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Lessons learned and messages for commissioners of adult social care in councils.
Introduction
This briefing is based on experiences collected in 2024 following the rollout of digital social care records (DSCR) into adult social care registered provision. The previous government's white paper People at the Heart of Care made policy commitments to improve and increase the digitisation of social care through the digitising social care programme. The programme aims to ensure that 80 per cent of people in receipt of care benefit from a DSCR by March 2025.
This information is a summary of learning that can be used to have conversations about DSCR implementation benefits and challenges, to overcome barriers and to support and incentivise good practice. It is not formal guidance.
Who is this information for and why do we need it?
This briefing is aimed at commissioners and others working in councils, such as digital transformation and procurement leads, to set out the wider context of digital social care records and how councils can support their adoption across the care provider market. Commissioners have a statutory duty to oversee the quality, safety, and sustainability, of care in their local area and have an important role to play in supporting digitisation and sustaining the use of digital social care records in the longer-term. DCSRs can be a vital part of ensuring safer and better-quality care and securing better uses of data to ensure the right care is offered, in the right place, at the right time.
In October 2024, just under 30 per cent of registered social care providers were using paper records to maintain assessments, care plans and daily recordings on people they support (Adult Social Care in England monthly statistics, October 2024).
There are a range of ways in which commissioners can support care providers with the adoption of DSCRs. Understanding the obstacles to implementation and the potential solutions that have been developed by others to overcome them, will help commissioners to support the wider sector to adopt and sustain DSCR usage which will help with reporting, management and supporting future interoperability in health and social care.
What is a DSCR?
A digital social care record (DSCR), also known as an electronic care plan, allows the recording of the care information and care received by a person to be held on a digital system, replacing traditional paper records. DSCRs allow information to be shared securely and in real-time, with authorised individuals, across the health and care sector.
Moving care plans from paper to electronic formats makes it easier for care workers and managers to get the information they need to respond more quickly to people’s needs, minimise risks to people’s safety and reduce time spent on administration and reporting.
DSCRs will provide the platform for other remote care tools to integrate, supporting more personalised care and ensuring health and care professionals can build up a more complete picture of someone’s care needs. For example, as of November 2024 over 2,000 providers can already access relevant information from GP record through their DSCR ('Putting in on (digital) record', Social care blog).
In 2023, Care Quality Commission (CQC) published guidance about DSCRs and their importance in achieving good outcomes for people who use services.
CQC’s guidance highlights the benefits of the digital approach to care planning and how it supports providers to:
- capture information more easily at the point of care
- support staff to respond more quickly to people’s needs
- share important information quickly, safely, and securely between care settings
- minimise risks to people’s safety.
Councils’ roles in supporting digitisation
The ambition of The Care Act 2014 is for councils to influence and drive the pace of change for their whole market. This should assist to continuously improve quality and choice and deliver better, innovative, and cost-effective outcomes that promote the wellbeing of people who draw on care and support.
Under section 5 of the Care Act, councils have an overarching set of commissioning and safeguarding obligations in their local areas, to work with all providers of social care in their area to promote the efficient and effective operation of market provision in meeting care and support needs.
The Market Sustainability and Improvement Fund Guidance outlined what funding and support was available already for digitisation and suggested steps councils could take to encourage improvements in the adult social care sector.
The ‘Digital working in adult social care: what Good Looks Like’ (WGLL) framework was published in May 2023 by the Department of Health and Social Care (DHSC). It brings together the needs of councils and care providers into one coherent piece of guidance to set out what good digital working looks like in adult social care. It highlights not only the specific issue of DSCR adoption, but the importance and impact of wider digitisation, good data management and security, and the value of connected systems so that a person’s care can be managed better and more safely. It also sets out how councils can ensure they are both pushing forward their digital maturity and their role in how they can support the care provider sector. Councils can also complete a self-assessment on the digital 'What good looks like' framework to understand where their current position is.
The government has signaled its intentions to use a ‘left shift’, ‘from analogue to digital’ to support the achievement of ‘a national care service’. Increased uptake of DSCRs will help to enable wider efforts to digitise assessments and create a more joined up view of the person in health and social care records in line with the government’s ambitions for this system reform.
The NHS Transformation Directorate provided £75 million in funding over 2022-24 to support integrated care systems through matched funding to adopt and implement DSCRs and to test other care technologies that meet local needs, scaling those with proven benefits.
The Better Security, Better Care programme also continues to support providers to become compliant with the Data Security and Protection Toolkit (DSPT) to improve cyber resilience. When negotiating new contracts and frameworks with care providers, councils can consider commercial levers to incentivise or otherwise encourage providers to digitise. For example, specifying that providers should adopt digital social care records, be compliant with the Data Security and Protection Toolkit and use a secure email service (such as NHSmail) to receive discharge summaries.
