Scottish Care – Overcoming the acute design problem for social care and tech

Scotland’s technology provision for social care must be different in design to health, and it must be designed around people rather than organisations, Scottish Care’s Dr Donald Macaskill and Dr Tara French tell Highland Marketing’s Susan Venables and Matthew D’Arcy.

When the Scottish Government first launched its Digital Health and Care Strategy in 2018, membership body Scottish Care issued a critical response on behalf of the country’s independent care sector. “We described it as social care lite,” says Dr Donald Macaskill, the organisation’s chief executive. “And that was polite, because it was social care absent.”

The strategy’s understanding of the care sector was “dominated by health”, he says. “It was very much an acute sector design and paid lip service to beneficial outcomes for people, and had even less understanding of the complexity of the social care system.”

Move forward three years and a refresh to the strategy is now imminent. Macaskill believes that during this time progress has been made by the Scottish Government to try to better respond to specific digital challenges in social care. But, he would also tell you there is more to do. 

The progress that has been delivered has been in large-part driven by Caroline Lamb and her team, says Macaskill. Before her more recent appointment as the new chief executive of NHS Scotland, Lamb joined the Scottish Government in 2019 as its first ever director for digital reform and service engagement dedicated to health and care.

A “reorientation to understand social care better was already happening, even before Covid hit”, says Macaskill. “There was a development to understanding gaps in data, the lack of coherency across health and social care systems, inconsistent pathways and more.

“Then Covid happened. The gaps became absolutely obvious. And from then there has been developing partnership and collaboration. There are still holes, but the last year has undoubtedly increased mutual appreciation and awareness.”

‘The starting point should be people – not the system’

Dr Tara French’s appointment as Scottish Care’s technology and digital innovation lead personifies this closer alignment; her role funded by Tech Enabled Care – a Scotland-wide programme overseen by the Scottish Government.

French, whose background rests in design innovation practice in response to complex, societal challenges as a previous programme director at The Glasgow School of Art, insists the focus now needs to move to designing technology around people – not organisations.

“The starting point is still health,” she says. She describes current thinking as very heavy on “this has worked in health, let’s see if we can make it work in social care”.

“The starting point shouldn’t be health,” she says. “It shouldn’t be social care. It should be the people. Until we stop designing for the system, which we are continuing to do with the very best person-centred intentions, we are still designing solutions that help the system.”

Movement is being seen towards understanding the social care context, she says, but adds that for technology to play a role in social care it needs to be designed around how people interact with social care services.

“The whole philosophy of social care is around people’s choice and needs; aspirations of how they want to access care and support and what it means for their life,” she says. “We have to see a shift in mindset from digital by default, or digital first towards digital choice, if we are hoping people will contemplate engaging with technology to access care and support.”

Just handing out tech could be ‘dangerous’

Making this work in practice requires significant engagement with users, says French, adding that thinking needs to move on from how well-known solutions like telehealth can be applied to social care settings, for example. “We need to start from the broader perspective to understand what plays a role in someone’s care and support. It takes time and investment to undertake that in-depth process. But it creates value – you have understood the person, the context, the situation. Your design of how something can make a difference is evidenced by their lived experience.”

Macaskill gives an example of how devices were distributed to residents and staff in care homes during the coronavirus pandemic to help people maintain societal and family relationships, something he and French see as an understandable fast-paced response at the time, but that represents the challenge ahead.

“Before Covid we would have thought about what relationships are important, and why, and only then would we have thought about what technologies might help you to keep those feelings and relationships going,” he says.

“Instead pre-packaged devices were given to people in order for them to keep contact, without appreciating the average age of someone in a care home is 84. 80% of people over 80 have a visual impairment. 90% over 90. The vast majority have issues of dexterity and hand to eye coordination. And a huge percentage have auditory challenges. A device accessible and applicable for you and I, is not purposeful for that individual. We need to do the work around purpose, accessibility, and use,” he says.

“The presumption that you will give someone a piece of tech – with or without instructions – and expect that they will gain benefit is rather dangerous.”

Health and social care fundamentally different

People designing, procuring and implementing technology need to be aware of these complexities, he explains. “Fundamentally health and social care are completely different”, he says. “One is much more transactional and functional in nature. Whereas the nature of social care is dynamically about relationship – it is much more long term, and the way in which you use technology is going to be different.”

That complexity extends beyond designing systems for use in care homes too. An action plan has now been created for digital approaches in care homes by Tech Enabled Care. “But we haven’t seen the same for home care – care in people’s homes,” says French.

“It is relatively easy to maximise the use of digital in a built environment like a care home,” adds Macaskill. “But just as there are twice as many people in care homes as in an NHS hospital in good times, there are four times as many supported in the community as there are combined across care homes and hospitals. We need a digital and tech strategy for housing support in the community.”

The opportunity

Scottish Care has historically been proactive in technology policy development. This has included the creation of its own technology vision in September 2020, and previously to that a Human Rights Charter for Technology and Digital in Social Care.

The organisation now wants to create opportunities for practical exemplars that showcase social care providers using technology to advance human rights for people in their care.  

And the opportunity for tech developers that might want to support social care is to embrace a better understanding and engage with the care sector, says French. On this point, Scottish Care is open to dialogue to help: “Our role in creating opportunities for that to happen – how can we drive the market to ensure potential solutions meet needs.”

French concludes: “There are lots of ways we could be using technology and digital, but we haven’t unearthed them yet.