Building the evidence base for tech innovation in adult social care

Building the evidence base for tech innovation in adult social care
Institute of Public Care June 2021

• NHSX commissioned the IPC and Ipsos MORI to conduct a review of social care tech innovation. Findings from the first phase of this work, this rapid evidence review, provides insights into existing literature and evidence gaps in adoption and scalability of technology innovation in the adult social care sector.

Developing place-based partnerships: the foundation of effective integrated care systems

Developing place-based partnerships: the foundation of effective integrated care systems
Kings Fund 20 April 2021

• The King’s Fund has reviewed existing evidence and experience on place-based working, explored the development of place-based partnerships within three systems and undertaken targeted engagement with local leaders from ICSs, local authorities and voluntary and community sector organisations. This research highlights the potential role of place-based partnerships in improving health and wellbeing and illustrates how these opportunities can be realised.

Development of a predictive model for integrated medical and long-term care resource consumption based on health behaviour

Development of a predictive model for integrated medical and long-term care resource consumption based on health behaviour: application of healthcare big data of patients with circulatory diseases.
BMC Med 19, 15 (2021). https://doi.org/10.1186/s12916-020-01874-6

• A predictive model of integrated healthcare resource consumption (Adherence Score for Healthcare Resource Outcome, ASHRO) that incorporates patient health behaviours, and examined its association with clinical outcomes.

The impact of Extensive Care Service and Enhanced Primary Care in Fylde Coast

The impact of Extensive Care Service and Enhanced Primary Care in Fylde Coast
Health Foundation Improvement Analytics Unit November 2020

• Early impact of two complementary integrated care team initiatives developed in the Fylde Coast NHS vanguard, the Extensive Care Service (ECS) and Enhanced Primary Care (EPC), aimed at adults with complex chronic care needs. Both use risk stratification to help identify adults with complex chronic care needs who are at risk of hospitalisation. 
• The analysis has found that ECS and EPC patients were admitted to hospital in an emergency respectively 27% and 42% more often compared with their matched control group. Similar trends have been also found across other measures of hospitalisation. While the analysis found that neither model of care reduced hospital activity during the period analysed, it could not conclude that the higher levels of activity were a direct causal effect of ECS or EPC.
• Blog Are multidisciplinary teams an effective tool to reduce emergency hospital activity?

Key elements of a successful integrated community-based approach aimed at reducing socioeconomic health inequalities in the Netherlands: A qualitative study

Key elements of a successful integrated community-based approach aimed at reducing socioeconomic health inequalities in the Netherlands: A qualitative study. 

PLoS ONE 15(10): e0240757. 20 October 2020 https://doi.org/10.1371/journal.pone.0240757

• Since 2010, the Zwolle Healthy City approach, an integrated community-based approach, has been implemented in the Dutch municipality of Zwolle. This approach is proven successful in reducing health inequalities. The current study identified nine perceived key elements that contributed to the success of the approach.

Realising the true value of integrated care: Beyond COVID-19

Realising the true value of integrated care: Beyond COVID-19
International Foundation for Integrated Care 15 May 2020

• A thought leadership report which states that Covid19 presents an opportunity to reset our fragmented health and care systems so that they are integrated, driven by people and communities and resilient in the face of future systemic shocks.

Integrated care and the perils of population health management

Integrated care and the perils of population health management [blogpost]
Andi Orlowski, Deputy Direct or of Business Intelligence, Imperial Health Partners, 5 March 2020

• "The benefits of data analysis [for population health management] are immense and powerful. However, if the data doesn’t fully represent the population, we may be misled."
• "I strongly believe that local analysts, with experience of their neighbourhoods are essential for making the best use of data and helping system leaders make the most informed decisions."

Integrated management of atrial fibrillation in primary care: ALL-IN trial

Integrated management of atrial fibrillation in primary care: results of the ALL-IN cluster randomized trial
European Heart Journal, 29 February 2020, ehaa055, https://doi.org/10.1093/eurheartj/ehaa055

• A trial of an integrated care intervention across 26 practices in the Netherlands. The intervention  consisted of (i) quarterly AF check-ups by trained nurses in primary care (ii) monitoring of anticoagulation therapy in primary care and (iii) easy-access availability of consultations from cardiologists and anticoagulation clinics. 
• Elderly AF patients in primary care showed a 45% reduction in all-cause mortality when compared with usual care.

Abstract

Measures for person centred coordinated care

Measures for person centred coordinated care

An NHS England funded project undertaken by the Primary Care Group at Plymouth University

• The website is a compendium of Patient Reported Outcomes Measures (PROMs) and Patient Reported Experience Measures (PREMs) that can be utilised within programs that aim to deliver or evaluate person centred and coordinated care (P3C). 
• Tools include
• Person Centred Care Patient Reported Measures (P3C-PRMs) – tools that specifically measure some aspect of P3C, such as communication, shared-decision making or self-management and
• Quality of Life (QoL) measures – i.e. measures that can be used to measure how health might, for example, be influencing aspects such as a person’s social and mental health.
• The website includes a “Commissioners Guide”, explaining how to deploy and utilise these tools in real-life healthcare settings.

