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Adult Social Care & Health - Being Digital strategy, 2020-2023

Foreword

This strategy is an ambitious programme that sets out a vision for digital capabilities that meet the range of needs of both our community and workforce, in order to support and enable effective service delivery.

Through the use of technology we will support residents to have access to the information they need to make choices about their care and support and to engage with us in a way and at a time that suits them; we will enable users of Adult Social Care services to have greater access to and ownership of their records; and we will support staff to have the tools, systems and equipment they need to do their jobs.

We will do this by working with teams, services, residents, carers and other organisations to look at opportunities to simplify processes and provide greater accessibility through digital tools, in order to improve outcomes for people and allow better co-ordination of care across the NHS and Social Care.

Being Digital is not about replacing our services with digital only options; it is about enabling and encouraging those who can use digital and online tools to do so. Making services available digitally can bring about many benefits, including saving time and effort by making services available at a time most suitable to users; and providing quick and appropriate channels when we are contacted for advice and support. We are committed to user involvement, at every stage, and to continually develop and improve on what we have.

This Digital Strategy, through driving digital innovation and the use of technology, will help us to achieve the best possible health and wellbeing outcomes, supporting people to live independent and fulfilling lives in their own homes and communities and provision of the highest-quality care.

Departmental Management Team
Adult Social Care & Health,
East Sussex County Council


Introduction

Digital technology is everywhere. The speed of innovation; affordability of hardware; and a greater desire for convenience in sectors, including entertainment, shopping and banking have all led to ‘digital’ becoming an integral aspect of our daily lives.

This ubiquity has also spread to the workplace. In Adult Social Care & Health (ASC&H), all policies and procedures are digitised and available on the intranet; every frontline worker, and many support staff colleagues, have a workplace-issued smartphone; interactions and interventions with clients and carers are recorded digitally; and members of the public can read information online about social care provision and services in East Sussex and engage with and manage their own services, such as sourcing support or self-referrals.

There are multiple challenges facing ASC&H in becoming digital. In a period of financial constraint, the adoption of any new technologies needs to be targeted and release efficiencies. Established business processes and protocols may need to be disrupted. Staff have to feel empowered and confident in using new technology; there must be acknowledgement that this will take time and will have to take place around existing workloads. Finally, there exists a challenge for local authorities to keep pace with societal expectations; from renewing a passport and opening a bank account through to watching on-demand films, so much can be transacted easily online.

It is important to recognise that ‘Being Digital’ is not about digital technologies per se. Whilst these are the enablers it cannot happen without a fundamental shift in organisational culture away from favouring traditional channels  such as face-to-face, to prioritising digital ones such as online. This has the potential to change the relationship between services and their users as well as altering the way that staff work. As a result, the new ‘being digital’ vision is much a cultural change as it is a change of delivery.


Aspirations

  • We can meet growing demand for adult social care and target resources where they are most needed
  • We ensure that our workforce is working as efficiently and effectively as possible with the tools required to enable them to do this
  • Ensure our systems support and are driven by practice, not that practice is driven by our systems
  • That we look to reduce or eliminate where possible unnecessary effort that we have a range of appropriate and accessible on-line tools for use by staff, clients, carers, and external agencies
  • That we enable people to engage with us in a way that suits them That we support people to access the right information at the right time so that they can make informed choices about what to do next
  • That people can access the information they need flexibly and when they need to– not just during ASC’s working hours
  • That people contact ASC because we will add value to their situation, not because they don’t know what else to do
  • We want to optimise how our resources are used – working with those who need us; not creating delay and disappointment for those who don’t.

We don’t want to:

  • Dissuade people from contacting us – this is about empowering and enabling people to identify the best option for them
  • Remove the human element – we recognise that people enquiring about social care may be stressful/confusing; if they want to speak to someone, we will make that easy.

An analysis carried out in May 2018 showed that, in a sample of 2,762 contacts received into HSCC, only 38 led to a support plan. This is a conversion rate of 1.4%. In fact, a mere 14% of contacts led to an assessment of need tool (ANT) being completed, which suggests two things; that most contacts are not primarily about new clients, or that their queries are being met through information and advice.

