How connecting health and social care can save lives

Con­nect­ing health and social care is a nec­es­sary 21st-cen­tu­ry evo­lu­tion of over­bur­dened ser­vices.

Just 20 per cent of a person’s health out­comes rely on med­ical care; hous­ing, edu­ca­tion and oth­er social fac­tors col­lec­tive­ly influ­ence the remain­ing 80 per cent. Join­ing up domi­cil­iary care, men­tal health ser­vices and health­care, through dig­i­tal­i­sa­tion and shar­ing data, cre­ates a con­tin­u­um of care, but is only hap­pen­ing in pock­ets.

A wave of cheap, con­sumer-based tech­nol­o­gy is becom­ing avail­able on mobile devices, bring­ing the oppor­tu­ni­ty to deliv­er bet­ter care in people’s homes, pro­mote well­be­ing and avoid expen­sive hos­pi­tal­i­sa­tion.

A smart­phone can mea­sure pulse, res­pi­ra­tion, blood pres­sure and blood oxy­gen, and even do ECGs. Minia­turised, mobile tech­nol­o­gy is shift­ing care out of hos­pi­tals and surg­eries, and con­nect­ing net­works of pro­fes­sion­als around patients.

Com­mu­ni­ty inter­est com­pa­ny Care City equips domi­cil­iary care work­ers and even shop assis­tants with mobile dig­i­tal tech­nol­o­gy to pro­mote healthy age­ing and social regen­er­a­tion in East Lon­don.

“Diag­nos­tic tech­nol­o­gy is devel­op­ing fast, is cheap and portable, and already in the pock­et. That’s excit­ing for health and social care as the diag­nos­tic brains are in the cloud,” says John Craig, Care City chief exec­u­tive.

Consumer tech delivers cross-functional care

In a Care City pilot, part of the Inno­va­tion Test Bed run by NHS Eng­land and Office for Life Sci­ences, care work­ers with mobile devices take obser­va­tions that are run against an algo­rithm using the so-called nation­al ear­ly-warn­ing score. If the screen turns red, from green, the care work­er esca­lates to a health work­er who uses the data to make a clin­i­cal diag­no­sis, sav­ing resources and keep­ing peo­ple out of hos­pi­tal.

This exem­plar, hap­pen­ing in homes in Bark­ing, is proof of how dig­i­tal inno­va­tion at the edge can con­nect rel­e­vant care pro­fes­sion­als with patients in their homes. Inte­grat­ing data, IT sys­tems and gov­er­nance to pro­vide joined-up patient jour­neys at scale, how­ev­er, is a far greater task and Man­ches­ter is arguably the most advanced region.

Around the coun­try, 14 regions are build­ing inte­grat­ed care sys­tems and Man­ches­ter has used its devolved local gov­ern­ment sta­tus to form the Greater Man­ches­ter Health and Social Care Part­ner­ship.

Dr Tom Tasker, local GP and chair of the joint com­mis­sion­ing board, says local gov­ern­ment agen­cies no longer pull in dif­fer­ent direc­tions with dif­fer­ent bud­get­ing pri­or­i­ties. “Health and local author­i­ty com­mis­sion­ers togeth­er pro­vide the best val­ue for the Sal­ford pound,” he says.

Connecting agencies improves health outcomes

The health­care mod­el that the part­ner­ship embraces is broad, con­nect­ing mul­ti­ple agen­cies, includ­ing schools, men­tal health and children’s ser­vices, in sup­port of Manchester’s mantra: “Start well, live well age well”.

May­or Andy Burnham’s A Bed Every Night ini­tia­tive to counter home­less­ness has bucked the nation­al trend, reduc­ing rough sleep­ing by over a third in the past year. Wrap­ping health inter­ven­tions, care pack­ages and hous­ing togeth­er has been a key fac­tor in the suc­cess sto­ry, says Tasker.

Inte­gra­tion on this scale is an immense task. But social enter­pris­es and tech­nol­o­gy firms, work­ing with local author­i­ties and clin­i­cal com­mis­sion­ing groups (CCGs), are prov­ing that join­ing up small dat­a­points along the patient jour­ney also pays. At Leeds Teach­ing Hos­pi­tals NHS Trust, mobile com­put­er vision sup­pli­er Scan­dit tri­alled bar­code scan­ning on dig­i­tal devices as part of the NHS Scan4Safety pilot, designed to boost com­pli­ance of drug admin­is­tra­tion and patient safe­ty.

Care work­ers can esca­late to health work­ers who use data to make a clin­i­cal diag­no­sis, keep­ing peo­ple out of hos­pi­tal

By link­ing infor­ma­tion on patients’ wrist­bands, encod­ed with a stan­dard bar­code, with an elec­tron­ic patient record and patient admin­is­tra­tion sys­tem, Leeds now has a near real-time view of the patient jour­ney. Such trans­paren­cy is valu­able in cost­ing treat­ment, improv­ing clin­i­cians’ prac­tice and real­is­ing sig­nif­i­cant finan­cial sav­ings.

Joining data to reimagine care experience

Pro­gres­sive health and social care admin­is­tra­tions are har­ness­ing data trans­paren­cy and busi­ness intel­li­gence (BI) as a rad­i­cal force in reimag­in­ing cit­i­zen care. West Cheshire CCG is build­ing an intel­li­gence-led organ­i­sa­tion. Start­ing point was a data strat­i­fi­ca­tion tool that pre­dicts risk of hos­pi­tal read­mis­sion. The BI team also want­ed to iden­ti­fy peo­ple at risk of first-time admis­sion, says Andy McGivern, asso­ciate direc­tor of BI for Cheshire CCGs.

Real­is­ing the ambi­tion called for social deter­mi­nants to be col­lat­ed and much time was spent talk­ing to the coun­cil and achiev­ing data-shar­ing agree­ments. Join­ing up data about patients’ loca­tions, admis­sions, diag­noses, obser­va­tions, men­tal health and pri­ma­ry ser­vices, pre­scrip­tion data, and 111 calls cre­at­ed new pro­fil­ing capa­bil­i­ty.

“Providers thought they knew their high-risk patients, but they only knew 60 per cent. The data sur­faced the oth­er 40 per cent of patients at risk of admis­sion,” says McGivern.

While politi­cians, com­mis­sion­ers and prac­ti­tion­ers grap­ple with sys­temic inte­gra­tion of finance, gov­er­nance and IT sys­tems, dig­i­tal is con­nect­ing health and social care in nov­el ways.

Refero, a secure engage­ment plat­form, is putting vul­ner­a­ble and exclud­ed young peo­ple at the cen­tre of their own fam­i­ly and pro­fes­sion­al sup­port net­work in south-west Eng­land. Video con­fer­enc­ing tools, such as LIVI and vCre­ate, are help­ing GP surg­eries and hos­pi­tal wards stay con­nect­ed with patients and fam­i­lies.

For­mer gov­ern­ment tsar for emer­gency care Pro­fes­sor Matthew Cooke con­cludes: “New tech­nolo­gies enable records to be more secure and to restrict access to those who need to know.” Dig­i­tal sys­tems can help pro­vide seam­less care across health and social care, but as Cooke sums up: “It’s work in progress at present.”