For health organisations, sharing health data with local authorities, and vice versa, throws up challenges but information sharing between health and social care professionals is one of the chief advantages of shared care records, allowing professionals a fuller view of their patient or service user, and meaning patients or users do not have to repeat their story to different professionals.
The Local Integrated Care Record Exemplar programme, in its preliminary bidding stages, offers an opportunity to ensure that technological partnerships between local authorities and the NHS are prioritised. The programme will offer matched, though as yet unspecified, funding to sites that have embarked on their journey to sharing care records. The programme’s focus on ‘place’ puts it in a position to incentivise solutions to interoperability that focus on people, not organisations.
As we have argued previously, shared care records have the potential to improve clinicians’ access to vital patient/user information. As we have also argued, shared care records must be central to efforts to deliver benefits to the population. And just as links with local authorities are vital for delivering integrated care and improving population health, considering early on where local authorities should fit within shared care record programmes is key to delivering the benefits of information-sharing.
While in health care settings, sharing information is an important way to avoid patients/users having to repeatedly tell their story, in social care, it may be that they are more likely to lack the capacity to tell their story, for example, as may be the case for older people with memory loss. The importance of sharing in social care is highlighted by the ‘red bag’ scheme – where important health and care records for users are kept in a red bag that accompanies a resident wherever they go. The red bag scheme improves hospital and care home communication but overreliance on the patient/user can still mean that important information about a hospital episode does not reach social care staff.
'Addressing challenges by establishing useful partnerships'
The social care sector is in a challenging technological position even before considering the challenges of sharing information across health and social care. A multitude of providers means that availability of technology is variable – smaller care homes may struggle investing in IT as basic as PCs. These and other challenges mean that data collection is often poor and makes it hard for commissioners of social care to understand what is happening to users.
There are also additional challenges at the confluence of health and care. Information governance can be a big barrier, though it is not insurmountable: information sharing frameworks that have been drawn up by Berkshire and Liverpool provide good starting points. In addition, sharing information between NHS and social care can be hampered by a lack of interoperability, with health and social care on different systems that do not speak to one another. Overcoming this requires engagement and liaison with local government from the outset to ensure that solutions are being designed with their input.
The final, and perhaps hardest, challenge is cultural. Local authorities span different footprints to NHS organisations, and sometimes have different populations to look after. The Local Integrated Care Record Exemplar programme has been designed with exemplars covering populations of 3–5 million people. This could include many local authorities with diverse and sometimes disconnected populations. Although this presents risks, it should not act as a deterrent to including local authorities. If anything, the treasure of shared health and social care information makes the need for partnering with local authorities paramount to achieving scale. In decisions about which areas have the most promise for developing their shared care records, good partnerships between health and social care organisations should be valued above having more extensive coverage of just the NHS.
Delivering integrated care
The Local Integrated Care Record Exemplar programme should be focusing on the goals of how record sharing can deliver integrated care and better outcomes for the population. Given that existing exemplar money is driving the digitisation agenda in the NHS, at least some of the local care record exemplar money should be used to improve social care digital infrastructure. This could be through improving data quality or updating systems, both of which have knock-on effects for improving data used for population health management.
Linking up health and social care records offers an opportunity for better joint-working and improving knowledge about local populations. In order to achieve this, a feasible and strong relationships must be encouraged across health and social care, focused on completing the jigsaw for each individual in a population.
Harry Evans Researcher, The King's Fund
