Digital infrastructure supporting health care during the COVID-19 pandemic

Healthcare is a key frontline service in the response to the COVID-19 outbreak. The NHS has had to react at pace to plan and deliver services in new and innovative ways.

Digital healthcare solutions are at the fore of ensuring not only the delivery of acute care for those patients suffering from COVID-19 but are also supporting the successful continuity of care and the day to day running of a health service which still needs to maintain “normal service” as well as its pandemic response. Digital infrastructure is helping the NHS and other partners to adapt and to meet the demand for health and care in a number of ways.

Supporting the delivery of care

In many ways, the NHS and frontline care in particular were already making inroads towards transitioning to digital and online platforms before the pandemic emerged. Many GP surgeries allow online appointment booking, and where appropriate, monitoring of those with long term conditions can be done remotely through at-home testing facilities, such as home heart monitors or monitors to help people monitor their diabetes.

Many care providers also already offer telehealth solutions for clients, and patient records are now stored online. However, in many ways the COVID-19 pandemic has catalysed uptake of digital solutions to healthcare diagnosis and delivery, with an increase in online consultations, greater use of the NHS Digital and NHS24 online and app platforms and a rise in the development of digital solutions to better support care in the community.

Support and training for frontline staff

In addition to supporting the direct delivery of care to patients, digital health infrastructure is also being adapted and used to deliver training and support to staff on the frontline. Blogs and online forums, including social media groups are enabling people to share experiences and best practice, and to create a sense of community among healthcare workers. In addition, virtual and e-learning opportunities are being developed to enable staff to access educational activities remotely. These include supporting the rapid education of the healthcare workforce in how best to manage the respiratory conditions encountered, as well as providing education to staff who may have been redeployed to other departments or settings as a result of the pandemic response. Online learning has also been used to help train volunteers and help the public to keep up to date with the latest developments across the health service.

Beyond healthcare to support the response to the pandemic

Artificial intelligence and data analytics also have a vital role to play in helping prevent the spread of coronavirus and other infectious diseases as digital solutions look to be developed to help beyond acute healthcare responses.

Predictive analytics and scenario modelling can be used to help identify those populations who are at risk of spreading the virus and of falling most severely ill to help support shielding campaigns and protect vulnerable groups as lockdown measures ease.

A project run by UK firm Biobank is looking to use samples collected by volunteers to map genetic sequencing in order to identify whether certain genetic characteristics make people more predisposed to become seriously ill, or more likely to contract the virus in the first place. This may help in the development of a vaccine and can also help identify those groups who will be most vulnerable when lockdown conditions are lifted so that they can be monitored more effectively.

Modelling and analytics can also be used to try and project any potential “second waves”. It is hoped that AI, analytics and machine learning will be able to help organisations learn from events such as the SARS epidemic, as well as quickly creating new knowledge from the millions of data points being generated in this outbreak.

Final thoughts

The significant humanitarian response to this global pandemic is being underpinned by a digital infrastructure, the extent of which we have never had at our disposal before. This digital support, of care delivery, communication, analytics, and modelling is being used in conjunction with insight from health and scientific specialists to try and help us find a path through this pandemic, deliver care, aid recovery and prevent re-emergence.

Making best use of the data and digital capacity we have throughout our health and care infrastructure will be a key part in preparing and meeting the needs and challenges that communities are facing.


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Further reading: articles on COVID-19 from The Knowledge Exchange blog

Safeguarding in social isolation: how social care teams are adapting to the new normal

We are all adapting to life in “lockdown”. For many of us this is a period of transition which will require some changes to our normal daily routine, perhaps working from home or socialising less. But what if you are a vulnerable person who is already socially isolated or if the place you call home is not safe?

The First Minister of Scotland Nicola Sturgeon in a briefing to the media stressed that life shouldn’t feel normal, but for many people who work in social care or social services they are trying to carry on as normal, providing key services to some of the most vulnerable people in our communities.

Social care teams across the county are working flat out to ensure they can maintain vital services and provide support and care to vulnerable adults and at risk children. Advice has been published by the government and by professional bodies like the BASW  (British Association of Social Workers) to try and provide some guidance to frontline care staff. But the reality is that care workers, both in social work and residential care are having to adapt to new and unprecedented circumstances to keep vulnerable people safe in our communities.

Funding for councils announced to support continuity of care

Councils have been allocated £1.6bn of funding by the Chancellor, designed to help them manage the impact of Covid-19 on services, including social care. Additional measures also include £1.3bn which is designed to help the discharge of patients from hospitals to continue their care in a community setting, to free up vital NHS resources over the coming weeks.