NHS Long-term Plan: legislative proposals

NHS Long-term Plan: legislative proposals
Health and Social Care Select Committee 24 June 2019

• The Committee found that NHS England and NHS Improvement proposals  for legislative changes to the Health and Social Care Act 2012 in many cases continue the direction of travel towards a more integrated collaborative and placed-based system. It broadly supports NHS England and NHS Improvement’s proposals to:
• to promote collaboration and lessen the role of competition in the NHS, especially the proposal to repeal section 75 of the Health and Social Care Act 2012 and revoke the regulations made under it;
• remove the Competition and Market’s Authority’s role in mergers of foundation trusts;
• ease the burden procurement rules have placed on the NHS, ensuring commissioners have discretion over when to conduct a procurement process, with the inclusion of a ‘best value’ test; and
• allow greater flexibility locally over payment systems.
• However the Committee comments that the plans remains too NHS-centric rather than looking at the wider system with which it seeks to integrate and that the Department of Health and Social Care, NHS England and NHS Improvement should be clearer about the roles local government, the voluntary and community sector and independent providers should play in the future of the NHS.
• Themes of the report are competition, integrated care, NHS leadership, and Cross-party endorsement of legislative proposals

National survey of local innovation and research needs of the NHS

National survey of local innovation and research needs of the NHS
AHSN April 2019

• Findings from a survey of clinicians and managers (n=257) to identify local NHS innovation and research needs in England identified workforce issues such as recruitment, retention and skills (41%); integrated care for those with multi-morbidity and/or complex social care needs (39%); and optimising the use of digital technology and Artificial Intelligence (AI) (33%) as the top system level priorities for innovation and research.
• Specific challenges and opportunities associated with technology and AI were seen to be related to the use of technology to improve patient self-management. Some stakeholders also highlighted limitations with the implementation and uptake of new methods in this sphere. Amongst those who placed optimising technology as their top priority, understanding the relevance and clinical effectiveness of the technology was seen as being a key evidence gap.

Better Evidence for Better Care

Better Evidence for Better Care
doteveryone January 2019

• A  review of the social-care data landscape and found that insufficient data is collected on the areas that matter most, including the outcomes for people who receive care. It is in the interests of the entire social-care sector to support a better care evidence base. This paper outlines the actions needed to make this change, based on two recommendations: committing to understanding the whole care ecosystem and measuring outcomes, not process.
• Part of the Data, skills and culture for a better care system programme from doteveryone.

Joined-up listening: integrated care and patient insight

Joined-up listening: integrated care and patient insight
Kings Fund 30 August 2018

• This article articulates the opportunity that integrated care presents for using insight from people and populations to design services that meet their needs and reflect their priorities. This includes breaking down siloes within and between organisations to listen to what patients are saying across their entire pathway of care
• "The insight we can get from patients, users and the public – from engagement, participation and involvement activities, feedback and surveys or through simply listening and observing – should be central to the business of the health and care system. "

Care City - Innovation Test Bed

Care City
NHS England Innovation Test Bed

• Care City was jointly founded by NELFT and the London Borough of Barking and Dagenham in October 2013 to support alignment across the health and social care system.
• The programme of work is organised around three strategic priorities:
• Innovation: To stimulate continuous improvement and innovation across the local health and social care system
• Research: To advance the application of cutting-edge research into practice by bringing research closer to local people, and facilitating new models of research.
• Education: To increase resilience across the system’s workforce by inspiring new entrants from within our local community, creating opportunities at all career stages, and evolving our workforce model
• A blog by the Chief Executive of Care City (16 July 2018) discusses the work to cross divides between systems and people and to better connect technologists, entrepreneurs, clinicians and patients.
• "improvement across health and care will not be achieved without the infrastructure, skills and relationships to support it."

Integrated care: organisations, partnerships and system

Integrated care: organisations, partnerships and system
Health Select Committee 11 June 2018

• This inquiry report explores the development of new integrated ways of planning local health and care services (sustainability and transformation partnerships and integrated care systems) and delivering care (integrated care partnerships and accountable care organisations), which have arisen out of the NHS five year forward view. 
• The report supports the move away from a competitive landscape of autonomous providers towards more integrated, collaborative and placed-based care. However, it finds that understanding of these changes has been hampered by poor communication and states that the government and the NHS must improve how they communicate NHS reforms to the public. (Kings Fund summary)

Innovative models of general practice

Innovative models of general practice
Kings Fund 7 June 2018

• This report looks at innovative models of general practice from the UK and other countries and identifies key design features which will be important in designing effective GP services in the future.
• The report sets out five attributes that underpin general practice: person-centred, holistic care; access; co-ordination; continuity and community focus.

Next steps for social care funding reform

A fork in the road: Next steps for social care funding reform. The costs of social care funding options, public attitudes to them – and the implications for policy reform
Health Foundation, Kings Fund May 2018

• This paper pulls together new financial modelling, public perceptions work and policy analysis to identify the problems with adult social care in England and outline options for its reform.
• One of the key points is the lack of public understanding of how social care operates or is funded. People often struggle to distinguish between social care and the health services provided by the NHS.

C3 Cloud: A Personalised Care Plan Development Platform

C3 Cloud: A Personalised Care Plan Development Platform

EU Digital Single Market project, 19 March 2018

• The C3-Cloud project will establish an ICT infrastructure facilitating a Personalised Care Plan Development Platform to enable continuous coordination of patient-centred care activities by a multidisciplinary care team or informal care givers.
• The platform will allow collaborative creation and execution of personalised care plans for multi-morbid patients through systematic and semi-automatic reconciliation of clinical guidelines. This will be achieved with the help of Decision Support Modules for risk prediction and stratification, recommendation reconciliation, poly-pharmacy management and goal setting.
• Pilot studies will focus on diabetes, heart failure, renal failure, depression in different comorbidity combinations in order to demonstrate the feasibility of the project. 
• The project is led by University of Warwick

HSC inquiry: Integrated care: organisations, partnerships and systems

Integrated care: organisations, partnerships and systems inquiry
Health Select Committee, 7 February 2018 to date

• An inquiry into Sustainability and Transformation Partnerships (STPs), Accountable Care Systems (ACSs) and Accountable Care Organisations (ACOs). 
• Evidence (oral and written) from NHS Confederation, NHS England and others available here.