A few months ago we started a ‘discovery’ – a 12-week period of intensive research – looking at adult social care information and advice on NHS Choices and elsewhere. We’re almost at the end of this phase of our work, which feels like a good time to share some of the things we’ve found.
Social care needs more support right now
Across the country there is a lack of public understanding about adult social care, how it works, what someone’s journey through social care might be, the costs, and how to access it.
Since we started this discovery, the Competition and Markets Authority has published its study of the care homes market, NICE has launched guidance for people’s experience of adult social care services, CQC has put out the first findings from its review of local health and social care systems and the Public Accounts Committee has given its verdict on NHS Continuing Healthcare. Jeremy Hunt and the Department of Health have added ‘and Social Care’ to their titles to more obviously demonstrate their responsibility in this area. And the debate over how we pay for social care has been making the headlines, not least because the Green Paper on social care for older people is expected later this year.
All in all, now feels like a good time to be doing this work.
The phones are always ringing
Our research took us to the call centres run by local authorities and national charities. There, trained professionals are on hand to offer advice and information, usually to carers and family members but also to the people who need care and support themselves. Local authorities also get a lot of calls from health professionals, community groups and care providers who need to make a referral or check a case.
By all accounts, phone is the preferred channel for this sort of conversation. There are several different reasons given for this:
- People prefer the phone. One GP told us that her older patients feel that a phone call is more ‘reliable’ or ‘real’ than a form on a website. If the need for care has come out of a crisis situation like a fall or stroke, it may be more comforting to speak to a human.
- People’s first instinct is to call. Councils told us that most callers hadn’t looked online first, even when the information they needed was easily available.
- A phone call is sometimes the best channel. For example, health professionals can more easily discuss a case or bounce around ideas than they can on email, and a conversation between a social worker and a carer might uncover needs that would have remained hidden otherwise.
- Digital information and services are not quite good enough yet. This could be a content problem, a findability problem or a usability problem.
Whatever the reasons, local authorities are struggling to shift people away from the phone towards more cost-effective online channels, even those councils that have had success doing this for other services.
Another thing we learned from these visits is that it’s not easy to script a conversation about care and support needs. There are frequently asked questions (like ‘how do I get a carer?’ or ‘what support can you give me?’) but there’s not a single answer to many of these. The best response will take into account an individual’s strengths, assets, needs and circumstances – a conversation, not a straightforward question and answer.
So while we might be able to develop chatbots or other smart tools to handle some of the basic requests for information, we’re not going to see Alexa or Siri running the three conversation for needs assessment and care planning any time soon.
Local services for local people
Despite there being around 30 national directories of social care services as well as hundreds of local directories, no one seems to have got it quite right. Either the information that people want (for example, how much a care home costs) isn’t available or the information is out of date or the user reviews don’t paint an accurate picture.
The reason none of these directories have quite nailed it is that it’s a big, difficult, expensive job. A comprehensive directory of care and support services would need to list everything from nursing homes and homecare agencies to dementia cafes and befriending services. It would have to keep this information up to date and moderate user reviews. To give you an idea of the scale of the problem, one county council told us that they have 6,000 such services inside their borders.
There is a need for a reliable, up-to-date directory though – one that publishes machine-readable data about local services for use by IT systems in general practice, hospitals, urgent and emergency care and social care. Something like this has the potential to make referrals and signposting more efficient, and to reduce the amount of local knowledge that professionals need to hold in their head.
Some areas are more joined-up than others
Health care and social care are separate systems run by different organisations, but it’s more important than ever that they work together. As the CQC puts it, “without good relationships and a shared, agreed vision between system partners, achieving positive outcomes for people who use services, their families and carers is significantly compromised.”
With this in mind it’s disappointing to have heard councils tell us that, “GPs are poor at recognising what social care can do” and “the NHS doesn’t have a clue about social care services”. GPs we’ve spoken to have said, “we’re meant to have meetings with social workers but we don’t” and “I leave messages but I don’t hear back.”
It’s not all doom and gloom though. We’ve heard really positive stories about care coordinators in GP practices who handle patients’ social care needs, thereby freeing up GPs’ time and (because they know more about local services, benefits and housing) providing a great service. Social workers in hospital discharge teams have spoken about working closely with NHS colleagues to put in place discharge plans and care packages. Social prescribing schemes have told us how they are making it easy for NHS staff to refer or signpost towards local services that address social needs.
NHS Choices won’t fix systemic problems, but it can help to get the right information to people at the right time (thereby reducing requests for basic information and signposting and freeing up professionals’ time), it can encourage greater self-care, wellbeing and prevention, and it can show what joined-up health and social care services look like.
Once we have refined our recommendations with our commissioners we’ll start designing prototypes in April for how to deliver better social care information on NHS Choice. We also plan to publish all our findings so that others can benefit from our research and hopefully build on what we’ve learned.