13.12.14
Information sharing: It’s about people, not databases
Source: Public Sector Executive Dec/Jan 2015
The new Centre of Excellence for Information Sharing has hit the ground running and has big ambitions. PSE heard from its director, Stephen Curtis, and head of dissemination Holly-Marie Draper.
Public services could be more user-focused, effective and cheaper to deliver if public organisations and agencies improved their information sharing – but there are a host of cultural, behavioural, technological and governance issues that sometimes seem to get in the way.
They do not need to. That is the message from the new Centre of Excellence for Information Sharing, launched on 15 October by Cabinet Office minister Francis Maude MP.
The organisation, which has 17 staff and is based out of Leicester, builds on the work of the predecessor Improving Information Sharing and Management (IISaM) project, whose ambitions were more localised. The new Centre is funded by four government departments – Work & Pensions, Communities & Local Government, the Home Office and Health – and is working on the principles of better data sharing and a number of policy areas and initiatives: public service transformation, troubled families, health and care integration, welfare reform, gangs and youth violence, re-offending, safeguarding, policing and mental health, and domestic violence.
It is a repository of best practice, but more importantly is a proactive resource for local areas where different agencies, departments and workers want to work together more closely and get beyond old barriers to information sharing.
The service user experience
The centre’s director, Stephen Curtis, in an interview with PSE at our Manchester offices, told us that the Centre hopes to “sharpen the focus on what’s needed” and said the work of the Public Service Transformation Network (more on page 37) has been “an important starting point”.
“The issue is often knowing where to start,” Curtis said, explaining that information sharing problems can be split into three ‘pillars’: information technology (specifically the old myth that a database can solve an information sharing problem); information governance (the perception that problems with legislation are what stops information being shared); and culture and behaviour.
It is this last which Curtis describes as the ‘missing pillar’, with too much focus usually on the first two.
“We need to start at ‘what are we trying to do’, and what’s getting in the way. For the Centre of Excellence, the starting point will be a story about the role information sharing plays in the service user experience.”
Getting to know each other
At the launch at Admiralty House were a team from Leicestershire with an interesting case study on police and mental health teams working together there (see box out). A key aspect of the work there is the ‘triage car’, where mental health practitioners attend incidents with police, helping divert people away from the criminal justice system and into more appropriate settings, which has both decreased police time spent dealing with such incidents and resulted in better outcomes for people undergoing a mental health crisis.
Curtis explained: “The story is about how those services – and their frontline workers – got to know each other, and then worked with managers to redesign the services, taking their different approaches into account and allowing them to share information.”
Once they started working more closely and redesigning their approach, they found that 20% of cases the police dealt with had a mental health factor – but those people weren’t known to the mental health services. “That was a really interesting finding,” Curtis said.
“That information sharing process started with a difficult ‘elephant in the room’ discussion between the two services – saying, ‘What’s the real problem? Let’s have a conversation’. And what came out was about different approaches and cultures, so they designed this way of working together and worked through those cultural issues, and designed something they believe works and is legislatively fine. There is not much technology involved, both need some mobile working, but it’s not about a joint database.”
Trust and trials
The centre’s head of dissemination, Holly-Marie Draper, noted that the two agencies can come at incidents that have a mental health component with contrasts in their main focus – public protection versus that person’s own welfare – and so creating trust was the first necessity. “Putting them in a car together for eight hours a day is one way to start to do that!” she said. “They’ve become co-workers, not two different services.”
The triage car now deals with about 120 incidents a month, with only about 4% of people having to be taken to custody. Most contacts result in a vulnerable person report being added to the police crime system. But both agencies insist this is “just the beginning” of their joint working and information sharing, and within months of going live last year, it was saving the partner organisations nearly £10,000 a month.
It is important to note, Curtis added, that in practice such a scheme may not work everywhere – especially rural regions or those with many dispersed population centres – but the principles still apply. Even if mental health practitioners cannot feasibly attend incidents in a triage car, they could perhaps be based with police at the contact centre, for example. Telephone triage was also part of the pilot at Leicestershire and worked effectively.
