Creating sustainability in health and social care

The question of the sustainability of funding for health and social care services has been in the spotlight recently. The Conservative Party manifesto contained proposals around making individuals pay for more of their social care costs, to deal with the “challenges of an ageing society”. Meanwhile, figures suggest that NHS Trusts in England overspent by £770m last year despite a focus on efficiency savings.

However, creating and maintaining sustainability in health and social care is much broader than financial sustainability. It means considering other factors, including environmental, training and project management issues. This takes planning, commitment and an understanding of the aims and expectations of staff and senior management.

A research symposium earlier this year (hosted by Healthcare Improvement Scotland and partners) explored these issues further, looking at the evidence underpinning ways to create sustainable health and care systems.

Environmental sustainability

Environmental sustainability is something which all organisations are being asked to address and improve. The issue of climate change has led to a focus on behaviour change and a more sustainable use of resources.

  • Buildings – This includes the planning of new healthcare buildings, as well as adaptations to existing structures to make them more energy-efficient. Alternative building materials and designs have been used in new projects to improve energy efficiency, with some buildings even incorporating wind turbines, solar panels and geothermal capture centres. Reducing waste water and improving temperature regulation through heat capture and insulation techniques are also being adopted. While these may be costly initial spends for many, the long-term cost savings are also significant, as well as ensuring that the buildings meet minimum national requirements for energy efficiency and contribute to emissions reduction targets.
  • Resource, waste and recycling management – In many offices and clinical centres, individuals are encouraged to be personally responsible for their own reduction in waste and improved use of recycling facilities; however, this must also be facilitated at an organisational level. Clearly labelled recycling bins, promoting reduction in of the use of disposable water and coffee cups, and encouraging employees to use less paper when report writing (printing double sided for example, or going paperless where possible) are all simple ways in which environmental sustainability can be promoted in health and social care settings. Innovative techniques such as reusing water in internal plumbing, or creating bespoke recycling facilities to help reduce the amount of clinical waste incinerated, are being developed.
  • Remote monitoring and the use of technology – There have been major advances in the use of remote technology to host meetings, video-conferences, follow up appointments and assessments for those in receipt of reablement care via tele-health. Remote monitoring of patients, as well as the use of tele-health and other digital platforms can allow consultations and routine check-ups to take place without either party having to leave the house or office, thereby reducing vehicle emissions used in transport. In social care, remote meetings and cloud-based reporting can allow front-line social workers to remain out on visits instead of having to return to the office to fill out reports, again reducing vehicle emissions.

Sustainable resource management

In the face of more limited funding, joint working between health and social care is being heralded as a new way of cost saving, making the most of ever-depleting resources in the face of ever-greater demands. Being efficient with resources, through effective planning and management is one of the key ways to ensure resource sustainability in the long term, especially for the NHS and local authority social care teams.

Approaches include:

  • Making full use of the entire health and care ecosystem – This means using the entirety of the health and social care ecosystem, its capacity, expertise, resources and the end-to-end care it can provide. It means engaging carers, GPs, nurses, and pharmacists to improve efficiency, make better use of resources, spread the workload and improve satisfaction levels and outcomes for service users.
  • Using careful and well-managed commissioning models  This means making good decisions about commissioning and outsourcing to make best use of funding and other available resources. It also means allocating to appropriate projects, being mindful of the possible consequences of payment by result frameworks, and getting the best value possible.

Sustainability in practice

The final level of sustainability in relation to health and social care practice involves the sustainable implementation of programmes. This means finding ways to ensure that implementation is carried out in ways that ensure long term success and positive outcomes. It involves understanding context, and the culture of the organisation and makes reference to something discussed previously in our blog on implementation science.

Ensuring sustainability in practice requires multiple efforts including:

  • Making sure that practice becomes embedded into everyday work
  • Sharing best practice
  • Maintaining motivation among your workforce
  • Using robust, local evidence in a way that is clear and concise.

Understanding what kind of evidence leads to sustainable programme implementation is also important: economists prefer cost-based strategies, chief executives want one-page summaries, professionals want examples of other organisational based programmes and what was required to implement effectively, and councillors want case studies based around the positive impact on services users. Case studies can at times actually be the least helpful because even in a failing programme there is usually one example you can use to find positives.

