My Health, My Care, My Home - healthcare framework for adults living in care homes

8. Data, Digital and Technology

For the framework to succeed, we must fully embrace the digital world and use data and technology appropriately to enable people to live well. The current digital landscape across care homes in Scotland is diverse. Many care homes use digital care planning systems and electronic medication management, and provide Wi-Fi access throughout the home for use by people living in the care home and any families or visitors. Other homes lack both accessible devices and connectivity, with significant implications for all.

Improving the use of data to support people living in care homes

Care homes are data-rich environments, collecting and collating detailed records of people's needs, plans and activities. They also provide data to inform the requirements of their regulator, contract monitoring with Partnerships, and intelligence to support national statistics on care home services – such as the Care home census. During the pandemic, the Safety Huddle Tool was developed to provide real-time data to inform the pandemic response, with respect to outbreaks, staffing and hospital use. It has been necessary to collect this data from care homes directly as it is not possible to identify the whole of the adult care home population using so-called 'routinely collected' health data in Scotland. This challenge limits our ability to use our national data to understand the needs of those living in care homes. This includes having reliable data on vaccination uptake and effectiveness, understanding patterns of hospital use, exploring pathways into care homes and their use to provide temporary care and support (e.g. respite and intermediate care services). Furthermore, there is inconsistency across the health system in what is considered to be a care home, with care home mortality statistics being based on alternative codes and definitions than those used by the Care Inspectorate as care regulator. Such inconsistencies mean we have a poor understanding of vital events and make existing and historical data difficult to compare.

Improving care home data in Scotland has the potential both to better understand the needs of those living in care homes and the staff who support them, but also to evaluate the implementation of this framework and generate evidence from practice around the most effective models of support. However, this will require specific work to improve the reliability of the data which NHS services collect on those living in care homes and routine systems to identify who lives in a care home, even on a temporary basis, so data are inclusive of the whole care home population. Joint working must take place between national bodies such as Public Health Scotland, National Records of Scotland and the Care Inspectorate, with improvements to NHS digital systems in Scotland. The National Care Service identifies the need for improved data about those receiving any social care, including those living in care homes. It is essential that there is both a review of the existing care home data landscape and work with key stakeholders which establishes the core data which should be collected and the specific purposes for collection, to ensure it is used to benefit those living in care homes.

Scottish Government analysts will shortly commence a review of care home data. The aims of the review are to ensure a coherent suite of data collections, reduce requests on data providers and more comprehensively understand and meet the existing and emerging needs of data users.

This Care Home data review will form one strand of a wider review of the entire social care data landscape. It will provide an important stock-take as we move towards the National Care Service. It will also support us to meet the recommendations set out in the Independent Review of Adult Social Care and reports from the Office for Statistics Regulation. It is envisaged that this will enable the monitoring of future approaches to the delivery of care, such as this healthcare framework.

Sharing information electronically

The importance of being able to share confidential information about the health of an individual, between the healthcare and social care workforce, was a common theme arising through the engagement sessions. We heard from healthcare professionals working in hospitals who did not have access to personal plans or ACPs when treating someone from a care home. Care home staff told us that they would often not receive adequate information at the time of hospital discharge to enable them to provide appropriate care.

It is important that when different professionals or organisations become involved in the provision of care to an individual, that relevant and appropriate personal information is shared between them and that data entries are understood to mean the same thing. The latter could be achieved by introducing and adhering to data standards and should enable professionals and organisations to deliver co-ordinated, effective and seamless services to the person living in a care home.

The Scottish Information Sharing Toolkit enables service-providing organisations directly concerned with the safeguarding, welfare and protection of the wider public to share personal information between them in a lawful and intelligent way. The Sharing Toolkit should be used to help organisations sharing or handling NHS Scotland's data to take the necessary steps to confidently share and use health data.

Digital technology for the individual

Being mindful of a person's life before they have moved into the care home and maintaining connections with the wider community is important and can be aided through the use of technology. This can enable the continued participation in faith or wider community activities.

During the COVID-19 pandemic there were strict restrictions on what people living in care homes were allowed to do, and who were allowed to visit them. Video calls allowed continued connection with family and friends who were not able to visit. They also enabled people to join church services, weddings and funerals in a virtual manner from the care home. Opportunities to use technology in this way must continue whenever it benefits the individual living in a care home.

However, this depends upon good Wi-Fi or broadband connectivity, access to appropriate phones, tablets, or laptops and staff with the time to help those who need it. It is therefore essential that this is available in all care homes in Scotland.

Digital technology to support the MDT approach to care

Increasingly videoconferencing technology has been used by healthcare teams to assess and review people rather than bringing them to hospital. This was particularly important during the COVID-19 pandemic as it allowed people to have healthcare interventions without the risks associated with attending a clinical environment such as a clinic or hospital.

