Do you have a digital mindset?

Accelerating health and care integration

Digital technology is helping to transform the way citizens interact with service providers across all other service industries. The time is now ripe for changing the relationship between health and social care commissioners and providers and service users. This week’s Thought from the Centre blog brings you the views of our lead partner for social services on the need for an increased focus on digital transformation across health and social care through the adoption of a more ‘digital mindset’.

The current Government’s drive to accelerate health and social care integration by 2020 means it is imperative that Councils and NHS organisations increase the pace of change to successfully manage future demand. The recent publication by the four key national organisations (Local Government Association, NHS Confederation, Association of Directors of Adult Social Services and NHS Clinical Commissioners) – ‘Stepping up to the place – the key to successful health and care integration’ sets out a ‘call for action’ for integration and transformation to happen faster and to go further so that integrated and person-centred care becomes the mainstreami. To achieve this stakeholders need to consider some of the imminent challenges for the care market, and the critical role of a ‘digital mindset’ in accelerating health and social care integration.

What’s stopping us - system demand?

There are many pressures facing adult social care but the relationship between demand and supply seems to be at the heart of the challenge. The relationship between commissioners and providers, and the miss-match between an assessment of need and the availability of support services. Achieving the right balance and the ability to flex to respond to local circumstances could have a major impact on the delivery of support and care.

We know that care homes and home care providers report being squeezed between reductions in local authority funding, and increasing employee and regulation implementation costs. The issues and challenges are well rehearsed and we won’t replay them here. It is a sobering thought to consider what might happen if one of the larger care home providers exited the market. For example, Four Seasons recently reported an annual loss of £264 million and its credit rating was downgraded by Moody’s to unsustainable.ii This is an organisation that cares for 20,000 older people in 450 care homes and has 31,000 staff. The potential impact of closure would have far reaching implications for health and social care.

Alongside this pressure in the market, we know, that demand pressures continue to increase and assessment and treatment targets continue to be missed, including an increase in delayed hospital discharges due to a lack of support packages in the community. For example, over the past two years there has been a 31 per cent increase in delayed hospital discharges, with 1.15 million ‘days lost’ in 2015. These figures, however, only account for delays after clinicians and other professionals deem a patient to be ready for discharge, and do not include all patients who are no longer in need of acute treatment. The National Audit Office suggest the true figure for patients aged 65 and older who are no longer benefiting from acute care could be as high as 2.7 million ‘bed days lost’.iii Age UK argues that a combination of acute shortages of good health and care services to help older people recover are the main problems behind most delayed discharges of older people from hospital wards. Along with poor co-ordination, buck passing between the NHS and care services, and a lack of information and general confusion about what’s available and who is responsible for paying for care.iv

For professionals on the ground who have to deliver services 24/7, dedicating their time to driving change and service improvement, struggling to meet increasing expectations of both themselves and their patients can feel overwhelming. The interdependency of problems requiring solutions is self-evident; the consequences for people are significant and contributory factors myriad. For individuals, their carers and family the impact of these challenges is palpable on a very personal level. And while pace is needed to accelerate change to the new models of care delivery w, for practitioners–the need to provide people who are frail and vulnerable with access to much needed services quickly and efficiently, is even more important.

There is an inherent tension that we cannot shy away from. And while we need to scale up citizen-centric services and urgently improve the here and now, real improvement is also about focussing on those issues that will help us to manage future demand better for the benefit of individuals and communities.

How can a digital mindset accelerate adoption?

In 2014 Deloitte surveyed more than 1200 public sector leaders from over 70 countries on digital transformation and 82 per cent of the 400 respondents from the UK say that digital technologies and capabilities would enable employees to work better with other employees. 84 per cent say that digital technologies and capabilities enable employees to work better with citizens and 88 per cent say improving citizen experience and transparency is an objective of their digital strategy.v

We now have access in public sector to the digital tools (cloud computing, mobile devices, analytics) and the talent to stage a real transformation in integrated service delivery. But we need a digital mindset to really take advantage of these new and exciting accelerators. A digital mindset requires us to see old problems and old processes with new eyes. It is a different way of thinking about customers, services, and process. It’s faster, iterative, and adaptable. And if local government and health adopt a digital mindset, the changes can be revolutionary.

At its core will be transforming how to think about those using the services as early as possible in service design, while making use of technology as an enabler to co-create services. In the survey, more than one-third of respondents say that citizen demands are among the primary drivers of digital transformation and 82 per cent of government agencies aim to improve customer experience through digital transformation. However, only 13 per cent of agencies reported involving citizens in the process of creating user-centric digital services. We believe the time is ripe to:

  • change the balance and demand that citizens are always involved in the co-design of services. 
  • adopt a digital mindset across adult social care and healthcare and use digital tools to enable integration and transformation to happen faster and to go further so that integrated and person-centred care becomes the mainstream. 
  • learn from best practice examples across both sectors and transfer and scale up what works best in achieving these goals.
  • re-imagine the way services interact with each other and get ready for a technologically advanced, citizen-centric era.

Stepping up to the place – the key to successful health and care, NHS Confederation, 2016. See also: integration’
ii Four Seasons in crisis talks as earnings slide 39%, FT, April 27, 2016. See also: 
v The Ascent of Digital Report, Deloitte, 2014. See also:

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