If the comparative fortunes of the NHS and social care were not already plain to see before the pandemic hit, Covid-19 has laid bare some stark differences between the two, including around technology and data. The government was initially only reporting coronavirus deaths occurring in hospital and excluding – largely because of a lack of comprehensive, accessible social care data – those who would have died in care homes.
More broadly, social care makes much less use of technology than the health system does. There are a number of opportunities to use technology to support the work of front-line staff, including to speed up the assessment of those who receive care. Recently there has been an increased use of technology in care homes, but it remains piecemeal and little is known about the impact.
Given this context, this blog draws on experiences of evaluating a Test Bed project – a programme allowing NHS organisations and innovators to deliver digital technologies in real health care settings – to set out the challenges of measuring the impact of technology in social care settings.
Limitations of the social care data landscape
In general, there is a lack of emphasis on collecting routine social care data in domiciliary care. To get a comprehensive understanding of how services are used, policy-makers, regulators and researchers need to be able to link different datasets together. Currently, social care professionals often end up repeating health concerns about their clients to different health practitioners because of this disconnect between the two reporting systems.
The ability to link GP and hospital data – commonly using a unique NHS number as the identifier – is useful because it is more consistent, detailed and robust than data held by domiciliary care providers. However, in our experience of the Test Bed, there is a sense of two very separate systems – health on the one hand and social care on the other – which overlap in their purpose, but communicate with each other in different languages. Data sharing across these systems has been inconsistent. GPs can hold information about a person receiving care on their records, but this won’t necessarily be held by a care provider (and vice versa).
The way that information is recorded varies too – even within a single home care agency. Agency leaders have reported that they receive background notes on clients from the CCG or social services. However, this is only provided for clients who receive funding to pay for their care, with the agencies recognising that information they hold on privately funded clients is limited. The amount of information held is also at the discretion of each agency and individual it concerns.
Digital innovations would be better understood if evaluators had access to systematically recorded health outcomes of clients – with those notes integrated into health IT systems. Local health and care record exemplars have started to adopt best practice by shaping a set of standard data definitions and streamlining data architecture, with the hope of other areas following suit. This would also benefit social care users, with professionals in charge of their care having access to the same information about them – saving users the time of having to explain their problems twice and increasing the likelihood of their needs being comprehensively met.
Evidence of successful digital innovations in social care
Although additional funding was committed before Covid for local digital health projects in social care settings, there is still a mountain to climb in delivering technologies in social care at a greater scale. As we’ve seen in the Test Bed, these challenges still exist locally when it comes to compiling accurate, complete data from different agencies, and it’s difficult to observe real, measurable impact of these interventions (such as fewer client admissions to hospital).
Recently announced support for care homes to use digital tablets that record clinical observations is perhaps welcome, but is this too little, too late? If technology was given greater recognition in social care to begin with, many care organisations would have already been equipped with the tools they needed for remote assessments. And, more crucially, there would be a greater evidence base to support their use and how to implement them effectively across the wider system.
Thoughts for the future
Delivering digital interventions in social care settings has the potential to bridge the communication gap between health and social care. There are broad issues to address in the immediate term, such as better data infrastructure across care organisations – starting with a data warehouse centralising care records with the ability to link them to clients’ medical records, which are closely intertwined with one another.
There are local examples of this happening, where data from public health, housing, education and social care have been integrated into one dataset. However, we are still far from achieving this at a national level, and it will require a significant amount of time and money. But with the challenges that we’ve seen in feeding data through from care homes and agencies to national health bodies during the pandemic, the disparity feels even more crucial to resolve than ever.
The trouble is that Covid-19 has triggered a need for digital means of monitoring social care recipients that cannot be done through simple behavioural observations. At the same time, barriers to digitising an entire sector must not be underestimated, particularly in one so fragmented as social care providers, which has so little of the basic infrastructure that we take for granted in the NHS. For example, just the fact that the vast majority of care organisations are set up as private companies puts legislative and commercial barriers in place, which exacerbates the problems with integrating data better with the health service and medical records.
The disparity between health and social care must be addressed – starting with data. This is not merely an exercise to help monitor and research services but, crucially, will benefit those receiving care.
Rolewicz L (2020) “Much more to do: Understanding the impact of technology in social care”, Nuffield Trust comment.