Councils have been advised to use this money as they see fit. However, one key priority is the continuity of care for service users, particularly as the virus spreads further into the community and there is a greater chance of care staff having to self-isolate and remove themselves from the workforce for a period.

Another measure designed to help ease this pressure on frontline staff are the social care clauses included in the emergency Coronavirus bill which temporarily remove the duties placed on councils to provide adult social care to all who are eligible. Instead councils will be able to prioritise care for those they consider to be most at risk in the event that adult social care services become overwhelmed. However these measures have been met with criticism from some charities who have said they will place already vulnerable adults at even greater risk.

Concerns raised for vulnerable children

The Children’s Commissioner for England has raised concerns about children who live in chaotic households, impacted by domestic abuse or substance abuse, and the effects that social distancing could have on their physical and mental wellbeing. For many children who are on the radar of social services, lockdown could be an especially isolating and difficult time. Additional concerns have been raised about vulnerable care leavers and young homeless people.

Government plans have ensured that some places have been kept in schools for vulnerable children to continue to attend. The definition of “vulnerable children” outlined by the government advice includes all children supported by social care, including those on child in need and child protection plans, looked-after children, children with disabilities, and children with education, health and care plans. However, the plan has drawn some criticism, including around its potential for heightening stigma experienced by children, and for putting the health of foster and kinship carers at risk.

How staff are adapting to new ways of working

It is not news that even before the outbreak of Covid-19 in the UK, the social care system was under significant stress.

Increased demands on those who work in residential and domiciliary settings include the practical challenges, increasing use of PPE, infection control and refresher training regarding contingency and emergency plans for residential care homes and challenges with supplies, including food and medication for residents. Additional challenges include the social and emotional stress of residents who may not receive visitors and must, where possible, socially distance from others.

Those who work in child and family social work are having to be increasingly flexible, managing many more cases and where possible managing elements of their work remotely via telephone or videoconferencing. Essential services are being prioritised.

In some instances there have been discussions around inviting final year social work students, or students studying social care to help support staff with additional tasks, or as has been the case with the NHS inviting retired colleagues back for a period to help already stretched teams.

An uncertain next few weeks

Many social workers and care staff have raised concerns around continuing to carry out their statutory duties as the population enters a lockdown phase and the additional risks this not only places on them as frontline staff but also the additional risks it may present to vulnerable children and adults.

Many are calling for explicit guidance from government on how social carers and social workers can be best supported to safeguard people at particular risk of harm, isolation and neglect. This includes practical support like the allocation of protective equipment, the enabling of improved sharing of information via digital channels and professional support, including the implications for registration if they are unable to meet duties, timescales or usual legal compliance during this crisis.

As the care system and its staff begin to feel the strain caused by this outbreak, calls are being made for social care to be recognised and acknowledged by government and others as a vital service. While one charity, the Care Workers Charity is launching a scheme to provide grants for those care workers who need to self isolate, many of whom will do so without pay, the GMB union have warned the coronavirus crisis could lead to the total collapse of the care system. It said care staff were being left with no protection against the virus, no childcare and poverty sick pay if they become infected.

Staff safety and continuity of service are clearly the priorities for the social care sector as we begin this period of unprecedented “lockdown”. It is clear more guidance and support is needed for staff who are on the frontline as they continue to deliver vital care and support services to some of the most vulnerable people in our communities.

If you enjoyed this article you may also be interested in reading:

Joining the digital revolution: social workers’ use of digital media

‘Digital prescribing’ – could tech provide the solution to loneliness in older people?

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Top research resources for social care and social services

The news in June that the Government’s Green Paper on social care will now be delayed until the autumn (having already been deferred since 2017) brought sighs of weariness rather than real surprise from the sector.

The recent focus on NHS funding, and the NHS’s 70th birthday, has also highlighted ongoing concerns that the funding crisis in other areas, including social care, mental health services and public health is being pushed to the sidelines.

What is clear, is that the need for evidence-based interventions, and proven value for money, is only getting stronger as budgets continue to be stretched.

The value of research

So, what’s the role of research knowledge within social work and social care? The Social Care Institute for Excellence has suggested that research can help practitioners and decision-makers to understand:

  • the social world in which those who use services live
  • why positive and negative events occur in the lives of some and not others
  • the relative success of interventions and their impact on these events
  • the role of the social care practitioner in relationships and interventions with service users
  • how social policies impact on the lives of people using services.

Studies such as cost-benefit analyses or randomised controlled trials are also part of the evidence base although they are less common in social care/social services than in health contexts.

Research takes place in different ways, with different aims. And the outcomes of research can be communicated in different ways. Blogs such as our own at the Knowledge Exchange aim to signpost readers to recent research on particular topics. Other good sources of accessible discussion of research findings include The Conversation blog and Community Care.

