Better InformationSharing - Care Association Alliance 19th July 2018 (updated presentation) - Social Care - Oxfordshire Association of Care ...
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Better InformationSharing
Care Association Alliance
19th July 2018
(updated presentation)
Keith Strahan, Registered Social Worker, NHS Digital
keith.strahan@nhs.net
Contents 1. The Social Care Sector 2. Information Sharing? 3. Information Governance, Cyber Security and the Data Security and Protection Toolkit 4. Digital Opportunities, including NHSmail 5. The NHS Digital Social Care Programme 6. Care Passports
1. The Adult Social Care Sector
Adult Social Care Sector - UK
The adult social care sector in
the UK contributes £46.2 billion
to the economy.
It represents 6% of total
employment and average
earnings are £17,300.
Skills for Care’s The Economic Value of the Adult Social Care Sector – UK
The Adult Social Care Sector - England
Estimated Number of Adult Social Care jobs by employer type
Registered Nurses
were one of the only
jobs to see a
significant decrease
(although there
are still over 40,000
in the sector).
Skills for Care’s The state of the adult social care sector and workforce in England 2017’
2. InformationSharing?
Optometrist Dietician
Assisted Family/ Adult Social Care:
Some of the Technology: Friends Public and private
(e.g. Community domiciliary services
information Equipment Services,
Telecare, Blue
Voluntary
Local Authority:
Adult Social Care Ambulances
Sector Commissioning
flows with Badge) Dentist
Falls Service
Care Homes...
Person/Carer Care Home GP
Transport Safeguarding
Other Local Prisons vulnerable
Service
Authority adults
Acute
Mental Health (e.g.urgent Social Worker:
Organisations care, Duty Team Podiatrist
outpatients,
admissions)
Hospice/End CCG:
Commissioning
Community of Life
Nurse Occupational
Social Work Pharmacy Therapists
Case Manager
Police Physio
Single Point
Care Navigator/ Local Authority:
Assessment
Multidisciplinary Housing
team link
From Care Homes - Information Sharing?
Care Home 1
• First home to be rated outstanding by CQC
• Information from hospital is routinely posted and reaches the Care Home anytime up to
a week after discharge.
Care Home 2
• Patient was discharged to a new Care Home.
• The home did not receive timely discharge information and were not properly prepared
for when their new resident arrived at the home late in the evening. The patient’s leg
had recently been amputated, she was immobile and very distressed.
Care Home 3
• Resident was discharged back to her Care Home for people with severe neurological
problems.
• The discharge summary arrived by post 3 weeks later; stating the patient had MRSA!
The Care Home had not previously been aware…
From Domiciliary Care – Information Sharing? • No discharge summary or update on the client’s condition • Incorrect medication information • No update on mobility issues • Very short notice that a client is returning home • No consideration of the impact of a change in care needs e.g. the time required to re-arrange care schedules and provide an increased package. • No single point of contact. • Repeatedly given contact information to hospital wards but nobody contacts the Home Care organisation.
Information
Sharing?
https://www.cqc.org.uk/publications/th
emed-work/beyond-barriers-how-older-
people-move-between-health-care-
englandBeyond Barriers - July 18 • Although most adult social care providers have contact with hospitals and the people they provide care for in advance of them being discharged from hospital, comments indicate they providers are not routinely involved in a joined-up discharge process. • There is variability in how often social care providers receive discharge summaries. • The content, accuracy and timeliness of the discharge information received are also inconsistent with variability in the communication and handover of information from different wards within the same hospital. • Throughout, responses from registered managers of domiciliary care agencies indicate that their services are the most overlooked with regards to involvement in discharge and provision of adequate and accurate information. • When people are discharged to services with missing or incorrect information this puts people’s health and wellbeing at risk.
Beyond Barriers (continued)
• Multiple respondents spoke of not being informed of when people would be discharged.
• Medication and unsafe discharges issues resulted in people being readmitted to hospital.
• Pressures surrounding discharge, lack of joined-up discharge planning and poor or
inconsistent handover of information can have a negative effect on relationships
between health and social care providers, leading to a breakdown in trust.
• Poor planning and information sharing can undermine seven day working, with some
social care providers feeling ill-equipped to accept discharges at the weekend.
• A lack of joined-up planning for discharges can result in duplication of work and
unnecessary chasing for information.
“Digital information sharing between health and social care
systems appears to be largely absent”.PRSB Report: Care Homes Information Flows
3. Information Governance, Cyber Security and the Data Security and Protection Toolkit
Information Governance and Cyber Security: Background
July 2016 - National Data Guardian Review of datasecurity,
consent and opt-out
Conclusions regarding the old Information Governance
Toolkit:
• Limited attention to cyber security
• Difficult for smallorganisations
• Often seen as a lengthy tick box exercise
• Health oriented e.g. terminology Dame Fiona Caldicott
National DataGuardian
Recommended that its ‘10 Data Standards’ should be
implemented.
