For more than 30 years, governments of all persuasions have promised a version of more care delivered closer to people’s homes, so the failure to move more care into primary, community and out-of-hospital settings must count as one of the most significant and long-running failures of policy and implementation in the NHS and social care.
Most recently, the new government has become the latest to commit to delivering this shift through their ambition for a ‘Neighbourhood Health Service’. The next few months will start to show if they can succeed where others have failed.
There are many challenges facing the primary, community and care sectors. For example, in June, GP practices delivered nearly 5 million more appointments compared with the same month in 2019, but this still falls short of meeting demand and patients are struggling to access care. The recent changes to the Additional Roles Reimbursement Scheme means more GPs can be recruited, but it won’t be enough to resolve the scale of the pressure facing primary, community and care services.
It’s not a short term problem, trends show that we have an ageing population, increasingly more people will have long term conditions, and more people will be living with multiple conditions. Moving more care into community settings could help alleviate the pressures on hospitals, treat and manage conditions earlier, all the while making care more convenient and accessible for patients.
The shift to a more community care focused NHS could be accelerated by bolstering digital technologies in GPs, pharmacies, community trusts and care providers to help reduce the number of people needing to access already over-stretched hospitals while improving patients’ independence, dignity and choice. But instead, too often, community providers are overlooked when it comes to targeted funding, tailored support and suitable tools that are needed to digitally transform and improve services with patients. This exacerbates the negative impact of digital tools available to staff and patients.
Digital experience below expectations
Technology and innovation will be essential to change community care to better suit staff, patients and people who draw on services, and is one of the ways that the government can deliver their vision of moving care closer to home. The King’s Fund’s recent publication, commissioned by Nourish, on digitally enabled care in the community explored the experience of people and staff in using digital technologies in out-of-hospital settings, as well as what the future could hold, if there’s an investment of funding and capacity.
We heard how the current digital experience in healthcare settings is far below people’s expectations. Patients shared examples of harm, which should not happen but does, because digital systems don’t join up. We also found a continued reliance on letters, which means safety critical information is sometimes delayed and even mislaid.
Staff are equally frustrated by technology that simply doesn’t work for their needs or isn’t provided. For example, district nurses who often work in people’s homes are sometimes equipped with laptops that are heavy and run out of power while also being unable to connect to the internet. Often, digital technologies used by those working in community settings are designed with hospitals in mind, making it harder for Allied Health Care Professionals to use the equipment, or sometimes they resort to far-from-ideal solutions such as duplicating work across multiple software systems.
Our research found there are other barriers too. Even newer initiatives like virtual wards can sometimes fall short of their full potential due to siloed ways of working, as the overall technology is commissioned by one provider organisation, but staff working closest to the patient, from a different organisation, don’t always get the training needed to support patients on how to use the technology.
However, it’s not all negative. The bright spots show what could be possible.
When records are shared effectively, we heard how care experiences are dramatically improved, and care is safer for patients. Staff have more confidence in their decisions and can deliver more for their patients, which in turn improves their own workplace experience.
When technology is suitably designed and configurable it can be used effectively, to be person-centred and improve independence and dignity. Technology that is configurable, combined with staff who have the skills, confidence and capacity can better shape the service around patients’ preference and capabilities. For example, this might mean an app on a tablet for one person or a tablet as a notification screen for another.
Technology is continuously advancing
Emerging technologies have the potential to transform care and empower people. For example, digital stethoscopes, augmented reality (AR) and point of care ultrasounds mean the staff member who is with the patient in a community setting can easily share medical information to a remote member of staff for guidance and specialist support. The ongoing miniaturisation of technologies also means more convenient access to diagnostics in the community, which could help unlock quicker diagnosis and more appropriate treatment options for patients, reducing long waits and waste. The developments in AI, robotics and 3D printing show technology can empower patients and support individuals to live independently by creating assistive aids and empowering patients to have more control of their living environments.
These technological developments have significant potential to enhance community based care, but to do so they also need further development and robust evidence. Some developments can also pose ethical questions on the nature of human connection in health and care.
It’s rare for out of hospital care to be the focus when it comes to the time, investment and staff support needed for digital transformation, and it can also feel like the technology is inherited from the hospital sector. This can be frustrating for patients and staff. However, recent research shows that when services have the digital basics, staff capacity and skills, and suitable technology, patient care improves.
The system is under significant pressure, and it can be difficult for leaders to know where to begin. A good starting point would be for the new government to invest properly in digital technology in community settings, as part of their mission to deliver more care closer to home.
Pritesh Mistry is a fellow in digital technology at The King’s Fund