Meanwhile, database services such as the Idox Information Service or Social Policy and Practice will provide more comprehensive coverage of issues, bringing together research studies from other parts of the world which are transferable.

Social Policy and Practice

Many NHS Trusts and councils subscribe to the Social Policy and Practice database as part of their package of support for learning and development.

Recent feedback from users has highlighted its strong coverage of many current priority issues in public health, such as:

  • dementia care
  • delayed discharge
  • funding of long term care
  • safeguarding of both children and adults
  • supporting resilience and well-being
  • tackling obesity
  • asset-based approaches

As a UK-produced database, Social Policy and Practice also includes information on topical policy issues such as minimum alcohol pricing, sugar taxes, and the possible impact on the health and social care workforce of Brexit.

The database is produced by a consortium of four organisations: Social Care Institute for Excellence, Centre for Policy on Ageing, Idox Information Service and the National Society for the Prevention of Cruelty to Children.

Idox Information Service

With a wider range of topics covered, the Idox Information Service has been identified as a key database by the Alliance for Useful Evidence. Cross-cutting issues which impact on health and social services, such as poverty, housing, and social exclusion are covered in depth. It also covers management and performance topics.

The Idox Information Service also offers a range of current awareness services and access to a team of expert researchers, in addition to the database. The aim is to support the continuing professional development of hard-pressed frontline staff while also supporting the sharing of research and evidence across the sector.

Meeting the needs of the social care sector

Both Social Policy and Practice, and the Idox Information Service aim to increase the social care sector’s capacity for evidence-informed practice.

As battle lines are drawn over government funding, it’s clear that these will continue to be financially challenging times for public services and that demand for services will carry on growing. Investing in learning and development is one way to ensure that staff are equipped with the skills and tools to be the best that they can be. This in turn will ultimately improve performance and outcomes for the most vulnerable in our society.


To find out more about the history of the Social Policy and Practice database and the consortium of publishers behind it, read this article from 2016 which we have been given permission to share. Trials of the database can be requested here.

Read more about the unique support offered by the Idox Information Service. More information on subscriptions can be requested via the online contact form.

How to make people with learning disabilities feel more included in society

Image: Accessible music technology OpenUp Music/Youth Music Network

This guest blog was written by Val Williams, Professor of Disability Studies at the University of Bristol.

People with learning disabilities can often find themselves feeling excluded when it comes to making decisions about their lives. This can range from everything, from shopping to making music or even bringing up a baby. Sometimes this exclusion can be exacerbated by the kind of support that they receive from social services – but it can also be countered by sensitive personal assistance or support.

In a recent research project, which brought together disabled and non-disabled researchers, we looked at ways to improve this – and how to include people with learning disabilities in decisions.

Part of the project found that by taking active roles in the arts, people with learning disabilities can lead the way towards meaningful inclusion. Beth Richards, an actress with learning disabilities, led part of the research about people with learning disabilities on TV. She found that actors with learning disabilities are often limited to roles which depict the “disability”, the tragic or dependent life of the character, or their effect on others around them. A successful actor with learning disabilities, for instance, told her:

“I wish TV makers would think more creatively and give people with learning disabilities any role – romantic, fantasy, comedy, shop assistants, office workers. I’d like to play James Bond, Romeo, Dobby in Harry Potter or a detective or many other roles.”

The Queen’s Birthday Honours in June 2018 include an MBE to the actress with Downs Syndrome, Sarah Gordy, for her “services to the arts and people with disabilities”. As Gordy said upon receiving the award, “diversity is an opportunity, not a problem”. She is good proof of that.

But there is a lack of accessible information. There is no shortage of talented actors and drama companies supporting people with learning disabilities, but the TV industry and its workings are still shrouded in jargon. Processes such as commissioning, auditioning and scriptwriting tend to exclude those who do not have someone to help them navigate all this.

In another part of the research, my colleague Marina Gall looked in detail at how music making can be transformed by the Open Orchestras approach in which young people with multiple and complex needs are enabled to learn musical skills, play in ensembles and become music makers. A new technological instrument – the Clarion – can be played on computers and iPads, using one’s hand, a small sensor on any part of the body, or via a person’s gaze. It can be adapted to suit most students’ physical needs.

One of the co-founders of Open Orchestras, Doug Bott, told our research team, that the approach is “personalised around the individual young person”. But at the same time, it’s trying to ensure that music is an important part of the curriculum for all young people, and has been immensely successful in changing perceptions of people with learning disabilities. This is not therapy, it’s a route to making music and to performance.