Another issue with evidence is the reluctance to report on issues or challenges, or failed projects, when actually some of the greatest insight can be gained from this. All of the learning that can be gained from failures could be useful when trying to make programmes more resilient so they can be more sustainable.



Final thoughts

The concept of sustainability in health and social care cuts across many areas of organisational management and personal practice and behaviour. Encouraging and participating in sustainable practice can mean anything from being more environmentally friendly by digitising reports, recycling paper or changing to energy saving lightbulbs to promoting sustainability of resources through efficient and effective management, utilising the skills, expertise and resources of the entire health and social care ecosystem.

These approaches to sustainability should not only help health and social care as a profession to be less impactful on the environment but will also allow organisations to save money, improve efficiency and ultimately improve outcomes for patients and service users as a result.


* The 5th Annual Research Symposium: Evidence for sustainability – exploring the current evidence underpinning ways to create sustainable health and care systems was held on 16 March 2017. It was jointly hosted by Healthcare Improvement Scotland, Health Services Research Unit and the Health Economics Research Unit at the University of Aberdeen, and the Nursing, Midwifery and Allied Health Professions Research Unit at the Chief Scientist Office.

If you enjoyed this blog, you may also be interested in other articles on implementation theory and commissioning in health and social care.

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Denmark’s digital ambassador: should the UK be following suit?

 

By Steven McGinty

On 26 January, the Danish Ministry of Foreign Affairs announced that they would be appointing the world’s first ‘digital ambassador’ to act as the nation’s representative to major technology companies, such as Google, Apple, Facebook and Amazon.

At a conference on the future of the Foreign Service, the Foreign Minister, Anders Samuelsen, explained that:

Denmark must be at the forefront of technological development. Technological advances are making such a great impact on our society that it has become a matter of foreign policy. I have therefore decided to announce the appointment of a digitisation ambassador.

In a follow up interview with Danish newspaper Politken, Mr Samuelsen expressed his belief that multinational technology giants “affect Denmark just as much as entire countries”. He highlighted the examples of Apple and Google whose market values are so large that if they were countries they would only narrowly miss out from inclusion in the G20 – the global forum for cooperation between the world’s 20 major economies.

As a result of this economic strength, together with tech firms’ impact on the everyday lives of citizens, Mr Samuelsen argues that the technology sector should be treated as a form of ‘new nation’, which Denmark must develop closer relationships with.

Cooperation between nation states and the technology sector

Technology companies are becoming involved in activities that were once reserved for nation states. For example, Mr Samuelsen’s Liberal party accepts donations in Bitcoin – an online currency which challenges the state’s role as the only issuer of legal tender. And Microsoft have signed a partnership agreement with the French Ministry of Education to provide teacher training, in order to prepare teachers for running special coding classes.

The technology industry argues that it is better placed than national governments to provide effective digital services, at cheaper prices. In terms of national security, computer engineering expert and academic, Jean-Gabriel Ganascia, argues that this is probably the case. Mr Ganascia highlights that Google and Facebook have vast image databases that enable them to use facial recognition software far better than any national security service. Therefore, countries have started working with technology companies on a variety of crime and public safety issues.

Citizens are also spending greater amounts of time on social media platforms. In an interview with The Washington Post, Mr Samuelsen stated that more than half of the world’s data has been created in the past two years (much of this from major platforms such as Facebook). This trend has implications for the privacy of citizens and the spreading of false information, a phenomena that has been labelled ‘fake news’. These issues are fundamentally important for citizens and nation states, and are likely to increase cooperation between countries and the technology sector.

Australia’s Ambassador for Cyber Affairs

Although Denmark will be the first country to introduce a digital ambassador, another government has made a similar appointment. In January, Dr Tobias Feakin was appointment as Australia’s Ambassador for Cyber Affairs. His role focuses on cyber-security, but also includes issues such as censorship and promoting internet access. At this stage, it’s unclear whether Dr Feakin will have direct contact with technology companies and whether this relationship will involve discussions over economic issues such as taxation.

Is a digital ambassador necessary?

Not everyone, however, is buying into the appointment of a government representative focused solely on digital issues. Technology journalist, Emma Woollacott, believes that it’s a ‘terrible idea’.

