Integration and Innovation: the White Paper proposals touching on digital and data driven health and social care

On 11 February 2021 the Department of Health & Social Care published its legislative proposals for a Health and Care Bill: Integration and Innovation: working together to improve health and social care for all.

Over the next few weeks we will be publishing a series of articles covering the contents of the White Paper. In this week’s article, we consider the proposals touching on digital and data driven health and social care.

Introduction

It is trite to observe that Covid-19 has massively accelerated digital transformation. When individuals are literally risking their health, if not their lives, simply by being in close proximity to one another, the benefits of remotely delivered, digital health and care seem obvious: patients, health and care workers, and the broader community are all afforded a degree of protection that cannot be easily achieved when care is delivered via an in-person model.

While the revolutionary promise of technology has been championed for a number of years now, particularly in the fields of primary and outpatient care, wide-scale adoption has generally been slow, arduous and downright resisted in some quarters. However, the pandemic has changed all that and, building on the ‘Digital First’ agenda set out in the NHS Long Term Plan, the White Paper recognises in the executive summary the need ‘to deliver care using innovative and creative solutions, exploiting the potential of digital and data’ (paragraph 1.7).

At the heart of the proposals, of course, is the ambition to join up the different parts of our health and care systems to work towards the ‘triple aim’ of supporting better health and wellbeing for everyone, better quality health services for all, and sustainable use of NHS resources. The intention is to move to a system of integrated, user-centred and personalised care, linking GPs, home care and care homes, community health services, hospitals and mental health services. Driving this transformation will be the power of digital and data (paragraph 1.9).  

Specific proposals

The Government has set out a number of proposals touching on digital and data driven health and social care, including an intention to:   

1. Legislate to ensure more effective data sharing across the health and care system (paragraph 5.34). Further detail on precisely what these reforms are going to be will be set out in the forthcoming Data Strategy for Health and Social Care but the White Paper already indicates that primary legislation is being looked at to:
   1. require health and social care organisations to share anonymised information that they hold where such sharing would benefit the health and social care system;
   2. introduce powers for the Secretary of State to require data from all registered adult social care providers about all services they provide, whether funded by local authorities or privately by individuals; as well as to require data from private healthcare providers;
   3. make changes to NHS Digital’s legal framework to introduce a duty on NHS Digital to have regard to the benefit to the health and social care system of sharing data that it holds; and clarify the purpose for which it can use data;
   4. introduce a power for the Secretary of State to mandate standards for how data is collected and stored, so that data flows through the system in a usable way, and that when it is accessed/provided, it is in a standard form, both readable by, and meaningful to, the user/recipient.
2. Publish proposals for the future design of the public health system that is informed by insight from population health data on disease prevention, protection from health threats and individual and community health and resilience (paragraph 1.18).
3. Change the way data is collected from the various parts of the health and social care system – not just for purposes of central government assurance and oversight, but to allow local authorities, providers and consumers to access the data they need, while minimising the burden on data providers (paragraph 5.103).
4. Use technology and data intelligently to support the commissioning and delivery of high quality health and care services (paragraph 5.107).
5. Support the MHRA to develop and maintain publically funded and operated medicine registries which capture detailed and bespoke data, including data from private providers, to support patients, prescribers and regulators, in making evidence-based decisions about the safe use of medicines (paragraphs 5.159 - 5.164).
6. Review the system of payment under the National Tariff to ensure that it facilitates new payment approaches to support collaboration and the use of digital health and care technology (paragraph 5.51).
7. Permit international data sharing to support reciprocal health agreements with ‘Rest of the World Countries’ (countries outside the EEA and Switzerland), supporting reimbursement mechanisms so as to make healthcare more accessible for UK residents when they travel abroad, to support individuals with long-term conditions who usually have to pay higher insurance premiums, and to monitor and evaluate the cost-effectiveness of these agreements over time (paragraphs 5.168 – 5.172).

Comment

The desire to ‘build back better after Covid’ and to use technology and data to drive health and social care improvement is admirable. Covid-19 will remain in circulation globally and new mutations of the virus will arise. Although the vaccination programme will allow a slow return to normality, we may see ongoing need for social distancing measures for some time yet. This – coupled with a desire to capitalise on the progress that has already been made and to move forward to a sustainable, efficient, integrated and responsive health and care system – means that digital health and care solutions that support these objectives will proliferate.

While there have been significant advances in the digitisation of healthcare, the same cannot be so readily said of social care which lags some way behind. If health and social care are genuinely to become integrated there will need to be a good deal of levelling up between the two spheres. The intention to improve data sharing across the health and care system is an obvious priority area but, as ever, the devil is in the detail and we shall have to see what is said in the Data Strategy for Health and Social Care.

To support the vision of the White Paper there will need to be a baseline digital architecture in place and we are likely to see bodies such as NHS Digital and NHSX continue to develop and impose standards for digital health and care solutions.

Finally, any move to a fully integrated, digital and data driven health and care system risks leaving some behind, whether because they do not have the necessary skills, lack access to internet and other IT infrastructures or simply do not have the confidence to navigate the digital world. Eleven million people in the UK lack basic digital skills or do not use digital technology at all; many of these are likely to be older, with less access to education and in poorer health than the rest of the population. Any legislative reform must ensure that concerns around digital exclusion, data-driven discrimination and trust in digital health and care are addressed and assuaged.

To find out more about the White Paper and how it could affect your organisation, please visit our ICS webpage.