Making decisions

People with learning disabilities also face inequalities and problems in the NHS, as well as in a cash-strapped social care system. For instance, since the Mental Capacity Act 2005 came into force, support staff are legally required to support people with learning disabilities to develop their own capacity to make a decision. What we saw in our data was that people with learning disabilities can be proactive in seeking out this support – and we recorded conversations with personal assistants where people wanted to talk about decisions relating to safety, health or simply about future cooking plans. The skills that a personal assistant needs to have are to listen, look out and be responsive to the people they are supporting.

One of the key messages from our project is that health and social care practices sometimes get stuck. We used the word “institutionalised” for those times when professionals stick to a rigid and inflexible way of doing things, leaving the disabled person without the power to have a voice.

These difficult moments were also highlighted by actors with learning disabilities who helped to interpret our data. Our research benefited from a collaboration with the Misfits Theatre Company in Bristol, showing how sensitive interactions between people with learning disabilities and their personal assistants were often the trigger for good decisions, and giving those with disabilities a feeling of control over their own lives.

But quite small comments can create problems, spoiling an empowering relationship. The theatre company made a brilliant video called A Good Match about their own perspectives and experience of managing relationships with a personal assistant. One of the Misfits actors said: “It’s my house … and I don’t want my (personal assistant) telling me what I can and cannot do.”

 

After looking at a range of activities that can exclude or include people with learning disabilities, we concluded that inclusion happens when three things come together. Sometimes people with learning disabilities are included because of changes to technology, as in the Open Orchestras approach. At other times, they are included better because of new ways of doing something, or through new skills that they may learn – as actors, or as TV performers.

The ConversationBut at the heart of all this is a new belief in the equal value of people with learning disabilities. This is why we recommend that social care services need to focus less on what people cannot do, but instead promote a genuine belief in what people with learning disabilities can do – with the right support.


Val Williams is Professor of Disability Studies at the University of Bristol.

This article was originally published on The Conversation website and has been republished with permission under a Creative Commons licence. Read the original article.

Going grey behind bars: meeting the care needs of older people in prisons

The population is ageing. People are living longer, and are in need of greater levels of care than ever before. But how is this increase in life expectancy and demand for care being met in prisons? Our prison population is also ageing, at a time when the sector is under increasing pressure, low staff numbers, higher levels of prison violence and disorder, and poor, crowded living conditions. In an environment which is largely designed to support young, able bodied men, how are prison staff and care teams liaising to help meet the needs of older prisoners?

A care plan for ageing prisoners

A report published in 2017 by the Scottish Prison Service called for a specific care plan for ageing prisoners to react to and provide planning to reflect the change in demographic of the prison population. The report found that between 2010 and 2016, the number of men aged over 50 in Scotland’s prison population rose by more than 60%, from 603 to 988. According to a Ministry of Justice report on prison population, the number of inmates aged over 50 is projected to grow from 12,700 to 13,900 by the end of June 2020, a rise of 9.5%, while the number of over-60s behind bars will grow by 20% from 4,500 to 5,400 over the same period.

In July 2017 Prisons and Probation Ombudsman produced the Thematic Review: Older Prisoners, which stated that HM Prison and Probation Service needs a national strategy to address the needs of the increasing numbers of elderly prisoners. It highlighted six areas where lessons still needed to be learned: healthcare and diagnosis, restraints, end-of-life care, family involvement, early release and dementia, and complex needs.

The difficulties older prisoners face on prison estates are far reaching. Not only are there physical barriers to moving around and living within a prison environment, but the increased mental health and social care burden is significant, as well as the potential need to begin end-of-life care. Many prison inmates suffer from multiple, longstanding and complex conditions, including addiction, and these conditions are exacerbated by a phenomenon known as “accelerated ageing”, which suggests that prisoners age on average 10 years faster than people of the same age in the wider community.

While some prisons have effective care plans which allow older prisoners to live with dignity, often older prisoners rely on the goodwill of officers and fellow inmates to meet the gaps in their care needs. And while in England and Wales the Care Act means that, a statutory requirement to provide care lies with the local authority within which the prison is located, this is not a guarantee. Calls have been made for care planning in prisons to become more robust, with minimum standards of care and a clear pathway of delivery, with accountability and responsibility of specific bodies being made explicit.

 

Prison staff, care teams and the NHS in partnership

Any care planning for older people needs input from a number of different sources, and care planning for older people in prison is no different. It will require input from professionals across health, social care, and housing and the criminal justice system as well as wider coordination support and legislative and financial backing from central and local government.