The Centre has also published other case studies including Cornwall’s Living Well Pioneer Programme, co-located and integrated public services in Melton, the Surrey Mental Health Crisis Concordat, and the £300,000 Transformation Challenge Award-funded project to share information among public services across a range of policy areas in Bath & North East Somerset.
Full details of each of these are available at the Centre’s website (see right).
‘Already too late’
Curtis acknowledged that its proactive, on-the-ground work is currently focused on “what you might call vanguard areas, those trying to push some of the boundaries”, because they are those already involved with the Public Service Transformation Network, the Health & Social Care Integration Pioneers, or the Ending Gang & Youth Violence areas.
“Part of the problem is needing to predict that an information sharing problem might arise before it does,” he said. “If somebody tells us their organisation has a problem – in that ‘they, the other organisation, won’t sign the protocol’ – we already know it’s too late. The question I’d ask is ‘how are those two services getting on?’, because that’s probably at the root of the problem.
“Transformational work needs services to collaborate. Structural change can only take you so far, with shared services for example. But real transformation is about putting the user at the heart of frontline services, and making sure those services are joined up so it’s not the user doing all the legwork – it’s the services working together around the user.
“It’s about designing how services are going to work across organisations. It can lead to some structural change, but initial work is about interventions, cohorts being targeted, information sharing.
“The people who know how to do that are the people who know how it all works: the frontline staff, public, voluntary or private. Public services need to start drawing on person-focused business intelligence: at the moment it sits in silos. We work on the ground and get into the nitty-gritty of what some areas are doing, and how they are trying to approach things. And we use that to try to tease out the real problem.”
Engagement and culture
There is no bidding process for areas to request help from the Centre. Curtis said: “We have to make a judgement about whether an area is ready to engage with us. We can’t go in and ‘do’ their information sharing work, that’s not what we’re about.”
Engagement will usually focus on staff involved with transformation, rather than, say, information governance. “They do their job, that’s what they’re there for, but we’re about the policy agenda,” Curtis said.
“Certain sectors do have certain cultures: the health service is very hierarchical, and traditionally has worked as a ‘national’ health service, with a cascade approach – ‘this is what we are all doing’ – which makes it difficult to work with social care, who are locally focused. They are two very different cultures, and it’s a big challenge to bring those two things closer together because of that. There are similar issues with police and local authorities, or DWP and local authorities. There are definitely patterns, aligned to the different sectors, that make it hard to work together. But there are also individuals – and leadership – that help to overcome those issues.”
Co-location of services can help, but not if it’s seen as an end in itself, or is driven purely by the desire to cut costs. Curtis joked that he’d seen examples of supposedly ‘co-located’ services whose staff worked at opposite ends of the building behind locked doors.
“But it can play an important role if handled correctly,” he said. Information sharing “needs constant work…with changes of key personalities, things could move backwards. Transformation isn’t something you ‘do’ which is then ‘done’.”
Case study: Leicestershire’s approach to supporting people with mental ill-health
A man in his late 50s is seen behaving strangely in a park. When a police officer arrives at the scene, he finds the man sitting on a park bench marking his wrists with a razor blade. As the situation intensifies, the police officer has a duty of care to ensure the man and the general public are safe and calls for support from the ‘triage car’. The car is staffed by a police officer and a mental health practitioner who attend calls where people are experiencing a mental health crisis. They have access to both police and health systems and are able to find out more about the individual.
His name is Mike and since his wife Alice passed away over two years ago, he has had a history of drug and alcohol misuse. With this in mind, the mental health practitioner and police officer use their combined knowledge to assess the situation and are able to convince Mike to give up the razor blade voluntarily.
Mike’s records show that he currently receives support from a care team. The practitioner contacts his care worker and together with Mike, they tailor his care plan so he is able to receive additional support at home.
What’s the story?
The Centre of Excellence for Information Sharing wants stories from PSE readers: how has information sharing improved outcomes for users of your public services? What barriers had to be overcome, and what improvements were made to get over them?
Follow the #InfoStory hashtag on Twitter and share your story via the website
Tell us what you think – have your say below or email [email protected]