Boundaries are difficult
There is an interesting paradox within human nature that disconcertingly
appears to revolve around self-interest. The public has no objection, indeed
seems almost to expect, that information given to one healthcare
professional will be available to other healthcare professionals
subsequently involved in the same individual’s treatment or care — and even
to the local housing department when accommodation or a rent rebate are at
issue.
Linking records to avoid having to give the same details over and over
again to different agencies is perfectly acceptable if it is — in the nicest
way — of benefit to the individual. On the other hand, and in stark
contrast, the concept of linking records between, say, the Inland Revenue,
Social Security, DVLC, and the police, is viewed with the gravest suspicion.
Although such linkage may be of profound benefit to society as a whole in
the reduction of fraud, or the detection and prevention of crime, a
substantial proportion of the public would find it deeply troubling. Here,
as so often, there is the classic confrontation between the interest of the
individual and that of society at large.
Ironically, however, it is at this point that the paradox is reversed.
For those agencies that are part of central government and where, it is to
be hoped, links are in the genuine public interest, they can be achieved
without too much difficulty. The technical problems are not great, and
interdepartmental differences are not incapable of resolution.
Links that are for the benefit of the care of the individual, however,
are a different matter. The originators of such data — in healthcare, social
services, housing or education — live in structural and managerial
compartments that can differ considerably. Even in healthcare, all part of
the same NHS, there are differences of culture and emphasis between primary,
secondary and tertiary care. The widespread view is that, for the benefit of
the patient/client, the solution is to create some form of integrated record
between these components. The question that has not yet been fully answered
is quite how that can be achieved.
In previous issues of the Journal examining, in particular, joint
working between healthcare and local authorities, we have explored some of
the basic differences in managerial structure and responsibility. Those
remain, but two of the articles in this issue look at other aspects that
need to be worked through if an integrated patient/client record is to be
achieved.
Terence Roberts, who has extensive experience of joint working in two
London boroughs, examines in his article some of the practical problems that
exist at the operational level, and with which the introduction of an
integrated record would have to deal.
In particular, he cites slow progress for the National Service Framework
for Older People, published in 2000, proposing a common assessment system
for community care for the elderly, which now — four years later — is still
only at the pilot stage. This does not bode well for the currently proposed
National Service Framework for Children, with its integrated record
available to all concerned agencies. As a practical manager, he suggests
that much more positive enthusiasm has to be generated at operational level
if integrated records are to be achieved.
In his article, Roger Staton, Head of the Social Care Information Policy
Unit, reviews the current position on information sharing, and the
legislative framework upon which such sharing is based. He describes a
three-layer protocol that has been adopted in a number of areas, in which
there is very considerable emphasis on the need for detailed sharing
agreements to be made between the agencies concerned. And, like Terence
Roberts, he emphasises the need for raising enthusiasm and knowledge at
grassroots level if success is to be achieved.
In a society where the treatment of a patient/client may well involve
several structurally discrete agencies, there will always be borders to be
crossed. An integrated record is one element in a far more complex solution:
we ignore the other elements at our peril.
Michael Fairey |
