The Scottish Government recently announced a further £384 million to improve rural broadband access. While this announcement is welcome, it begs the question as to how this investment in digital infrastructure will be used to improve public services, including the most pressing: the integration of health and social care?
Access to high quality broadband offers citizens many benefits. But it does not directly support the Scottish Government’s long-held aim of assisting people to stay in their own communities for as long as possible.
Doing so requires a much closer collaboration between the health and social care communities. And this requires further investment, at a national level, to build on the underpinning broadband infrastructure to facilitate better trust and collaboration.
Social care provision spans all three sectors of the economy. The people involved range from gig workers on a minimum wage to CEOs of large corporations who run a string of care homes, with everything in between. It includes the 22% of the population who regularly volunteer as well as tens of thousands of individual carers.
Interestingly, Derek Feeley’s recent report on health and social care cites Care Inspectorate data that indicates, when it comes to community-based services, quality is generally highest among third sector providers.
The links between these diverse people and organisations and the NHS are often mediated through councils, who have a statutory duty of care for some services, and who commonly fund local voluntary organisations.
A mechanism is required to allow these diverse people and organisations to collaborate effectively to service citizens’ needs well and cost-effectively. Such collaboration requires the sharing of data that is often sensitive and needs to be properly protected.
Interlude: About Mary…
Eighty-eight-year-old Mary had her hip replaced at the beginning of the week. Her surgeon was brilliant, and everything was very slick – the NHS staff called it a “care pathway”. She’s feeling a bit stiff, but a whole lot better. She’s ready to go home and is looking forward to a cup of tea and her own bed. But there seems to be a problem, the nurse keeps talking about her “care needs” when she gets home. She seems to have fallen off the pathway, and she doesn’t quite know why.
Why is Mary’s discharge being delayed?
There isn’t a formal, digitally enabled pathway out of hospital that ‘joins up the dots’ – connecting all the resources available to meet Mary’s needs. The reasons for this include:
- Different organisations using different systems, all protected within their own firewalls.
- Health and social care providers not having a common vocabulary to describe Mary’s needs.
- There being no means available to keep Mary’s data confidential, securely providing only the minimum information required to allow Mary’s discharge needs to be met.
- Considerable, often confusing, bodies of law and regulation as to how Mary’s information can be shared.
- Where data is shared, it involves lengthy discussion, with elapsed times of months or years, to produce paper-based data sharing agreements.
Interlude: More about Mary…
A young ‘gig’ economy commercial home care worker lives on Mary’s street. She knows Mary quite well and would be delighted to do some additional hours so close to home to deliver the statutory care she requires – particularly as she is not paid for all the travel she regularly does across town.
The Council’s contractor has time to make the necessary modifications to Mary’s home but needs her key safe code to do so. And, as Mary is suffering malnutrition, Food Train have a volunteer in the area who could help her to eat well when she does get home and can continue to monitor and record her condition.
But the Hospital discharge team doesn’t know any of this. Finding out requires filling out paper forms and passing these to the Council, many phone calls and emails, and the net result is that Mary spends another week in hospital. And when she does eventually get home, everything hasn’t necessary been coordinated and put in place for her.
She is fortunate to have a son to make her that longed for cup of tea – and to spend a further two weeks dealing with social services, and others, to allow his mum to live as well, and safely, as possible, at home.
How might this situation be improved?
Firstly, the situation needs to be recognised as a whole system failure across many organisations as they try to manage modern, legal, technical, and ethical requirements across increasingly complex networks of organisations and people.
There is a collective failure to address Mary’s needs, because they are all trying to use the tools that have worked in the past: relationships, meetings, pen and paper, spreadsheets, email, and siloed data stores.
In the context of different technical and clinical languages, cultures, and funding obligations across care providers, it is all just too painful to progress Mary’s needs effectively.
Health and social care: It takes two to tango
There needs to be a focus on pan-agency trust frameworks where there are agreed rules, roles, eligibilities, standards, and definitions.