Prisoners with physical disabilities or diseases such as dementia need specialist care at a level that standard prison officers cannot give. Research has suggested that prison staff are being expected to shoulder this extra burden, often having to perform beyond their duty to care for and look for signs of degeneration in prisoners, particularly those who show signs of Alzheimer’s and dementia.

A number of research studies have looked at the provision of training and the use of additional, multi-agency staff to try to bridge the gap in care for elderly prisoners. In 2013 a review was conducted of multiple prisons, including some in England, the USA and Japan, which examined the training available on each estate for prisoners with dementia and similar conditions.

A number of schemes have been trialled, including extra training for staff, the allocation of specific wings or cells adapted to cater to the specific needs of older and vulnerable prisoners, and the use of peer to peer buddying or befriending services to help with care and support. Some prisons have also trialled the introduction of “dementia champions” to identify and support those with early signs of dementia or Alzheimer’s.

Extra challenges on release

As well as social care needs inside prison, specific rehabilitative needs of older prisoners being released from prison is also something that prison charities and reform bodies are keen to raise onto the agenda. A report from the Prison Reform Trust in 2016 highlighted the challenges of rehabilitative and parole needs of older prisoners, commenting that older people released from prison are being “set up to fail” by a lack of adequate provision to meet their health and social care needs on release. It highlights the limited and inconsistent housing, employment, debt and substance abuse advice available specifically for older offenders and suggest that their particularly vulnerable position puts them at risk of serious harm or reoffending.

Final thoughts

The population of older prisoners in our prisons is growing, and it is clear that a comprehensive strategy is needed to ensure that the specific, and at times unique care needs of these prisoners are met. This will mean greater cooperation from social care, health and criminal justice agencies, but will also mean reassessing how we think about social care, how it should be delivered and funded. The needs of older prisoners go beyond physical adaptations, to mental health, dealing with social isolation, the onset of chronic illnesses and at times the provision and planning of end of life care.

Follow us on Twitter to see what developments are interesting our research team.

If you enjoyed this blog, you may also be interested in our other articles:

Helping people with dementia to live well through good urban design

Planning for an ageing population: some key considerations

Co-production in the criminal justice system

Buurtzorg: reinventing district nursing in Scotland

Buurtzorg roughly translates from its native Dutch as “neighbourhood care”. The model, used extensively in the Netherlands, has attracted international attention as a novel way to deliver community based nursing programmes. Its positive reputation and recorded successes in areas of Holland are attributed to its innovative use of locally-based and locally-aware nursing teams to deliver high-quality person-centred, but low-cost, care.

Seeking to improve core health outcomes

In the Netherlands, Buurtzorg was designed to engage three key health priorities:

  • Health promotion
  • Effective management of conditions (in a community setting)
  • Disease prevention

It focused particularly on the elderly, those who move regularly between hospital and home, and those with long term, constant care illnesses. It has also been used with patients with progressive illnesses such as dementia, with some nurses within the teams being given training to become dementia specialists where appropriate.

The model includes the following key elements:

  1. Holistic and personalised care – where assessments of need are integrated into and form the foundation of agreed care plans
  2. Mapping networks of informal care, and assessing ways to involve these networks in treatment plans
  3. Identifying other formal carers and organisations who provide care services and coordinate their input
  4. Taking steps to support the client in his/her own environment
  5. Promoting self-care and independence on the part of patients.

A number of studies of pilot sites across the UK and beyond have identified the positives and some challenges of applying the Buurtzorg model in different contexts. Some of these are outlined in the table below.

Applying the model in Scotland

In a Scottish context, the model has been applied in a number of areas, with the initial pilots making way for a wider roll out of adaptations of the model. In March 2017, as part of a wider research project, nurses and management staff from NHS boards across Scotland met in Perth to discuss learning and exchange best practice around how the model could be adapted and further rolled out in the future.

It highlighted the different stages that many Buurtzorg areas were at in their roll out, with some like Aberdeen and the Borders far more established than Argyll, who were at the time only in the earliest stages of their Buurtzorg journey. The research and learning event gave practitioners the opportunity to engage and further cement both formal and informal learning networks, which have been identified as key to the success of the Buurtzorg model both in the UK and elsewhere.

The importance of information sharing and informal learning

Rolling out the model in test sites highlighted the importance of planning and learning, and of creating a strong sense of trust between practitioners and NHS management, but also between the Buurtzorg nurses and their service users and other professionals. This change in mindset regarding ways of working, and a change in the chain of accountability was something, which, according to those practitioners who attended the Perth event, many sites have found to be a significant barrier to effective implementation.

However it was also highlighted that promoting and facilitating the creation of formal and informal learning networks and learning spaces can be an effective way to generate conversation about best practice as well as allaying some fears that may persist regarding working culture and approaches, including partnership working with other agencies and understanding risk in the working environment.

