IEG4 Insights

Politics, people and perfectionism stifling place-based care

Posted by Paul Tomlinson on Mar 29, 2019 4:29:21 PM
Paul Tomlinson
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Paul Tomlinson, CEO and Founder of IEG4 Limited, TechUK Local Public Services Committee Chair, argues that technology is not the inhibiting factor in the delivery of Place-Based Care.  Rather, it’s politics, people and perfectionism that are stifling progress.

Is the only reason we provide Health services in the way we do because that’s the way we always have?

In the past, in order to get stuff we wanted, we were served by a person gathering our requirements, putting them into a format their organisation could interpret and then, the organisation’s representatives would hand over a proposal to address our needs.   This is how it was for the services in our ‘private’ lives.

Now, every single day, millions of us show we have the capacity to engage with a ‘digital world’.  To get what we want, when we want it, we are prepared to do a lot of work.  We identify our requirements and take time to feed these into the service providers.  The next day, we get what we want delivered, where we want it, through a joined-up supply chain which works on the shared information we’ve willingly contributed.    

However, access to health and care services is still controlled, or do I mean patrolled, by individuals who, like in the example about the past above, seek to understand our needs personally, then interpret and apply these to what our siloed institutions have to offer. All on an organisation by organisation basis.

After decades of this kind of behavioural programming, we attend a GP surgery with an ailment and expect to receive something which will make us better, usually medicine.  In answer, GPs have been trained to match solutions to the evidence we present from what they have in the medicine bag.  An industry of local pharmacies depends on being able to supply them.  This expectation model, on all sides, is tough to turn around, even though many are recognising the need to do so.

One example of how Social Care is broken. And how Lego systems can help.

Austerity has driven local government to focus and prioritise statutory services, and now many peripheral services are no longer funded, hence local government is able to help increasingly fewer citizens. Many social ailments, such as loneliness or early stages of neglect, go unaddressed. Charities and other voluntary services are stepping into the breach, but how does the citizen find out about who provides what?

What is the user need?

An elderly person, or more likely their carer or family, need to find services and products to assist with care. Right now, the data to help them is totally fragmented or even unavailable.

To make matters worse, at an already stressful time, there is an element of ‘who’s going to pay?’.  Consider a family who are looking for help as they turn to local government Social Services for help with their elderly relative. Typically, they will be asked to apply to the NHS for Continuing Health Care (CHC), because if the needy citizen has one of three primary health care needs, then the NHS fund all the care required. NHS budgets appear more flexible than those of local government, so the council’s first move will always be to see whether the service will be paid for with someone else’s budget.

Getting CHC should follow an eligibility process laid down by NHS Digital standards, and the NHS targets this process to be completed within 28 days (shorter if the person is in hospital). It includes assessments across 11 domains carried out by CHC nurses but often with external inputs from GPs, Physiotherapists, Nutritionists etc.  If the citizen doesn’t have a primary health need then CHC funding is rejected, although there may be a small amount of discretionary Funded Nursing Care (FNC) allocated. However, in 60% of cases nationally, at the end of 28 days (sometimes longer), the family/carer are back at stage one needing help as their claim for CHC is rejected. At this point, local government Social Services will perform an eligibility assessment on the citizen, called a Social Care Financial Assessment, which determines, basically, whether they are wealthy enough to pay for their own care. This is a means test which includes any value they have in their primary residence. If this is over a certain amount then they are expected to self-fund their care, which may include giving a claim over the primary home if necessary.

For many people the time it takes and the knowledge it requires are too much. They end up being neglected by the system we have created, relying on family support alone, paying for themselves for partial private care despite entitlement or maybe even dying while they wait for the system to catch up with their needs


Care is the same whoever pays for it, and citizens or their carers need one place to look for help. The services should be a combination of necessary services - some NHS, some local government and some (often more) from the third sector.

The correct blend of services from multiple sources, funded by different pots, will require extensive data sharing, and, to facilitate access to the data – easy to use search and planning facilities.

Multiple data sources and multiple interfaces will require real Lego systems and true implementation of small pieces loosely coupled (see Eddie Copeland: Policy Exchange 2015).

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Topics: digital local government, digital transformation, Health & Social care

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