Current developments:
A View from Social Care
Terry Dafter
Chair of ADASS Informatics Network
November 2014
Background and Challenges
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Ageing population
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Rising numbers of people with multiple
long term conditions
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70% of all health and care spending
As of 2011 – 52% of over 65s had a limiting longterm health condition or disability – a rise of 50%
in the decade since 2001
Over next 30 years number of people with
dementia will double
Public services under financial pressure
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Over next 20 years, proportion of
population 85+ will more than double
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
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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.
Policy Drivers
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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 (Web of Support)
Quality – seeking continuous
improvement in the quality and
experience of health and care services,
including greater transparency and use of
data
Prevention – exploring ways to
reconfigure services to manage increasing
demand better across health and care
Current and Future State
Current
•Systems designed with the provider/
commissioner in mind, not end-user
•Too many paper based processes in
health and social care
•Risk averse cultures around IG 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
•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 (preemptive interventions)
•Dynamic market, open to innovation
System Differences
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In Health the systems predominantly:
– Support clinical governance and
payment by results
– Coding and standards based around
clinical conditions and pathways.
Social care systems
– Support a person-centred customer
journey and care management
arrangements
– Provide performance information
and link to systems for billing and
payment purposes.
– Frequently operate complex
interfaces to corporate systems.
– Sometimes interface with third
sector and private sector
organisations.
Our current infrastructure,
processes and practices are a challenge
Citizen focused health and care
Data
(e.g. NHS Number,
standards, open
APIs)
Information
Governance
(e.g. aligned IG Toolkits)
Network
(e.g. PSN, N3)
DH – Leading the nation’s
health and care
We need to clearly understand the levels
of intervention required to ensure
alignment:
• What must happen nationally?
• Where do we need collaboration and
agreement across the whole system?
• How can local innovation flourish?
• How can we support cultural change?
Delivery of core priority
programmes
Achieving broader strategic
objectives
Care Act implementation
Integration &
interoperability Pioneers
Integration &
interoperability Standards
Information Governance
Integration &
interoperability – IDCR &
Tech Fund
Transparency &
Comparative Data
Infrastructure and
systems
Economic case
Citizen-focussed
technology
Current state
Market development
Target future state
Capability & leadership
National work
programme
focused on two
broad areas
1) delivery of key
programmes, and
2) how to start to
develop a wider
consensus
around
investment and
change
Being in Newcastle:
Wider Issues around Federation
• 3 Elements of functionality
– Portal functions: publish search
and find items across the systems
– Switch functions: orchestrate
processes and perform
transactions
– Index functions: name and identify
things and register relationships
• Systems now exist that will
support
– Federated identity
– Relationship management
– Document sharing
• Challenge therefore is to federate
in a local system and then beyond
• Not an issue of technology more
one of trust and leadership
Wider moves to build around the
user?
• National move towards access
to GP record
• Social care has a model of
‘web of support’
• Care accounts are coming with
respect to the Care Bill
• Giving the person more
involvement helps with data
ownership and sharing
• Raises issues around capacity
and informed consent
• Can the technology support
this
• What about issues of identity
and authentication
In Summary
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Feels like we are building a moving
train
Not so much what is unplanned but
rather what is planned that is
problematic
Need to understand it’s not just
health and social care organisations
– User and Independent Sector
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Important that the various national
programmes are synchronised and
consistent
– Better Care Fund
– Tech Fund
– Pioneers
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Technology is there
The will is there
Need for local and national
leadership if we are going to deliver
Best chance we have to do something
in a generation