Dynamics Matters Podcast Ep 49: What the health and social integration bill means for local government

Welcome everyone to episode 49 of the HSO Dynamics matters podcast.

Your regular sonic dive into the world of Microsoft technology related matters and much more besides.

I’m your host Michael Lonnon.

Now, with the attention span of a goldfish, I find long government papers can be baffling.

And also good at hiding the positive and the negative aspects of what it’s aiming to cover.

And so with the governments new paper on Joining up care for people, places and populations, I met with Microsoft’s integrated care specialist, Helena Zauam, to get to the heart of the bill find out how it will impact local authorities and the NHS.

So, grab a brew, sit back, relax, and enjoy the show.

Michael Lonnon

We are going to chat about the government’s new paper that’s recently come out: joining up care for people, places and populations paper. There’s lots of good stuff in there, and the purpose behind it seems really positive. Why has it taking so long to get here do you think?

Helena Zaum

I think the financial difficulties around social care have been running for many decades, and whilst there are voices in the sector that have some concerns about what’s in the paper and there’s lots of debate about it, as you’d expect, I think it is great that at least we’ve got something to get started with and a basis from which to move forward. I think successive governments have struggled to deal with the social care issue and at least now we’ve got progress and consensus around the need to change, which is really positive.

Michael Lonnon

What do you think the challenge is going to be? Because the paper talks a lot about the use of digital technology and the management of data and data governance. I can just imagine the difficulties in connecting NHS to local government authorities. What do you think the challenges is going to be in delivering on the paper?

Helena Zaum

There are a number of challenges; financial, obviously. It’s great to have some funding, but we could always do with more, hopefully, this is just the beginning. I think everybody in the sector is hopeful there will be more. There’s some great things in the paper particularly around people in receipt of social care, who are living and breathing these services, they have been quite widely consulted, which is really positive. Also, as you say, how the opportunities around data and digital have been explored, is quite positive. For my side, one of the things I think is a little bit missing is the role of local authorities who obviously have an important role to play in terms of orchestrating things. And equally, some of the additional responsibilities that come through the government’s previous paper, the changes to NI etc, which we know, have not necessarily been very well received, because there’s concern that they place disproportionate impact on people who were already struggling with their finances. There are also the onward challenges, which have been there for some time, including how much value, we as a society, place on social care. How important we think it is, is an election issue and that remains an ongoing concern. I think that influences the way government handles the NHS, and then also handles social care. From an individual standpoint, we as citizens all need to step up and thank the people who both orchestrate and then deliver care and make it clear that this is an issue that matters to all of us.

Michael Lonnon

it’s not going to be easy is it to get this in place?

Helena Zaum

No, it’s not, but it’s good that we’ve got some lines in the sand. We can get started. And certainly it’s interesting to hear and see the level of interest that’s beginning to come out of the Department of Health and Social Care and the teams they’ve set up to get moving on the social care agenda. I think there’s lots of grounds for optimism but still lots of work to do.

Michael Lonnon

We did a piece of research recently with local government authorities that I found quite interesting. When we asked what they felt could be the biggest challenge in implementing this paper a lot of it was to do with the relationships that they had with healthcare organisations. That was quite surprising. It wasn’t so much a data or technical challenge, nor even a financial one. It was tough relationships. Is that something you’ve seen in some of the work you’ve been doing?

Helena Zaum

Definitely. In terms of the challenges the Integrated Care System policy work and the fact those are coming to fruition presents some real opportunities to rebalance those relationships of trust across the system. I do think the debate is still dominated by the NHS and the part that comes out in how those bodies and structures are built. But actually in the Integrated Care Partnership components of those structural changes is the bit where local authorities, and also, the third sector and other local partners will really start to come in. And I think that’s where the rubber is going to hit the road in terms of where these relationships of trust need to be formed and grow. Technology is has an important role to play in supporting those relationships of trust. If you think about the opportunities created by having a shared digital workspace, using teams to collaborate, having virtual meetings, etc, it brings an opportunity to bring in more partners. That also allows for sustained communication, which ultimately forms the foundation of trust. I do think it’s very important, further to the point that I was just making that we as citizens, and also government decision makers are very clear that social care is every bit as critical as the work done by the NHS, because ultimately, social care and public health in fact, those two areas really have the opportunity to help us breathe new life into the NHS, at a time when its pressures have never been higher.

Michael Lonnon

In the research that we recently did, there wasn’t anyone who said this was a wrong thing to do or the wrong way to look at it. It wasn’t perceived as a negative, it was just perceived, there would be challenges in following it. Ultimately, authorities and healthcare organisations understand there’s significant benefits in connecting information, in creating that 360-degree view of a citizen. It helps pre-empt problems they might be facing. What sort of benefits do you think there’s going to be following this paper?