Online services and automation provide further opportunities for digital technology to improve efficiency in commissioning and market shaping. Increasing care quality and mitigating the risks of provider failure can be achieved through dynamic data collection, analysis and reporting tools, offering insight into spend and activity, capacity and availability, and predictive capacity for future demand. The Care data matters: a roadmap for better adult social care data’ considers data opportunities and the What Good Looks Like framework for adult social care provides additional guidance to councils and care providers on digitisation.
How adoption of DSCRs can benefit councils
High-quality care planning is fundamental to the identification, arrangement, delivery and monitoring of safer, more personalised, care. Social care is a complicated environment with many moving parts. An individuals’ needs are dynamic and there are multiple agencies and staff involved in the life of an individual with care and support needs, who often may also have health needs.
Individuals may live at home, with formal and informal social carers and healthcare staff supporting them, or they might live in a home with other people in a group setting (shared living, or residential or nursing care). Regardless the risk of paper-based information storage on an individual being incomplete, out of date, or unavailable is too high.
Moving care plans and other systems (such as medication management systems), into a digital format, as a DSCR, makes it easier for care providers to manage care and respond to people’s needs more rapidly, accurately, and personally.
Midlands and Lancashire Commissioning Support Unit published a report in 2021 ‘Benefits of Digital Social Care Records’ which offered some evaluation to a range of overall benefits of DSCRS.
Efficiency and productivity
- More time efficient, there are fewer steps and less time are needed to complete care tasks and they are easier to update and access for staff.
- For home care staff, there can be reduction in time needed for travelling back to office to update paper records or take paper records back to office.
- Care workers feel able to better prepare for care visits and plan and organise.
- Provide greater consistency, accuracy and legibility than paper records.
- Greater/more detailed visibility of service user needs and outcome trends.
Improved care
- When used with wider digital systems can provide alerts to changes in behaviour or outcomes, or provide reminders to improve care such as medication reminders.
- Provide oversight of daily activities and care provided and improve communication between people, their relatives and care providers.
Risk management and safeguarding
- Reduce the risks to people drawing on care and support the provision of safer care quicker access to information by including health and other information.
- Records are less likely to go missing and can identify whether records indicate issues of concern or identify if information is missing.
- Easier auditing processes.
Workforce
- Can improve communication in multiple directions, this includes communication between staff and colleagues (e.g. different shifts in care homes) or managers.
- Improve staff morale as staff felt more able to come forward with concerns or issues and workers. described feeling more motivated or enthusiastic.
- Working for a digital-focused organisation increases staff sense of engagement alongside an increased sense of job importance due to new skills – and that this can help with recruitment and retention.
Financial outcomes
- Cost savings are perceived to be related to several benefits already identified above – time saved, mistakes avoided, and costs avoided, better use of system resource.
Benefits analysis conducted by the Digitising Social Care Programme (NHS Transformation Directorate) in 2024 also underline these findings, suggesting that significant time savings have been seen across the workforce, such as: handover prep time, onboarding, care plan reviews and auditing. Some case studies suggest 20 minutes and more can be saved, leading to more time for care workers to engage with people and to support their social care needs.
DSCRs and ‘What Good Looks Like’ (WGLL) pilot assessments
Partners in Care and Heath (PCH) are improvement partners, working with DHSC and NHSE. Following the publication of the WGLL framework for adult social care in May 2023, the PCH digital technology programme co-designed a WGLL self-assessment tool with councils.
The tool not only sets out what ‘good’ would look like but also what ‘not started’, ‘in progress’, ‘well-established’ and ‘advanced’ looks like across each success measures, and where to look for the evidence of that. The framework and tool provide a holistic view of digital maturity, ranging from basic digital foundations through to more advanced digital elements. It is important to support getting the foundations in place as soon as possible and digital social care records are seen as a key part of that ‘foundation.’
In the framework, the question that directly addresses DSCR adoption is:
Ensure Smart Foundations statement 6: work with your integrated care systems to support care providers to adopt Digital Social Care Records (DSCR) and to test and scale technologies that support the quality and safety of care.
Not started
There is no evidence of joint working between the council and ICS to support care providers to adopt DSCRs and / or to test and scale technologies that support the quality and safety of care. There are no use of commercial frameworks to drive adoption of DSCR.
In progress
There are plans to work jointly with the ICS to support care providers to adopt DSCRs through commercial frameworks. There are plans to work jointly to test and scale technologies that support the quality and safety of care.
Well established
Plans to work jointly with the ICS to support care providers to adopt DSCRs through commercial frameworks and / or to test and scale technologies that support the quality and safety of care are on track to be delivered.
Advanced
The council works in partnership with the ICS to support care providers to adopt DSCRs and there is strong evidence that providers have done this. Commercial frameworks are used to incentivise adoption of DSCR. You can identify several examples of technology which supports the quality and safety of care being tested and scaled across your model of care.
Through late 2023 and early 2024, PCH worked with three of the nine social care regions in England. The 52 councils in this region comprised a mixture of small, medium, and large, urban, and rural, county, unitary and metropolitan councils and were seen to be broadly representative of all councils. A total of 44 councils took part in the pilot, this is 86 per cent of councils within the three regions.
