps (as some have been suggesting for several years), time for something like the US equivalent of the Health Insurance Portability and Accountability Act 1996 (HIPPA) and the subsequent Health Information Technology for Economic and Clinical Health Act 2009 (HITEC).

Especially given that we are likely as a result of the reforms, to see a significant increase in third party providers, health insurance and private healthcare adoption across the board.

Personally, I think HIPPA and HITEC equivalents in the UK are inevitable, and once the reform bill is passed then these will be next on the agenda, who knows we might even see elements of these appear in version 9 to start paving the way.


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