According to Ms Woollacott, Denmark already has a good relationship with technology companies, highlighting that Facebook has recently announced plans to build a new data centre in Odense, creating 150 new permanent jobs. These views may have some merit, as Mr Samuelsen has confirmed that the deal between the Foreign Ministry and Facebook was the result of three years of behind-the-scenes work.

Ms Woollacott also argues that Denmark is setting a worrying precedent by equating a private company to a nation state.  In her view, the importance of the technology sector could have been acknowledged through hiring knowledge staff, rather than granting it a ‘unique political status’.

However, Professor Jan Stentoft, who researches the insourcing of technological production to Denmark, believes creating the ambassadorial post is a good idea. He explains:

We have much to offer these companies, but Denmark is a small country, and we obviously need to make ourselves noticed if we are to attract them to the country.

Marianne Dahl Steensen, CEO of Microsoft Denmark, also welcomed the creation of a digital ambassador position, but did acknowledge that the company ‘can hardly be equated with a nation’.

Should the UK introduce a digital ambassador?

By introducing a digital ambassador, Mr Samuelsen is taking a pragmatic approach to ensure Denmark is a key player in the international digital economy, as well as attempting to manage the impacts of an increasingly digital society.

Although appointing an ambassador for the technology sector poses philosophical and ethical questions, the UK should closely monitor how this new role develops and the potential benefits (and challenges) it brings for Denmark. In particular, if the new role is able to improve dialogue between technology companies and the security services on matters such as privacy, or help address the sector’s need for digitally skilled workers, then maybe introducing a digital ambassador is something worth exploring.


Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our other digital articles

Government Transformation Strategy 2017 to 2020: has it been worth the wait?

Whitehall, London

By Steven McGinty

On 9 Feb 2017, and after over a year of delays, the UK Government finally published the Government Transformation Strategy 2017 to 2020.

It’s been a long time since the Government Digital Strategy was published in 2012. Therefore, it’s understandable that politicians, industry leaders and media commentators have been frustrated by the lack of a new strategy in 2016.

In January 2017, Iain Wright MP, chairman of the Business, Energy and Industrial Strategy Committee (BEIS) warned that the UK risked being left behind and losing its competitive advantage in the digital economy because of its ‘absence of clarity and strategic focus’.

Similarly, Stephen Metcalfe, chairman of the Science and Technology Committee, wrote a letter to digital minister Matt Hancock highlighting his disappointment at the lack of a government digital strategy.

However, now that the Government Transformation Strategy is here, what does it say and will it have a lasting impact?

A brief overview

According to Ben Gummer, Minister for the Cabinet Office and Paymaster General, the Government Transformation Strategy is:

“The most ambitious programme of change of any government anywhere in the world, by a government that has already done more to transform itself than any other.”

It sets out the government’s aim to build on the success of the 2012 strategy, and to not only focus on improving the citizen experience but to change the way services are delivered. The strategy states that the government will achieve this by transforming:

  • Whole citizen-facing services – ensuring an improved experience for citizens, businesses and users within the public sector
  • Full government departments – enabling organisations to deliver policy objectives more flexibly, improving citizen experience, and working more efficiently
  • Internal government – supporting the collaboration of government departments and delivering digitally-enabled change more effectively

However, the majority of the strategy is structured around five main objectives:

Business transformation

Government departments have made significant progress over recent years.  The strategy explains that lessons have been learned through this service transformation process, and that there is now cross-government agreement on the key areas that transformation must focus on. These include bringing policy development and service design closer together and recognising that government services are delivered through a variety of channels (online, telephone and face-to-face).

Grow the right people, skills and culture

Since 2012, government departments have been recruiting digital, data and technology specialists to improve their digital capability. However, the strategy accepts that the public sector is working in a competitive market and that recruiting and retaining staff is likely to remain a challenge. Embedding a new culture is also identified as an important enabler of change, with several goals highlighted, including increasing civil servants’ knowledge of digital and improving digital experts’ understanding of government.

The Digital Academy, which was formed in 2014 by the Department for Work and Pensions (DWP), will be transferred (by the end of 2017) to the Government Digital Service (GDS) to create nationwide training opportunities for civil servants.

