Assessing the applicability of GIS in a health and social care setting: planning services for informal carers in East Sussex, England
Ronan Foley
Geography Division, School of the Environment, University of Brighton, Brighton BN2 4GJ, UK
Social Science & Medicine, Volume 55, Issue 1, July 2002, Pages 79-96
Abstract
Informal carers save the state’s health and social care services billions of pounds each year. The stresses associated with caring have given rise to a number of short-term care services to provide respite to carers. The Carers (Recognition & Services) Act of 1995 identified formally for the first time, the important role that unpaid carers provide across the community in Britain. The planning of combined health and social care services such as short-term care is a less developed application of geographical information systems (GIS) and this paper examines awareness and application issues associated with the potential use of GIS to manage short-term care service planning for informal carers in East Sussex. The assessment of GIS awareness was carried out by using a semi-structured questionnaire approach and interviewing key local managers and planners across a number of agencies. GIS data was gathered from the agencies and developed within a GIS to build up a set of spatial databases of available services, location of users and additional geo-demographic and topographic information. The output from this system development was presented in turn at workshops with agencies associated with short-term care planning as well as users to help assess their perspectives on the potential use and value of GIS. A renewed emphasis on a planned approach to health care coupled with integrated/ joint working with social care creates a need for new approaches to planning. The feedback from planners and users, suggested that a number of key data elements attached to data-sharing may prove to be simultaneously progressive yet problematic, especially in the areas of ethics, confidentiality and informed consent. A critical response to the suitability of GIS as a tool to aid joint health and social care approaches is incorporated within a final summary. r 2002 Elsevier Science Ltd. All rights reserved.
Keywords: GIS; Health care planning; Social care planning; Carers; Qualitative mapping; UK
Introduction and Aims
The Carers (Recognition and Services) Act of 1995 (Department of Health, 1995) identified formally for the first time the important role that unpaid Carers play across the community in Britain and this was further recognised in a national strategy document in 1999 (Department of Health, 1999) which ring-fenced d140 m for additional services for carers. Carers are generally defined as;
‘‘.. someone who regularly helps a disabled, ill or frail, relative or friend or neighbour. The help given can range from tasks like dressing, shopping or household tasks, to taking full responsibility for practical personal and emotional support.’’ (Carers National Association, 1994).
Carers save the state’s health service and social care services billions of pounds each year by looking after ill or disabled relatives or friends (Department of Health, 1999). The stresses associated with caring have given rise to the development of a number of short-term care services whose broad aim is to relieve carers from the stresses of caring either in the form of a break from caring inside or outside the home. These services range from medium to long-term care outside the home, day care and care in the home and are provided by a variety of different statutory, voluntary and private organisations.
As with most health services, the spatial dimension of provision for informal carers is an important issue for service planning. Within an increasingly IT literate society there has been a developing interest in how spatial aspects of service planning and delivery can be managed. Geographical information systems (GIS) have become an increasingly important technology within the broader Geography of Health area in the last ten years (Gatrell & Loyt . onen, 1998a; Smith & Jarvis, 1998). A . key element of all service delivery is the notion of planning adequate service delivery to provide equitable and equal services to all potential users of that service. Within a local setting, geography has an important role to play in deciding what services go where and the particular local geographical areas served by those services (Curtis & Taket, 1996; Curtis & Jones, 1998). The ability to link maps of services, clients and local populations with relational databases of associated information has allowed managers and planners of health and social services to use this new technology to better run their services. Applications of GIS within the broad health area include epidemiological studies (Hirschfield, Batey, Brown, & Marsden, 1990), locality planning (Wain, 1997), service site location (Burns, 1995) and optimal routing of emergency services (Gatrell & Naumann, 1992).
However, GIS research in the informal sector is more limited but with an increasing interest in the wider health/social care nexus (Milligan, 2000), it is apposite to assess ways in which GIS might marry health and social care planning. The application of GIS for the planning of joint health and social care services is far less developed than research on formal health care, though there are some applications such as the planning of services for Alzheimer’s Disease sufferers (Dowie, Koval, Burnhill, & Healy, 1991) and the operation of a GIS-based management system forNHS Trust services in the Leeds/Bradford area (Birkin, Clarke, Clarke, & Wilson, 1996) which are evidence of research in this area. However, it is the ability and also suitability of a GIS system to manage data which linked the health and social care sectors, a process widely encouraged underrecent legislative change in the UK, which points towards the need for the development of this underresearched area of GIS application (Department of Health, 1998; Department of Health, 1999).
The principal aim of the research reported in this paperis to assess the potential applicability of GIS in the study area of East Sussex, Brighton & Hove (Fig. 1) through a study of informal carers and the provision of short-term care services to those carers. This involves assessment of the existing awareness and usage of GIS within health and social care planning, the identification of potential difficulties in encouraging this awareness and an examination of the problems of developing awareness through the creation of a series of theoretical case studies. The process of identifying local awareness and usage was carried out by qualitative semi structured interviews with a number of key stakeholders in the study area. The case studies were then developed within the context of current service provision policy frameworks and designed to use geographical aspects of those policy frameworks to develop the key GIS data elements. The case studies were used as a tool to research the problems associated with the potential adoption and uptake of GIS technology to manage the community based short-term care services for carers, in particular, carers of children with disabilities in the study area. This assessment was also intended to identify problematic areas of data availability, suitability and management in this complex area to see whether the introduction of GIS were likely to be relevant and appropriate.
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