Even if contacts around information and advice are in the minority, if clients’ questions can be met primarily through digital it could represent a significant saving to the business. The same analysis states face-to-face contacts cost, on average, £8.21 per transaction; phone calls £2.59; but those contacts through the website cost only £0.09.

Technology should not be used for its own sake, but to widen participation and access. In the care and support sector, human beings must always remain at the heart of everything, but there is a place for digital, virtual and augmented reality, artificial intelligence and robotics where it presents an efficiency for the business and an improved offer for the client. The recent COVID-19 pandemic, and radical shift in the way that many of us have found ourselves working, has also accelerated the need for alternative solutions to traditional processes.

We know that technology alone will not solve all the challenges facing social care but it can, under the right conditions, be an enabler of preventative, personalised and joined up care and support

This document should be referred to as the guiding framework through which the above aspirations can be achieved.


Vision

Our vision for digital and associated technologies in Adult Social Care & Health can be summarised as follows:

“We see digital as having the potential to enable and empower communities and residents to live their best and most independent lives possible. We will achieve this through a skilled workforce, a constant focus on user needs and a willingness to adopt new technologies.”

Principles

  1. Client-led continuous service improvements
  2. Digital inclusion
  3. A “digital culture”

The following will underpin our vision:

  • User involvement, at every stage
    • Undertake digital development, based on user need
    • Improve solutions in response to user feedback and evolutions in user behaviour
  • Transforming ASC services using digital tools to enable community capacity and manage service demands by enabling people to help themselves
  • A strong culture of evaluation, data and insight
  • Interoperability of systems, both within our own products and with our partners’
  • A skilled, confident workforce comfortable with new technology
  • A clear direction of where we as a department wish to take digital in the medium- and long-term 

We will explore each of these aspirations through four different strands; people, practice, providers and partnerships. Under each heading we shall also provide Some case studies of what we are already doing and some examples of what we might do differently

Digital exclusion

The Office of National Statistics (ONS) records the proportion of non-internet users as halving between 2011 and 2018, down from 20% of adults to 10%.

However, the 2018 Lloyds Bank Consumer Index goes a little further, by defining an internet user as being able to do a single task in each of the following areas:

  • Managing information (using a search engine, visiting a previously accessed website, etc.)
  • Communicating (sending an email, posting on social media, leaving a message on a forum)
  • Transacting (buying an item or a service online)
  • Problem solving (verifying a source of information or solving a problem with a device using online help)
  • Creating (completing online application forms, using digital to create new artwork, video or music)

Using these metrics, the report estimates 8% (4.3 million people) of the UK adult population have zero digital skills, and a further 12% (6.4 million) could be classed as possessing only limited skills. The Centre for Economics and Business Research estimates the number of adults still lacking in digital skills by 2025 will number 7.9 million.

The ONS study shows the south-east region has a low rate of non-internet users when compared to the national average, and the highest number of people who fulfil the criteria of being a skilled internet user, based on the Lloyd’s Bank definition.

Breaking those figures down further, it’s revealed that of those who are classed as non-internet users, 55% come from adults aged over 75, and 24% of those aged 65 to 74. Disability is also a key consideration; in 2017 it was recorded that 56% of disabled adults were non-internet users.

Given the work that ASC&H does to support many people within either (or both) of these cohorts, it is important that alternative channels remain open and accessible to all clients and carers. In addition, our aspiration is that nobody is disadvantaged or receives a lesser level of service because they lack the skills to engage with digital resources.


People

We want to empower and support people to do more for themselves through online self-service, including needs and financial assessments and real-time information about services.

Our ethos around care and support is putting the cared-for individual at the centre of the decision-making process. Person-centred care maximises the choice of the individual, promotes independence and seeks to build upon existing strengths and abilities.

This approach also needs to be reflected in the way that we design our digital products. Users need to be involved in the lifespan of all major projects with a customer focus, and iteration of existing products should be led as much by user testing as it is by the needs of the business. 

Case study: Adults Portal

The ASC&H website offers clients, carers or even third-party referrals into social care via the adults portal.

Here, people can input information about their needs and financial circumstances and receive indicative advice as to whether they would be eligible for either care and support or financial assistance.

