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NHS England wants to see digital record-sharing between health and social care organisations established in all parts of the country, based on its 44 sustainability and transformation plan (STP) areas.
“The technology approach to an STP is that the record will be shared in settings locally,” Paul Fleming, NHS England head of digital technology for the Midlands and east, told the NHS Sustainability Day event in Birmingham. That’s where technology and STPs can really make a difference.”
In January 2016, NHS England created STP areas covering in most cases a city region or a county. [https://www.england.nhs.uk/wp-content/uploads/2016/02/stp-footprints-march-2016.pdf] Some of these already run record sharing across health and social care organisations, such as Bristol, North Somerset and South Gloucestershire’s Connecting Care project, which allows community nurses working for local community interest companies to access GP and hospital records including blood test results and appointments.
Others have projects covering parts of their areas, such as the Leeds Care Record in West Yorkshire, which shares its software on an open source basis through the Ripple initiative. [http://www.theinformationdaily.com/content/post/leeds-is-receiving-1m-from-nhs-england-to-turn-the-leeds-care-record-into-ripple]
Fleming said that such projects can join up services for patients without reconfiguring organisations. “People don’t get ill in a convenient place, in a convenient time,” he said.
The Summary Care Record is already in use across England, but only covers basic information about patients. Fleming said that there is no deadline for STPs to bring in such shared records, but “by 2021, with the paper-free agenda, we’re expecting information to flow to increase safety, to increase quality,” he said.
He gave the example of a patient living in Merseyside who visits a GP with a persistent cough, which leads to a cancer diagnosis. A few weeks later, the patient feels worse and visits a walk-in centre in another borough. “The walk-in centre doesn’t see the GP record,” said Fleming, and it sends him to a different hospital, but “the hospital is in a different borough to the initial consultation”. It cannot see the GP record either, so has to rely on what the patient can remember, writing a care plan stating that he should be sent to another specialist acute hospital if he gets worse.
The patient is sent home, but is later rushed unconscious by ambulance back to the same hospital rather than the specialist one, as the care plan is not available to North West Ambulance Service. “They’re in an A&E in the wrong hospital. They’re taken in the middle of the night to the special acute hospital,” said Fleming. The specialist hospital doesn’t have the care plan, and has to rely on the patient’s family. It produces an end-of-life, palliative care plan – on paper. “This whole system doesn’t work,” he summed up.
The persistent existence of paper records has prevented digital joining-up in many areas, Fleming said. NHS England is tackling this by funding both exemplar hospitals and whole healthcare systems to digitise, the latter through local digital road-maps. “We can fund a whole city or a whole county,” he said.
In some cases, the STP areas line up with city devolution. Greater Manchester, which under its devolution settlement has gained control of its health and social care budget, is a single STP. However, the seven local authorities that form the West Midlands Combined Authority are split between three different STP areas, and one of them is linked to its old county – Coventry, with Warwickshire – rather than to its combined authority partners including Birmingham.
Cultural issues could also get in the way, Fleming warned, showing the event a Mail Online story headlined ‘Now Tesco has access to your medical records’ all about the Summary Care Records system which shares basic information with chemists, including those who work for Tesco. “This happens all the time when we want to make big changes in the NHS,” he warned, although he added “There are legitimate issues around data and security.”
One way to improve public knowledge and confidence is to get people more involved in their own health through self-care and prevention. “The public is still set very broadly in a ‘doctor knows best’ scenario, this sort of paternal view of care, and we need to start turning that around. Technology can play a big part in that,” Fleming said.
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