Festina Lente?
The NHS Plan was quite clear: If patients are to receive the best care,
then the old divisions between healthcare and socialcare need to be
overcome. And, it might well have added, so too do the barriers within the
NHS between primary, secondary and tertiary care.
To take first the divisions between healthcare and socialcare, the
Journal has on a number of occasions in recent years commented on some of
the obstacles that need to be tackled to break down the divisions.
Differences of culture, separate funding streams, lack of will and
problems of confidentiality all play a part in maintaining the separation of
service provision, even though in so many cases the patients/clients are the
same.
One way forward is to examine the development of shared information
between healthcare and socialcare authorities: after all, both types of
authority are embracing, or are urged to embrace, patient/client-centred
records.
Trials in Cambridgeshire, in Hammersmith, and in Fulham have examined a
variety of ways in which areas of shared information can be achieved.1
A perception is emerging that the development of shared care
depends on the use of a common language with a shared understanding of how
and where it is to be used.2 All
this is useful groundwork, the gradual placing in position of building
blocks essential to success at some point in the future. In a sense, it is
the creation of a cultural infrastructure, without which just as with
technical infrastructure solid, visible achievement is hard to attain. It
follows therefore that this is a slow process, one where advance is by
gradual organic growth, rather than by dramatic major steps.
To turn now to the healthcare scene, not everyone will be overjoyed at
the prospect of slow organic growth. The last decade and a half has
certainly seen the development of a workable technical infrastructure that
can, and in many cases has, allowed the easy and rapid transfer of
information between primary and secondary care. Such examples, however, have
been driven by locally perceived needs, and by local initiatives that have
been able to use the benefits that the technical infrastructure has made
possible. The question now is whether the cultural substructure within the
NHS has been sufficiently nurtured to respond to massive central
procurement: that is, will advance now come by dramatic major steps, or will
the central endeavour, like the technical infrastructure, become the base
upon which gradual organic growth can occur.
The articles in this issue of the Journal illustrate some aspects of this
critical conundrum. In his article, Nick Morris, Information Systems Manager
of the Scottish Borders Council describes the Borders Ability Equipment
Service, run jointly by Scottish Borders Council and Borders NHS. The
project shows admirably how joint working between healthcare and social
services has positive advantages for patients/clients, as well as making
more effective use of resources. It shows also how information technology
not only offers clients choice and a far more effective service, but also
enables staff to provide a more informed and rapid response to client need.
In their article, Joanna McQuillan, Implementation Manager, and Dr
Gillian Rankin, Head of Service Development both from the South and East
Belfast Health and Social Services Trust show how use of a single shared
electronic record system and a call-management centre have streamlined
referrals between services. The combination has dramatically reduced the
time for a referral to reach the appropriate professional from an average of
five days to three minutes.
Of particular interest is the fact that although South and East Belfast
is a unitary authority, it still faced and therefore had to overcome
many of the difficulties faced by authorities in both England and Scotland,
namely those of culture and difference of approach.
Ray Foley, National Project Manager of the Revision of Waiting and
Booking Information Project, appraises in his article the Projects aim to
pull together capacity-and-demand reporting across the entire activity of
whole trusts, and thus to examine how best the two parameters might be
matched. This initiative too, in a micro sense, grappled with the problem of
pulling together differing strands of information into a single coherent,
and meaningful, entity.
All three projects show what can be achieved by determination and vigour
at a local level. Equally, they show how powerful a tool information
technology can be in solving major management problems that have hitherto
impaired the service given to patients and clients alike. These are the
product of endeavour at local level, the seeds in fact of progress by
organic growth. The great question that the English National Health Service
must now face is how or even if that successful process can be
replicated nationally.
Michael Fairey
References
1. Staton R. Delivering 21st century IT: the social care
agenda. Br J Healthcare Comput Info Manage 2002; 19(9): 235.
go to reference in text
2. Staton R. Information sharing in healthcare and
socialcare: a question of understanding. Br J Healthcare Comput Info
Manage 2004; 21(4): 246. go to reference in text |
