Care Home Data Review - Full Report

Data Rationalisation

Current data collections

A key issue highlighted in discussions with data providers is the sheer volume of requests for data, along with limited staff resource to dedicate to data collection. In order to better understand the scale, size and scope of data collected, one of the first stages of the review was to undertake a mapping of all the current requests for care home data, at national level. The results of the mapping exercise are available on the Care Home Data Review webpage.

The landscape mapping illustrated the range of national care home data collections, across a number of different data producers, at different frequencies and for a number of different purposes. Many of the national collections feed into published reports, such as the Care Home Census official statistics publication, or other published resources, such as the Care Inspectorate’s datastore and PHS’s Insights in Social Care - Care Home Services Dashboard.

As already noted, in many cases these collections cover similar information however, to date, there has been limited high-level oversight of what is collected across the sector or harmonisation of data collection between the data producers. This means that the data landscape can, at times, be cluttered and confusing with some data from the different collections being disjointed, sometimes contradictory and failing to provide the insight that is required to meaningfully inform decisions.

Since the start of COVID-19, there has been an increase in the amount of data being collected directly from care homes, which do not have a nationally run and resourced data, records and technology infrastructure. This means that data requests can have a very real cost in terms of time taken away from providing care. This cost needs to be balanced by an associated benefit to the provider and ultimately to the outcome for people who use the service.

In addition to these national collections, there are also a number of local (LA/HSCP) data collections. Depending on local requirements, there may be differences in the data collected, definitions and methods of collection across local areas.

There were numerous calls for much greater alignment of the data requests across local and national data producers:

“[One change for biggest benefit would be] genuinely integrated data gathering and reporting - between local and national statutory partners.”

Whilst the review covers national care home data collections, national data producers will need to work with local areas to both understand and take account of how data is collected and used locally.

Case study: A care home data provider’s perspective

Prior to the COVID-19 pandemic, care homes in Scotland were required to submit an Annual Return to the Care Inspectorate (CI). This return sought a wide range of data relating to care and support needs of residents, admissions and discharges, policy and procedural systems and workforce data. The information which the CI receives, contributes to the assessment of risk and levels of inspection that service should receive in the year ahead.

In addition, care homes are also asked by the SG to supply care home census data annually. This census requests information on admission/discharge and resident population and is supplied to PHS, via the CI, who analyse and publish the information on behalf of the SG.

Throughout the year, care homes also have to make notifications to the CI for a range of issues or events such as outbreaks of infection, incidents, or adult support and protection issues.

With the onset of the pandemic in March 2020 the volume of notifications of outbreaks of an infectious disease went up, and CI asked us to notify if we were experiencing severe staffing issues. From May 2020, the CI added the weekly staffing return, and in Sept moved from using the usual outbreak notifications to specific covid 19 ones. SG then introduced the TURAS Safety Huddle Tool, requiring care homes to complete a daily status report which included information relating to outbreaks of infection, occupancy, and bed status.

In addition to infection outbreaks data being supplied to CI and SG, similar data is also collected by the local public health team, and the HSCP. Not only is there duplication, but there is no feedback loop apart from local public health.

There is significant burden on care home managers to complete data input with little opportunity to see the benefits of providing this information in terms of national workforce or strategic planning for the sector. There is significant duplication in the question sets, therefore there is clear risk of data errors and variation. The Safety Huddle data has been questioned on numerous occasions regarding validity and the frequency.

The sector would benefit from being involved in cost benefit discussions to identify meaningful and measurable data for everyone, while reducing the risk of duplication and errors. The range of questions should be reflective of what matters to residents.

Rationalising current data collections

Understanding data needs

In order to ensure we are collecting the right information, it is essential that we have a clear understanding of the data needs across the sector. In order to inform any decisions around what/how data collections can be rationalised, we need to be clear on what data are required, by whom, by when and for what purpose. These needs will vary both by use (e.g. regulatory, planning, quality & safety, monitoring & evaluation and national reporting) and by the person/organisation using the data (e.g. care home staff, LA/HSCP, inspector, central government and academia). We need to ensure any rationalised set of data collections still meets the needs of the variety of data users. Understanding these different needs will allow us to evaluate the trade-off between the timeliness of data versus the quality of the data required.

The CHD Working Group will work closely with the data provider/user networks to further develop a shared understanding of the data needs of providers, service users, HSCPs/local and central government, other relevant organisations and academia. This information will inform the rationalisation of data collections and in understanding and addressing data gaps (see next section).

National collections

To improve the coherence across data collections, national data producers (SG, PHS, CI) will work together to discuss and propose areas where data collections/variables can potentially be dropped, either due to no longer being required or duplication. This work will be informed by the understanding data needs work outlined above, and proposals for rationalisation will be agreed with the appropriate data provider / user network. Areas identified for priority consideration are:

• Options for running the next Care Home Census – understand requirements, in particular if much of this data can be extracted from alternative sources.
• Consider stopping SG free personal nursing care Quarterly Return and the potential to incorporate it into the Source social care data collection. Producing options paper on what the challenges are and how/if they can be overcome
• Consider potential to re-purpose data collected for regulatory and statutory purposes e.g. how data collected by CI compares to the Turas Care Management data collection.