As we move through the COVID-19 pandemic, the use of videoconferencing technology for consultations will continue to be important. Whilst face-to-face assessments must still take place when they are necessary and clinically appropriate, the use of photos and video-consultations can allow quicker access to advice and treatment for some health conditions (e.g. an unusual rash, or advice on wound-care) and can reduce the need for unnecessary travel. This is particularly important for people with mobility issues, or for people with cognitive decline. NHS Near Me is the platform that is currently used for video-consultations with healthcare professionals, and so staff working in care homes must be familiar with this, and be able to support people living in care homes to use it.

Videoconferencing technology must also be available to health and social care teams to enable the MDT to function. All care homes must have access to appropriate laptops or tablets to support videoconferences and have Wi-Fi and broadband connectivity that is sufficient to host these systems.

Near Me

Near Me is a secure form of video consulting that is widely used across NHS Scotland for health and care appointments. In 2021, a case study examined the use of Near Me to reduce the backlog of health reviews in Glasgow. Conducting the care home reviews via Near Me allowed staff and professionals to come together in a single call. Further benefits of Near Me include:

• Reduced travel to appointments: time, cost, convenience
• Reduced time away from home
• Easier to attend if you usually need someone to take you to appointments
• Enables you to have someone with you for support at your appointment (either with you or joining the consultation by video from another location, even from abroad)
• Better for the environment
• Reduces spread of infectious diseases

Digital approaches in care homes

The uptake and use of digital technology across the care home sector is a source of significant variation. Reducing this variation and ensuring people living in care homes can benefit from digital technologies to facilitate and support healthcare is key as we move forwards. This will not be without challenges – it requires investment of resource, addressing governance issues, establishing clear data sharing pathways and supporting the development of a digitally-skilled workforce.

The Connecting People Connecting Services Action Plan responds to the current and emerging needs of people living in care homes to realise the benefits of digital technologies. It provides a wider view on the scope of the digital issues and how to address them. The plan sets out key aspirations for enhancing Scotland's care homes' digital capacity to be able to fully embrace the potential for supporting people living in care homes and enabling new care management processes through the use of digital technology. Initial work took place during the COVID-19 pandemic, when the programme that supports the action plan equipped all interested care homes with tablets and dongles for connectivity. This saw people living in care homes being able to connect with outside services and loved ones during the periods of lockdown. Crucially, since November 2020 a number of digital training opportunities have been made available for care home staff with the goal of helping staff gain confidence and key skills to navigate day-to-day digital tasks to support those that they care for. The digital action plan for care homes will continue to be delivered and evolve through engagement with care home staff and managers. Information about current work and opportunities to participate in training and programme development sessions can be found on the Technology Enabled Care website.

Technology Enabled Care (TEC)

Technology Enabled Care (TEC) is a programme within Scottish Government which focuses on citizen facing digital solutions. It has a number of online digital resources that are designed for care homes, and include resources on device security, training resources and information on digital champions. All care home staff can potentially play the role of a digital champion, and can help colleagues and those living in the home to build their confidence and skills to get online.

Technology to support learning and development: Project ECHO

Project ECHO enables collaborative learning and the development of 'communities of practice' via multi-site videoconferencing. These meetings have often focused on palliative and end of life care issues, with input from the local specialist palliative care team. Highland Hospice is a super-hub and has helped establish and train eight other hubs across Scotland.

It is a recommendation that more care homes across Scotland have the opportunity to take part in Project ECHO.

Project ECHO

Project ECHO (Extension for Community Healthcare Outcomes) is an internationally recognised collaborative model of health education and care management that empowers health and social care professionals everywhere to provide better care to more people where they live and enhance their skills, confidence and build relationships with other professionals.

The ECHO model is guided by four main principles:

1. Amplification – using technology to leverage scarce resources

2. Best practice – to reduce disparity

3. Case based learning – to master complexity

4. Capturing data – Monitoring outcomes

There are a series of 'hubs' established across the UK, which have their own knowledge networks based on needs identified by the community itself.

Recommendations

8.1 Undertake a review of the existing care home data landscape to ensure it is used to benefit those living in care homes.

8.2 Data standards should be introduced, so that data entries from different organisations are understood to mean the same thing.

8.3 The Information Sharing Toolkit should be used to help organisations sharing or handling NHS Scotland's data to take the necessary steps to confidently share and use health data.

8.4 People living in care homes should have opportunities and support to use technology to connect with the world outside the care home, including access to good Wi-Fi and broadband connections.

8.5 There should be access and support for people living in care homes to use NHS Near Me for video-consultations with healthcare professionals.

8.6 There must be appropriate technology within every care home to support virtual MDT meetings.

8.7 The actions listed within Connecting People Connecting Services should be implemented.

8.8 All care home staff should have access to resources that build and strengthen their digital skills, such as those developed by Technology Enabled Care.

8.9 Digital initiatives that support learning, such as Project ECHO should be explored.