Functionality currently exists for carers to submit full assessments, which in most circumstances means that no further evaluation of their situation is necessary.

Most recently, the portal has been expanded to include the ability for anyone to raise a safeguarding alert about an individual online.

In the future, we are also looking at whether the portal can be used for simple reviews (such as instances where a client may only have one or two pieces of telecare equipment). Another feature being explored will be the ability for clients to interact with their case workers and exchange documents electronically.

Opportunity: Artificial intelligence in chatbots

Driven by the volume and range of enquiries that come into the Blue Badge Team (disabled car parking badges), ASC&H put itself forward to pilot any developments the council wished to pursue with chatbots.

The data coming in from our website was twofold: that the Blue Badge pages were frequently visited, and that they did not answer every question asked by clients. This insight was reached through a combination of complaints, Google analytics and feedback submitted through customer thermometers.

In response, the Blue Badge pages were redesigned, and the new national badge processing system was integrated into the content. Both measures have been successful at reducing the levels of dissatisfaction, but chatbots continue to be explored thanks to their potential to help with multiple areas of business.

Current viable iterations of chatbots include use a combination of user knowledge base input and machine learning – essentially, crawling the website for information and refining answers through experience – to aid users. Modern chatbots can be deployed on a site all hours, assist with filling in forms, work with voice operated virtual assistants, and even hand off to a human being if required.

Of course, in social care we are often dealing with vulnerable people, so risks need to be assessed; for example, we would need reassurance that any attempt to report a safeguarding concern through a chatbot would not get lost. However, the notion of a chatbot that can direct users to the right information and resources remains an exciting prospect.


Practice

We want to empower and support staff to use digital tools to create efficiencies and improve service delivery, for example agile working staff, digital contacts with clients, video assessments to reduce visits, artificial intelligence to manage routine tasks. 

Our staff are the most important factor in our success at delivering high quality care and support. It’s said that the one constant factor in local government is change, and that maxim is nowhere better embodied than Adult Social Care & Health, where we expect our workforce to adapt to the introduction of new legislation, the demands of continuing professional development and restructures within the department, the council and the wider health and care sector.

Additionally, we are now asking staff to familiarise themselves with a host of technologies, the merits of which may not be immediately apparent. Very few people get into social care because of their passion for digital.

This is why it is imperative that when we consider introducing new technology into social care settings, we commission, design and test with practitioners in mind if they are expected to be end users, or if they are advocating it for client usage.  We also need to ensure that there are clear expectations as to how we expect staff to work and support and training available to them to enable them to work in the way required.

We also need to acknowledge that there are groups of staff who continue to use paper resources, either due to perceived convenience or historical work practices. Getting our staff to use digital to its full potential will take more than just pointing out its advantages; it will also involve, in some areas of the business, a wholesale change in culture.

Case study: Digital inductions

Prior to the lockdown imposed due to the pandemic, the first digital induction took place with new starters at Health and Social Care Connect. This was done to upskill them on all the digital services that the council and its partners offer to boost wellbeing and independence.

Some of the topics covered include:

  • East Sussex 1Space: the ASC&H online care and support directory
  • ESCIS: the local community, events and activities directory
  • Library services: including e-books, audio books and free access to online versions of magazines
  • Local healthcare: including online GP consultations

Feedback from attendees was entirely positive, and we shall seek to hold similar events in the future.

Opportunity: Remote assessments

The need for social distancing during the pandemic has hastened the need to explore new ways of determining a client’s circumstances without meeting in person. Using the postal system, telephone or video chat works well when determining, for example, an individual’s financial situation; but what about a service such as occupational therapy, that has traditionally required a practitioner to assess a client and their home in person?

NHS Health Education England have a solution: remote assessments using what are known as ‘mixed reality’ environments. This is, very simply, a merging of real and virtual worlds, where physical and digital objects co-exist and interact in real time.

In practice, this potentially means that an occupational therapist can conduct a review of a person’s home without leaving the office. The client (or carer, or family member) would only need a device like a tablet or a smartphone and the ability to move around their property. The images are relayed back in 3D through a virtual reality headset, and in turn the occupational therapist would be able to mark up where adaptations are potentially needed or even insert virtual representations of equipment into the spaces, viewable by both parties.

