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The Four Futures for Health and Social Care Report examined four possible scenarios for integrated health and social care by mapping future landscapes for the sector. In response to this, we considered the role of software systems and related technology in making these four possible futures a reality.
Both papers consider the most centralised and the most devolved scenarios, from a centrally driven approach with a strong national framework, to solutions being developed locally, based on regional priorities. They consider whether the service provision will be driven around professionals, or whether it will be more user-centred. Also, both papers illustrate how important technology will be to ensure the sustainability of public services.
Regulated consumerism – Future 1
Regulated consumerism envisages a centrally-directed future where there is strong national standardisation and personal health and social care budgets are the norm. Individuals are means tested against national criteria and then use a combination of benefits and payments to access the care that they choose.
So how would this look in terms of technology? We could expect large-scale national citizen portals and e-marketplaces, with social care and health records integrated into a single record, including personal budgets. With shared services, intuitive professional portals would become increasingly important, so that health and social care staff can access both systems.
We’ve likened this to the Tripadvisor model, where the individual (or their family) is proactive in both researching and applying for care. The obvious advantage is that of significant personal autonomy. The drawback is that those without family or carer support may be unable to cope and be reliant on their local community or the third sector.
Me in my place – Future 2
Me in my place is a future which maintains the ‘user-centred’ ethos of Future 1, but which features locally directed provision, where services are commissioned and managed locally. Local authorities work closely with local providers and local third sector involvement is strongly developed. Community hubs are popular and local GP practices are co-located with social care. Just as in Future 1, citizens use a portal to manage their care choices and personal budgets, but this would be a much more localised portal with strong engagement and collaboration from local carers, services and third sector.
Technology would play its part, both in the shape of the self-service portal and in business intelligence and early intervention – local commissioners would use data analytics to understand where needs aren’t being met, or where there is surplus provision.
With more collaboration between services made possible by flexible software solutions, more preventative interventions are possible, but services may vary from one area to the next and it may lead to a feeling that you’re better off living in one particular area rather than another, should you need care.
Local drift – Future 3
This is the future closest to where we are at the moment with health and social care initiatives being driven by regional Service Transformation Plans and Clinical Commissioning Groups., and where some local authorities have started work together, such as Manchester, to better fit with health service economies of scale. The drive to full user control with personal budgets has mixed success, with profession centred control still persisting.
When you consider the increasing demand on today’s health and social care services, and the difficulties we face in meeting this demand, it’s arguably, if taken by itself, the least sustainable future of the four. It lacks a strong drive in any particular direction which is a bar to the transformation required within health and social care for a sustainable future.
It may, however, support one of the other futures as a blended scenario, applying a number of the self-service elements of the user-centred futures, serving to empower citizens in care choices, whilst ensuring the most vulnerable are protected by social workers.
Care as a benefit – Future 4
In this centrally directed future, profession-led social care could become part of the welfare system, funded by national benefits, rather than through council budgets. Although there is more scope for nationally-let provider contracts, the delivery of care could still vary significantly from area to area, depending on the level of provision.
Social care systems would be integrated with Universal Credit, with the IT needing to be capable of integrating data from social care and revenues and benefits so that everyone involved, including the service user, has access to a shared portal through which these elements are managed.
This future envisions a reduction in social care funding and would offer less opportunity for preventative investment and joined-up services. Some of the most vulnerable may be dependent on community support being available and it would represent a cultural shift for social workers as assessments of need would be more akin to benefits assessments than holistic care considerations. This future seems the least likely, although paying for social care support through the existing benefits system does offer a potential future.
A blended approach
So which future do I think would be the most popular, or even the most likely?
There’s a wave of opinion endorsing self-management and personal budgets, with strong local provider engagement which would point to Future 2 – Me in my place – but my hunch is that, in reality, we’ll end up with a blended approach of both Future 2 and the scenario closest to our current situation – Future 3 Local drift.
I’d expect a continuation of elements of regional direction, and more joined up regional working, but I’d also expect authorities to have autonomy to commission services to meet local need, using technology to provide self-serve portals for citizens and using analytics to identify effective services and put in place intervention strategies to help protect the most vulnerable adults in society.
Whatever the future may hold, whether care is directed centrally or locally, led by professionals or service users, it’s clear that those in health and social care will need to work closely together, alongside providers and the users themselves. IT infrastructures need to be flexible to integrate with other systems so information can be shared, whilst offering a range of easy-to-use online self-service options. Business intelligence tools will also be vital for service planning to be sure services are both cost effective and achieve the best outcomes for those in need.
I’d be fascinated to know what you think – please do share your thoughts using the blog comments box below.