Here in Spain, like so many countries across the world, the impact of COVID-19 has been devastating. Many of our care homes, home care organisations and wider social care services have been on the brink of collapse, heaving under the strain of surging demand.
Over the past 15 months, I’ve witnessed similar situations unfold in the UK, Europe and beyond, and a question comes to mind: could the COVID-19 death toll have been lessened through stronger, smarter and more collaborative social care?
The answer, I fear, is yes. In my work as a doctor, practising in hospital and primary care and then as health minister for the Basque Government, and as director of health system policies for the World Health Organization, I’ve seen over and over again how social care continues to be treated as separate from health, right across the world.
Cracks in the system
This siloed working has contributed to the shocking COVID-19 death figures we have seen, particularly in the UK and Europe. A lack of integration between health and social care, poor data sharing and isolated commissioning has meant that services are anything but seamless and many people have fallen through the cracks or, at times, the gaping holes.
This is partly down to the inequalities between health and social care, something that is sharply evident when it comes to digital. Despite pockets of good practice, all European countries seem to share one trend: that healthcare is way ahead of social care on the digital agenda.
Whether that is down to a lack of leadership, clear responsibility or investment, digital has not yet been normalised in social care as it has, to a greater extent, in health. This is despite COVID-19 accelerating the use of technology in so many elements of our lives.
Last October I began chairing a Commission to address this problem in the UK. Set up by the Association of Directors of Adult Social Services (ADASS) and the TEC Services Association (TSA), our goal was to explore how technology can be truly integrated into adult social care.
Over a period of six months we spoke to almost 60 people, including senior leaders in adult social care, housing and health, as well as frontline care workers and individuals, families and carers accessing support. We wanted to identify the barriers to mainstreaming digital within adult social care and the levers that could prompt large-scale adoption.
Our findings and recommendations focus on four key themes. The first is that digital social care services must be proactive and co-produced with people, their families and carers. We also found that digital infrastructure, skills and approaches in social care must be improved if individuals and the care workforce are going to maximise digital opportunities.
Giving people ownership and control over their health and social care data is also vital, enabling access by the right people at the right time. We also believe that greater collaboration across care and support at all levels is critical, so services and policies are joined-up and focus on boosting not just health, but the wider wellbeing of people, their families and carers.
A central element of this is making sure that Integrated Care Systems (ICS) consider digital social care provision as well as digital health provision. With the Government’s recent health and social care white paper seeking to create ICSs in every part of the country, it is vital they become welcoming places for social care, with an equal balance of power. This will help to create the conditions for health and social care to advance together and provide local communities with co-ordinated digital care.
However, it is not just the UK that has begun to create place-based care partnerships. In New Zealand, major reforms to the health system are helping to provide a smoother transition between services so individuals receive more integrated health, care and social welfare support in their local communities.
In America, accountable care organisations (ACOs) now take responsibility for providing all health and care services for specific populations, with the goal of offering a more continuous approach to care.
In Sweden, the ‘chains of care’ model focuses less on provider-centred care and more on care designed around a patient’s needs. A multi-disciplinary team of doctors, nurses, social workers and other professionals work together across different local geographies to support individuals.
Spain, too, is moving towards place-based care systems with the deployment of integrated health organisations (IHOs) in the Basque Country. These IHOs seek to deliver more joined-up, person-centred care for patients, especially those living with chronic conditions.
For example, in 2010 the Basque Government launched Southern Europe’s first strategy to prevent and manage chronic disease. Among other projects, it implemented digital health and care services across a population of 2.3 million. The services shared data across electronic medical records in primary healthcare and hospitals, giving the entire population digital access to their health and care data and launching electronic prescriptions with all pharmacies.
This set the scene for increasing digital connectedness in Spanish social care, something that has been invaluable during the pandemic. Patients have been able to access medicines without having to physically go to their doctor and health professionals have had the tools and skills to quickly organise virtual consultations.
This digital route to integrated care is also being seen in the Netherlands, within the Buurtzorg model. ‘Buurtzorg’ is the Dutch word for ‘neighbourhood care’ and this system sees small teams of community nurses providing a range of personal, social and clinical care to people in their own homes in a particular local area.
Nursing teams are connected through the ‘Buurtzorg web’ – an intranet they helped to design. It enables nurses to share knowledge, support and manage business processes such as online scheduling and documentation. The Buurtzorg web is accessible through desktop and mobile apps and it is estimated that using it for admin functions saves approximately 20% of the costs of a typical home care agency. Importantly, the tool can also be accessed by patients themselves.
Another example of digital solutions ‘gelling’ health and social care provision is the GERI toolbox. Used in Denmark, this mobile kit helps home care nurses – in collaboration with GPs – to offer proactive care to older people. The aim is to catch deterioration in health before an acute admission to hospital becomes necessary.
During a home visit, a home care nurse brings their GERI test kit and takes clinical readings based on the symptoms of the patient. The data recorded during the visit is transferred to a joint IT platform that can be accessed by the home care nurses, GP and hospital clinicians. The goal of sharing the information is to reduce the risk of misunderstandings and provide a better basis for decision-making for further treatment.
In France, there are also several pioneering examples of technology being used in social care. But, like many of the projects I have cited, they are nearly always ad hoc initiatives, isolated pockets of good practice as opposed to national systems, rolled out at scale.
This links back to the ADASS TSA Commission. One of our recommendations is that the UK Government funds the creation of a ‘Personalised Care Innovation Programme’, with stage one of development involving work with people and care practitioners to capture the most effective proactive services and technologies. Running in parallel, stage two would pursue a ‘top-down’ approach, using regional data to confirm priority needs and determine how support organisations will embed digital technologies into their care practices.
An assessment of these local initiatives will help to develop a business case for stage three, the creation of a two-year programme of 10 social care innovation projects. Stage four will see national deployment of all learnings.
But it is only the work in those early stages – implementing and evaluating local services – that will enable proof of impact and cost effectiveness to come through. This evidence, and the business case it creates, will give technology suppliers and social care commissioners strategic direction so they can specify and develop digital solutions that offer the most value to individuals in the future.
I believe that this innovation-led, business case process would be of real value across Europe. I would like to see the UK setting up an international social care technology ‘knowledge network’ to share its approach so other countries can take inspiration and the UK can be inspired by others.
But ultimately, if technology is ever going to be truly mainstreamed in adult social care, there needs to be a significant policy intervention to give it an organised push. This isn’t just about funding a few trailblazers or exemplars here and there. Instead, we need major funding for a nationwide implementation programme, including partnership arrangements with the private technology sector. If there is ever going to be a right time, surely this post-COVID moment is it.
To download the ADASS TSA Commission report on integrating technology into social care, visit www.tsa-voice.org.uk.