Helena Zaum

One of the things that I argued for is that when we think about the digital infrastructure for an NHS ICS organisation, we often, particularly on the NHS side, get quite obsessed with the idea of an integrated health and care record. Of course, that kind of chronological capability is very important for clinical decision making and there’s lots of other things that go into the digital infrastructure bag for an ICS. One of the things that’s very important is that we have, and this I think very much speaks to this social care and community-based agenda, is a single view of an individual, which brings in information not only from that integrated health and care record. So the statutory information, but also information about, for example, day to day patterns. The Internet of things can deliver insight on somebody’s daily routine and whether it is out of whack. Are they go to the loo more often, waking up later, not making a cup of tea, not going out. Information from the home is another thing. We know that housing is absolutely at the root 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 a massive issue leading to loneliness, which we know has a big impact on people’s health. Then there’s other things. Information from the community that might be provided by the third sector. Perhaps Helena, as mum hasn’t been to the groups that she normally attends, that could be a sign that something’s not quite right. Or perhaps the air quality is out of whack and if you’re a person who’s living with COPD breathing challenges, that might be a good reason not to come into town that day. I think we need this 360-degree view of an individual, which goes beyond the health and care record, in order to deal with the wider determinants of health and make sure that getting on the front foot and delivering proactive services, is important.

Michael Lonnon

How important is information governance in managing the information between the two then? Do you think we need to get a consistent data record? Do we need to get more commonality in the information that’s flowing between authorities, healthcare organisations and the NHS?

Helena Zaum

Yes, but there’s two different ways of tackling it and we probably need a bit of both. The first is that we as citizens need to have more control over our data. Who’s using it and for what purpose. I think we’ve all had a bit of a lesson in this with the NHS app, and the COVID response and the test and trace apps, so we’re more informed about what that means than we would have been pre pandemic. If there are any silver linings, I guess that’s one of them. But I foresee a future whereby I Helena will decide which bits of my record I might want to share with you, Michael, as my physiotherapist, and with perhaps my mental health practitioner. And I might decide to give you access to some things and not all. That’s the sort of future we’re heading for. And that’s a really important part of the jigsaw in terms of information governance, so that more institutional agreement about what’s being shared and for what purpose. I think the paper is a little unambitious here but it’s at least saying we’ll anonymise data and that should be shared. That’s a good start. I think we need to be more ambitious about that, and some areas are having good success with sharing health and care information we need to learn from and build on that success. It couldn’t be a more critical area though, and it comes hand in hand, for me, with other important areas around responsible innovation, good use of what I call assisted intelligence, rather than artificial intelligence. For me, these things all form an area of focus that ICS needs to be addressing, as they get themselves fully set up. How are we going to use this data, for what purpose, how are we governing it? Also, how are we doing this in a way which is responsible because there’s huge opportunity, but we need to get hold of that opportunity in an ethical way.

Michael Lonnon

I suppose then that will answer the final question, which is, if you had to recommend how to implement this, would it be starting at where are you now, how are you using information today? Where does it reside and who’s using it and for what purpose?

Helena Zaum

This is one of the struggles that ICS’s have. There are quite aggressive timelines around how all of this is going to work, we’ve got digital differences across both NHS organisations, and social care organisations in terms of their starting point. For example, there are quite a lot of providers of care, who don’t use digital records and that’s one of the great things that’s come out of these papers is that it is going to focus here and support digitisation. It’s really hard to say where to start but digitising everybody’s records is absolutely critical. Getting people collaborating and communicating as one team using digital means is another important area. Taking out some of the rubs of people having lots of different sign ons and laptops, and this sort of thing. I think that information governance and responsible innovation needs to be part of that consideration. We need to get rules in place about how we can explore this joint data opportunity. It’s clear to me that unless we get our data act together, we’re not going to be able to deliver services which are preventative or anticipatory. And we’re not going to be able to deliver services which are personalised. And that’s really important. Particularly in social care. But I think the NHS also wants to deliver care to us which resonates and works for us as individuals. A lot of work to do but exciting times.

Summary

The underlying message of the paper is a positive one – connecting citizen health and care records to create efficiencies and reduces blockages in getting people the best care. But it faces a number of challenges.

A lack of budget, technology incompatibility, general scepticism and strained relationships. Yet it marks, for many, the start of something truly transformational.

To deliver on it, it requires a united technology and data approach from across health and social care organisations. And that will mean better collaboration and communication between all parties, and, of course, technology is a key enabler of this too.