These now provide the basis for the ‘Data Security and
Protection Toolkit’ which replaced the IG Toolkit in April 18.10 Data Standards
3 Themes (the 10 Standards are incorporated under the most relevant theme)
People:
Ensure staff are equipped to handle information respectfully and safely,according
to the Caldicott Principles.
Process:
Ensure the organisation proactively prevents data security breaches andresponds
appropriately to incidents or nearmisses
Technology:
Ensure technology is secure and up-to-date.
10The Data Security and ProtectionToolkit
The Data Security and Protection Toolkit is now live.
It is an online self-assessment tool for data security.The Data Security and Protection Toolkit
• It is recommended that all social care providers
complete the Toolkit as they will hold, process or
share personal data.
• Crucially, when an organisation has reached the
appropriate level of compliance with the Toolkit
it will enable them to assure themselves that
they have met the requirements of the General
Data Protection Regulation (GDPR).
• Care Quality Commission ‘well led’ inspections
Key Lines of Enquiry (KLOEs) include data
security. Using the DSPT will be helpful in
demonstrating compliance to the CQC.The Data Security and Protection Toolkit: Information for Social Care Providers - June 18 Provides an introduction to the Data Security and Protection Toolkit and written with Care Providers and the NHS Digital Social Care Programme https://www.dsptoolkit.nhs.uk/News/33 Including • How to register • The steps social care organisations need to take • What support is available and • An explanation of the levels of the Data Security and Protection Toolkit
Toolkit: Registering and Support Step 1: Register for the Data Security and Protection Toolkit https://www.dsptoolkit.nhs.uk/Account/register Step 2: Complete your organisation profile, you will be asked a series of questions about your organisation. Step 3: Read the Entry level evidence items https://www.dsptoolkit.nhs.uk/Help/32 and start pulling this information together. Step 4: Go to your assessment on Data Security and Protection Toolkit and start with the entry level evidence items https://www.dsptoolkit.nhs.uk/ Additional help is available on https://www.dsptoolkit.nhs.uk/Help Requests for Support can be made by email to exeter.helpdesk@nhs.net or telephone 0300 3034034 https://www.dsptoolkit.nhs.uk/Home/Contact
Toolkit – ODS Codes • You will need your ‘ODS Code’ in order to Register • If you don’t know your code it can be obtained from the helpdesk exeter.helpdesk@nhs.net • CCGs are encouraged to provide these to speed up the process • ODS Codes are normally in the format ‘A***’ for HQ organisations and ‘VL***’ or ‘VM***’ • Toolkit can be completed at HQ or site level Additional help is available on https://www.dsptoolkit.nhs.uk/Help Requests for Support can be made by email to exeter.helpdesk@nhs.net or telephone 0300 3034034 https://www.dsptoolkit.nhs.uk/Home/Contact
The Data Security and ProtectionToolkit • Extra time has been allowed for social care organisations to be fully compliant with the required standards as it is understood that for many this will be a new process. • There is a new “Entry” level. It will enable social care providers to meet minimum legal requirements and have access to NHSmail. • It is then expected that social care providers move on to achieve ‘Standards Met’. The ‘Standards Met’ level demonstrates that an organisation is - ✓ Compliant with the expected standards for health and social care to hold, process or share personal data. ✓ Ready to participate in a wide range of secure health and care digital solutions for the benefit of all.
Toolkit – Entry Level • 16 Assertions only • List can be found here:- https://www.dsptoolkit.nhs.uk/Help/32 • Entry Level is new and not yet fully built in to Toolkit • So not yet possible to publish complete submission • But can still apply for NHSmail
The Levels in the Data Security and Protection Toolkit
Name Description
◆ Entry Level • Time-limited level (subject to review) for social care providers.
• Evidence items for critical legal requirements are being met; but some
expected mandatory requirements have not been met.
(https://www.dsptoolkit.nhs.uk/Help/32)
• Allows access to NHSmail.
✓ Standards • Evidence items for all mandatory expected requirements have been met.
Met • Access to NHSmail, other secure national digital solutions, e.g. Summary
Care Records, and potentially local digital information sharing solutions.
Standards • Evidence items for all mandatory expected requirements have been met.
Exceeded • The organisation has external cyber security accreditation.
• Evidence of best practice.
Critical • Evidence items for critical legal requirements have not been met by the
Standards Not organisation.
