Advances in technology that modernise health and social care are not only providing effective home care for patients through ‘virtual wards’, but will serve to greatly reduce pressure on a severely over-stretched sector. By Nan Spowart.
TECHNOLOGY, innovation and collaboration will help ease the huge pressure the pandemic has generated on the already struggling NHS and social care system.
That’s the view of Justene Ewing, vice-president of Health and Care at technology firm CGI, who believes now is the time to introduce new ways of thinking.
Stressing that she has enormous respect for the health teams and carers whose dedication to duty has been so apparent over the last 20 months, she also recognises the challenges the current system presents and has in fact written to the Chancellor to point out that it is unwise to carry on with the same ways of working and expect different results.
“We’ve talked for a long time about shifting the balance of care, but we have not managed it and part of the reason we have the significant pressures we have is because, as a nation, we have developed such a high dependency on the NHS,” she says.
“We know that an ageing workforce, coupled with the challenge of recruiting new healthcare professionals, adds further pressures to an already unsustainable situation. We really need to change the way we are doing things.”
One of the biggest problems for the NHS is so called “bed blocking”, where a patient is fit enough to be discharged from hospital but still needs care. Ms Ewing is adamant that the response to improving health and care must start in the person’s home.
“Home is where the heart is and where most people are. It is where they should be and, when it is safe and clinically possible, where they should stay,” she says. “This requires health and social care to be modernised, re-designed and fully integrated as a whole system approach. The person in their home and in their community is at the heart of our thinking.”
The technology available now is “amazing” but has no use if it does not drive better outcomes, according to Ms Ewing.
“In the health and care space, there is a real opportunity to give people better technology in their homes,” she says. “We can use it to understand peoples’ patterns of living to enable them to have help when they need it, rather than when the system says they should have it.
“If we understand the person better we can wrap services round their pattern of living and empower them to live a better quality of life and, if you start to think about how you enable people to be in their own homes for longer, that creates capacity in hospitals.
Virtual wards are already using digital technology but can be taken a step further by realising the potential of the virtual community based hospital, for example, to allow people to be clinically observed at home so they can avoid unnecessary admissions and be discharged from hospital after procedures to recover at home when they are well enough.
“There are a few examples of freeing up beds by discharging patients well enough to be at home and who do still need to be observed,” says Ms Ewing. “If we are able to do that right across the whole system, it would make a massive impact and create more space for people who really need it.”
There is also technology available to give complete visibility about individuals to social care and health but it is not yet being used.
“That ability for a social worker or carer to see what the GP is saying, or the GP to have visibility of what care aspect or concerns there are from a person’s home support, or even just an integrated view of where a person is on a pathway, is just not there,” Ms Ewing says.
“That means you get a lot of duplication and the person has to tell their story over and over again to lots of different people because the system is not joined up. If we are able to have a more integrated view of an individual it means we can make better decisions for them and better decisions for our workforce.”
Better systems and data integration between health and social care is urgently needed and it is commonly recognised that the care workforce has been seriously undervalued.
“They are trusted to do dirty jobs but are not trusted with other basic medical needs,” Ms Ewing points out. “Why not give them more training, more professionalism, more responsibility and the money to go with it? We need to think about the role the carer can have in supporting the person in their own home in the community, and digital technology is a huge enabler of that. This does require a whole system rethink about services. That is complicated and hard, but we are out of options now and have to do something different.”
While acknowledging that there is some collaboration between health and social care and the third sector, Ms Ewing believes there needs to be better integration and support along with better data sharing.
“We have integrated joint boards across every regional area, but we still don’t have a single patient record – there is no single view of the person anywhere.”
While both patients and workers might feel utterly overwhelmed at the thought of using new technology and adapting to change when things are so hard at the moment, Ms Ewing says that if it is prepared for, implemented and used effectively, it can simplify life and drastically cut duplication rather adding complications.
“Collectively, we can make working in the sector quite a bit easier if we are prepared to work together as one team to achieve it.”
She also stresses that as a private company, CGI wants to work with the public sector to make conditions better for everyone.
“Our key thing here is really working with health and social care to understand the problems being faced and what they want and need to do,” she says.
“It is about consulting and our strength is in helping put it all together – system integration is what we call it. It is about really understanding how to get that single view of a person and make life better for them, their families, the workforce and the system overall. We need to think differently to be sustainable for the long term.”
COMMUNICATION IS KEY TO BETTER NHS SERVICES
IN the UK, the good news is that people are living longer – but the bad news is that this longevity often comes with health problems.
The NHS is also under intense pressure but the technology exists to improve matters for people, their families, carers and NHS staff, according to Lynne Huckerby of CGI, pictured right.
“The new Digital and Health Care Strategy for Scotland talks about the digital front door and we see that as being the first step in making services much more accessible,” she says. “Basic things like booking an appointment or ordering repeat prescriptions are not equitable. In some areas, people can do that easily but it is not uniform across Scotland.”
Rather than replacing the existing system, CGI’s vision is to build on what is there, identify where the gaps are and construct the technology capablity to enable services to be better delivered. This could be helped by sharing data. Recent service user research undertaken by CGI found that patients expect their data to be shared with health professionals and carers and are surprised when it isn’t.
“They don’t understand why they have to tell their story 15 times to different health professionals and they also expect feedback from their health interactions,” says Ms Huckerby. “A lot of the time they go for scans and then have to phone for results, rather than the results being automatically shared with them.
“We generally need to get a bit better about being more accessible than we are because people do want to understand what is happening and how it affects their care.”
The way the current system works incurs too much duplication and ties up services and staff, she says. However, Ms Huckerby recognises it is not possible just to apply a piece of technology and expect it to be a magic cure.
“Without thinking about the organisational structure and culture it is futile to think technology alone will solve the problems,” she says.
“That is why considering the service and culture redesign is so important because it is not just about designing it around the people who use it, it is about the staff as well.
“Our research also shows that while it is really positive that health and social care services are integrating, the staff perspective is that there are two management systems, two learning systems – basically two of everything that teams working together have complete or fill in at least twice.
“We know from conversations that staff are exhausted and we need to show them there is a strong path towards transformation.
“Change is complex and we need to swiftly innovate and collaborate to provide a better experience for all.”
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