Integrating healthcare and socialcare
This issue of the Journal is devoted to what may well in the
future be seen as one of the most important areas of progress in the
development and maintenance of care: the current drive to integrate
healthcare and socialcare services.
Over the years, the Journal has pointed to the obstacles that have
in the past existed to make that process difficult: differences in
mechanisms for funding, antipathies between elected and appointed bodies and
professional jealousies, to name but a few. In recent years, however, there
have been encouraging signs at the grass roots that, given goodwill and the
occasional financial stimulus, progress can indeed be made.
The Somerset NHS and Social Care Trust (1,2) showed that in
organisational terms, integration could be achieved. Rotherham’s child-care
services and South and East Belfast H&SS Trust (3,4), amongst others, have
shown what data integration can achieve. Demonstrator projects in
Hammersmith and Leeds (5) have also examined aspects of data sharing.
These pioneering efforts have pointed up critical factors for success of
enormous importance to those who are about to embark upon the task. High in
the list is the need to develop a joint — and mutually understood —
vocabulary: experience showed in South and East Belfast (a unitary authority
for many years) that this was an absolutely basic step.
As is only to be expected, also high in the list is the paramount need to
engage the users throughout the process if success is to be achieved — a
lesson which, in passing, applies with equal force to national healthcare.
Views about confidentiality and, more particularly, access to patient/client
data, all these have to be both discussed and harmonised if joint projects
are to be successful. And all these factors assume that problems of
technical compatibility are either non-existent, or can be solved.
Two of this issue’s articles show the way in which these problems can be
attacked. In his article, Tom Rothwell, Managing Director of Medisec,
describes the joint project between the Countess of Chester Hospital and
local social service organisations in Chester and Flintshire. The project
was designed to reduce the number of days when patients fit for discharge
none the less remained in hospital because the appropriate social service
was not yet available. Within three months, the new system enabled a
reduction of 50% in such cases, and when extended to Flintshire the
reduction was over 70%.
In our second article, Penny Hill, the Social Care Information Strategy
Manager for Warwickshire County Council examines in some depth the problems
that need to be faced in developing integrated care plans. Her review of the
cultural, professional and organisational hurdles that need attention is one
that any authority embarking on integration would do well to heed.
Across the country, therefore, there are signs that systems can
successfully be integrated. How do these developments fit in with the
national picture?
The picture is complicated in England by the fact that two major
departments are involved: the Department of Health, via Connecting for
Health for the NHS; the Department of Health, with another hat, for the
adult socialcare personal record system; and the Department for Education
and Skills for the child socialcare personal record system. In terms of
readiness for integration, there are major differences between the three
elements, socialcare being some way behind healthcare, but striving to catch
up.
The informed bystander could be forgiven for supposing that in many ways
the difference in ‘readiness’ could be turned to profit, the less ready
learning from the most advanced. Nationally, however, it is possible to
discern a pale reflection of the difficulties encountered in years past by
authorities in the field.
In his article, David Johnstone, Director of Adult and Community Services
in Devon, Co-chairman of the Electronic Social Care Record Implementation
Board and a member of the NPfIT National Programme Board sets out his
personal view on the central position. He explains that there is no
overarching governance arrangement to ensure consistency in vision, strategy
or standards. Current arrangements are informal, and there is no structure
mandated to ensure congruence for those areas where interoperability is a
requirement.
For those who, at all levels of healthcare and socialcare, accept that
the way forward relies on the effective integration of services — an
integration that is almost totally reliant on combined electronic records —
this analysis is depressing. Authorities in the field have shown that
progress can be made. It would be sadly ironic if the centre has to work its
wearisome way through all the same problems: Marx rears his head again:
“those who do not heed the lessons of history are destined to repeat them.”
Michael Fairey
References
1. Hayward R. Somerset’s development of an integrated information system
for mental health services: organisational foundations. Br J Healthcare
Comput Info Manage 2000; 17(1): 18–19.
2. Hayward R, Shuff C. Somerset’s development of an integrated
information system for mental health services. Br J Healthcare Comput Info
Manage 2002; 19(3): 18–19.
3. Payne W. Enabling multi-agency child care in Rotherham. Br J
Healthcare Comput Info Manage 2006; 23(6): 19–20.
4. McQuillan J, Rankin G. The streamlining of referrals at South & East
Belfast Health and Social Services Trust. Br J Healthcare Comput Info
Manage 2005; 22(1): 23–5.
5. Staton R. Delivering 21st century IT: the socialcare agenda. Br J
Healthcare Comput Info Manage 2002; 19(9): 23–5. |
