Transparency data

Digitising Social Care Programme: accounting officer assessment

Updated 13 April 2023

Applies to England

It is normal practice for accounting officers to scrutinise significant policy proposals or plans to start or vary major projects, and then assess whether they measure up to the standards set out in Managing Public Money.

From April 2017, the government has committed to make a summary of the key points from these assessments available to Parliament when an accounting officer has agreed an assessment of projects within the government’s Major Projects Portfolio.

Background and context

The People at the Heart of Care: adult social care white paper (December 2021) committed to at least £150 million of investment in the digital transformation of the adult social care sector. This included targeted support to pilot and scale the use of care technologies in the adult social care sector.

The Digitising Social Care Programme has been established to accelerate the adoption of digital social care records, sensor-based falls prevention and detection technologies, and other types of care technology where there is evidence for their benefits to the quality, safety and efficiency of care delivery.

At the outset of the Digitising Social Care Programme, approximately 60% of Care Quality Commission (CQC) registered care providers did not have a digital social care record. We know that investing in digital technologies can dramatically improve the quality and safety of care by ensuring that care workers have appropriate access to the health and care information that they need to support care delivery. We also know that the use of innovative care technologies, such as acoustic monitoring, can help to reduce falls in care homes by 20% or more – saving the NHS over £2 billion a year.

Without further investment, the rate of adoption of care technologies in adult social care will remain slow (behind that of the NHS). To accelerate adoption and realise benefits for the adult social care sector and the wider health and care system, we are:

• supporting the piloting of care technologies, through integrated care system (ICS) footprints, to build an evidence base for their impact, developing implementation guidance and establishing an assured supplier list

• working with ICSs to scale up the use of care technologies where there is a strong evidence base for their benefits

To date, we have:

• established an assured supplier list for digital social care records
• developed a standards and capabilities roadmap to drive the adoption of standards over time
• funded pilot activity to understand the benefits of digital social care records and sensor-based falls prevention technologies
• launched our Adult Social Care Digital Transformation Fund to support the local scaling of digital social care records and sensor-based falls prevention technologies, and the piloting of other types of care technologies across all 42 ICSs

The Digitising Social Care Programme business case has been approved by the NHS England Transformation Directorate, Department of Health and Social Care (DHSC) and HM Treasury. The Digitising Social Care Programme also received an amber rating at its Gate 0 Assurance Review in May 2022. A further Gate 3 Assurance Review is planned for February 2023 – around which time the programme business case will also be updated to ensure continued viability.

Assessment against the accounting officer standards

Regularity

To be regular, the programme must rely on clear legal powers, which are either specific legislation (setting out what ministers are able to do) or DHSC’s inherent (common law) powers.

The Government Legal Department (GLD) was consulted as part of the design phase and prior to the drafting of our programme business case. We specifically considered whether the ‘preferred option’ was legally compliant with subsidy control and the inherent (common law) powers as they apply to both DHSC and NHS England.

In relation to subsidy control rules, we carried out legal assurance against each of the 6 subsidy control roles. We have followed due process and the programme is deemed legally compliant in this regard. In relation to the inherent (common law) powers as they apply to both DHSC (as commissioner) and NHS England (as our delivery organisation), it has been deemed that DHSC has a clear remit in adult social care, while NHS England has specific remit around integrated care and the delivery of healthcare services in adult social care.

On both these counts, the programme is legally compliant with its commissioning and delivery organisations’ inherent (common law) powers.

Propriety

This ensures that the use of public funds is proper and meets the highest standards of public conduct and relevant Parliamentary control procedures and expectations, including on transparency. We have also considered as part of this assessment whether the programme has been implemented in accordance with Managing Public Money.

It is our assessment that the use of public funds is proper and meets the high standards of public conduct and Parliamentary expectations. The programme has been designed and is being delivered in line with Managing Public Money.

We have set out in the programme business case several options for the model and mechanism for making funding available to support care providers to buy and implement care technologies. This assessment against our critical success factors (CSFs) has been set out with a preferred option identified to provide match-funded investment – distributed through all 42 ICSs and made available to all CQC-registered adult social care providers through locally facilitated grant funds.

This preferred model and mechanism has been set out and approved by ministers. It is considered the fairest approach to distributing funding to meet our policy objectives, meets our value for money criteria and is legally compliant with subsidy control rules (see ‘Regularity’).

We have an established approach to managing programme risks and issues. The preferred option meets our standards around acceptable levels of delivery and reputational risk. There is also no known impact on any other government policy or damage to any lawful private sector business in an unwarranted way.

Value for money

This assessment is required to ascertain whether the programme is good value for money to the Exchequer – and not just DHSC.

Within our programme business case, we identified a range of options for meeting our programme objectives. These were assessed against a series of CSFs.

The preferred option identified is to establish a centrally funded team to support with the development of guidance material, central funding to support the piloting of care technologies in 10% of adult social care providers, plus the inclusion of central funding for the initial implementation costs.

It is our assessment that the programme offers a good value for money and this is reflected in our full cost model. The anticipated benefit to cost ratio for the programme is 4:1.

The preferred option being premised around match-funding also maximises value for money and ensures ‘buy-in’ from care providers, which reinforces sustainability of use and feasibility of realising anticipated benefits.

Feasibility

An Infrastructure and Projects Authority (IPA) Gate 0 Assurance Review was carried out in May 2022. The Digitising Social Care Programme received an amber rating with a recommendation that an IPA Gateway 3 Assurance Review should be carried out in 9 months’ time. There were no major feasibility issues identified as part of this review. The IPA review team, while recognising the scale of the challenge, noted that objectives of the programme were achievable within the timeframes.

Since the date of the last review, we have seen a 7% increase in the rate of adoption of digital social care records from 45% to 52% (up from 1.5% baselined rate of adoption over the same time period). We have received delivery plans from 41 (98%) ICSs to support the standing up of local implementation support teams and locally facilitated grant funding. We have also seen a 25% increase in the number of assured suppliers of digital social care records. This contributes to a positive feasibility assessment of the programme.

Conclusion

In conclusion, as accounting officer, I am clear of the case for change and business requirements. The adult social care white paper sets out the direction of travel for a digitally transformed adult social care sector. The Digitising Social Care Programme is critical to this – ensuring that care technologies are piloted and then scaled where there is a compelling benefits case for the improvement in quality, safety and efficiency of care delivery.

The programme business case sets out the justification for investment in our preferred option – providing central support and investment for the scaling of care technologies (digital social care records and sensor-based falls prevention technologies) where there is a clear evidence base and building a pipeline of care technology pilots that can support local investment decisions.

We have set out in our programme business case (and companion cost model) our assessment of how we arrived at our preferred option (considering cost-benefit ratio).

As accounting officer, I am clear that the preferred option that is set out is proper, regular, feasible and offers good value for money for the Exchequer. This summary sets out the key points that informed my approval decision.

Copies of this summary will be deposited in the library of the House of Commons and sent to the Comptroller and Auditor General and Treasury Officer of Accounts.

Shona Dunn, DHSC Accounting Officer
16 March 2023