Last week’s government announcement that it was cutting its proposed investment in the social care workforce drew widespread condemnation from social care organisations and was just the latest sign that the sector is not receiving the resources it needs to deliver care in the digital age.
Providers and policymakers agree that a digitally mature social care sector is vital to fulfilling the promise of hospital-at-home care and alleviating the bed crisis in the NHS.
As the NHS struggles with understaffing, extended waiting times for elective treatment and overflowing emergency departments, having a modern, joined up social care system is critical to reducing pressures on hospitals.
“Digital wards, care homes, rehabilitation – they all need to be addressed fundamentally, but until we address the workforce crisis, staffing and training, we won’t have the bandwidth to deal with this,” said Katie Thorn, project lead at Digital Social Care, in an interview with Digital Health.
In its follow up to its December 2021 white paper on social care on Tuesday, the Department of Health and Social Care (DHSC) confirmed that it would spend only half of the £500 million originally pledged in 2021 to invest in the social care workforce. The DHSC said that the remaining £250 million remained “within social care but has yet to be allocated”.
In February, meanwhile, an Expert Panel of the House of Commons Health and Social Care Committee delivered a report on the status of government commitments made to the digitisation of the NHS in which it suggested that most of the areas in which the government’s digital performance remained inadequate were those affecting social care.
The government’s June 2022 paper, “A plan for digital health and social care,” included a pledge to increase digital connections and provide more personalised care to support people in monitoring and managing chronic health conditions in their own homes.
It also said it would create a digital workforce strategy for bridging the skills gap and enable recruitment retention and growth of the digital, data and technology workforce.
Finally, it promised to roll out integrated health and care records to the entire population in order to provide a “functionally single health and care record that people, their carers and care teams can all safely access”. Most of these areas remained underfunded, the panel said.
A digitally immature care system
The Expert Panel’s review listed five common issues that have hampered delivery of the commitments across many of the policy areas: poor progress towards interoperability; poor digital maturity “particularly, but not exclusively, within social care”; insufficient planning, especially around the accessibility of digital products, in order to reduce exclusion of some groups; the challenge of ensuring that close to 18,000 providers implement electronic records despite a lack of previous investment; and a shortage of staff with the relevant technical skills to deliver digital services.
Rajiv Tanna, co-founder and CPO of home healthcare technology platform birdie said large portions of the social care patient management infrastructure is far behind that of hospitals, adding: “People are doing rostering on whiteboards and care management on [paper] files.”
Digital exclusion remains a key issue for many social care users who might benefit from being able to use health monitoring apps in their own homes; some live in areas without broadband or mobile coverage or are unable to afford them; others lack access to a device such as smartphone or tablet or do not have the skills to use online environment safely.
The panel noted a lack of effective plans to reduce inequalities, and warned that the health of excluded groups could decline further, as reliance on access to technology and the internet becomes a primary focus of health and social care provision.
The ability to increase communication between health and social care agencies also remains a work in progress. The Care Provider Alliance testified to the Expert Panel that having NHS-designed system in social care settings often leads to “complex implementations”.
In addition, the Panel found that “national standards relating to the procurement and use of digital technology within the NHS often do not apply to social care,” resulting in silos; as a result, it said, “social care provider systems…are often poorly integrated with health systems.”
This gap undermines wider goals, such as the development of unified single health and care records. The government’s June white paper found 86% of NHS organisations and 45% of social care providers have some form of EPR, but within localities different EPR systems with variable usability and interoperability.
Perennial problems of funding and staff
These challenges are exacerbated by a lack of discrete funding and workforce shortages that are at least as severe, if not worse, than those in the health service.
Consistent roll out of technology is key to improving care provision and allowing better integration between health and social care. Yet funding commitments and deadlines remain vague. The relative fragmentation of the care sector, compared to the health sector, complicates things further, adds Thorn of Digital Social Care.
Of the 25,000 care homes and 1.5 million care staff, just 7% are operated by local authorities, she says. The vast majority of the provider sector consists of small and medium-sized businesses employing fewer than 250 staff. Many care homes operate in converted Victorian buildings that are not adequately equipped for digital adoption.
“At the end of the day, these are generally very small organisations,” Thorn adds. “In terms of digitalisation, it’s fair to say we have been slower to adapt in social care than in health, but a major reason is that it is expensive to do so; local authority and NHS funding doesn’t contain enough money to innovate.”
National funding for roll out of basic shared care records has been prioritised for the least digitally mature regions. The government confirmed it would spend the remaining £100 million of its original £150 million digital investment commitment over three years. It remains unclear, however, whether this money is likely to include an allocation for shared care records.
Some organisations that testified before the Expert Panel – including the Chartered Society of Physiotherapy, the Care Providers Alliance (CPA) and the Professional Record Standards Body – called for ring-fenced funding in order to digitalise social care.
The other main obstacle to helping the social care sector reduce the digital maturity gap is the lack of effective workforce planning and subsequent staff shortages, care organisations say.
As a result, staff lack the ability to undertake training to use digital systems and technologies effectively and it is impossible to develop digital skills, literacy and leadership in the care sector.
The Expert Panel noted that although the CPA found 45% of social care providers are worried about lack of digital skills among care staff, turnover gives them little incentive to invest in training.
The DHSC’s announcement last week that it would release only part of the money originally committed to social care workforce development, was especially jarring.
Skills for Care programme head Claire Smout, in a blog on the charity’s website, illustrated a more direct benefit of creating a more technologically enabled workforce.
“People work in care because they want to spend time with the people that they’re supporting,” she said.
“Once technology is embedded, it enables you to spend more time with people.”