The Transformation of Care and Support Informatics as an Enabler, not a Barrier to Change

1. Informatics and the Care ActJoint Programme OfficeCharlotte BuckleyDepartment of HealthTina HornsbyPeterborough LA

2. The Transformation of Care and SupportInformatics as an Enabler, not a Barrier to Change • Care Act – delivering the most significant change in the legal framework, funding and provision of adult social care for over 50 years • Integration – Better Care Fund and Pioneers accelerating joint working and new models of care. Technology Fund supporting capacity building across sector, with a focus on interoperability and opportunity for Local Authorities to apply • Personalisation – increasingly putting the citizen at the heart of the system, in control of their care and support • Quality – seeking continuous improvement in the quality and experience of care • Prevention – exploring ways to reconfigure services to manage increasing demand Against a backdrop of - • Limited Resources – Local government facing challenging settlement, so we need to seek ways to drive innovation to better support staff and reduce burden

3. The Informatics Challenge Current Position Future Position User at the heart of the system, with the same level of customer service/ interaction as in other areas of life ASC professionals and providers embracing technology as a key part of getting the job done and reducing burden A fully joined up information ecosystem within health and care, and ideally other critical agencies (e.g. providers and VCS). Effective prediction (through analytics) and prevention (pre-emptive interventions) Dynamic market, open to innovation • Services designed with the provider/ commissioner in mind, not the end-user • Paper based processes, with professionals having to spend time processing information rather than supporting people • Silo-ed working, with often little information and intelligence shared between professionals or systems • Traditional market model, with small number of suppliers focusing on council back office systems

4. To deliver, we need to understand interdependencies Our ultimate objective is to provide higher quality, more joined up care to the service user, and to support them in taking greater control of their health and care. Citizen focused health and care • To achieve this, we need to take action across a number of different programmes to agree common approaches. These include: • Being able to share information securely across networks • Streamlining governance toolkits • Agreeing standards – starting with NHS Number • Promoting a more open technology strategy (Open APIs)

5. Summary of Informatics Priorities Nationally • Seeking to share data and increase interoperability between health and care systems, including scoping the case for information standards in ASC • Implementing the information system changes/upgrades required by the Care Bill • Encouraging bids to the Tech Fund to support the development of Integrated Digital Care records between health and social care • Supporting personalisation and addressing the resulting new data requirements • Improving information and advice to citizens • Encouraging greater innovation and diversity in the current marketplace • Embracing new technologies to drive greater use of digital services for local populations • Ensuring that there is appropriate sharing of data, in the best interest of citizens, including taking forward the Caldicott2 recommendations • Implementing the Zero Based Review and continuing to develop the adult social care outcomes framework (ASCOF)and the new transparency tool • Developing informatics solutions which support working with all providers especially voluntary and community providersand the independent sector

6. Care Act Cross-Cutting Themes • Scale: • Large number of self‐funders coming into the system • Much higher volume of data and information stored for longer • Case for replacing any manual systems with technology and investment in online assessment systems • Need for reduced admin burden e.g. pre‐population of data • Skills • Separate workstream on workforce development • Personalisation • Online information and assessment • Improved links to advice and care records • National consistency • Eligibility criteria • Deferred payments • Cross Boundary Working • Technology supporting information flows across agencies • Information Governance • Implications for data sharing, consent models, access to data and applications and services across networks. • Transparency • Being open and transparent about rules and processes

7. Service Specifications: Essentials • Universal Advice and Information: • Improved content – focus on needs of self‐funders and links with health/housing services • Increased use of nationally available information • Connectivity with sources of independent financial advice • Development of directories of services at local level (drawing on national level directories in time) • Assessments • All LAs will need to consider their assessment systems and ensure that they are able to scale up to increased demand • All LAs will need a system for recording carer’s assessments and plans. • Financial Assessments and Charging • This may require some changes to value fields (parameterised) • LAs will need a financial assessment system compliant with the Bill • All LAs will now need a system for managing DPAs • Interest rate – set nationally. Government still need to specify whether fixed to individual or variable

8. Service Specifications: Essentials • Care and Support Plans • Functionality to calculate PBs and IPBs either through RAS or alternative • Personal budget must include meeting all needs but only the cost of meeting eligible needs will count towards the person's cap on care costs. Systems should therefore be able to capture this information • New functionality to ‘meter’ (algorithm) including potential to ‘stop the meter’ (e.g. if individual moves into NHS funded care). • Ability to set different levels of cap for different demographic groups • Functionality to keep individuals updated on progress towards cap and inform individuals when they reach the cap (ahead of time) • The Act requires authorities to give people written confirmation of certain parts of the process, such as a copy of their assessment written confirmation of the determination on their eligibility, and a copy of their care and support plan • Reviews • All systems will need to have appropriate functionality to prompt reviews of care plans and to send out relevant information to individuals on progress towards the cap.

9. The Engagement Proposals • The Care Bill • Engagement with Local Authorities on confirming specifications for Care Act • Engagement with current suppliers on meeting the specifications • Engagement with potential suppliers on the market opportunities of the changes • Online Information and Advice • Personalised on‐line advice to follow on‐line assessment • information and advice to help citizens exercise choice – including information about providers and the continued development of e‐market places • Collection and use of data to support understanding of local needs and local market • Access to care and health records • Tools to support any or all of the above. • NHS Number – and wider scoping work on standards • We expect that correspondence between health and social care will use the NHS Number as primary identifier • Expect all new systems and software upgrades to have the NHS number built in as primary identifier – preferably automated via links to PDS/ Spine mini‐services or a batch process. • Expect all LAs who do not currently use the NHS number to have a strategy for implementing this across relevant systems

10. Engagement on Standards • NHS Number is one standard • Standards could also support • Secure email exchange • Portability of information between local authorities so data is transferred efficiently and effectively • Use of API’s • Great potential to innovate the market not just in social care • Probably more of a medium to long term solution

11. Questions • How much engagement would you want around the national work on IT and its applicability to the Care Act • Are there any specific areas where you would welcome further help and assistance? • Are there any activities you would expect to be happening nationally which have not been covered here? • Are there any activities which could be led by LGA or ADASS to support local authorities better? • Are there any major risks that we should be aware of?