In Scotland, approaches have varied, from encouraging nursing teams to create videos and then post them to an online forum, employing more formal training plans to incorporate multiple agencies and ensure that everyone is “singing from the same hymn sheet”, or holding informal drop-in or open space events where staff are supported in their role and given advice to alleviate and find potential solutions to issues.

Practitioners also highlighted that it is important to provide a space where teams can examine what did not work well, and why. Learning from mistakes can often be as beneficial as learning from good practice, as these can provide insights into issue management and resolution as well as how to implement the programme effectively.

It is also clear from feedback, that while a strong core network of nurses and other community based practitioners is vital to the success of Buurtzorg care models, the back team support is also just as important. Creating efficient and streamlined processes leaves nursing teams free to care for patients and allows them more time to develop and deliver the person-centred care which is a key element of the Buurtzorg model.

Final thoughts

Learning from the experiences of the trial projects in Scotland has provided invaluable insights on how the model can be applied and some of the challenges that can be encountered because of the differing context. This knowledge can then be used to shelter and steer newer projects away from danger areas toward best practice and innovative collaborative working. Applying Buurtzorg in Scotland gives the potential to create and implement new models of holistic person-centred care, where practitioners with local and specialist knowledge interact at a local level with other care providers, join up approaches and create a better care experience for service users.

Follow us on Twitter to see what developments health, social and community care are interesting our research team.

If you enjoyed this blog, you may also be interested in our other articles on health care and reablement care

 

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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From data to intelligence and improvement – what cutting edge councils are doing in the UK

Group of workers having a meeting

By Steven McGinty

Data has the potential to revolutionise the delivery of local services. Just like the private sector – where organisations such as Amazon and Facebook have leveraged user data – local councils have the opportunity to reap significant benefits from analysing their vast silos of data. Improving efficiencies, increasing levels of transparency, and providing services which better meet people’s needs, are just some of the potential benefits.

Although many councils are still at the early stages of utilising their data, some are innovating and introducing successful data initiatives.

Wise Councils

In November 2016, the charity NESTA published a report highlighting the most ‘pioneering’ uses of data in local government. The report emphasised that most local services would benefit from data analysis and that a ‘problem-oriented’ approach is required to generate insights that have an impact on services. The case studies included:

Kent County Council

Kent County Council (KCC), alongside Kent’s seven Clinical Commissioning Groups (CCGs), have created the Kent Integrated Dataset (KID) – one of the largest health and care databases in the UK, covering the records of 1.5 million people. The core requirement of the dataset was to link data from multiple sources to a particular individual, i.e. that information held about a person in hospital, should also be linked to records held by other public bodies such as GPs or the police.

This integrated dataset has enabled the council to run sophisticated data analysis, helping them to evaluate the effectiveness of services and to inform decisions on where to locate services. For example, Kent’s Public Health team investigated the impact of home safety visits by Kent Fire and Rescue Service (KFRS) on attendances at accident and emergency services (A&E). The data suggested that home safety visits did not have a significant impact on an individual’s attendance at A&E.

Leeds City Council

Leeds City Council have focused their efforts on supporting open innovation – the concept that good ideas may come from outside an organisation. This involved the initiatives:

  • Data Mill North (DMN) – this collaborative project between the city council and private sector is the city’s open data portal (growing from 50 datasets in 2014 to over 300 data sets, in over 40 different organisations). To encourage a culture change, Leeds City Council introduced an ‘open by default’ policy in November 2015, requiring all employees to make data available to the public. A number of products have been developed from data published on DMN, including StreetWise.life, which provides local information online, such as hospital locations, road accidents, and incidents of crime.
  • Innovation Labs – the city has introduced a series of events that bring together local developers and ‘civic enthusiasts’ to tackle public policy problems. Leeds City Council has also provided funding, allowing some ideas to be developed into prototypes. For example, the waste innovation lab created the app, Leeds Bins, which informs residents which days their bins should be put out for collection.

Newcastle City Council

Newcastle City Council have taken a data-led approach to the redesign of their children’s services. The Family Insights Programme (FIP) used data analysis to better understand the demand and expenditure patterns in the children’s social care system. Its aim was to use this insight to support the redesign of services and to reduce the city’s high re-referrals and the number of children becoming looked-after.

