Adult social care technology innovation and digital skills reviews

Driving digital transformation in adult social care is a key component of our vision. Our work with the social care sector has shown how technology and digitisation can greatly improve outcomes for people, freeing up time for staff to spend on delivering care and relieving pressure on NHS and care services.

To ensure our work is led by the latest evidence, NHSX commissioned Ipsos MORI and Institute of Public Care at Oxford Brookes University to conduct two reviews: one jointly on scaling digital technology innovation, the other in partnership with Skills for Care on digital skills and capabilities. The reviews will support us in taking forward digital transformation in adult social care and are relevant to local government, the NHS, care providers, technology suppliers and beyond.

An executive summary of the reviews is published below. The full review report can be found on the Ipsos MORI website.

Executive summary - NHSX introduction

Digital technologies have tremendous potential to improve social care. They can extend the services on offer, giving people greater independence and control over their care and are proven to help support wellbeing. They can free up the time care workers now spend on administration tasks for more face-to-face care. And they can help care providers to operate more efficiently, so they can do more to look after those they support and their employees.

To help speed up the digital transformation of adult social care (ASC), NHSX recently commissioned reviews of the current extent of digital technologies and digital skills in the sector and how both could be scaled up. The reviews’ findings and recommendations are summarised in this paper. Afull review report is available on the Ipsos MORI website.

The two reviews looked at the technologies currently in use and how they are used by representatives of the ASC workforce, people with care and support needs, unpaid carers, local authorities, and regulated care providers. These groups were also asked for their views on digital technologies and their levels of skill and confidence in using them. The research team consulted technology suppliers and service providers, and digital learning and development providers as well.

Among all these groups, the reviews found both general and group-specific barriers to and enablers of faster uptake of digital technologies. The findings support recommendations for accelerating digital transformation that have five cross-cutting themes:

1. Involving end-users in developing a sector-wide vision for digitising ASC, including strategies for each user group
2. Developing co-produced standards and systems to support implementation of this vision
3. Raising awareness and knowledge of digital technologies across both the ASC sector and among end-users
4. Improving access to funding and procurement support for digital investments
5. Defining the specific digital skills needed by user groups in the ASC sector and providing targeted training and support, including support for digital leaders.

The findings and recommendations of the reviews are relevant to individuals and organisations across the ASC sector, including:

• people with care and support needs
• unpaid carers
• care providers
• local authorities
• companies developing or supplying digital technology to the sector

We will continue to work closely with all groups that have contributed to the reviews to decide on next steps and determine how together we can shape the future of ASC digitisation, and which groups are best placed to take forward specific recommendations.

Findings from the reviews

Findings and recommendations as summarised by Ipsos MORI, the Institute of Public Care and Skills for Care:

Digital technologies currently used in ASC

The report considered a range of digital technology including business and management technology, consumer technology and support and monitoring technology. See the glossary of the review report for a full list of definitions.

Views on the benefits of digital technology

There were high levels of agreement among the workforce and the sector more generally that digital technology is important in ASC. Participants associated digital technology with a range of benefits including better quality of care and outcomes for people who need care and support and unpaid carers, improved working practices and improved efficiency. The main area where views differed was on the financial benefits of digital technologies. While participating technology suppliers explained that one aim of their products and services was to offer cost savings, care providers surveyed held mixed views about financial benefits. This included providers both with and without experience of implementing digital systems. Local authority staff thought the case for the non-financial benefits of technology, such as freeing up more time for person-centred care and improved quality of care, was more clear-cut.

The extent of digital technology use across the sector

The use of some, often basic, digital technology for care and support was widespread but mixed, suggesting its full potential is not currently being realised. Use of digital communication, including email and video calling, was common among all participants, the exception being people with care and support needs and unpaid carers aged 85 and over. Access to and use of technology was lower among care workers than other groups in the workforce. Consumer digital technology was also increasingly being used to deliver care and support or by those with care and support needs. A range of digital technology was used to deliver care, but awareness and knowledge of care specific digital technology was variable among the workforce and care providers, and fairly low among people with care and support needs and unpaid carers.

