Digital ambition and delivery in health and care
Breakfast
ADASS Spring Seminar
Meeting
National challenges and digital responses: What we are seeing DEMAND MARKET WORKFORCE FINANCE
DEMAND GROWTH/ACUITY
MARKET FRAGILITY
Growth/acuity Fragility
FINANCE PRESSURES WORKFORCE CONSTRAINTS
Constraints Pressures
Creating an unsustainable model of health and care
The opportunities for digital are not sufficiently addressing these challenges
Solution rather than outcome led Siloed interventions
• Digital programmes too often focus on implementing a ‘tool’ rather than the benefits
• Impact, particularly financial, often not tracked
• Insufficient focus on use to drive better prevention
• Application of digital often siloed in individual organisations
• In part due to seed funding from central government
• This impacts on benefits and interoperability & insight
Data for insight
• Data and insight is often not easily extracted
• Prohibits focus on how data can help drive preventative care and improved flow
• Ability to join up of data still prohibits opportunity
Frontline & citizen engagement
• Often a disconnect between strategic ambition and translation to frontline
• Workforce not sufficiently digitally enabled
• Citizens not being nudged towards individual ‘wellness’
National challenges and digital responses: What we are seeing
In our experience of working with health and social care systems, including all 42 ICSs in the last 12 months, we see a common set of challenges facing the sector and a consistently unhelpful trend in how digital is being deployed.
Four core challenges persist in the sector:
• Demand management provides a real opportunity to improve outcomes. It has rightly been the focus of the sector for years, but the sector can’t continue to just do more of the same.
• Market fragility cannot be easily solved as it is a direct consequence of workforce constraints and financial pressures.
• Workforce constraints and financial pressures are very unlikely to be resolved in the next 10 years – in fact, they are forecast to worsen.
Something needs to change!
Digital is rightly seen as a critical enabler that can unlock a new preventative and more sustainable model of health and care. However, currently it is not having the impact it could have. This is because digital interventions are often:
• Tactical, small scale and targeted at specific problems rather than embedded at the heart of a strategic transformation journey.
• Being delivered in organisational and service silos, leading to fragmentation, duplication and a lack of co-ordination of digital activity.
• Driven by funding pots which are often national. They therefore encourage an unhelpful focus on the technology, as opposed to the transformation, and exacerbate the tactical and fragmentation challenges.
• Missing clear line of sight to how they will help address the key challenges and pressures facing the system.
• Not clearly aligned to how they will enable delivery of a future vision of health and care.
• Creating lots of activity and use of finite resources but lacking tangible impact and benefits, which in turn is leading to the loss of confidence of health and care professionals that digital can enable the transformation that is required.
Digital blueprint for health and care
HEALTH & CARE SYSTEM
HEALTH & CARE EMPHASIS
PRINCIPLES & CHARACTERISTICS
DESIRED OUTCOMES
DIGITAL & AI SOLUTIONS
IMPACT / BENEFITS
Empower active independence and wellness
People readily access technology to maintain their health and independence, without the need for formal care or support.
Technology supports local connectivity for health and care in communities.
Technology strengthens wellness.
People know how to access early care and support themselves and actively do so.
Assistive technology, community support apps. NHS App, personal interactive robotics.
Whole-system prevention
The Health and Care system is focused on proactive as well as reactive care.
Technology, data and insight is used to identify where someone's health or care may deteriorate and actively intervenes to try and prevent this happening. Predictive analytics reduces health escalation. Prevention is a core measure of success.
Many health and care needs don’t escalate as system focuses on actively preventing this happening.
Generative AI productivity solutions, sensors and wearable monitors, personal interactive robotics, on-line screening and advice with relevant professionals.
Acute care supports assessment, intervention (where needed) and discharge
Relentless focus on flow to prevent escalation
Where people need more formal care and support, technology helps to map out patient flow to prevent escalation wherever possible.
Technology enables quicker, more holistic and joined up care, supporting people to exit formal care and support, where possible.
Community care enables step down from hospital to home
Empowered return to independence and self-care if possible
Integrated records and support help to return people to independence& self-care wherever possible.
Technology connects people back into local community support as well as formal support where needed to keep them at home.
Reduction in cost: Lower costs for agency staffing, length of stay, acuity, contacts and re-admissions.
Improved retention: less attrition of staff and increased resource re-deployment.
People stay in hospital or other acute health and care support for shorter periods.
Longitudinal health and care record for each citizen (ShCR, EPR, etc), robotic process automation, insight driven dashboards powered by integrated data, virtual wards and care.
Most people can return home, or to lower intensity support and don’t return to acute care.
Assistive technology, community support apps. NHS App, personal interactive robotics, virtual wards/care.
Digital foundations, including high-quality integrated data to enable the right digital platform to support capabilities at home or in professional settings; Electronic clinical systems (EPS, EPMAs, etc) to capture patient records and enable effective performance reporting; System integration to enable holistic view; Robotic process automation to reduce need for paper; Cultural change – engagement of key clinical and operational staff to help drive digitally enabled changes to practice; New operating model – including different roles for clinicians and virtual MDTs, Real time intelligence and forward reporting to consider flow, needs and pathways.
Productivity gains: increased capacity of staff and less time recording through use of technology and integration.
Improved outcomes: reduction in escalation of needs, increased numbers of people living at home or in community settings and improved mobility and wellness.
SYSTEM ENABLERS
Digital blueprint for health and care
The health and care sector has struggled to envision a digitally enabled future. When discussing digital initiatives with health and care systems, the focus often jumps immediately to digital solutions, and in social care, it frequently jumps straight to technology enabled care (TEC). However, these discussions are commonly perceived and framed as being for the techies. This exacerbates the challenges highlighted on the previous slide - it isn’t just about digital, it’s about transformation.
In response, Channel 3 has co-produced this digital blueprint with stakeholders from across the sector. It is a work in progress, we know it isn’t perfect and we have found that unsurprisingly it is hard to fit all of this onto a single slide. In its current form, the wording and language may not hit the right tone for everyone, so the plan is to evolve it by incorporating your thoughts and challenge ourselves to improve it.
The good news is that where we have shared it with health and social care leaders, it has been well received and some have even adopted it as their own digital blueprint for the future.
In short, the purpose of this slide is to:
• Frame discussions around the person’s journey through health and care.
• Encourage the sector to bring digital to the heart of the strategic transformation journey, to focus more on the transformation than the digital.
• Start with the future clinical / social work vision of how we want to deliver health and care in the future to improve outcomes, especially with challenges like moving from crisis to prevention.
• Provide clear line of sight to the outcomes, impact and benefits, ie how digital will help to directly address the core challenges facing the system.
• Recognise that digital solutions are important, but their impact is predicated on the required system enablers being in place to support effective transformation.
Questions for discussion
1a. Do you agree with the national challenges we have outlined above?
1b. Do our examples of how digital interventions are currently being delivered resonate with your experience in your local system?
2a. Do we have a shared strategic and digital ambition across health and care?
2b. What are the challenges to delivering that ambition at the scale and pace required?
Further ideas, questions or comments? Drop me a line:
Ralph Cook - Partner, Adult Social Care
Ralph.Cook@Channel3Consulting.co.uk
Notes
www.Channel3Consulting.co.uk