The FIP uses data in three different ways:

  • Grouping families by need – The council have undertaken cluster analysis to identify common grouping of concerning behaviours, such as a child’s challenging behaviour or risk of physical abuse. When a child is referred to long term social work, senior social workers analyse the concerning behaviours of the case, and then make a referral to a specialist social work unit. Since introducing this data-led approach, social work units have been organised based on needs and concerning behaviours. This has resulted in social workers becoming specialists in supporting particular needs and behaviours, providing greater expertise in the management of cases.
  • Embedding data analysts – Each social work unit has an embedded data analyst, who works alongside social workers. Their role is to test what works, as well as providing insights into common patterns for families.
  • Enabling intelligent case management – Social workers have access to ChildSat, a tool which social workers use to help manage their cases. It also has the capability to monitor the performance of individual social work units.

Investing in data

Tom Symons, principal researcher in government innovation at Nesta, has suggested that councils need support from central government if they are to accelerate their use of data. He’s suggested that £4 million – just £1% of the Government Digital Service (GDS) budget – is spent on pilot schemes to embed data specialists into councils.

Mr Symons has also proposed that all combined authorities should develop Offices of Data Analytics, to support data analysis across counties. Over the past few months, Nesta has been working on this idea with the Greater London Authority, and a number of London boroughs, to tackle the problem of unlicensed HMOs (Houses in Multiple Occupation). Early insights highlight that data analytics could be used to show that new services would provide value for money.

Final thoughts  

After successive years of cuts, there has never been a greater need for adopting a data-led approach. Although there are undoubtedly challenges in using council data – including changing a culture where data sharing is not the norm, and data protection – the above examples highlight that overcoming these challenges is achievable, and that data analysis can be used to bring benefits to local councils.


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. 

Grandparents – the ‘hidden army’ of kinship carers

mamy and the little boy

By Heather Cameron

Tomorrow is the International Day of Older Persons, designated by the United Nations in order to recognise the important contributions made by older people, while raising awareness of the issues of ageing.

Today there are around 600 million people aged 60 years and over world-wide. A number that is set to double by 2025 and reach 2 billion by 2050.

With people living longer and healthier lives, it is not surprising older people are playing a considerably more active and increasingly important role in society. Not least when it comes to contributing to the care of their grandchildren.

Extent of kinship care

Kinship care – when children are brought up by relatives or family friends in the absence of their parents – has grown markedly in recent years.

It is estimated that between 200,000 and 300,000 grandparents and other relatives are raising children who are unable to live with their parents. Common reasons cited for this include abuse and neglect, parental illness or disability, parental substance misuse, domestic violence or death of a parent.

In examining the prevalence of kinship care, drawing on census data, a recent University of Bristol study found that there has been a 7% increase in the kinship child population in England since 2001 – more than three times that of the population growth rate of all children in England, which was 2% over the same time period.

The study also found that one in two (51%) children were growing up in households headed by grandparents.

Positive outcomes

With regard to the children in kinship care, research suggests that they do ‘significantly better than children in care’, both emotionally and academically.

Indeed, a recent study on the educational outcomes of looked after children found that children in long-term foster or kinship care made better progress than children in other care settings.

The largest kinship carer survey in the UK, conducted by Family Rights Group, also highlights the effectiveness of kinship care in preventing children entering or remaining within the care system, to the benefit of both the child and the public purse. The data found that 56% of children had come to live with the kinship carer straight from the parents’ home, with 27% having been in unrelated foster care.

The caring contribution of grandparents has also been shown to have made a material difference to maternal rates of employment.

And as 95% of children being raised in kinship care are not officially ‘looked after’, billions of pounds are saved each year on care costs.

But while benefiting the public purse, and despite evidence that kinship children have better outcomes, many kinship families face a financial burden. The University of Bristol study found that 40% of all children in kinship care in England were living in households located in the 20% of the poorest areas in England (an improvement of only 4% since 2001), and three quarters (76%) of kinship children were living in a deprived household.

Impact on grandparents

As there is no statutory requirement for local authorities to make provision for kinship carers and no automatic right to child benefit, many receive no formal support; leading to financial hardship, and the stress that comes with it.

Many kinship carers have had to give up work or reduce their working hours, either permanently or temporarily. And this is often their main source of income.

A study from Grandparents Plus on discrimination against kinship carers found that of the 77% of grandparents that have asked for professional help, only 33% received the help they needed. And 30% said they didn’t receive any support at all.

The study also found that, overall, kinship carers score ‘significantly below average’ when it comes to their wellbeing.

Other recent research has suggested that regular and occasional care for grandchildren can impact on the mental health of grandparents. The findings indicated that ten additional hours of childcare per month increases the probability of developing depressive symptoms by 3.0 and 3.2 percentage point for grandmothers and 5.4 to 5.9 percentage points for grandfathers.

Policies that substitute informal with formal childcare, it argued, could improve the mental wellbeing of grandparents.

