Integrated care and service reform

(sorry I missed last week’s blog – just too much going on)

From my perspective “digital” has to include electronic communications between health and care services. Indeed Jeremy Hunt, the Secretary of State for Health, announced recently that he wants every part of the NHS and social care to be connected paperlessly by 2018 with an ambitious timeline between now and then. My sense is that most people are pretty sceptical of this, however I saw him recently at the North West’s “Dementia Challenge: 1 year on” and he seems extremely well informed so we’ll see.

Being paperless in the NHS will be a big step forward for localities and not just because the NHS has something of a track record when it comes to mislaying hospital records (

This is important because of the potential improvements in service quality and delivery. Let me give you an example. About two years ago we spent considerable time and effort working with NHS colleagues trying to improve what is called “early years” information sharing. As with all good ideas, this is really simple. All we were asking was that maternity services relay, with consent, pregnant mums’ contact details to local children’s centres so they could get in touch and say what’s on offer.

This is really important because 40% of children in Greater Manchester alone fail the school readiness assessment at the start of year 1. This means that they’re behind in terms of social skills, basic learning and communication skills and this is important because of the considerable research that shows that children that start school behind struggle to ever catch up ( The best time to intervene to support a child in need is to work with the parents 3 months before the child is born.

Children’s Centres play an important role in helping families and making sure that children get the best life chances in deprived areas. However, if you don’t know where the children are, it is kind of hard to help them. I know some councils used to employ (and possibly still do) door knocking teams to try to find them.

As you can probably tell, we really struggled to make headway with this. For a range of reasons quite about 40% of maternity services just didn’t want to know.

Technology was part of the problem but actually the real issue was attitudes. I went to several meetings where NHS colleagues could not distinguish between child welfare support provided by children’s centres and safeguarding services that include removing children at risk of harm from their parents. As one person told me, “I’ll be damned if they were going to help break up families”.

Of course others immediately understood the benefit and were enormously supportive. Early years is just one area – I’ve had similar experiences relating to dementia and the frail elderly in improving hospital discharge, coordinated community care support and the like.

A corporate digital strategy should therefore face up to challenges that are less about technology – people and cultural barriers.  A digital strategy should recognise these components, otherwise it’s meaningless.

There’s been some great work in this space over the years – the Common Assessment Framework for Adults pilots( which incidentally seem to have been dropped which is a great shame,  and more recently the Improving Information Sharing and Management work that has focussed more on troubled families (

The NHS’s digital strategy ( published in 2012 picks up this area in “Theme 5: Steward the health and care system towards a health information revolution” by:

“implementing the Digital First channel strategy for health and care to deliver a consistent approach to digital across the system, including bringing together the best information and services from across the NHS, public health and social care into a single integrated customer service platform for citizens”

I don’t know about you but “a single integrated customer service platform for citizens” sounds ominous. Perhaps this will be a standards based approach rather than an actual single system – we will see.

In the meantime I would argue that there are some significant low hanging fruit to be picked by looking at the potential value in more effective information sharing between health and care services. Work that could improve the quality and dignity of care by cutting lost and erroneous information, make better use of resources, leveraging voluntary and community organisations better, provide better intelligence and insights and increasing productivity.

In this space technology is certainly a powerful enabler, but the challenge in many localities is still hearts and minds.

Phil Swan, iNetwork