A national perspective on information and technology in adult social care

Challenge and opportunities

3 Major challenges facing health and care system Ageing population Over the next 20 years, proportion of population aged 85+ is set to more than double Rising numbers of people with multiple long term conditions People with LTCs accounts for 70% of all health and care spending As of 2011 – 52% of over 65s had a limiting long-term health condition or disability – a rise of 50% in the decade since 2001 Over the next 30 years the number of people living with dementia is set to double Public services are under financial pressure Funding gap from rising demand set to be £30bn by 2021 (Nuffield/ NHS) LGA projecting a funding gap for local government of £16.5bn by 2020 (largely because of rise in social care costs) Pressures on services Over the 5 years to 2013, the number of over 80s attending A&E rose by 65% NAO suggest 20% of emergency admissions are for existing conditions that primary, community or social care could manage. DH – Leading the nation’s health and care

4 Supported …and around 6 million people caring for a friend or family member. …around 400,000 people in residential care, 56% of whom are state-supported …around 1.1 million people receiving care at home, 80% of whom are state-supported …1.5 million people employed in the care and support workforce Social care impacts on a large number of people across England

5 Older people are the core user of acute hospital care - 60% of admissions, 65% of bed days and 70% of emergency readmissions. 72% of recipients of social care services are older people, accounting for 56% of expenditure on adult social care. Three quarters of people aged over 65 will need care and support in their later years

6 To tackle these challenges, there is a wide range of policy initiatives across health and care… Care Act – delivering the most significant change in the legal framework, funding and provision of adult social care for over 50 years Integration – Better Care Fund and Pioneers accelerating joint working and new models of care between primary, acute, community and social care Personalisation – increasingly putting the citizen at the heart of the system, in control of their health and their care and support Quality – seeking continuous improvement in the quality and experience of health and care services, including greater transparency and use of data (MyNHS transparency hub) Prevention – exploring ways to reconfigure services to manage increasing demand better across health and care Plus local authorities are also: Delivering wider policy policies - e.g. children’s services, troubled families, Undertaking wider transformation programmes to drive efficiencies and manage pressures

Information and technology can be a key enabler of change

8 Investment in technology and information is a key enabler…. Help put the citizen and communities at the heart of the system, support design and delivery of services which really meets individual and carer needs and support self-care Support information to be more easily shared across multi-disciplinary team, and with citizens themselves, to improve the quality and experience of care Deliver new systems which integrate data and records held by different organisations to improve care packages and enable early and more effective interventions Drive continuous improvement through increased transparency and participation in our health and care system, and supporting sector-led improvement Help support new delivery models to develop and process improvements to increase efficiency, reduced delay, elimination of duplication and offer more cost effective services

9 …but we know our current infrastructure, processes and practices prove a challenge Citizen focused health and care We need to clearly understand the levels of intervention and insure alignment: What must happen nationally? Once for all? Where do we need collaboration and agreement across the system? Where can local innovation flourish? How can we support cultural change?

Roadmap for change

11 Our national priorities DH – Leading the nation’s health and care 1.Focus on delivery of the core social care national programmes and influencing broader national policy where appropriate 2.Working in partnership with other national and local agencies to develop the underpinning work that will enable future change and progress across the whole system 3.Supporting complimentary initiatives in which DH Social Care has strong interest but does not have the direct levers

12 Integration & interoperability - Pioneers Information Governance Transparency & Comparative Data Delivery of core priority programmes Economic case Citizen-focussed technology Market development Achieving broader strategic objectives Current state Target future state Capability & leadership Integration & interoperability - Standards Integration & interoperability – IDCR & Tech Fund Care Act implementation Our national work programme focused on two broad areas – 1) delivery of key programmes, and 2) how we can start to develop a wider consensus around investment and change in this area? Infrastructure and systems

The ADASS Perspective

14 The Care Act is part of a wider agenda and must be seen in context Care Act – delivering the most significant change in the legal framework, funding and provision of adult social care for 50 years Integration – Better Care Fund and Pioneers accelerating joint working and new models of care. Technology Fund supporting capacity building across sector, with a focus on interoperability. Personalisation – increasingly putting the citizen at the heart of the system, in control of their care and support Prevention – exploring ways to reconfigure services to manage increasing demand

