Community care neglected in national digital transformation efforts

Digitally enabled community care is being hampered by a lack of investment and siloed approaches to technology implementation, according to the King’s Fund.

A report by the public policy think tank said digital technology could help improve the quality of care given to people in the community, but there is currently a very disjointed national approach to care services.

In his 2023 plan for the NHS, now prime minister Keir Starmer said Labour’s vision was to make the NHS a “Neighbourhood Health Service”, treating people early in the community. 

The King’s Fund report said digital technology could help deliver “the long-held but unrealised ambition of moving care closer to home”, but that significant improvements to infrastructure and the use of basic technologies are needed, followed by increased capability and capacity in the community, to integrate technology and new skills.

It said community providers struggle to access funding for innovation and digital transformation.

“Community providers report that they struggle to access funding for innovation and digital transformation. The community sector is often overlooked in national digital priorities and funding streams, which exacerbates the variation in digital capability affecting how services can be improved or transformed,” the report said.

“Digitally enabled care in the community is currently limited by low levels of investment and siloed approaches. There are examples of good implementation and use of technologies, but these need to become the norm, not the exception.”

In its research, the King’s Fund spoke to patients and staff who were frustrated with the current state of community care.  

When medical information cannot be shared digitally, there is a continued reliance on letters. This can create safety risks or lead to people experiencing needless harm, such as spending significant periods of time in pain

“Listening to people who draw on services in the community recount their experiences, it is clear there is a great deal of frustration around the disjointed approach to care services. We also heard about patient safety failures, people feeling like they have no control in their care, and the impact of poor technological implementation,” the report said.

“Technology can be an important enabler of joined-up care in the community, but people’s experience of communication and shared care information is highly variable. When medical information cannot be shared digitally, there is a continued reliance on letters. This can create safety risks or lead to people experiencing needless harm, such as spending significant periods of time in pain.”

A previous King’s Fund report on the use of digital technology in health and social care, published in 2021, said social care was being left behind and there were huge gaps between the digital maturity in health and social care organisations. These gaps are still evident today.

Some integrated care systems are attempting to improve interoperability between acute, primary and community care by creating or procuring systems that can link all electronic records.

However, the report said that in some cases, hospitals and social care providers don’t have digital records in place, whereas in other areas, the silos in place “impede the transformational potential of technology and data”.

Some care services try to embrace more advanced technology, such as apps and patient portals, but even then the lack of joined-up care can lead to patients being frustrated by the number of apps they have to download.

“Currently, use of digital technology is mimicking silos in the system, and people are frustrated at having to piece their care together. This fragmentation is partly due to the funding and approaches to digitalisation replicating organisational silos in the system and the technology then copying this,” the report said.

“Instead of a standardised approach to implementing digital technology, there is a need to start from people’s existing capability and build digital health and care support from there. This might mean some people have an app on their phone; for others, a better option might be a tablet acting as a display for simple notifications.”

According to the King’s Fund, technology is often designed for hospitals without understanding the community requirements. One example of this is the growing use of virtual wards, where patients are kept at home. However, homecare workers are asked to support these patients without receiving adequate training on how to use the technology.

The King’s Fund report called on the Department of Health and Social Care (DHSC) to create a vision, together with patients and staff, that puts digital independence and dignity at the heart of community care, with local flexibility in how it’s achieved.

It also wants to see an increase in the distribution of funding and support for innovation and joined-up procurement to ensure digital tools are compatible.