NHSX draft strategy – the digital revolution in adult social care

Under NHSX, the Department of Health and Social Care, NHS England and NHS Improvement have published the Secretary of State’s vision for how data will be used to improve the health and care of the population.

Recognising that digital developments were essential to the pandemic response, the draft policy sets the scene for a digital revolution in health and social care – which means big changes are coming for care providers.

Key commitments – transparency, autonomy and automation
The draft strategy sets out a long list of commitments across a variety of areas, but the key themes of transparency, autonomy and automation are ever-present.

Individuals using health and adult social care services will be able to access their full records and manage their own data to make sure it is up to date and reflects their circumstances and preferences. By drawing multiple sources of information together:

• individuals should not need to repeat themselves;
• patients and services users can more easily access personalised guidance and support; and
• health and care staff will have all relevant information at their fingertips.

NHSX makes clear it wants to put the citizen at the heart of their own care. By giving individuals access to more information, it should be easier for them to understand the factors that affect their health conditions – encouraging and enabling them to play a more proactive role and take ownership of their health and wellbeing.

The draft strategy recognises that staff need to have up to date information about the person in front of them, whilst also removing the need for them to collect data that already exists. NHSX proposes that automated systems will increase the ability for staff to access relevant data in real-time, whilst reducing the administrative burden on them to collect data when they could be providing personal care.

Providers will need to consider which systems can be automated (for example automated appointments and referrals) and how they can rationalise the data they hold, to reduce the time spent by staff inputting and processing data.

Move to NHS data frameworks and cyber standards
Technical and data standards will be key to establishing a seamless flow of information between organisations. The Government has already communicated its plan to improve data collection within an “enhanced assurance framework” and to “improve accountability within the social care sector”. [1]

Whilst recognising that 30% of care providers are still using entirely paper-based systems, NHSX is pushing ahead with its digitising social care record programme. The new legislation will empower the Secretary of State to mandate standards for how data is collected and stored while NHSX will create a data framework for adult social care, setting out “what data we intend to collect and the standards used to collect it, so we know we are getting the data we need.”

Any new data framework or cyber standards will need input from both public and private care providers if data development and technology is to support the needs of the adult social care sector.

Despite some passing references to collaboration, in the absence of digital technology champions in the social care sector, digitised records and digital services will most likely be health-centric and designed to meet the needs of the NHS. Unless care providers rapidly invest and innovate, those who have limited or no access to basic digital infrastructure may find themselves locked out of the new information system.

A new duty to share information
The draft strategy sets out several commitments to introduce new legislation, including:

• a new duty to share anonymous data for the benefit of the system as a whole (both data that was never identifiable, for example, bed capacity, and de-identified data)[2];
• a new power to enable the proportionate sharing of data without breaching the common law duty of confidentiality (for example where appropriate, personal information for the purposes of supporting the health and care system); and
• a requirement on all adult social care providers (both public and private) to share information about the delivery of adult social care services in England.

NHSX does recognise that existing legislation and information governance policies are unnecessarily complicated. As a result, health and care data is often not shared even when it should be and frontline staff resist sharing critical information for fear of “getting it wrong”. Proposed changes to legislation should remove some of these legal barriers and foster a culture of data sharing across health and social care.

It is expected that everyone will understand it is a key duty and responsibility in their job to share data, this will require substantial investment in digital skills for frontline staff as well as significant improvements in information governance across the sector.

The ultimate goal set out in the draft strategy is to have a health and care system underpinned by high-quality, readily available data. Specific reference is made to sharing information on “quality, costs and workforce requirements” which can then be used to plan people’s care services, provide information to help people and their carers access information, and for planning and commissioning services.

Adult social care providers will be expected to share increasingly detailed information about their operations and service management, so that commissioners and local decision-makers can: commission specialist services, undertake workforce planning, manage population health and intervene where there are serious failings. Serious thought will need to be given as to how this can be achieved through automated systems without increasing the administrative burden on front-line staff or prejudicing providers’ commercial objectives.

Preparing for the future
There is much to be applauded in the draft policy. Personalised and remote services will allow more people to remain in their own home, or the home of their choosing, whilst retaining the security of being ‘close’ to clinicians and carers. Increased transparency and simplified data governance should enable individuals to become partners in their own care, releasing staff to provide higher quality services. However, there is a significant amount of practical work to be done to unite the health and care data systems. Whilst the pandemic response may have created a lot of momentum and willingness to innovate, there remains a significant financial challenge to achieving full integration.

Approximately 15,000 CQC registered care providers have limited or no access to basic digital infrastructure and time is fast running out for providers who are yet to invest in digital technology. The financial pressures of the pandemic have meant that many providers have relied upon their reserves and uncertainty about future funding means that innovation budgets have been depleted.

Those providers who have invested in new software packages or committed to long-term support systems will need to factor in the costs of keeping these digital systems up to date with NHS and legislative requirements. Providers that have previously had minimal interaction with NHS commissioners will now need to familiarise themselves with NHS data standards and information systems.

Whatever stage providers are at in their digital transformation, it is clear that significant changes are on the horizon. Both service user expectation and legislative changes will drive a digital approach to care services (a ‘CareTech’ marketplace). A willingness to adapt and innovate will be key if care providers want to reap the benefits of integration.

The draft strategy is available here – the online survey will close at 5pm on 22 July and providers are encouraged to comment and offer views before the final version is published.

For more information

If you would like more information and support on your plans for integrating digital and technology within your personalised care services, please contact Emma Watt.

[1] Health and care white paper – https://www.gov.uk/government/publications/working-together-to-improve-health-and-social-care-for-all
[2] A duty to share for individual care already exists under section 251B of the Health and Social Care Act 2012

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