The road to joined up care

Joined up health and social care could provide a more inclusive and holistic service to our population. To achieve joined-up, or whole care as it is also known, the government has outlined a radical plan for joining up health and social care IT systems, and sharing information about individuals and communities across services. In this article, Sinead Quinn, healthcare programme manager at technology trade association Intellect, discusses what has been achieved and what still needs to be done to achieve the vision of joined up care.

Complete integration
One of the most significant issues in improving whole care processes in England is the incomplete integration of service across health and social care, and their incorporation across a wider range of services including housing and education services.
A substantial amount of good work has been done in England towards achieving integration between Health and Social Services. Many projects have been completed successfully, but many more are in danger of being overlooked. This is partly due to lack of a co-ordinated vision, and partly due to the over centralisation of programmes, which meant a lack of shared standards and shared vision.

Where are we now?
Throughout local government and the NHS there is an awareness of the need to modernise. However, the biggest problem we currently face is achieving integration of service access, especially across health and social care. For example, currently in mental health there is virtually no access to information across client systems and the same data is often entered into two different systems.
Systematic sharing of information would both remove overlaps and save time. It would also lead to faster and more effective intervention, and improved outcomes.

What is holding us back?
The problems that hold us back from seamlessly joining all care services are cultural, legal and practical. Intellect has identified three critical barriers, one of information sharing governance, one technical and one commercial, to achieving this vision.
Currently, the biggest technical handicap is the lack of continuity that would enable information to be shared and systems to interoperate. Overcoming this barrier is not technically onerous and will deliver huge benefits. For example, it will allow organisations to choose systems secure in the knowledge that their choice would comply with national standards and would effectively share information across communities.
To move forward, it is necessary to develop an up-to-date, citizen centric architecture framework for joint working. This needs to be supported with rigorous standards for interoperability.

What else needs to happen?
There is insufficient cross-government co-ordination in the development of personal care records in health and social care. The consequent risk is that personal electronic care records might be incompatible and not support multi-agency information exchanges.
There also needs to be a stronger link between these initiatives and the broader local government modernisation and the transformational government programme. Intellect recommends that a cross- Government Personal Electronic Care Record Implementation Board be established with responsibility to ensure consistent and compatible electronic records are developed.
Government may need to resolve outstanding legal barriers to professionals sharing information, at the very least clarifying such issues emerging from. For example, the Victoria Climbié Inquiry where staff treating children must be certain as to the status of parental consent to share information across agencies.

Collective governance
A means of collective governance is needed that can work across public sector functions, including national and local government. This calls for the ability to coordinate investment programmes across government departments, and even across central and local government. By encouraging local development founded on a philosophy of continual improvement we can stimulate and accelerate the necessary widespread changes in working practices and culture.
Best practice collective governance also requires the development and maintenance of cross-agency architecture frameworks, that maintain tight linkage between ever-changing business needs on the one hand and IT applications and infrastructure on the other.
Such a framework would provide a basis for a radically different future, for example, in which electronic records are owned and managed by the individuals to whom they refer, rather than by the State or agencies on the State’s behalf. The issues of information governance, confidentiality and security would take on a very different hue and would require a new generation of solutions.

How can we begin to achieve this?
There is much more energy, both in the services and in the ICT industry, that could be unleashed and focused onto the issues described, than is presently being sought by the public sector. A move from fewer prescribed national/regional systems toward rigorous standards and a freer market that can be more locally driven would be a major step forward.

For more information
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