Information technology could help adult social care departments to combat the severe financial and demographic pressures they face. But it may be some time before savings are fully quantified and realised, finds Gordon Carson, who looks at three contrasting uses of computer power
(illustration by Fred van Deelan/The Organisation)
Systems to help service users manage their own care
Many of us will have used the services of internet retailers to cut our Christmas shopping bills. By enabling service users to purchase and arrange their own care directly through an e-marketplace, technology providers may provide similar benefits for councils and users alike.
System Associates, based in Maidenhead, is developing internet-based technology to simplify the process of arranging care. Its Assist system helps users manage their personal budgets, purchase care and find information on the costs, quality and safety of providers. The company is working with Leicester and Leicestershire councils, which could be the first authorities to go live with Assist next month.
System Associates believes Assist can save money by enabling users to perform care management tasks previously undertaken by council staff, and by driving down the costs charged by providers because of the greater transparency an e-marketplace would bring.
The company plans to add to the Assist framework, including with facilities for users to assess their needs and plan their support.
“It’s going to save local authorities time,” says System Associates director Claire Simpson. “Anything where users can self-serve is almost certainly going to reduce the overall effort of the authority.”
Arlene Adams, managing director of OLM Systems, part of technology provider OLM Group, says there is likely to be a gradual transition to more online self-service systems so users can feel comfortable but retain access to core support from councils.
“There will always be social workers and people on the end of the phone if needed, just like in the banking world where you can still phone your branch,” she says.
“The rising cost of care means local authorities can’t continue to do things the way they are, so I think it will mean much faster adoption over perhaps a period of 24 months.”
If the consumer experience of online shopping is anything to go by, there are likely to be cost benefits for users who embrace technology and buy their own care. But local authorities will still have to invest up-front in technology, and it could be some time before they can quantify any savings.
Identifying people who will require services
Like a social care version of the film Minority Report, in which computers identify criminals before they offend, predictive case-finding technology has been touted as a way to identify people at risk of needing residential care or intensive services so authorities can intervene early and keep them in their own homes.
Although it’s hoped it will become a mainstream tool in social care well before 2054, the year in which Minority Report was set, the technology’s application in the sector is still in its infancy and the potential for cost savings is unclear.
Work on predictive case models for social care has been led by health research body the Nuffield Trust, building on systems already in place in the NHS.
Patients are assigned a score, reflecting their risk of an unplanned hospital admission in the next 12 months, after information on their medical conditions, treatment, response to treatment and admissions history is fed into a computerised algorithm developed by think-tank the King’s Fund. Those most at risk are referred to the virtual ward – a multi-disciplinary team led by a community matron – for early intervention.
Martin Bardsley, head of research at the Nuffield Trust, says there is potential for predictive case finding to analyse data from the health and social care records of many thousands of people, with information from different sources linked pseudonymously to ensure service user confidentiality.
However, there is still a lot of work to do before it can be applied in social care, and field trials may be two years away, he says.
Former Department of Health strategic finance director for social care John Bolton believes there needs to be much greater consistency in the social care data recorded by local authorities if predictive case finding is to succeed nationally.
“Technology is great but we have to rely on the data,” he says.
Telehealth and telecare
Telehealth’s potential to save money was identified in the evaluation of a Kent Council pilot project, which found it could save nearly £7.6m a year, about 2% of the adult care budget.
Telehealth technology is installed in the homes of patients with long-term conditions to enable them or their carers to take a set of daily measurements such as blood pressure, blood oxygen and blood sugar. The readings are monitored remotely by health professionals. It differs from telecare, which monitors movements through sensors.
One Kent telehealth user, Janice Maunder, is clear about the benefits. From a situation where she was admitted to hospital up to six times a year, the emphysema sufferer ended up in hospital only once in 2010. “By doing my measurements every day, I can see if I’m starting to go downhill,” she says. “It catches things early.”
Kent Council, with the county’s primary care trusts and equipment from telehealth company Viterion, established the telehealth pilot in 2005, enrolling 250 people with chronic obstructive pulmonary disease, coronary heart disease, or diabetes mellitus, to use the technology until July 2007. Of these, 137 still use telehealth, out of 591 current users in Kent.
The evaluation of the pilot, published in October 2010, found that telehealth brings peace of mind to patients and carers, supports independence, promotes better disease management by clinicians and patients, and delivers savings through fewer and shorter hospital admissions.
Over six months in 2006-7, telehealth saved an average of £1,878 per patient. Across the county, this would have produced the £7.6m annual saving. This accrues to the NHS, but the council is confident it can deliver social care savings too.
Initial concerns that the group targeted for the pilot – over 65s – would find the technology daunting were unfounded, says Hazel Price, the council’s programme manager for telehealth.
She also points to the benefits for carers. “People who look after others with long-term conditions have a high probability of suffering from a long-term condition themselves,” she says. “But as we reduced the carer burden, they felt the patient was supported and that enabled them to have more freedom. It’s likely that those carers will have less impact on the social care system.”
Kent says it is committed to telehealth, despite plans to save £21m in adult care over the next two years. The council has recruited 2,300 people to the £31m Whole Systems Demonstrator programme, a trial of telehealth and telecare across three authorities (Newham and Cornwall are the others), which will shortly report its findings.
In its vision for adult social care, the Department of Health said the trial would address the lack of “robust evidence” on the impact of telehealth and telecare.
“PCTs have been waiting for the Kent evidence,” says John Bolton. “Some of the technology companies have been waiting for it too, to look at how they pitch future products. We are at the edge of a technology breakthrough we probably can’t envisage.”
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