Build better tools, processes and governance for civil servants

Civil servants vary widely in how they work, including the digital technologies they use and their approach to policy development. The new strategy explains that the government will create a better working environment by developing common and interoperable technologies that can be shared across government and adopt a more agile working environment.

Make better use of data

Data is vital for providing services that meet the needs of citizens. However, the strategy emphasises that the government must earn the public’s trust in managing data safely, securely, and ethically.

Create shared platforms, components and reusable business capabilities

The government has already had some success in introducing shared platforms, such as GOV.UK – a publishing platform which brought together over 300 government agencies’ and arm’s length bodies’ websites within 15 months. The strategy outlines the steps to be taken to encourage the development of new technologies, including leaving large single contracts with IT firms – a practice which is deemed a barrier to providing better technologies for civil servants – and purchasing from a wider variety of suppliers, such as SMEs.

From digital to transformation

It’s important to note that the strategy’s title has changed: from a digital strategy to a transformation strategy.

Jane Roberts, strategy director at Kable, suggests that this reflects the government’s realisation that digitisation is not a process with a defined end date, but a ‘constant dynamic ongoing process.’ Government, says Roberts, now understands that digitisation involves more than just moving services online, and that whole scale change is needed, from encouraging civil servants to work more collaboratively (including sharing cross-governmental data), to digitising back office processes.

In addition, Roberts also highlights the need for digital services to be designed to cope with this dynamic process. This includes supporting the integration of new technologies – particularly those related to the Internet of Things (the use of internet technology to connect everyday items) – and responding to increased citizen demand for greater control over their personal data.

What does it mean for local government?

The Government Transformation Strategy makes no comment on the challenges facing local government. However, London Borough of Camden councillor, Theo Blackwell, suggests that the strategy leaves scope for a ‘digital settlement’ to be developed between central and local government. He observes that the strategy:

leaves the door open for this discussion to be starting and concluded in short order, kickstarted by elected mayors and combined authorities in May 2017, and building on the groundwork of the last two years”.

Mr Blackwell also sets out what needs to be done to achieve this digital settlement:

  • Support the ‘coalition of the willing’, as well as improvement – encouraging local councils who have already made progress with digital transformation to work together, as well as helping struggling councils to improve;
  • Open platforms and a new market for start-ups – enabling the development of platforms and smaller start-up companies;
  • Shared Resource – developing partnerships between local councils and central government, which fund digital initiatives jointly.

Missed opportunity

The strategy has also received a significant amount of criticism for its lack of detail and limited commitments. Independent digital analyst, Jos Creese, has described the strategy as:

“…a mix of re-packaged principles and refreshed ‘transformational government’ themes, coupled with some new but not revolutionary ideas.

Creese argues that there is a general lack of pace with government programmes, such as with GOV.UK Verify – an identity assurance platform that allows people to prove who they are when using government services. And – unlike Theo Blackwell – Creese believes that the lack of collaboration between central government and the wider public sector is a missed opportunity (particularly as 80% of public services are outside central government). In his view, the strategy should have addressed some of the fundamental challenges facing local services, such as healthcare and crime prevention.

Final thoughts

Although the Government Transformation Strategy has received a mixed response since it was first published, there are certainly positives which provide hope for the future. Firstly, it was important that the strategy was finally published to provide a clearer indication of the government’s future direction.  Secondly, in the coming months, the government will have the opportunity to provide greater clarity, and set out how they intend to achieve the praiseworthy objectives of the strategy and realise the full potential of digital transformation.


Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our other digital articles

Digital – making the case for investment within local government

By Steven McGinty

In March, a report by Nesta and the Public Service Transformation Network suggested that local councils could save £14.7 billion by going ‘digital by default’ by 2020, i.e. moving all transactional services online and digitising back office functions.

However, this is not the first report to highlight the potential savings in going digital. In 2015, the Policy Exchange think tank published a report outlining how £10 billion could also be saved by councils by 2020, if they made smarter use of data and technology. Similarly, the Local Government Association (LGA) has published guidance on the benefits of digital technologies for councils, including financial savings.

