What the health and social integration bill means for local government
“The most important things in life are the connections you make with others.” – Tom Ford
In February 2022 the government released their paper: ‘Joining up care for people, places, and populations’. In it they outlined their proposal for integrating health and care. The ambition being to reduce service fragmentation between primary and secondary care. By doing so, it will become easier to share outcomes and deliver to a common purpose.
This joined up approach will bring public health and NHS services closer together to improve citizen outcomes. And connecting data across local authorities and the NHS will also provide place-based leaders with the information to deliver new services to tackle problems facing their communities.
Joined up service provision is key to solving Local Governments most pressing issues around supporting people to live healthier, happier lives. And Microsoft has developed the tools needed to achieve this. Enabling local authorities, and their health and care counterparts, to meet the Spring 23 deadline for integration, while keeping people and those who support them front of mind.
Solving a challenge steeped in history
The integration bill is a long time coming, given coordination between primary and secondary service delivery is poor. With information or actions between organisations often lost. And where primary care and hospital teams might have to form treatment plans without crucial insights from a person’s carer; or different specialists might focus only on one or two conditions, without considering the needs of a person holistically.
Duplication in use of resources or patients’ time is also an issue. Asking citizens for the same information many times, by different organisations, can lead to delays in diagnosis or treatment. And these are among the issues the integration bill aims to address
This is not to suggest there hasn’t been willing. But successive governments have struggled to figure out the best way to bring the NHS and Local Government together. Financial difficulties around social care have been ongoing for many decades, and whilst there are voices in the sector that have concerns about what’s in the paper, there is at least consensus and desire to get started, and a basis to move forward. Helena Zaum, Microsoft UK’s Social Care Lead, believes the paper contains many positives, “There are some great things in the paper around people in receipt of social care who are living and breathing these services having been widely consulted.”
It’s a start, but there remain question marks about the detail within, “I think the role of local authorities is missing. Which is important given the important role the play in terms of orchestrating things.”
The paper covers at length the use of digital technology and the governance of data to achieve the outlines within. If you consider the size and complexity of the NHS and Local Council, you can imagine the hurdles to overcome in delivering collaborative services.
It’s not all about money, it’s about relationships too
A recent Local Government research paper revealed what they believe is the biggest challenge in integration. It wasn’t funding.
Surprisingly, the relationships between organisations was the most common barrier, with one respondent stating: ‘Over-control from an NHS which doesn’t understand social care or local councils/democracy.’ Helena Zaum believes there’s a good reason for this:
“The Integrated Care System policy coming to fruition presents opportunities to rebalance relationships of trust. I do think the debate is still dominated by the NHS around how those bodies and structures are built, but in the Integrated Care Partnership, components of those structural changes is where local authorities, and also the third sector and other local partners, start to come in.”
Technology has an important role to play in building and supporting those relationships of trust. If you consider the opportunities created by having a shared digital workspace, using Teams to collaborate, having virtual meetings, and so on, it serves to bring people closer together. It allows for sustained communication which forms the foundation of trust.
It’s important, that we, as citizens, and government decision makers, are very clear that social care is every bit as critical as the work done by the NHS, because they are two areas with the opportunity to breathe new life into the NHS, at a time when pressures have never been higher.
The benefits of social and health care integration
In the same local government research, 74% of respondents felt it would be difficult or very difficult to successfully integrate health and social care. Yet only 14% felt it would not have a positive impact on service delivery. For Helena, it’s important integration achieves a key aim:
“One of the things that’s important is that we have, and this I think very much speaks to this social care and community-based agenda, a single view of an individual. A view which brings in information from integrated health and care records, statutory information, and information about, for example, day to day patterns.”
Connecting patient social and health information to create a 360-degree view allows organisation to deliver holistic care fit around people needs, giving people the right care and support to maintain healthy independent living.
Digital connectivity allows organisations to use devices and applications to deliver insight on someone’s daily routine and whether it is out of the ordinary. Are they go to the loo more often, waking up later, not making a cup of tea, or going out? Helena believes daily monitoring and information sharing solves the root cause of wider health and societal challenges, “We know that housing is the origin of good social care but if people are struggling to get in and out of their home because it’s not adapted for their mobility challenges, that can be an issue leading to loneliness, which has a big impact on people’s health.”
Then there’s other things such as information from the community, provided by the third sector. If someone hasn’t been to the groups they normally attend, this could be a sign something’s not right. Or if the air quality becomes bad in town and you’re a person living with COPD breathing challenges, having advanced notice of this might prevent an uncomfortable trip into town. A 360-degree view of an individual goes beyond the health and care record. It enables organisations to deal with the wider determinants of health and care.
Success resides in the data
Data and insight flowing between organisations creates a need to improve consistency of data records. The idea being to get more commonality in the information flowing between social and healthcare organisations.
As citizens, we need more control over our data. To know who’s using it and for what purpose. We’ve had a lesson in this with the response to COVID and the creation of the NHS and test and trace apps, so we’re more informed about what works, and what doesn’t.
In the future, citizens will want to decide which bits of their record they’re happy to share with their physiotherapist, and with their mental health practitioner, for example. And they might decide to give full access to some things, and others not at all.
This is an important part of the jigsaw in terms of information governance and needs a more institutional agreement about what’s shared and for what purpose. The paper suggests we’ll anonymise data before sharing it. A good start. But more ambition is needed here.
Information sharing goes hand in hand with other important areas around responsible innovation, for example, assisted intelligence. And it forms an area of focus as organisations set themselves up. How is data being used, for what purpose, how is it governed, and is it done in a way which is ethically responsible? It needs a considerable amount of thought.
Where to begin
When health and care organisations have a shared mission, work with citizens, and pool their ideas, energy, and resources, the result is often the delivery of outstanding quality and tailored, joined up care. Care which improves the experience and outcomes for individuals and populations.
In recent years, and in particular during the pandemic, we have seen many examples of the power of collaborative working. Thus the underlying message of the paper is a positive one. Using connected citizen health and care records to create efficiencies and reduce blockages in providing the best care. But it faces a number of challenges, some of which are fundamental to success, as Helena has seen first-hand, “There are quite aggressive timelines around how this is going to work. And we’ve digital differences across both the NHS and social care organisations in terms of their starting point. For example, there are many providers of care who don’t use digital records.”
The paper has not shied away from calling out these digital challenges within the paper, “and that’s one of the great things that’s come out of these papers is that it is going to increase focus and support digitisation. It’s not easy to say where to start but digitising everybody’s records is critical.”
Getting people collaborating and communicating as one team using digital means is an important area of focus. Information governance and responsible innovation need also to be part of the issue. And this means setting rules around how organisations can explore the data opportunity, because unless consensus is reached on how to jointly manage data, no-one will be in a position to deliver services which are preventative, anticipatory, or personal.
A lack of budget, technology incompatibility, general scepticism, and strained relationships abound, yet the integration paper marks, for many, the start of something transformational. To deliver on it requires a united technology and data approach from across health and social care organisations. And that will mean improving collaboration and communication between all parties. Technology is, of course, a key enabler of success.