Findings in regard to DSCRs
In total across the three regions, 24 councils (60 per cent) described themselves as ‘well established’ or ‘advanced’. Analysis suggests correlating drivers are:
- safe practice 1: ‘meet the requirements of the UK General Data Protection Regulation (GDPR), the Data Protection Act 2018 and comply with the common law duty of confidentiality, providing transparency and public engagement on how personal data is used’
- ensure smart foundations 8: ‘be aware of the upcoming transition from analogue to digital telephone networks, and assess telecare users’ current equipment for digital compatibility, working with suppliers to test reliability and develop contingency plans as detailed in the Telecare stakeholder action plan’
- safe practice 3: ‘be clear and transparent about the purpose and use of data, whether that is for individual care, research, service improvement or commissioning purposes and ensure you follow appropriate standards based on the specific use of the data’
- well led 7:’ ensure data sharing and use is done in line with data protection laws, and the common law duty of confidentiality, knowing when you can and cannot use care data for purposes such as research and service planning’
- improve care 3: ‘draw on timely and accurate data to inform commissioning, understand the needs and requirements of local populations and manage health and social care services more effectively’
This suggests that leaders and systems in councils that are more aware of the benefits and need for safety, standardisation, and security in sharing data and increasing the benefits of digitisation are more likely to be more advanced in their rolling out of DSCRs and have found more ways of overcoming any barriers to adoption.
The current context and barriers within care providers
There are over 11,000 registered domiciliary care services and about 15,000 residential and nursing care services registered with the Care Quality Commission, working across 28,000 care provider locations (CQC updates figures annually in its 'State of Care' publication).
CQC acknowledges that innovative practice and technological change are important tools to drive improvement and deliver better outcomes and experiences for people alongside new ways of working or new care models that improve their outcomes.
As of July 2024, 72 per cent of CQC-registered adult social care providers in England are estimated to have a DSCR (Figures are updated as monthly statistics). Analysis by NHS England in September 2023 suggested that providers need more time to adopt DSCRs and more help to overcome perceived barriers.
The size, shape and volatility of the provider market seems to present a larger challenge than first realised. There is an increase in new entrants to the home care market who are more likely to be very small – meaning the ‘tail’ of providers that have not yet taken up DSCRs is lengthening. There are many providers that do not establish themselves within their first year of business, never reach the date of their first CQC inspection, and discontinue operating. Data suggests around 14 per cent never make it to a data return identifying whether they have adopted DSCRs.
Larger locations (with more customers) have higher adoption rates of DSCRs in care homes. Care homes with lower capacity tend to be for younger adults (capacity for around 34,000 people) rather than those for older people and tend to have lower rates of adoption. This is also likely to be true of community care locations.
NHSE data appears to show that when a provider with multiple sites makes a business decision to adopt DSCRs they adopt them across all sites.
However, DSCR adoption is highest in mid-sized care home providers - rather than the largest or smallest. Mid-sized providers (capacity for 250-499 residents) have the highest take-up, with somewhat lower take-up in the smallest providers and particularly low take-up in the largest providers - ‘above 2000 capacity’ providers.
Those largest providers represent around 30 per cent of beds and care home users.
Data indicates that locations rated overall ‘outstanding’ by CQC have higher rates of DSCR adoption and those locations rated ‘inadequate’ have lower rates of DSCR adoption. However, by ‘DSCR-adoption,’ the vast majority of locations are rated ‘good’ or ‘requires improvement’ and few are rated at the extremes - ‘outstanding’ or ‘inadequate’ (4.3 per cent and 1.1 per cent respectively in August 2023).
The Strategy Unit report (2021) identified as barriers to DSCR take-up:
- leadership, or lack of buy-in
- a skills or organisational knowledge deficit
- resource availability or costs – start up and maintained status
- time and effort
- infrastructure, such as poor wi-fi, broadband or mobile signal
- care recipients or unpaid carers might not like DSCR – do not like seeing devices
- managers and staff do not buy-in
- procurement difficulties
- interoperability with other systems
- incompatibility with current workflow processes
- data protection concerns.
Case studies from integrated care systems about adoption and implementation have reinforced how important it is to tackle each of these issues.
Addressing barriers to DSCRs
DHSC and NHSE’s Transformation Directorate, through the Digitising Social Care (DiSC) programme have sought to impact on funding, choosing and managing suppliers, assured solutions, practical help to set up technology, upskilling the workforce, which address many of the potential barriers in this list.
DHSC has now made publicly available a range of helpful animations that explain simply and clearly the benefits of DSCRs.
Many ICS systems have also sought to bring information and confidence in DSCR adoption and implementation to support the provider sector on its footprint.
Case studies
The case studies below identify how barriers can be broken down by addressing cultural expectations and outcomes in systems, by focusing on partnerships, including strong delivery partnerships, by focusing on standards and expectations and by focusing on relationships that make everybody feel a part of something.