The current state of care

The UK’s social care sector is large and disparate, employing more than 1.5 million people and delivering care in settings ranging from care homes and hospitals to community centres and prisons. Alongside the NHS and the recently-introduced Integrated Care Systems (ICSs), it is those in the industry (and, in the capital, London Boroughs) that play a critical role in ensuring that society’s most vulnerable individuals receive the care they need.

But with around one in five of the population aged 65 or over and the number of people with comorbidities rising from 1.9 million in 2008 to 2.9 million in 2018, new approaches to care, greater levels of investment and innovative technologies all have an increasingly key role to play.

And that’s before you consider the impact of the 2007/8 recession on funding and services, Brexit on workforce shortages, Covid-19 on the demand for resources, and the cost of the living crisis on the price of care and employee wage expectations.

The public sector is responding to the challenges within the system

The good news is that the sector is responding. Across the care ecosystem, priorities, approaches and delivery models are being re-imagined to meet the needs of both today and the future. Here are some key trends to keep an eye on:

1. A shift towards patient-centred care

Whereas the focus of care delivery was once on the products, services and processes provided by the likes of care suppliers and the NHS, in recent years this has gradually shifted towards the people within this system. This includes both the workforce administering care and the patients receiving it, with principles such as fairness, independence, genuine choice and control, well-being and care in the community increasingly threaded through the fabric of care services. In December 2021, the government published ‘People at the Heart of Care’, setting out its vision for adult social care reform centred upon people. This is underpinned by investments in technology, including an additional £150 million to achieve widespread digitisation and drive technology adoption.

2. Care being conceptualised at a ‘place’ level

People may be at the heart of care, but it is places that are where care is ultimately administered. Whilst the UK has historically chosen institutional care, in which those with care needs travel to places such as hospitals to receive a service, the 1980s saw a shift in emphasis towards the concept of ‘care in the community’. This prioritises the principles of patient choice, independence and wellbeing by delivering care in people’s homes and is increasingly underpinned by advances in technologies such as broadband and sensors.

On a wider level, whole systems of care are being redesigned to join up people, places and the services that matter most to them. For example, the recent introduction of Integrated Care Systems (ICSs) is a ‘place-based approach’ that aims to better coordinate the delivery of care services among an area’s key actors, including the NHS, local authorities and the third sector. In techUK’s recent report, the trade body sets out what ICSs must prioritise to make digital, data and technology work for them and their populations. You can learn more about innovation in place-based care by listening to a recent techUK podcast episode or checking out the ‘Health and Wellbeing’ day of the trade body’s flagship Digital Place Week 2022.

3. Greater interoperability and data sharing

The larger and more complex a system, the greater the potential for digital or technological solutions to navigating these challenges. The social care system could benefit from this relationship, provided its constituent parts communicate effectively with each other. This is no easy task, both from a technical and cultural perspective. In February this year, the government published its ‘Joining up care for people, places and populations’ white paper, setting out its proposals for health and care integration. This takes the key enablers of integration (workforce, digital and data, plus financial pooling and alignment) and proposes a series of reforms that will enable care services to work better together. These are then built upon in the NHS’s draft ‘Standards and Interoperability Strategy’ and Chapter 4 of techUK’s ICS report, and mobilised through techUK’s Interoperability Working Group.

To ensure the supplier market is clear on the expectations of local government, LOTI crowdsourced and then developed wording that can be used in technology tenders and contracts that ensure interoperability of systems and access to data are no longer points of contention in contract discussions.

The immediate collaboration opportunity

The introduction of the Care Cap reforms presents an immediate opportunity for collaboration between boroughs and the industry. For boroughs, we know this will mean rapidly re-thinking and re-designing processes and parts of their technology infrastructure to allow for the successful assessment of care costs. LOTI’s previous work on helping boroughs to achieve better technology procurement outcomes revealed the complex nature technical architecture in boroughs is more often than not centred around a handful of large suppliers. This, we found, presents significant challenges for boroughs to engage with innovators, particularly when technology bolt-ons have been added over the years to improve functionality.

Saying this, LOTI’s engagement with boroughs over the past three years has shown that their appetite to engage with innovators has significantly increased particularly when innovations are able to evidence improved outcomes for people (both receiving and delivering services) in a cost effective way, over the long term.

One other factor, that we found is often a barrier to better engagement with the innovator market, is the procurement regulations (or perception of). To address this and help boroughs understand how they can engage as early as possible with the supplier market, LOTI developed a guide to innovation in procurement, which covers more specifically the activities and approaches that boroughs can individually and collectively undertake prior and as part of procurement, to explore ‘the art of the possible’.

What suppliers can do to better engage with boroughs

1. Start conversations with real world improvements or specific needs the solution offers, rather than functionality.
2. Understand the needs of the people who receive the service, be it social care or otherwise.
3. Be curious about the experience of frontline workers and involve them in product development.
4. Offer regular product development sessions.
5. Be transparent and clear about the functionality of your solution (including interoperability, data standards etc.) and cost implications (particularly on-going costs).

Truly re-inventing the future of social care involves not only technology but also different parts of the systems working together

Everyone recognises the importance of technology in delivering and administering care packages. There are numerous examples of emerging technologies such as Internet of Things (sensor devices) and Assistive Technologies (ATs) that have enabled people to live better, and longer lives independently. LOTI’s AT library and research report highlight and showcase the effectiveness of some of these solutions in the real world.

There is no doubt that these emerging technologies are making a significant contribution to improved outcomes for people.

However, to truly re-invent or re-imagine social care requires much more than that. LOTI’s upcoming work on new service models in adult social care seeks to explore with partners from all sectors the possibility to adopt radical ways for addressing needs in fundamentally new ways. Our research on social care innovators, has revealed that the marketplace is flourishing, with numerous solutions either ready for deployment or in advanced prototype stages. Complementing this, our research on new service models found that organisations, particularly those in the third sector are taking advantage of emerging technology to re-invent care provision.

In summary, at LOTI we firmly believe that, more radical thinking is needed for services to be financially sustainable over the long term whilst delivering quality care that meets people’s heightened expectations for these services.

For updates on LOTI’s work on this topic, please visit the LOTI website.

This article was co-authored with Rory Daniels, former Programme Manager for Social Care at techUK.