When considering the priorities for the Executive Briefing Programme (EBP) this year, health and social care integration came top of the list.
This was not just because of the political priority currently placed on the topic, or because of the digital transformation challenges it contains, but also the opportunity to make a real difference to the public sector and to the public.
From a local government CIO standpoint, health and social care integration more than any other topic, will define and shape the role of technology in future public services design. It will drive innovation, new ways of working, shared services, better management of data, user-centred service design and greater efficiency in our most expensive public services.
That said, it’s not the technology that will make or break success, it is the willingness to redefine service models in ways which:
- balance social care and health better as joint services, in priorities and funding,
- focus on the integration of a wider set of care services, based around a location,
- above all, put the individual service user at the heart of service design and delivery.
These things do not yet happen and they depend on cultural and governance change, much more than on resolving technology barriers.
Over the past few months we have been analysing the numerous reports, studies, projects and policy initiatives. We have consulted with expert witnesses in primary and secondary care, local councils and industry commentators, all freely contributing ideas, case studies and first-hand experiences. Despite the many initiatives, programmes and bodies set up, we have found widespread frustration with the slow progress being made in the UK.
There were varying opinions about what change should look like, but an overwhelming feeling that there was a great deal needing to change.
This is a complex problem, and one which challenges the traditional role of care professionals, as much as it challenges government policy and thinking. It requires a broad approach, managed in a way which protects service user interests. Judgement is needed, not just a ‘one size fits all’ digital process – or as one contributor said:
“One of the things I feel strongly about is the risk that patients/service users will fall through the gaps: in a silo setup, it is clear that once a service user enters your silo, you are responsible: in an integrated care setting this is much less clear: and when both health and social care are involved, communication and agreement on where responsibility rests for particular problems – and services – will need to be discussed and agreed.”
Devolution, shared budgets, new IT and digital solutions, coupled with strong political and public support for change, are all creating the impetus to do better. Increasingly, local authorities and the NHS are working together on transformation programmes and local, place-based ‘Sustainability and Transformation Plans’ (STPs) to improve the quality of care, wellbeing and efficiency.
Not surprisingly, there is some remarkable innovation across the UK, and case studies appear almost daily demonstrating better cross-care coordination, simpler and safer care pathways, faster decisions, and improved efficiency. But they are often too narrow and not scalable, shareable or capable of being generalised. In fact, the current trend to fund individual innovators and leaders risks creating isolated islands of unrepeatable best practice.
Our research report – “Part 1 – Confronting the Challenges” - talks about what needs to change in a more forthright fashion than some reports. It is intended for a wide audience because a whole system change is required – it’s not (just) an NHS problem, or a social care problem or a government digital service problem. Part 2, to follow in the autumn, will go into more detail on the technology and digital implications of designing truly integrated services, building on the findings from Part 1.
Even if you don’t agree with all of our conclusions*, I hope that you will find our report useful in the challenges it lays down and in the examples and case-studies we have included.
Download the report.