It is acknowledged that the rationalisation of current collections may prove challenging, as the current collections are designed to meet the needs of the collecting organisation. In some cases the needs, in terms of data, granularity, timings etc, will be different across organisations and we will need to ensure that any rationalised set of data collections still meets the needs of the variety of data users. Data rationalisation will also require agreement on data definitions / standardisation and data sharing (covered separately elsewhere).

Under the Local Government Data Platform project, work is underway to explore how rationalisation can be attained across a sector, using data returns relating to housing and homelessness as a pilot. COSLA, Scottish Government and professional associations are involved in this work, which will start by identifying areas where:

• there is duplication in current reporting
• data is not being used locally and nationally,
• the burden of collecting, collating, and reporting the data outweigh the benefits.

Further engagement will be undertaken to reach consensus around where there may be opportunities to drive reductions in the current landscape. Any resulting proposals to reduce reporting would then be progressed through the new governance process outlined previously.

This pilot will generate learning that can then be applied to other areas, such as Social Care.

Core minimum dataset (CMDS)

A longer term option to rationalise the data collections fully would be the establishment of a core minimum data set (CMDS). The aim of the CMDS would be to simplify and standardise the current multiple requests into a set of commonly agreed key data requirements. The CMDS would require the collective agreement of what data is important to ensure it provides a consistent and reliable dataset for multiple data uses / users. The establishment of a standardised CMDS would also allow system providers to incorporate requirements into their Management Information Systems.

A number of recent projects have looked at the potential benefits, considerations and potential problems associated with building a minimum data set for care home data. A notable example is the “Developing research resources and minimum data set for Care Homes’ Adoption and use” (DACHA) study ^[5],[6], which has looked at developing a CMDS for adult care homes in the UK and set out the principles for the creation of a useful dataset. Furthermore, in England as part of the digitising social care programme, there is work to develop an Adult Social Care Reporting Minimum Data Specification (RMDS).

A key consideration is the multiple uses for which care home data is used, and the importance of agreeing a “core” set of data that is able to meet all of these needs. The establishment of CMDS for care home data would also require the agreement of data standards/definitions (considered later in this report).

The Care Home Data Working Group will look to determine the feasibility of establishing a core minimum dataset (CMDS) and will link into the work already done in this area, such the Workforce CMDS established by Scottish Social Services Council (SSSC)/CI . The work will be informed by all stakeholders with an interest in care home data.

Case study: Workforce core minimum data set (CMDS), Scottish social service sector

The CMDS was first finalised in 2007 with a view to gathering data on all providers, services and staff working in the social service sector. The sector is defined in statute as all local authority social work services and all registered care services. It was driven by changes in the regulation of the sector brought about by the Regulation of Care Scotland Act 2001.

Before this, data with common standards was only available on local authority social work services and the care services they ran. Those common data standards ensured the comparability of data between local authorities. However, the data on provision by private and voluntary providers covered some sectors but not others, was gathered by a number of different mechanisms, at different times, and did not use consistent data standards.

There are approximately 2,500 separate organisations that deliver services in the social service sector in Scotland only 32 of which are local authorities. Common data standards are therefore important to ensure that data are comparable between these organisations, the services they deliver and the staff they employ. For example, there are no common job titles across the 2,500 providers so a way of categorising posts had to be developed. This has also been supported by the roll out of workforce registration which now covers 4 out of 5 employees in the sector.

The CMDS is embedded in two data collections which take place each December. One is the annual survey of Scottish local authority social work services (LASWS) staff undertaken by the SSSC (Scottish Social Services Council). The other are the Care Inspectorate’s annual returns which are completed by all registered care services. It was agreed that these two collections should gather the data from the sector replacing any other previous collections, with the CMDS ensuring the comparability of the two.

Data rationalisation: Aims and recommendations

Aim: Work with the sector to clearly articulate data needs and data flows to meet these needs.

Recommendation: Continue to develop a detailed map of data needs and reporting requirements, purpose of data and frequency required. For example, equalities data, regulatory data requirements, and emerging needs for the Healthcare Framework and National Care Service.

Aim: Rationalise and align collections against data need and improve coherence between data collections across organisations, where possible considering local collections.

Recommendation: Set up working group(s) / workstream(s) to investigate areas for rationalisation and where data collections/variables can be removed, due to lack of use / quality or duplication. Including:

• Consider options for the Care Home Census by reviewing data requirements and assessing if this data can be extracted from alternative sources, such as Source Social Care returns, Care Inspectorate data and Turas Care Management data collection.
• Consider opportunity to stop SG Free Personal Nursing Care data collection and the potential to incorporate into the PHS Source Social Care data collection. Producing options paper on what are the challenges, how/if they can be overcome and in what timescale.
• Consider potential to re-purpose data collected for regulatory / statutory purposes. For example, look at how data collected by Care Inspectorate compares to Turas Care Management data collection.
• Following rationalisation of the (previous) Safety Huddle Tool (SHT) return, now Turas Care Management (TCM) Data Collection, continue sector engagement to ensure continued relevance.

Aim: Look to establish a core minimum dataset that can be easily accessed and used by all those who need to use it.

Recommendation: Set up working group to determine the feasibility of establishing a core minimum dataset to meet the needs of those who need to use care home data for planning, service delivery, surveillance, regulation, policy development and research purposes.