All these documents make the positive case for digital. Yet, as discussed in a previous blog article, local government is still lagging behind when it comes to implementing new technologies. Jos Creese, Chief Information Officer (CIO) at Hampshire County Council and Chair of the Local CIO Council, explains that:

It’s doubtful if any local authority is not making savings from digital investment. The challenge is being able to quantify savings.”

This suggests that if local government is ever going to achieve its ambition of becoming ‘’digital by default’, then attempts must be made to evaluate projects, to develop a strong evidence base, and to share examples of best practice. Below I’ve highlighted some projects which provide a strong case for investment.

Manchester City Council

In 2012, Manchester City Council decided to create a more responsive ‘mobile first’ website that citizens could access from free Wi-Fi spots around the city via smartphones and tablets. The website was developed by an integrated team comprising IT and marketing staff from Manchester City Council, and developers from the supplier. From the beginning, the team reviewed how people interacted with the council, such as how they asked for services and how they reported problems. The website was tested by members of the public, as well as accessibility experts and representatives from organisations representing blind and partially sighted people.

This website redesign has led to Manchester City Council saving £500,000 in the first nine months and winning a European award for website design and functionality.

Nottingham City Council

Nottingham City Council has introduced a workflow management app, replacing an inefficient paper-based system. The new app allows staff from customer services, highway inspectors and response teams to enter faults, such as potholes or damaged street lights, directly into the system. It then automatically allocates the fault to the relevant inspector and, once the work is completed, digitally signs it off. Residents are also kept informed via updates, as the progress of the work is linked to the initial order raised.

The council has reported that the app has created £100,000 in savings in less than one year. In addition, the improved monitoring of productivity has led to 40% field efficiency savings and 60% back office savings in the Highways department.

London Borough of Camden

In 2013, the London Borough of Camden introduced a programme to create a single source of residents’ data. The Camden Residents Index (CRI) used a technological solution to match different types of data with individual residents (allowing the council to have a single point of view for each resident’s data).

The CRI has been used for a number of purposes, including detecting fraud and managing the electoral roll. For instance, the index was able to identify 752 council properties that could have been illegally sublet. The council estimated that a quarter of these properties were reclaimed, saving approximately £18,000 per property and £3.4 million in total. The CRI was also able to validate 80% of data from the electoral roll (which is higher than the 50% rate of the Department for Work and Pensions, which usually validates the council’s electoral data). This increased match rate resulted in less manual checking, which saved Camden council £25,000.

Poole County Council

Poole Borough Council has recently moved towards using cloud-based services. They highlighted three main drivers for this change: complying with the Cabinet Office’s Cloud First Directive; improving the agility of services; and making the necessary savings to the information and communications technologies (ICT) budget. The move has already saved the council £60,000; with an additional £750,000 worth of savings possible over the next three years.

Conclusion

Local council leaders may be anxious about making the case for investment, but investing in digital should be considered as a necessity, rather than a luxury, for meeting growing citizen demands with fewer resources.

These are just a few, of the many examples, of how local councils have benefited from digital transformation.


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Digital Agenda Norway (DAN): international digital leader but still pushing forward

Split Norwegian flag flying in the wind

Image courtesy of Pixabay via Creative Commons.

By Steven McGinty

Continuing my series on digital government best practice, I will be looking at the success of Norway and what they hope to achieve through their Digital Agenda for Norway (DAN) strategy.

Norway is already a leader in “digital government”, ranking second only behind Singapore in a study carried out by Accenture on implementation progress and citizen satisfaction. The Norwegian State Secretary, Paul Chaffey, suggests that this success has been built on a foundation of a population of tech savvy Norwegians, with a history of being at the forefront of cutting edge technology.

For instance, in 1973 Norway became the first country to connect to the US’ ARPANET, which was the military predecessor to the Internet. And more recently, maritime and off-shore technology developments in Norway have become of global importance. In particular, the use of Big Data modelling plays a significant role in finding new oil fields.

Egovernment policy development

In 2000, the government presented the eNorway action plan, a set of ICT initiatives designed to support the development of the ‘knowledge society’ and improve the lives of the people of Norway. The plan consisted of descriptions of the individual ICT initiatives of ministries, as well as common frameworks to support joint initiatives.

