Care integration
l Data and information will be requested, shared and used intelligently.
l System and professional regulation will be proportionate and intelligent.
l Day-to-day staff processes will be simple, helpful and effective.
l The government will legislate to make procurement rules more flexible.
l GPs will have more time to focus on clinical work and improving patient care.
l Appraisals will be streamlined, and their impact increased.
l There will be greater digitisation of services.
l A supportive culture is needed at a national and local level.
The first of these priorities is the one that will, when implemented appropriately, lead to the end of people having to repeatedly explain their medical or social condition, and it can be summed up with a simple phase: joined-up care.
Making joined-up care reality Joined-up care across health and social care requires a few obstacles to be overcome, particularly in social care where management of access currently held within NHS systems is needed. In order to share data with the NHS, social care needs to be as responsible for the data as the NHS is, and that means meeting the needs of the Data Security and Protection Toolkit (DSPT). Many social care providers have met an
entry level variant of the DSPT, which has given them access to NHSmail, but the entry level option expires in April and to maintain access to NHSmail, or to share any data with the NHS, will require care providers meeting the standard, more stringent, DSPT. That will require an understanding of
data security by a high percentage of people working in the social care industry, and a commitment to computer systems meeting certain criteria. DSPT is a gateway, however, not just to NHSmail, but to many more systems and data sources. One data source is GP Connect, where
it will be possible for qualified staff in social care to have access to the medical records for the people they care for, in real-time, at the touch of a button. Ultimately, this should lead to not just shared medical records, but to the actual medication being able to be shared
between different settings, so expensive medication will not be disposed of when a person goes from a care home to the hospital, for example. The cost to the NHS of wasted medication was estimated in 2015 to be £300m per year, and one of the contributing factors is medication being deliberately destroyed between care settings. There are still some concerns over who will be able to access medical records, and the NHS might be restricting access to just registered nurses, which will leave out residential care homes as well as domiciliary care providers. Over time, there will need to be
processes to validate people like registered managers who have the necessary skills to be able to access medical records. Other rich sources of data in England
are Local Health Care Records (LHCR), but these are held in multiple different systems and many of them do not interoperate with each other. In addition, there are 13 different LHCR systems across the country, each operating differently.
Making data work While it might be acceptable for a health care trust to ensure all the systems used by the trust interoperate with the specification of a LHCR, a social care provider with care homes in multiple parts of the country is going to need to meet the standards for multiple LHCRs in order to provide a consistent level of information flow for all their homes. This is exacerbated by software
March 2021 •
www.thecarehomeenvironment.com
providers who supply systems to multiple care providers, meaning that in order to have a credible level of interoperability, all 13 LHCRs would need to be supported. Given the challenges involved with
interfacing to a single LHRC, and the limited funding in social care that would need to be used to make the development work viable, there are only a few pilot projects involving interoperability through LHCRs. This issue is being addressed through a
standard provided by the NHS called the National Record Locator (NRL). While this is currently only supported in England, it is being considered for use in Wales and possibly Northern Ireland, and even if Scotland keeps a different system, then at least there are only two standards to cover the whole of the UK. The NRL allows information to be
available to multiple systems using a pointer to show a patient record exists and where it is held. A person can then use the information held on the NRL to contact the organisation where the record is held to request more information, or more importantly, directly retrieve the record if the source system is enabled to allow this. Increasingly, LHCRs are creating
interfaces to the NRL so that all the information available within LHCRs can be accessed via the NRL, and as a result the opportunity for fully joined-up care exists.
Making sense of the data The ability to transfer data is only one part of the solution. While it is better to
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