Of course there are positive impacts on grandparents too, many of whom find caring for grandchildren rewarding and who enjoy closer relationships with them, which can in turn have a positive effect on their health. As the research suggests:

the effect of grandchild care provision on grandparents’ health seems to depend on its intensity, the cultural context, as well as on its stability and change.”

Final thoughts

It is clear that grandparents play an increasingly vital role in family life. But it seems this role is in need of greater recognition and support, if society is to continue to benefit from this ‘hidden army’ of kinship carers.


If you enjoyed reading this, you may also be interested in our previous blog on the economic opportunities of an ageing society, published on last year’s International Day of Older Persons.

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The power of personal budgets

Image by Tristan Martin via Creative Commons

Image by Tristan Martin via Creative Commons

Described by supporters as having revolutionised the way the social care system in England is organised, personal budgets have developed to become the norm in social care commissioning in England.

One of the ideas underpinning personal budgets is the development of a new relationship between people who use care services and the organisations who provide them. The new approach was designed to move away from previous prescriptive services towards more bespoke, personalised models of care, where service users are directly involved in planning and deciding what care they receive, and how they receive it.

Within the personal budgets model an allocation of money is given to a specific person from their local authority, following an assessment of need. Money is allocated to the individual, who then works with a professional to work out the most appropriate support. The idea is based on the ideas of transparency, empowerment and personalisation of care.

There are 4 options for service delivery which recipients can chose from to best suit their care needs:

  1. Managed council budgets – where councils arrange the care that is needed following an assessment and an agreed set of outcomes to go alongside a pre-agreed care plan;
  2. Individual service funds – marketed as a more flexible option than local authority led management, this allows recipients to select an alternate organisation to manage an individual’s care budget, and deliver the required services;
  3. Direct payments – this option sees the money paid directly into the account of the person in need of support and allows them to buy care services from an agency or to employ their own carer, or a mixture of both;
  4. Mixed package – a combination of any of the options above, where recipients of support may give some of their budgets to a care provider (either a charity or local authority) but may get a portion of the budget paid directly to them so they can pay, for example, for additional carers to visit during the night.

Seniorin mit Pflegerin

Those in favour of personal budgets point out that the model promotes the personalisation agenda within health and social care in a way that no other policy does. It gives control of spending directly to the person in receipt of the support and has been heralded as a new age for transparency, increasing choice and control, reducing bureaucracy and cutting costs. Personal budgets have also become a key part of the health and social care integration agenda, as well as being highlighted within the recent reform of SEND (special educational needs and disability) care and provision.

Supporters also argue that one of the best and biggest changes between personal budgets and the original direct payment pilots are that personal budgets are designed to produce outcomes, not pay for a service. They are co-produced with the person in receipt of care, as well as professionals from a number of sectors, care providers and family, if appropriate, to ensure that care plans and agreed outcomes are established when the budget is allocated and that the payments achieve those outcomes.

pregnant carer giving pills and medication to her elderly pacient

However, studies have shown that there are big variations in service provision, choice can be limited and poor practice and processes can have a big impact on personal budget delivery and effectiveness. There has also been criticism of the high level of support within government for the model, despite the limited number of pilot roll outs and reviews into outcomes.

In 2016 a National Audit Office report was critical of the way that public services have monitored the impact of personalisation through personal budgets, as very little evaluation of their long term benefits and efficacy have been completed. The report stated that the Department of Health needed to “gain a better understanding of the different ways to commission personalised services for users and how these lead to improvements in user outcomes.” It is clear that there is a lack of evidence as monitoring does not allow service providers to understand how personal budgets improve outcomes.

Critics also argue that personal budgets are ineffective and cannot provide suitable care for everyone in need. They argue that there has never been, and never will be adequate funding to implement personal budgets properly. The principle is only effective, they argue, if there is an unlimited supply of both funds to pay for services and service providers delivering high quality service, which under current conditions of austerity there is not. Supporters counter however, that the concept of “self-directed support” is fundamentally a good one, but admit that poor delivery can deter some people.

Conclusion

Personal budgets can empower people in receipt of care, allowing them to take control of how their care is delivered. This recognition that care should be individualised is a big step forward for people who rely on care services on a daily basis.

However, reduced budgets, inconsistent service provision, and a lack of information for recipients has meant that some people have missed out on the benefits of personal budgets. In practice, services are patchy and evidence of actual benefits, in terms of improved outcomes, is lacking due to the limited number of research studies.

In order to fully realise the power of personal budgets for everyone in receipt of care, the provision, implementation and understanding of the model must be improved. Support for people to help them make the most informed decisions about planning their care packages should also be increased.