Encouragingly, among the workforce there was openness to using digital technology more widely. On the whole, frontline staff taking part in the research wanted to develop their digital skills to be able to do so. There was also recognition among ASC staff that there will be an increasing need for digital skills in the future. Acquiring them was seen as an essential part of career progression. Similarly, there was agreement among the local authorities and care providers interviewed that digital technology would be part of their future way of working.

The reviews also found evidence that the COVID-19 pandemic had increased opportunities to develop digital skills in the face of difficulties. The pandemic has led to an increase in the use of digital technology, particularly communications technology. However, it may also have increased disparities in use of technology by staff in different roles, with less increase in use among care workers than, for instance, registered nurses.

Digital skills and confidence

There was consensus among registered managers and others with responsibility for developing the digital skills of staff that there were gaps in the digital skills of the frontline workforce. The types of skills thought to need improvement were predominantly basic digital skills. The workforce’s self-assessment of their own skills and confidence was largely driven by familiarity and opportunity to use technology, with confidence being higher in organisations that had adopted digital systems. The digital skills and digital confidence of people with care and support needs and unpaid carers varied greatly. However, as would be expected, those who had been using technology for a long time, were using it for their work or had done in the past were more confident.

Age was an important factor concerning confidence. Among the workforce, younger groups exhibited higher levels of digital confidence, while older staff were more comfortable asking for support and were more interested in developing their digital skills. All participants with care and support needs who reported feeling not very or not at all confident in using digital technology were aged 65 and over.

Barriers to development of digital skills and adoption of technology

The review identified a range of barriers to developing digital skills and to the adoption and increased use of digital technology. At an individual level, the main barriers were:

▪ variation in familiarity and opportunity to use digital technology - this affected people’s digital confidence

▪ awareness and knowledge about the range of digital technology available, and a perceived lack of need for digital technology felt by some people with care and support needs and unpaid carers

▪ anxiety and stress generated by the introduction of new technology felt by some of the frontline workforce, and by some people with care and support needs and unpaid carers

▪ a concern among some staff that digital technologies could replace face-to-face care and support, potentially impacting on quality, and a related reluctance to work digitally

At organisation or sector level, the main barriers to the adoption of technology arose from:

▪ budget pressures making organisations less inclined to invest in technology, especially where financial benefits are not clear-cut or may be realised in another part of the health and social care system, or where organisations have competing priorities

▪ the lack of a digital vision for the sector to build on, with inconsistency in systems and a lack of interoperability

▪ the diverse nature of the demand for digital care technology (for example coming from SME care providers, local authorities, and people with care and support needs and their families), which was found to hinder the scaling and adoption of technology and limit purchasing confidence

▪ a need for stronger digital leadership in the ASC sector, and sufficient capacity and capability to introduce digital technologies into the sector and manage the related change

Enablers

The reviews also identified specific enablers to help overcome these barriers to the development of digital skills and the adoption and diffusion of digital technologies across the ASC sector. These enablers are specific to each group making up the sector.

People with care and support needs and unpaid carers

For people with care and support needs and unpaid carers, the enablers are better signposting, information and advice about digital technology solutions available as well as hands-on support to adopt digital technology, learn new skills and troubleshoot. The work of technology companies in developing care technology should involve these groups so that solutions are co-produced.

Digital technology suppliers

For digital technology suppliers, the enablers are a clear and comprehensive vision for digital technology in ASC from government, with aligned government policies, data industry standards and enhanced interoperability. They would also welcome public financial support for the ASC sector and capacity building among smaller care providers. Opportunities to learn about the needs of the ASC sector and bridge the divide between the technology and ASC sectors are important to this group as well.

Care providers

For care providers, the main enablers are more funding for investment in digital technologies, upskilling the workforce as well as help to understand the different technologies available. Alongside this, they would like support to review different digital technologies and develop a business case, advisory or consultancy services to decide what should be implemented, improved infrastructure (for example, reliable internet connectivity), and support to improve project and change management processes.

Local authorities

For local authorities, enablers include ‘Change Partnerships’ (that is, partnerships between technology suppliers, independent change management consultants and local authorities), reducing digital exclusion locally, improving their care management systems and their digital infrastructure, and making sure digital technology is discussed with people with care and support needs and unpaid carers when conducting social care assessments or planning support. Support for improving workforce understanding of care technology and its potential would help build this last enabler.