This will allow working relationships to be rebuilt based on a privacy protecting, auditable, automatable, immutable shared record approach to make it easier for all the stakeholders to understand and trust each other.
Broadband investment facilitates such trust frameworks – but falls very far short of providing all the tools required. You wouldn’t want to arrange social care provision through the commercial tools that have been built on top of broadband infrastructures, such as Facebook or TikTok?
Governments need to invest in their own tooling that sit above the broadband infrastructure, at a national level, to facilitates privacy-preserving, decentralised, data registers that can be shared by organisations across all three sectors of the economy.
This isn’t a tango, it’s a strip-the-willow. A ‘caller’ is required to agree the rules to allow all the dancers to express their own, individual, personalities and provide, collectively and effectively, the services required to meet Mary’s needs.
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What would good look like?
The support of alternative approaches to the provision of health and care services such as:
Data sources are expanding rapidly with the rise in IoT, wearable devices, activity detection, cameras, personal health and biometric monitor devices, sensors for door-opening or room-occupancy, and environmental sensors. All of these provide valuable insight into the health and welfare of those individuals living independently with illness, or support needs.
Providing GPs with a dashboard to easily access alternative approaches to support their patient’s mental and physical wellbeing, effectively tackling common issues such as mental health, obesity, and diabetes with ‘non-medicalised’, local, solutions.
Addressing key pinch points in the NHS
For example, providing hospital discharge units with access to relevant services, from organisations within all three sectors, who can support a reduction in delayed discharges from hospital.
Intelligence and data analytics
These are increasingly important parts of future care and welfare systems. The ability to capture, safely store and manage, and analyse data from multiple sources will enable improved standards of care, pre-emptive actions, and automated communications when issues are detected. Patterns across a large population can be correlated, to give early-warning of problems such as disease outbreaks. This is far harder to achieve in ‘closed’, fragmented, systems.
About the authors:
An experienced business leader and was the founding Chairperson of SICCAR. Prior to that he was involved in establishing CodeClan, Scotland’s award-winning Digital Skills Academy.
He ran a project in 2020 looking at ways of better involving the third sector to reduce delayed discharges from hospital. Find out more about this at: A National Care Service, with equal status to the NHS, free at the point of delivery?
The founder and CEO of The Safe Shores Group which incorporates Communicare247 and Safe Shores Monitoring.
Tom is a qualified electronics and communications engineer with a rich and varied career background including as a Communications and Electronic Warfare Specialist in the Royal Navy, a Ground Station Manager for the Defence Research Agency – Space Sector (on the European Space Agency ERS-1 project) and as an Operations Director for a BT Major Service Centre during the analogue-to-digital phase of the mobile phone industry.
In 1998 he founded Safe Shores Monitoring providing digital location-based safety systems for health care employees. It now supports the employer duty of care for over 20k employees across 150 UK organisations. In 2016, Tom launched Communicare247 to support the telecare service provider community with the analogue-to-digital transition and to share telecare data and insights with other health & social care services. It is currently engaged with consumer groups and key stakeholders across the public and private sectors.
Laura is Head of Delivery for BJSS in Scotland, where she has grown the team to over 120, and is responsible for delivery for multiple clients, from our offices in Glasgow, Edinburgh, and Aberdeen. Laura has predominately worked in IT consultancies for over 20 years, delivering change and digital transformation. She started her career as a software tester and has held various roles since then including Head of Testing, Head of Governance and Delivery Director, before joining BJSS in 2018, to lead the team in Scotland.
For over 25 years, Julian has been fascinated by computers, and in particular information technology and how this can help anyone in society. This has led to Public Sector facing technical, management and leadership roles in very small and very large organisations all at their core delivering improved services underpinned by technology. Today this passion is focussed sharply on user centred digital transformation across Government services within Scotland in an effective, ethical, and innovative way in his role as Executive Account Director for Sopra Steria.
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