As part of the health and social care integration work undertaken by the EBP, I have been interviewing people from across the sector - finding stories and experiences that can inspire others and give practical guidance. I recently interviewed Karl Goatley, Director of IT at Sussex Partnership NHS Foundation Trust, about the formation of SEEN (South East of England Data Networks Partnership). We talked about the vision that SEEN aims to deliver and how the ‘IT Crowd’ can facilitate improved care by underpinning essential information sharing.
The Carter review highlighted that there are a whole range of people doing things in isolation across the NHS: it recommends that Trusts need to work more closely together, make better use of their existing systems and/or invest in new modern systems to improve the access and accuracy of the data they use to manage their performance. With this as a backdrop, Goatley and his local NHS colleagues decided to come together with their Local Authority counterparts to better understand the issues.
“We rallied together technical and other ICT leads from both the NHS and local government and found we had the same base issues around how we configured our networks, the security boundaries, routing issues, firewall issues. We agreed that we should start addressing these problems immediately, by painting a vision for slick integration– and that was how SEEN was born,” says Goatley.
There is an assumption that there are technologies in place that would allow joint working between an NHS trust and local authority, or between two different trusts, but Goatley explains that in reality that it not the case: “The very base-level of being able to work in the same room, on the same Wi-Fi, to be able to plug into a system and then get back to their own systems hasn’t been fixed yet. So when we get to the next stage of saying we would like to give them access to our clinical system and vice-versa, we can’t do that because the basics are not in place.” As such the initial aim of the programme is to fix that base level, with any health and social care staff being able to get access to data and work seamlessly in any of the health or social care buildings.
“Our first ambition was to replace all the networks across the South East with a new ‘super integrated network’, but in reality that’s just too big and too complex to achieve in a timely manner, so the initial approach is going to be a ‘federation’ of these networks, and we will achieve our aim by effectively joining six major networks (three NHS and three local authority/PSN),” Goatley says.
Goatley believes that this is all possible, and they know that there are no real technology challenges because it’s being done elsewhere, instead the challenge is getting the buy-in at all levels across multiple organisations. “Technical people have a natural tendency to identify technical barriers before being able to accept the art of possible – so with lots of organisations involved there are lots of technical people who can find reasons not to do things. Ultimately SEEN needed the right level of sponsorship – STPs (Sustainability and Transformation Plans) and Chief Execs needed to give a mandate to pave the way for their IT leads to make it happen – but this has largely been a bottom up approach and we have brought the technical people on board first,” says Goatley. "Thankfully we now have that mandate and the SEEN programme features as an enabler to the STPs," he adds.
Not to say that there are no technical constraints. “It’s all technically possible but when you eventually get to the bit where you want to share patient information across systems you have to speak with your information governance teams, so you can take into consideration the legalities of what you can share with partners, and of course gain the patients’ consent before you can share their confidential clinical records. That level is hugely complex, and that’s the bit that in my mind that makes true sharing of information between teams exceptionally challenging,” adds Goatley.
This is something that Goatley thinks needs to be addressed centrally and with conviction, with clear law around what can and should be done with regards to sharing patient data: “If the government could come up with some very clear guidelines that pave the way for sharing then health and social care integration will be achieved much quicker, but there always has to be a balance of risk.”
SEEN has received good support from the HSCN (Health and Social Care Network), who have been part of their strategy meetings and whose directors have been keen to support the programme in recognition that SEEN attempts to emulate the new national network at regional level. Goatley thinks that central government now has a strategy for a thinner core, and very much welcomes initiatives like SEEN that are driven locally. And with the core changing, N3 disbanded and replaced by HSCN, now is a good time to be doing something different locally or regionally too.
Goatley’s advice to others wanting to make similar changes? “Make sure you recognise a very clear problem or need for the change from the outset – and get a workshop together to make sure you have all the stakeholders around the table.”
Although the programme has been started by the ‘IT Crowd’ it is being driven forward as a clinical transformation process through the STPs, rather than an IT project. Mike Oldfield-Marsh, Programme Manager explains that this serves two purposes: “Firstly the work must be aligned with national and local strategy, and so must engage with the local strategists who will simply want the technology to support their plans, not for them to get engaged with IT matters, as this would be a turn-off. Secondly, the point is that even we in the IT area are not here to design a technical solution. We want the experts in industry to do the clever stuff, fitting the needs defined by healthcare.”
In closing, Goatley is optimistic: “It’s so encouraging now that the thrust for sharing and collaboration, in particularly across the NHS and social care, has been rejuvenated through STP programmes. It is being driven by NHS England and in turn that gives us a new local mandate to get out there and start talking to each other, and working more closely together to join up our systems and patient information – ultimately because we all want what’s best for our patients/service users.”
The Local Government Executive Briefing Programme has published two reports into 'Health and Social Care Integration':
Part I: "Confronting the challenges".
Part II: 'The potential of digital'