The government has set out a radical plan for joining up health and social care IT systems and sharing information about individuals and communities across services.
The Commissioning Framework for Health and Wellbeing, now out for consultation from the Department of Health and the Department for Communities and Local Government, says councils, PCTs and practice based commissioners need to work together to promote well being and reduce inequalities.
They will need to assess their communities’ needs and jointly commission services from an increased range of providers.
It says: “In order to make effective decisions for individuals and groups, we need to use and share information in an effective way. This includes clarifying what information can be shared under what circumstances, joining up the IT systems of front-line practitioners and encouraging individuals and communities to be co-producers of information.”
The BMA is cautious about the proposals, particularly on shared records.
Richard Vautrey, a GP member of the BMA’s IT working group, said there was a real potential to improve patient care but added: “The bigger concern is about unfettered access of social services to health records. Anything that opens access to health records needs to be done with great care and caution for fear of undermining people’s confidence.”
However, the NHS Confederation welcomed the framework. Jo Webber, deputy director of policy, said: “We are moving towards increased partnership and some of the IT solutions have to be there. We need IT systems that can talk to each other.”
The framework itself does not contain many new ideas. Rather it is a consultation document on the practicalities of implementing policies such as extending choice, widening the range of providers, introducing outcome-based payment regimes, managing individual care budgets, joint strategic needs assessment and joint commissioning.
For example, it asks a series of questions about the joint strategic needs assessment, a new requirement set out in the Local Government and Public Involvement in Health Bill currently going through parliament.
A JSNA, it says, is “the means by which primary care trusts (PCTs) and local authorities will describe the future health, care and well-being needs of local populations and the strategic direction of service delivery to meet those needs.”
It will require a minimum dataset including details such as the demographic profile of the community, the current health status, how much need is currently met, what patients think of their services, outcome data and value for money.
If this is going to be done well, it says, PCTs and councils will need to use and analyse real-time data to identify people who are getting a raw deal. They will need to use a wide range of data sources, such as QOF data as well as case finding tools to support this work.
It says: “We are investing in better information systems to capture and use data more effectively. However, the systematic and routine capture of community views on services remains the biggest challenge.”
On data sharing, it calls for greater clarity around organisations’ responsibilities and legal requirements.
It says: “We need to work towards an environment of trust and partnership, which gives people reassurance that the confidential nature of information will be respected while enabling commissioners to make appropriate use of it for them and the wider public interest within existing legal and ethical constraints.”
Work is already underway on developing integrated health and social care records by 2010, it says, with a scoping study by NHS Connecting for Health due to finish in May 2007.
Frontline practitioners will also need joint electronic assessment tools such as the Single Assessment Process for older people and the Care Planning Approach used in mental health extended across disciplines.
PCTs will be expected to provide information to their communities, including about whether services meet a minimum level of quality, how services compare to others in the area and whether they deliver value for money.
It says: “The Department of Health’s recently announced national patient choice website will be an essential building block, which commissioners should supplement locally.”
On an individual level, PCTs will be expected to encourage people to use health information services such as HealthSpace more widely.
One of the main constraints identified by the framework is the lack of analytical expertise at PCT and council level. It looks to strategic health authorities and regional government offices to fill this gap.
Webber, agreed that skills are in short supply but said: “We have also got call-off contracts that exist for PCTs to buy in skills as they need them, for example some of the actuarial skills required for joint needs assessment.”
But she added that the NHS should be training and developing staff. She said: “There is a training and development issue, building up some expertise in house.”
Download, read and respond to the framework by May 29th 2007 here http://kc.csip.org.uk/groups.php?grp=462