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Out of the abyss and into the light

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Already struggling before COVID-19, the social care sector is now poised between opportunity and disaster. But a recent white paper may well be the blueprint for the way ahead, as Andrew Mernin discovers in conversation with Steve Morgan of Agilisys.

With sunlight now shooting through the cracks of COVID’s many barriers, our post-pandemic future is within touching distance.

The second half of the year is loaded with optimism and the rebuild after the great reset begins.

As parroted by many MPs, now is the time to ‘build back better’ – creating a fairer, more resilient future.

But what if you’re rebuilding a sector that was already staring into the abyss before the pandemic?

This is the task facing the army of leaders, innovators and dedicated professionals in the social care sector.

Having guided society’s most vulnerable through months of turmoil and isolation, they must now fix a system already broken pre-COVID.

In search of a blueprint, they may look to Agilisys, which helps public services to transform and improve using technology.

The organisation recently published the white paper Rethinking Health and Social Care Post COVID 19.

Steve Morgan, author of the report, writes: “The social care sector in the UK is staring into an abyss of shrinking care capacity and exponentially rising demand, driven by factors such as chronic underfunding and a lack of joined-up thinking, not to mention the unprecedented challenges of the coronavirus pandemic.

“This has led to talk about the ‘new normal’, but what will the new normal be for social care? How will this change the ways in which care is delivered and, crucially, what impact will this have on patients?

“As the new normal emerges and social care responds to the extraordinary situation we’re faced with, never has there been a greater need for technology-led transformation.”

At the start of the pandemic, Agilisys was approached by NHSX, the NHS’ digital innovation arm, to identify how technology could help with the challenges facing vulnerable UK residents.

Two elements soon became apparent – the condition of the social care was worse than originally thought; but technology’s positive influence on the sector was growing.

At the height of the pandemic, with the country in lockdown, mental health issues rose, social care services were cut and the elderly faced an epidemic of loneliness.

Meanwhile, thousands of COVID-positive residents were being discharged into care homes, leading to widespread resident deaths and staff shortages.

By any measure, the pressures on the sector were severe, and remain so, having been exacerbated by the pandemic. It is now at a crossroads between looming disaster and golden opportunity.

Speaking to Health Tech World, report author Steve Morgan, Agilisys’ partnership director, puts the size of the challenges ahead into context. 

“Firstly, the figures are clear; we have an ageing population, and that’s through advancements in health and social care over the years. There’s one figure in our research that really brings it home – approximately 25 per cent of the children born in 2018 will live to be 100.

“However, the challenge we’re facing is that, although life expectancy is increasing, there is no commensurate improvement in healthy life expectancy. So, a lot of the people who are living to be older will have poor health, with other co-morbidities that need to be managed as they age.”

An ageing, unhealthy population will have increasing care needs – but who will provide that care?

Morgan says: “Another element of the equation is the finding that the number of childless women who live to the age of 80 is going to double in the coming period. Why does that matter? Because the children of the elderly are the biggest informal care cohort. The cost of the care they provide equates to about £9bn a year.

“So, if more and more women are going to be older without children of their own to take up those caring responsibilities, that means there’s going to be a greater reliance on the care sector itself.”

But for many providers, the economics of providing services in the private sector just don’t add up, despite the sector’s reputation for being poorly paid.

“There are about 12,000 private providers across the UK and they operate on margins of around nine per cent,” Morgan says. “They also operate on 100 per cent occupancy as a business model.

“So, when you consider that around 95 per cent of the cost profile for these providers is their people, who are typically on minimum wage, every time the minimum wage is increased by the Government, their cost base goes up by one per cent.

“When you combine this with the result of outbreaks of the virus in care homes, at some stage a lot of those businesses will become unsustainable.”

Through a combination of technological innovation and lessons learnt from the pandemic, however, there is now an opportunity to redefine how the UK delivers care.

“One window of opportunity we’re seeing is through the use of predictive analysis; for example, identifying the triggers that [suggest] somebody in a domiciliary care plan, is in danger of moving into residential or acute care.

“This has massive cost implications; domiciliary care provision costs £16.86 per night, while if they go into acute it’s £400 a night, just for a bed.

“With predictive analysis, we can keep people in their homes – which has been one of the objectives around social care for many years – using this technology.

“For example, we did a piece of work for Barking and Dagenham Council. Using data we were able to identify those residents who were likely to present as homeless based on various triggers such as substance abuse or presenting into blue light services.

“Mapping those together, you can actually find that window of opportunity to prevent them from heading into acute care.”

The Agilisys report also highlights virtual appointments with healthcare providers as another tech-driven improvement to social care during – and potentially after – the pandemic.

Remote healthcare usage surged during COVID-19 – at the middle of July 2020, over 50 per cent of GP consultations were performed via video, rather than face-to-face.

Morgan notes: “Every one of the 307 million GP appointments each year costs around £30 when you include all costs such as property, heating, lighting, security and so on.

“If clinical appointments are carried out by a GP remotely via video, the number of appointments can increase. You can conduct 10 or so video consultations an hour as opposed to four or maybe five physical ones.

“The cost of delivering primary care in the UK drops substantially, which is something that we must do if we’re going to find a way through the budgetary challenge.”

The report also underlines COVID’s reawakening of the UK’s community spirit as a potential lasting positive in care terms.

In the early months of the pandemic, an original request for 50,000 volunteers to come forward led to 750,000 people offering their time to support at-risk groups and those in need of care across the country – and this spirit could be harnessed in the future.

Morgan says: “Any number of family members, friends and neighbours have helped those people who needed to shield or were particularly vulnerable. And that could be anything from making a cup of tea, to delivering groceries, picking up prescription drugs and driving people for an appointment.

“So that whole volunteer sector – of which there are still half a million people registered – was entered into a database, which can now be communicated to the right people with the right skills in a very short space of time, reducing the strain on traditional methods of social care delivery.

“We believe that the best way to harness this data is to distil it down to a local level and build that support network, along with the third sector organisations who were doing some good things within the local neighbourhoods, into formal care provision.”

With the pandemic now hopefully in its last embers, Morgan believes a collaborative approach is needed to enable the social care sector to adequately meet demand.

“The reason for the report primarily was to open people’s eyes and highlight that there’s no single organisation out there that can fix these issues; it’s got to be done as part of cross-organisation development work.

“For me, what has been missing when looking at social care is for somebody to sit back and take the holistic view, as to how existing technologies come together to deliver the outcomes that we need to see for vulnerable and isolated people.

“By identifying and fostering solutions, aligning tech solutions with known care issues; and using our communication networks and relationships to position new and emerging tech in a manner that allows it to be exploited quickly, we are confident that the UK care sector will be brought into the 21st century.

“By doing this, the quality of life for the UK’s most disadvantaged will be vastly improved – which is surely all the motivation we need to drive lasting change.”

To read the full Agilisys report, visit www.agilisys.co.uk/insights/rethinking-health-and-social-care-post-COVID-19/

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