Comment

28.04.17

Improving information sharing to support integration

Source: PSE Apr/May 17

Kevin Kewin, a senior adviser in the Care and Health Improvement Programme at the LGA, explains how social care can be transformed through the use of information and technology.

The funding pressures facing social care, and the NHS, have been prominent in media headlines in recent years. This is understandable in a context of rapidly increasing need, rising expectations and reduced funding. However, at the same time, many local councils, working with health partners, have been quietly transforming care services through information sharing and the use of technology.   

A recent LGA publication, produced with the Institute of Public Care and Oxford Brookes University, highlighted some of this innovation that is evident across the country and the impact that it’s having both in terms of improved outcomes for individuals and financial savings. The ‘Transforming social care through the use of information and technology’ document sets out five key ways information and technology is having an impact: 

  • Integrating information and services
  • Enabling people to interact with care services through digital channels
  • Promoting independence and wellbeing through the use of digital services
  • Integrating commissioning through the improved use of information and analysis
  • Enabling care professionals to work from any base at any time 

The publication is deliberately not aimed at IT specialists; it is to aid senior officers, and councillors, to support thinking as to how information and technology can support better care services.

Significantly, three of the publication’s themes directly relate to improving information sharing across a place and around individuals. 

ThinkstockPhotos-488565654

Integrating information and services 

Citizens accessing care services often wonder why they need to provide the same information to a number of different organisations they are in contact with, such as their GP, local hospital or domiciliary care provider. These instances can be frustrating for the service user and make delivering high-quality care more difficult for organisations. The reasons for these situations can be manifold: from information governance and data protection concerns – which may or may not be legitimate – to the age-old problem of ‘systems not talking to each other’. While some of these difficulties will not disappear overnight, many people are already beginning to see the benefit of care organisations that are sharing information more effectively to provide genuinely joined-up services.   

For example, transfers of care across settings – such as an individual moving from a hospital to social care support – can sometimes be problematic. The use of phone calls and faxes to transfer key information can lead to mistakes and delays. Cumbria is one area that has implemented an electronic referral and matching system across health, adult and children’s services. It allows NHS trusts in the area to automatically make referrals to social care which increases the speed of transfer. It has also supported efficiency savings, estimated at £400,000 per year. Similar approaches are now taking place with care providers, including care homes. 

In addition to a citizen only needing to tell their story once, there are clear advantages for professionals providing care in being able to see a single and joined-up view of the person and their ‘whole’ journey. There is also the potential to use this information to support integrated commissioning, including identifying those people most at risk of escalating care needs. 

Integrating commissioning through the improved use of information and analysis 

Effective and integrated commissioning across health and care relies upon a sophisticated understanding of the sometimes complex journeys that citizens take as they access services. We are increasingly seeing commissioners linking anonymised client-level data to understand what is happening across local areas, and specific pathways, to inform decision-making. Many councils are now working with partners and using systems to integrate data from multiple local sources, moving away from manual approaches which can be time consuming and error-prone. 

It’s important to engage the public on the use of their data and respect the privacy of information to prevent the reidentification of individuals. There are now many examples of effective federated approaches, which share only the required information, rather than centrally ‘pooling’, with the removal of personal identifiers prior to linking data.  

Leicestershire County Council, Leicester City Council and Rutland Council (LLR) have been synchronising data from across care and health. NHS and council partners can now analyse the end-to-end journeys taken by local people across the health and care system. Their tool is regularly updated and contains three years of anonymised, person-level historical activity and cost data. It presents information via report dashboards which allow the user to look at the pathways people take through the system, including trends in patient cohorts; test hypotheses and look at the impact of changes to services on the whole system; and analyse performance. 

The work in LLR has supported local organisations to reshape care services, intervene earlier and work better as a whole health and care system to make improvements. Specific examples include: 

  • Better understanding the services accessed by people known to have had a fall, as well as the services accessed before and after a fall assessment
  • Comparing service usage before and after a period of reablement
  • Measuring the impact of new intensive community support services (nursing care at home) on the health and care system compared with other interventions 

A co-ordinated approach to information sharing in the back office also needs to be complemented by support for frontline professionals to work in an integrated and mobile way.  

Enabling care professionals to work from any base at any time 

Integrated services can often rely upon professionals being able to work across multiple bases and locations. A frequent challenge in this respect has been for social workers and others to access – and were necessary contribute to – health and care information without managing multiple systems and logins. Increasingly, frontline social care staff are having easy access to appropriate client information at the point of care. A key area of focus is to ensure that this also includes relevant health information. The benefits of a mobile and joined-up approach are clear as staff spend more time delivering care, and less time navigating organisational processes and systems. It can also lead to improved decision-making and, where information is being captured, fewer mistakes and greater speed.  

Infrastructure issues are often a barrier to more mobile and integrated working. For example, councils have typically needed to access health networks (N3) to enable information sharing with health partners. The introduction of the Health and Social Care Network (HSCN) programme offers an opportunity to support integration and place-based collaboration. More generally, poor mobile reception and internet access remains a problem in many rural areas; the LGA is calling for the government to re-affirm its commitment to a national minimum broadband speed and improved phone coverage. 

The future of information sharing to support integration 

Successful information sharing is a key enabler of health and social care integration. As highlighted above, there are many challenges to ensuring this takes place consistently around the individual and across health and care systems. 

The national policy and regulatory framework must support local health and care organisations to share information, including ensuring that financial incentives are aligned rather than pulling organisations in different directions. 

We await further national news on the development and delivery of both local digital roadmaps and sustainability and transformation plans. While their development process has been imperfect, many plans include a significant focus on information sharing, particularly through the use of shared care records. There is a significant opportunity to further integration if the planning framework is supported by the necessary leadership and resources to deliver.

For more information

The ‘Transforming social care through the use of information and technology’ report can be accessed at:

W: www.tinyurl.com/LGA-SocialCare

Comments

Peter   02/05/2017 at 12:58

Once again a senior advisor manages to get through an entire blog without mentioning the significant impact that the EU GDPR will have in this arena. The significant changes brought in included in Article 9 for the processing of special categories of data open up a significant option whereby Health and Social Care will no longer be able to meet the rigorous standards for "Explicit Consent" 9.2 (a) and can take advantage of 9.2 (h) Health and Social Care) and other conditions to efficiently and effectively process personal data in health-care. Please will the IGA / LGA / NHS Digital etc present a case for adopting alternative conditions for processing under GDPR.

Andy   01/06/2017 at 13:55

It's not just integrated health and care professionals, the health system is not integrated and communication between health professionals is poor. It's certainly not patient-centric, as my recent experience with the NHS has proved with Adult care.

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