As of the summer of 2020, this is technology not only available to local authorities and healthcare providers, but already in use here in East Sussex; remote assessment tools have been trialled by the ASC&H Occupational Therapy Housing Team, as well as social workers in Children’s Services.

It must be acknowledged that an assessment taking place in this manner relies not only on client cooperation but also ownership (and ability to use) internet-enabled technologies, which should never be assumed. In addition, remote assessments are – currently – no substitute for in-person visits, especially in complex cases. Should conditions return to the point where in-person assessments are once again safe to conduct, remote assessments could be still offered as a quicker, more convenient option consequent to an appropriate risk assessment.


Providers

We want to support and enable care providers to use technology, to change the way services are delivered, to improve efficiency and to reduce errors, travel time and risks.

Within ASC&H, much of the delivery of care and support services is done through third-party providers. These range from large organisations with a national profile right the way through to sole operators. Within such a diverse group, it is inevitable that the ability to purchase, train, use and evaluate digital technologies spans a wide spectrum.

This strategy does not seek to impose uniform standards on providers. We would not expect a lone personal assistant to abide by the same standards as a large housing association. What we do envisage is that all our providers are comfortable with the technologies appropriate to their situation, and furthermore, that they can be confident at referring their clients to take up our digital offer.

Case study: Provider portal

Making the provider portal the default way of submitting information to the department would be a crucial step in terms of business efficiency. The benefits work both ways:

As things stand, providers can do the following through the portal:

  • submit actuals;
  • manage invoices;
  • manage contracts;
  • manage payments;
  • manage queries; and
  • view historic data about their service.

In turn, ASC&H can:

  • operate using just the one communication tool
  • administer payments and queries efficiently, as the portal feeds data directly into the ContrOCC backend database for ASC&H to process
  • provide updates on queries via the portal for tracking

Opportunity: Provider digital forums

It is no good if ASC&H forge ahead with developing its digital offer if partners and providers are not considered. We do not exist in a bubble, but as one of the hubs in a complex and ever-shifting local care economy. If we do not actively include our providers when considering or implementing widespread system change, at best we may only see an incremental improvement in performance; most likely we will be at a standstill.

To that end, ASC&H have instigated provider digital forums, albeit these have been placed on hold during the pandemic. The purpose of these forums are as follows: 

  • To inform providers about our offer, both to them and the clients they work with;
  • To share best practice with organisations who may not be able to draw upon the same resources or expertise as ESCC; and
  • To hear from providers themselves as to what they would like to see as the most useful digital developments from their perspectives. 

The first of these was led by ASC&H, but included involvement from Library Services, Digital Services and the local NHS CCGs Primary Care Digital Team. One of the most consistent items of feedback received was the pleasant surprise about how much could be done online; from holding video GP appointments, to self-referring into social care through to accessing free audiobooks and magazine subscriptions. 

The ability to do all these things, and more, is not merely a question of convenience. Where people have mobility issues, anxiety about going out or using the phone, or perhaps live in rural communities with little local infrastructure, using these channels to maintain wellbeing could prove crucial


Partnerships

Social Care and Health achieve better outcomes when they work together. The Sustainable Transformation Partnership (STP) has a key role in setting out a common vision and purpose. Being Digital sets out our vision for digital social care services that closely align with STP digital ambitions and makes full use of shared technology investment.

The division between health and social care is not always obvious, especially to members of the public. That is why we need to promote the notion of ‘no wrong door’ – that if a client coming to us has their needs best served by healthcare partners, and vice versa, they are referred to the correct destination without complication. To achieve this aim of a seamless service, digital has a role to play to ensure that systems can communicate with each other.

A client should not have to tell the same story repeatedly. Whilst observing best practice around privacy and data security, partners should be able to share and update client information with the expectation that it can be easily stored and accessed on each other’s’ recording systems.

Case study: SingleView

This supports multi-agency information sharing by pulling and displaying data from social care systems other key partner organisations such as education (Synergy) and the NHS (SystmOne).

