Comment / Finding sustainable funding models for technology-enabled care at home

‘Don’t just do something; stand there and think’  is a quote from, among others, Joseph Lowe – the editor of the Treasury’s Green book. At a time when resources in the health and care system are limited, it feels more relevant than ever to consider how we make accountable decisions and justify investment – and to think about the longer-term sustainability of new models of care.

One area this applies to is the use of digital models of care supporting people in their own homes.

Many systems significantly scaled up investment in technology-enabled care at home throughout the pandemic and the subsequent recovery. These included virtual wards or programmes for remote monitoring of patients with long-term conditions. Those systems are now considering how to continue to fund these initiatives longer-term at a time when they also face sustained operational pressures.  

A robust business case is a critical part of that. A good business case can be a powerful tool in bringing all partners together to consider – in a structured and logical way – the options that are available and which way forward creates the greatest public benefit.

Yet often people see the development of a business case as a necessary evil – a hurdle that has to be overcome to get to the important work of continuing to deliver innovation. They often encounter challenges in establishing stakeholder buy-in, accounting for activity flows between organisations, and demonstrating tangible benefits realisation supported by robust evidence.

The NHS England national Innovation Collaborative for Digital Health has been supporting integrated care systems to work together to try to tackle these barriers.  The collaborative is a learning and support network for health and care professionals delivering technology-enabled services to support people at home that’s delivered by NHS England in partnership with the Academic Health Science Network (AHSN).

Over the last two and a half years we’ve developed practical, proportionate resources to support local teams in building sustainable funding models that adhere to best practice while recognising the constraints of operating at pace, and often with limited resources. This includes guidance on the application of the five-case model to technology-enabled care, standard business case templates, national evaluations, and a repository of resources and transferrable evidence.

To date, the collaborative’s digital health workspace on the FutureNHS platform has over 2,200 members and growing, with 10,000 views and downloads of workspace content.

Throughout the collaborative’s work, we’ve been fortunate enough to work with inspiring teams across the country, who have shared their knowledge and expertise. We’ve tried to distil some of this learning into four key considerations when approaching sustainability.

1. It’s never to early to think about sustainability. Ideally, you should start to plan for it at the very beginning of your project. Often new initiatives are pump-primed from time-limited monies. It’s therefore important to think about where the service will be funded from once this is exhausted. That can sometimes mean asking difficult and challenging questions about the nature of your funding model. From the beginning, ask yourself the question – if this project is successful, what things can we stop doing, or do differently?
2. Consider the total cost of ownership. It’s a common saying that every £1 invested in technology equates to £3 in people, processes and culture. When planning for your future funding model, think not only about the technology that’s required, but also the wider resources needed to make the pathway a success. This might include implementation funding, interoperability requirements, communications, training, patient information materials, and data migration and platforms. Another important consideration will be the workforce impacts. Ask yourself, can any new demand be met from existing provision? If not, how might existing roles change? What training is required for staff, and what capacity do we need to develop? Ultimately, technology enabled care will be part of a blended approach alongside other alternative care models. You will need to consider what the right balance looks like for your organisation.
3. Design with the whole system in mind. When establishing your model, it’s important to bring together a wide mix of partners and collaborate with them early. That should include representatives from finance, clinical leadership, operational management, and evaluation and evidence partners, as well as other local health and care organisations. You may find that the value of the new service is complex, and the organisation that pays may not always be the organisation that benefits. There are several ways to address that. One tip many systems have found useful is to try to establish objective evidence that all partners can agree on, using techniques such as economic modelling, process mapping, and user journeys to develop this together.
4. Invest in evidencing benefits. Focus not only on cash-releasing benefits – which are nonetheless important – but also wider social and public benefits. These are areas that don’t necessarily release cash from the budget, but which create an improvement in wellbeing and the experience of patients and staff. For example, remote monitoring for long-term conditions can have a notable impact on levels of patient activation (how involved they feel in their own care) and levels of self-management, which may subsequently increase adherence to treatment and, as a result, improve outcomes.

Further guidance is available on the Innovation Collaborative workspace on FutureNHS This is a members’ only area. To join the workspace email: [email protected].

The collaborative is holding a national event exploring the technology-enabled health and care journey to support people at home on 23 March. Attendance is free and people can join in-person or virtually.

Health Innovation Manchester is the academic health science centre for Greater Manchester. Mr Quinn leads the benefits and rapid evaluation workstream of the national Innovation Collaborative for Digital Health.