ASC workforce

For the workforce, enablers are improving awareness and understanding of how care technology can improve outcomes for people with care and support needs and unpaid carers, and supporting staff to further improve their digital skills. Developing basic skills through tailored training and peer support would ensure staff have a baseline of transferable skills that can allow them to feel confident using digital technology, understand how technology can complement care and reduce concerns about impacts on face-to-face care. Improving access to digital technology in some parts of the sector would ensure staff have the opportunity to use and become familiar with common digital devices and systems.

Digital leaders

For leaders within local authorities and care providers, the main enablers are building more confident digital leadership within their organisations, including developing skills in change and project management, so that organisations are better placed to adopt digital technology and support its use by staff. In the short to medium term having leadership roles with specific responsibility for digital transformation will be important. But in the longer term, digital innovation and implementation should become the norm and be embedded in leadership roles throughout all organisations.

ASC sector

For the ASC sector as a whole, a key enabler is ensuring resources are available when investment in technology needs to be made, even if the financial returns on the investment are realised in the medium to long term and/or elsewhere in the system. Support is needed to develop a technology market which works for suppliers and end users, given purchasers may be large or small organisations or individuals, with varying levels of knowledge and resources.

Recommendations

Based on the above findings, the review research team proposed recommendations which were discussed with ASC representatives involved in the review expert reference group. They are relevant not only to NHSX, but also to other organisations within adult social care and to those developing or supplying digital technology to the sector. Further discussion of the recommendations can be found in the review report.

Skills review recommendations

1. Introducing digital technology to the workplace with appropriate support should be encouraged, irrespective of the current digital skills of staff. Access to digital technology can encourage the development of digital skills. Greater use of technology is associated with greater confidence in it and more positive views.
2. A programme of myth busting, reassurance and culture change is needed, alongside changes to ways of working that focus on informing and raising awareness of digital technology, and communicating the benefits.
3. Digital leadership skills should be developed further in the sector so that digital leadership becomes a ‘normal’ part of a leader’s role.
4. Efforts should be made to raise knowledge and awareness of the role, availability and suitability of digital technology in the direct provision of care.
5. There should be a continued focus on improving knowledge and confidence in data protection and information governance policies and procedures.
6. Greater collaboration and co-production of solutions would improve digital technology suppliers’ understanding of the needs of the ASC sector and assist in embedding digital solutions within ASC.
7. Digital skills support needs to be tailored - for example, through peers within and across organisations - and should aim to alleviate the anxieties felt by some of the workforce around greater use of technology.
8. Digital skills should be incorporated into ASC recruitment, qualifications and career progression.
9. There is a need to define and achieve a consistent baseline of transferable digital skills across the sector.
10. There is scope to improve consistency in the quality and availability of support for developing digital skills across the whole country and all workplaces, regardless of size of organisation or job role.

Technology review recommendations

1. Building a national vision for a digital ecosystem or ‘backbone’ for digital technology in ASC would assist digitisation of the sector.
2. More support is needed to mitigate the impacts of a fragmented customer base for care technology (as most care providers are SMEs and people with care and support needs may also purchase technology).
3. Raising awareness and understanding of digital technology in ASC is crucial to increase take up and buy in. People in all parts of the ASC sector need access to information about digital technology in ASC.
4. The development of sector-wide standards and systems should involve end users of digital technology. These should be co-produced with people with care and support needs, unpaid carers and the workforce so that standards reflect how these groups currently use digital technology and could do in the future.
5. Investment in digital technology should be encouraged in view of both financial and non-financial benefits. Investment should be system-wide, including where benefits are felt outside the immediate ASC sector. Care providers and local authorities need to be supported in making a business case for digital technology.
6. Further research needs to be conducted in view of the constantly changing technology landscape and to cover areas out of scope of these reviews. In particular, more work is needed to explore the economic costs and benefits of digital technology in ASC, and how digital confidence, digital skills and use of technology across end users may be impacted by broader demographic factors, including ethnicity or socio-economic status.