Technology is at the heart of tackling social care’s challenges according to Steve Morgan, partnership director for Agilisys, who has just produced a report Rethinking health and social care post-Covid-19 after spending time working with NHSX during the height of the pandemic working on finding technology solutions that could help the vulnerable and isolated members of the community needing access to care during the pandemic.
The work with NHSX allowed Steve and colleagues to develop a deep and broad insight into some of the social care challenges caused by the pandemic. He tells The MJ: ‘The intention of our white paper is to engender discussion with local government over how care can be delivered during and after the pandemic. Everyone who has parents or grandparents needs to look at the potential risks the care sector is facing and how loved ones can be cared for in addition to the potential big numbers that can be saved through technology.’
The challenges
The report identifies five key challenges facing the sector. The first is the UK’s ageing population with 20% expected to be over 65 by 2030, in just a decade, while the 85+ age group is the fastest growing demographic, set to double to 3.2m by 2041 and treble by 2066 to 5.1m, equivalent to 7% of the population. The next challenge is not just that the population is ageing but that very elderly people have multiple health problems and life expectancy has risen more quickly than healthy life expectancy. The average span of healthy life expectancy at 65 is 9.9 years meaning that those living beyond the age of 85 can expect a decade and more of ill-health requiring medical care.
The third challenge is in the economics of residential care with the private sector market, which subsidises public sector provision, increasingly squeezed by rising costs. Faced with profit margins of circa 10% and highly sensitive to increases in labour costs Saga, Care UK & Housing, Care 21, Mears and Mitie have all withdrawn from the publicly funded home care market with Mitie selling its home care business for £2 in 2017. Steve says: ‘The number of residential and domiciliary care providers will drop drastically. The only way they can survive is by charging more and the money has to come from somewhere. But the debate has become all about economics and moving away from people.’
The fourth issue is the pressure on local authorities caused by years of spending constraints. According to The Kings Fund, while funding has increased since 2014/15, it is still £400m behind the 2010/11 position, Under the Care Act councils have an obligation to ‘shape’ the care market but private providers are struggling. A survey by the Association of Directors of Adult Care (ADASS) in 2017 found that 39% of councils had experience of care providers ceasing to trade in the previous six months and 37% had contracts handed back.
The fifth challenge concerns the role of ‘self funders’ on whom much of the residential sector relies. In 2016/17 self funders paid £10.9bn on privately purchased care and they typically pay 41% more than publicly funded places. The COVID-19 crisis in spring in which many elderly NHS patients were discharged into care homes without any tests and subsequently developed the virus has put many self-funders off from moving into residential care. The report says a breaking point for the sector is if 10% of self-funders leave and the full cost of the sector then falls on the public purse. Steve adds: ‘There’s a huge amount of distrust about residential care because of the coronavirus. Most of these places have a profit margin of 10% and they need to be fully occupied. The key people are self funders and if you lose a self funder then that has a big impact. People who move their loved ones out of residential care tend to be self funders.’
The technology solutions
Steve Morgan says ‘it’s clear technology can play a big part in the future of social care.’ He cites the Helping Hands solution from Agilisys to tackle the data gaps between health and care highlighted when those at risk had to be shielded during the lockdown. Helping Hands is a software solution for councils initially designed to contact and register those shielding during the lockdown but expanded to other vulnerable users to identify their needs such as pharmacy pick-up, food parcel delivery or financial support. Management data could be monitored and reported in real-time ‘digitising the front door to care.’ Helping Hands can also help integrate complex care management systems.
A second area of growth is in communicating with the 750,000 people who originally volunteered to help health and care services during the lockdown. It is estimated that 500,000 volunteers will continue to be networked and connected via technology and using the Helping Hands software a ‘support bubble’ can be created around a home-based user with volunteers called in to help out on specific tasks finally delivering on the promise of ‘person-centric’ care.
A third area is remote healthcare usage with 50% of GP appointments conducted via video by mid-July. With each face-to-face appointment costing £30 and as many as ten video appointments able to take place in an hour the savings in both time and money from video calls are huge.
More in-house technology such as remote sensors which can reduce the need for home visits are also a potential saving; if just 50% of visits could be cut then a local authority with 2,500 cases could save £10m a year. The call centre will also change post-COVID with technology enabling the use of home-based staff, more virtual contacts and more pro-active early intervention, preventing the need for hospital care. It costs £400 a night in a hospital and £17 an hour for domicilary care,
The final section of the report explores three key actions; collaboration, creating robust cost-benefit analysis for the locality, and extend ‘horizon scanning’ of the technology marketplace.
In order to read further, the Agilisys white paper report is at https://www.agilisys.co.uk/rethinking-health-social-care-post-covid-19/