Written Evidence submitted by Dr Peter Bloomfield Head of Policy & Research Future Care Capital
Future Care Capital (FCC) is a charity which undertakes research to advance ideas that will help shape future health and social care policy and deliver better outcomes for individuals living in the UK. Our work to enable key stakeholders to better harness the value of health and care data has involved extensive research, policy development and advocacy activity in recent years.
FCC’s submission to the Public Accounts Committee focuses on the National Audit Office’s (NAO) recent report concerning the peak of the COVID-19 outbreak. Our evidence relates to:
1. The methods used to select providers and award contracts:
Better understanding of the ongoing procurement and implementation of technology-based solutions requires more robust scrutiny than has been in evidence to date. These interventions require procedures and structures to be in place that are as rigorous as for other medical supplies. Our concerns here are overwhelmingly about transparency, which is essential if the government is to maintain public trust, and the extent to which ‘deals’ entered into with tech suppliers in the short-term might have negative long-term implications; for example, for vendor lock-in, value for money and ownership of intellectual property (IP). Without a thorough appreciation of those given access to different health and care datasets, what technology is being developed with said data and, crucially, which entities may have been assigned IP rights and whether/how they might give rise to ‘fair benefits’ for the NHS and those it serves, there is a risk that the Department of Health and Social Care (DHSC) currently stands in breach of its own Code of Conduct for Data-driven Health and Care Technology.
2. Capacity to withstand a potential second peak:
We strongly agree with Point 13 in the NAO’s report, where it highlights that data regarding the impact of the pandemic on adult social care providers is limited. In addition, the following point in paragraph 3.7 is crucial: “At the start of the outbreak, therefore, there was no systematic national process to collect a wide range of daily data from care providers.” Improvements have been made by the CQC and ONS around social care data collection at the national level. However, the steps taken thus far are insufficient, if the aim is to provide intelligence in a timely and sufficiently granular form to enable leaders and planners to understand the local context and regional risks communities face in preparing for a second peak. The effects of the first wave were exacerbated by data challenges with a significant proportion of excess deaths amongst people in receipt of residential and domiciliary care. We have contributed to the work of the Centre for Data Ethics and Intelligence which underlines the asymmetry between health and social care data availability. We have also conducted recent research to better understand the availability of data pertaining to adult social care.
3. The methods used to select providers and award contracts.
3.1 The use of framework agreements and contract variations are to some extent understandable in the context of the initial emergency but should have been underpinned by a firmer commitment to transparency. Recent media coverage as well as written questions and answers between parliamentarians and Ministers in the DHSC have highlighted that that wasn’t the case and, in some important respects, remains as such.
3.2 It would, also, be useful to have greater visibility of the number and nature of access requests being submitted to NHSE/I in respect of the COVID19 Datastore and Platform for the purposes of research and/or innovation; at present, it is unclear whether the data is being utilised to best support preparations for a second peak. We are unable to readily discern whether other suppliers might be in a position to offer better value for money in relation to next stage technical interventions. Neither can we state with any confidence what the value of IP generated by COVID19 tech initiatives (whether for the Government or its tech partners) might amount to and, with that, the ramifications for wider use of recently developed technology products/services by other NHS organisations. It is imperative any benefits are ‘fairly distributed’ - in keeping with the DHSC’s own Code of Conduct for Data-driven Health and Care Technology.
4. Capacity to withstand a potential second peak.
4.1 The COVID-19 situation in care homes has rightly received a great deal of attention and government action has improved data collection efforts since the beginning of the outbreak - albeit, we would argue, too little and too late - with profound consequences for our charitable beneficiaries. There are, however, ongoing concerns about the timeliness and granularity of data available at the local level as well as groups who remain less visible than others whom we consider to be at greater risk from a second peak:
4.2 In the course of our recent research, we have identified 40 national datasets which provide information about adult social care. Of these 40, 22 datasets relate to the COVID-19 pandemic. These national datasets do not provide comprehensive information and, crucially, neither do they afford leaders and planners sufficient insight to prepare for a second peak.
4.3 We have written extensively about the paucity of adult social care data. Over a period of three years, we have demonstrated that information about the care sector and a disparity in data availability between publicly and privately provided care undermines the ability of policy-makers, commissioners and providers as well as service users to obtain the information they need and upon which they are reliant to ensure high quality care results.
4.4 Our most recent work reviewing and documenting social care data in England demonstrates a lack of publicly available data about adult social care. 74% of councils in England (114/154) do not publish data on adult social care in the public domain5. Similarly, data can only be accessed for those in receipt of publicly funded social care. In many cases, data is only available from local authorities using FOIA requests7.
4.5 Our research into social care, both related to COVID-19 and in a wider context, has highlighted further areas where data is inadequate - including, but not limited to:
I. Provision or reliance upon domiciliary care.
II. Individuals with learning disabilities and other disabilities.
III. The social care workforce.
4.6 These issues need to be remedied apace if we are to prepare for a second peak in earnest - social care is too critical to fail for those amongst us who are reliant upon it and hinges upon the data infrastructure that underpins it.