There are currently 243 external professional users (e.g. schools, GPs, the probation service, police, some voluntary organisations) who get a view of data such as organisational involvements, worker contact details, family relationships and case status. This is now being expanded out into ASC&H and community nurses.

Opportunity: EMIS into LAS

Health and Social Care Connect (HSCC) receive hundreds of referrals from GPs per month.

Currently, this information is manually input into LAS by HSCC personnel. This project is looking at how these referrals can flow from primary care (using EMIS, the patient records system most commonly used in East Sussex) directly into LAS.


The story of Fiona’s mum: how digital could work in practice

Below is a short scenario bringing some of what has been mentioned in this strategy together into a narrative that could feasibly take place in the near future.

Fiona’s mum

Fiona is a busy woman – she has a partner and two children, she’s working full time, and her family have recently moved back to East Sussex, where she grew up. Like many of us, Fiona is feeling a little guilty that she hasn’t visited her elderly mother as often as she would have liked to, so she’s happy to be close by.

However, during her latest visit, Fiona realises that in the time she’s been away there’s been a visible deterioration in her mother’s ability to get around her bungalow. Her mother, who has been very independent all her life, tries to laugh it off but her mobility difficulties are evident. Troubled by the visit, Fiona feels at a loss as to what she can do to help. That evening, she switches on her laptop and decides to ask Google what she can do.

When looking for ‘home help’, ‘mobility help’, or ‘walking aids’ the same site keeps cropping up, especially when Fiona includes the local area in her search: East Sussex 1Space. It’s a directory full of useful information, and services that look like they could be useful, but it’s all so new to Fiona. She sees it’s run by East Sussex County Council and decides to click through to the council website.

It’s now quite late in the evening, so Fiona is surprised to see she can chat online with somebody – except that straightaway, her correspondent identifies itself as a chatbot. It asks Fiona a few questions about her enquiry and recommends that she fills out a social care referral form on behalf of her mother, sending her the hyperlink to the portal and giving an expected response time from the moment it is submitted.

As a busy person juggling a job and children, Fiona is happy; she can do this at any time, and even save progress to come back later if necessary. Having finally got her mother to agree to an assessment, Fiona completes and submits the form. 

Within a couple of days, she is contacted on the phone by a friendly individual from Health and Social Care Connect, who suggests that Fiona’s mother would benefit from an occupational therapy assessment. As her mother struggles to get around, it is suggested that she can do a virtual assessment of the property; all that is required at Fiona’s end is a smartphone or a tablet. On the agreed date, an occupational therapist asks Fiona’s mother questions over a webcam; afterwards, the therapist dons a virtual reality headset, which interfaces with Fiona’s tablet.

Using the tablet’s camera, the occupational therapist is taken on a tour of the home without leaving the office.  The occupational therapist is able to record the assessment information in real time and email a copy of the paperwork to Fiona immediately after the assessment, saving them time typing up handwritten notes and ensuring a speedy response for Fiona.

Later, once the home adaptations have been put in place, Fiona is informed that they can use the online care account set up for her mother to send messages or submit reviews to Adult Social Care & Health when necessary. Later on, when it’s discovered that her mother has developed a leg ulcer, the information held by East Sussex County Council about her living situation is transferred over to the local healthcare trust and made easily available for the visiting district nurse to view.

Using digital technology, a person-centred approach to care and proportionate reviewing methods that do not burden the client, Fiona’s mother has regained her independence around her home, and Fiona has peace of mind that she can reach out for further support if required.


Conclusions

This strategy sets out how, by adhering to the vision, we in ASC&H will seek to implement digital developments for the foreseeable future.

Although technologies will change and evolve, the principles of user involvement, a skilled workforce, a culture of iteration and the forging of closer integration with our partners and providers will form the bedrock of our approach.

Despite this being a digital strategy, it must be acknowledged that digital has its limits. To date, not a single technological innovation has been able to reproduce the qualities of empathy and compassion that form the fundamental core of the very best care and support practices. Nothing can supplant face-to-face interaction; but we can look to digital to help us be more efficient, more effective and more responsive.

Delivering our aims

This document provides an underpinning set of principles by that should be observed when developing our digital offer.