15 Current Position Systems designed with the provider/ commissioner in mind, not end-user Too many paper based processes in health and social care Risk averse cultures leads to little information shared between professionals or systems Traditional market model, with small number of suppliers focusing on council back office systems Use of apps under-developed at a time of innovation Future Position User at the heart of the system, with the same level of customer service/ interaction as in other areas of life ASC professionals and providers embracing technology as a key part of getting the job done A fully joined up information ecosystem within health and care, including other critical agencies Use of big data: effective prediction (through analytics) and prevention (pre- emptive interventions) Dynamic market, open to innovation The Care Act in a Digital World

16 Recent Stocktake of Authorities Areas of Concern  Workforce  Communications  Affordability  Informatics

17 Care Act Cross-Cutting Themes Scale: 1.Large number of self ‐ funders coming into the system 2.Much higher volume of data and information stored for longer 3.Case for replacing any manual systems with technology and investment in online assessment Need for reduced admin burden e.g. pre ‐ population of data Personalisation 1.Online information and assessment 2.Improved links to advice and care records National consistency 1.Eligibility criteria 2.Deferred payments New functions 1.Funding reforms 2.DPA Cross Boundary Working 1.Technology supporting information flows across agencies Information Governance 1.Implications for data sharing, consent models, access to data and applications and services across networks. Transparency 1.Being open and transparent about rules, processes and outcomes Informatics Skills 1.Training and support for workforce development Leadership & cultural change 1.Supporting transformational change

18 In terms of Informatics For 2015/16 Case recording Managing Deferred Payment Administration Provision of online information and advice. ADASS confident this is on track, though there is some uncertainty in cases where local authorities may be in the middle of changing or upgrading their systems. For 2016/17 How data flows across health and social care system to the benefit of the individual and the professionals Need to develop an IT and informatics service that supports drive to person- centred care, portability and optimum system efficiency. This will come with a cost – particularly in terms of systems being compatible both within and between local authorities. DH – Leading the nation’s health and care

19 We should head towards a world of: 1.Fully automated business processes 2.User portals transacting online 3.On-line assessments, reviews and transactions 4.On-line access to health and social care record 5.Joined up health and care ecosystem including independent sector transferring data seamlessly 6.User in charge of their data 7.Wider use of bespoke apps to encourage self-care Need to be brave and take the opportunity

Engagement with suppliers

Developing a target ‘future state’ in social care informatics

22 Where are we headed? Improved citizen outcomes and experience, the transparency agenda, integration across service domains, enabling citizen participation Transparency Transactions Participation Interoperability and trust

23 Demand = Opportunity?

24 Opportunity = Benefits?

25 Numerous challenges across services within local government and the community across service domains – NHS, local government, social care, public health, voluntary sector Identity management Information standards – data and formats/ protocols Common terminology and definitions Open architecture and APIs Customer focus Communications infrastructure and culture Creating benefits case for investment Identity management Information standards – data and formats/ protocols Common terminology and definitions Open architecture and APIs Customer focus Communications infrastructure and culture Creating benefits case for investment

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28 Social care informatics scoping project Information Standards Benefits case and supporting narrative for LAs Identifying enabling ‘foundation’ standards for system Identifying and analysis of priorities and timelines Implementing optimal approach for standards development, adoption and implementation Client Level data Benefits case for primary and secondary use Opportunities for alignment of activities IG challenges – developing IG toolkit and guidance Quick wins – building on Care Act implementation, Pioneers work, sharing assets across health and care, enabling interoperability with ‘essential’ infrastructure

29 We need your help! To develop and establish in more detail and at a local level: What is the target state for information and IT enablement and what are the steps along the way that we must prioritise – what would success look like for citizens and how must we change to deliver? For each organisation; where we are now and what must we do first, second... and so on To develop a social care/local government digital maturity road map and index that embraces variation and innovation