5th April 2023
To create the joined up health and social care service that people need today, Integrated Care Systems will need joined up data too says Civica’s Mark Burgess
The issues in the UK’s health and social care sector continue to make headlines. Hospitals are under serious pressure, with 19 out of 20 beds occupied, and while ambulances stack up outside, many patients inside the hospitals have trouble leaving when they’re ready. In November 2022 it was estimated that nearly 14,000 hospital beds across the country were occupied by someone medically fit enough to go home or to a care home – up to one in every three beds in some Trusts1. As long ago as 2017, Age UK estimated that an excess bed day in the NHS costs over £2,0002, which means those 14,000 beds would be costing upwards of £28 million per day.
The health and social care crisis is complex, with many causes including the continuing impact of Covid-19, winter flu, and staff shortages. But another, less-reported cause of the blockages in the health care system is data. Specifically, the need for health and social care data to be better connected.
The recently formalised Integrated Care Systems (ICSs) are tasked with delivering the 'joined up' support that combines NHS and social care services to meet the changing needs of the population. However, while these two major services are being brought together administratively, their IT and data systems currently don’t talk to one another. If they did, health professionals in hospital could, for example, instantly see whether a patient ready for discharge had the support at home they needed – or whether a care home place was available – and make a quick, informed decision. That’s a simple example of how data can help to solve the health and social care crisis.
Health and social care gap
Published in June 2022, the government’s Plan for digital health and social care envisages that by 2025, all ICS teams “will have appropriate access to a complete view of a person’s health and social care record that they can contribute to.” Given where we are today, this is a big ask. The earlier Joining up care for people, places and populations government paper from February 2022 points out that 60% of NHS trusts have made “good progress” toward digitisation. However, local government has not enjoyed anything like the levels of IT investment seen in the health service. And while an NHS number unambiguously identifies an individual, linking them to their electronic health record (EHR) within most NHS systems, social care does not have an equivalent system.
Even within the NHS, there are formidable challenges in achieving the kind of joined-up data that will help to free up the system. In its report How better use of data can help address key challenges facing the NHS, the Health Foundation identifies a lack of linked data across services as the first barrier to action. Data is collected from primary, secondary and tertiary care, in different service areas and through different EHR systems. As the report admits, “progress towards full digitisation remains a work in progress.”
Progress from the bottom up
Achieving digitisation across health and social care – and by 2025 – faces formidable obstacles: technical, regulatory and administrative. But progress is nonetheless being made. The North West London ICS sees information sharing is critical to its role, stating that, “For care to be truly built around individuals, we need each of the professionals treating or caring for an individual to be able to view selected information about that individual's health, social care packages and – crucially – individual’s personal goals and aspirations3. The ICS’s integrated care records, created with information from different care providers, will be accessible to clinicians and care professionals via a series of dashboards.
Public sector platform CC2i has introduced a Hospital to Home solution that joins up acute trusts and social care so that discharge-to-access (D2A) cases can be managed more efficiently. CC2i cites benefits including safe and timely discharge of patients, and administrative savings of 30-50%.
'Bottom up' initiatives such as these point to what’s possible when technology and data are successfully joined up across systems. They show the opportunity for ICSs to engage with the technology industry on issues such as data quality, connectivity and accuracy, and create data-led systems that result in better outcome for people using the health and social care system.
Mark Burgess is Managing Director of MDM at Civica