This soon evolved into eNorway 2005, which had the main goal of developing a set of principles for ICT initiatives. From this, the government set out three primary targets for its ICT policy:

  • Creating value in industry;
  • Efficiency and quality in the public sector;
  • Involvement and identity.

Then, the government introduced eNorway2009, a strategy that would take Norway a ‘digital leap’ forward. It argued that the public sector had to be viewed as one unit, if digital progress was to be made. Therefore, the new strategy focused on the use of multi-disciplinary initiatives and projects. There was also a recognition of the need for cooperation between all sectors and levels of the public sector, as well as the private sector.

In 2012, the government also published a report on the digitisation of the public sector. It outlined the government’s key policy objectives for their digitisation programme – keeping Norway at the forefront internationally in terms of providing digital public services to its citizens
and businesses.

Major successes

  •  ID-Porten

A major development has been the implementation of the hub, ID-Porten, which verifies citizens via electronic IDs (eID).  It allows citizens to securely login to government digital services via a single login portal. There is also a common technical platform (ID Gateway), which allows citizens to login to services using four different eIDs: MiniID; BankID; Buypass; and Comfides.

BankID, Buypass, and Comfides all provide access to a high level of security (level 4). These IDs are required when accessing personal data and only issued to individuals who appear in person. However, MiniID provides only a medium-high security level (level 3) and pins codes can be sent via mail or through SMS. This is the most common eID (used by almost 2.7 million citizens) and provides access to digital services provided by the tax services and the Norwegian State Educational Loan Fund.

  • Altinn.no

In 2003, Altinn was launched to provide a single web portal for public reporting. This was driven by the amount of time Norwegian businesses were spending on statutory reporting. To resolve this problem, the three large public agencies in Norway – the Norwegian Tax Administration, Statistics Norway and the Bronnoysund Register Centre – started Altinn.

However, the project has now moved beyond that of public reporting. Now it’s responsible for providing an array of electronic forms (over 700) and digital services, as well as providing information for businesses.

The most used service by citizens is the completion of tax returns online. In 2009, more than 440,000 businesses chose to do their statutory reporting through Altinn.

  • Regjeringen.no

This is the main information portal for the Norwegian government. It has a user friendly design and in many ways is similar to the UK Government’s website GOV.UK.

Digital Agenda for Norway (DAN)

In 2013, the Norwegian government published the white paper on the Digital Agenda for Norway (DAN).  The strategy is linked to the Digital Agenda for Europe, and is also related to the Europe 2020 strategy.

The DAN explains that the government’s primary goal is that:

Norwegian society take full advantage of the value creation and innovation opportunities that ICT and the internet offer.”

This has been the philosophy from the early stages of Norway’s digital development.

The DAN highlights that greater digitisation is inevitable but notes that it will be important to identify areas with the greatest potential for development.

In terms of the public sector, the DAN identifies a number of areas for development:

  • Public sector information – increasing the accessibility and reuse of public sector information.
  • Digital services for citizens – improving digital registration for property rights and creating a paperless justice sector.
  • Commons technical solutions – the development of digital mailboxes for citizens and businesses, the use of digital document exchange, and the creation of common registers to support the public sector.
  • Organising and coordinating for more efficient use of resources.
  • Adapting laws and regulations to a digital public sector – requiring digital communication to be the standard method of communication for the public sector.

Looking to the future?

Norway has earned their reputation as a ‘digital leader’. Over the years, the government has set out a series of clear policies to support the transition to the digital age. Although not perfect, significant improvements have been made. For instance, 93% of Norwegian households now have access to the internet; this figure was only 55% in 2003.

The new DAN presents Norway with an opportunity to continue the success of recent policy initiatives. And on recent evidence, this is a clear possibility.

However, with other countries looking to improve their performance in digital government, it will be interesting to see if they will overtake Norway in international comparisons or if Norway’s sustained focus will pay off and enable them to be the world’s number one in terms of using digital services to increase citizen engagement and improve service delivery.


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IDOX specialises in election services, with Idox Elections offering end-to-end solutions for electoral management systems. Idox was awarded a number of contracts to support the Norwegian municipal and county elections held in September 2015. This follows Idox’s success in delivering similar election services during the Norwegian General Election of 2013.