Met • No access to information sharing tools e.g. NHSmail.Guidance for Care Providers
The Care Provider Alliance, in collaboration with NHS Digital, has produced specific Care
Provider Guidance and Templates on their website to complement the Toolkit.Guidance for Care Providers for Information Governance, Cyber
Security and the Data Security and Protection Toolkit
Final version of this guidance includes:
• Tool Tips
(guidance to accompany the assertions inthe newtoolkit)
• Guide for Registered Managers
• Guide for Staff
• ‘Big Picture’ Guides
(overall view of 10 Data Standards, including ‘How To’ Guide with model answers)
• ‘How to Guide for Entry Level’
(to be published shortly on the Care Provider Alliance alongside all the other Information Governance
Guidance for Care Providers)
If you have any questions on this guidance, please contact: ig.feedback@careprovideralliance.org.ukData Security and Protection Training
• NHS Digital, in conjunction with Health
Education England is developing Data
Security Awareness Training
• This training is not mandatory for social
care providers but is free and a good
resource to use to train staff.
• The Level One training can provide staff
with a good understanding of information
governance, data security and
responsibilities under national legislation.
• This will also satisfy basic training
requirements in the Data Security and
Protection Toolkit.
21Toolkit - Video Conferences
Please see the News web page on the
Data Security and Protection Toolkit website
https://www.dsptoolkit.nhs.uk/News/10
Next for Social Care:
Wednesday 15 August (12:30-13:30)
Wednesday 29 August (12:30-13:30)4. Digital Opportunities, including NHSmail
Matt Hancock: Secretary of State for Health and Social Care visiting Bridgeside Lodge Care Home – July 18
Digital Opportunities • Being part of Local Integration Plans - Including NHS and Local Authorities. - Building on good practice in the sector e.g. personalised care planning. • Using Secure email e.g. the national offer of NHSmail - Sharing information across organisational and geographical boundaries. - NHSmail collaborative tools included e.g. Directory, Skype for Business, etc. • Accessing ‘Health’ record - For example, Summary Care Records a national GP summary with over 55.2 million (96%) patient records. Proof of Concepts will be taking place with Care Homes and Domiciliary Care this year. Also potential to access GP Systems, Hospital systems, etc. • Learning lessons fromelsewhere - Community Pharmacy already have access NHSmail and Summary Care Records.
NHSmail
• NHSmail is a centrally funded, secure NHSmail Care Home Case Studies
email service available on the internet.
• It supports collaborative working across health
and care by the secure sharing of personal,
identifiable and sensitive information.
• Available NOW to all Care Providers (after
formally completing Toolkit).
• Not just ‘email to a desktop’ but Mobile Services,
Directory, Skype for Business, links to Office 365
as standard; top up services available (paid locally).
• National helpdesk – support available 365 days,
24/7 on 0333 200 1133, or via email at
helpdesk@nhs.net.Current use of NHSmail
>1.3M Clinically Approved
Accounts on the
Platform Nationally approved for clinicaluse
>600M 100% >7,500
Average number of Service availability over
emails per month last 18 months Individual organisationsBenefits of NHSmail Governance and control
▪ National standards enforced combined with local
administration flexibility
Security ▪ Best practice enforced
▪ National service desk and portal maintaining consistent
▪ Single points of security
quality and experience for all organisations and users
▪ React to incidents centrally
▪ Standardised national operations
(reducing fragmented nature of
responses)
▪ Report status of platform National collaboration
vulnerability within minutes ▪ Improved flow of information across
organisations via enabling a central
directory
Centrally-funded ▪ Collaboration features now connect
▪ Nationally funded core service organisations across regions more
▪ Service management and support easily, for example, Skype for Business
provided
▪ Minimises duplication across
organisations
▪ Releases time and funds to invest
elsewhere in local organisations Promotes a focused national vision
▪ One strategy for national collaboration
▪ Aligns local IT with national digital strategy
▪ Promotes a common message for IT servicesJoining NHSmail There are three routes onto NHSmail:- Local Sponsorship (CCG or CSU provides Local Administrator service) Self-Sponsorship (Normally for large Providers) National Administration Service A central online registration portal, currently being piloted. Launched in Summer 2018. Soon to be, Care Providers can participate, please contact feedback@nhs.net.
NHSmail - Frequently Asked Questions
How many accounts can an organisationhave?
• Normally 1 shared account and up to 10 named
user accounts
What is a user account and sharedaccount?
• User account for named individual e.g.
windy.miller@nhs.net
• Generic account for each home e.g.
trumptongreen.carehomecamberwick@nhs.net
(Access only via named account)
Where should I send any enquiries aboutNHSmail?
• feedback@nhs.netSummary Care Records
• Summary Care Records (SCR) Proof of Concepts will SCRs with additionalinformation
be taking place in Care Homes and Domiciliary Care include:
in 18/19.
• Reason for medication
• The aim ultimately is for SCR to be available toall • Significant medicalhistory
Care Providers in a similar way to NHSmail (also (past and present)
after formally completing the Toolkit).
• Anticipatory care information
• Summary Care Records as a minimum contain (such as information about the
allergies, adverse reactions and medication management of long termconditions)
information. • Communication preferences
• GP practices now have capability to enrich SCRs • End of life care information
with a set of additional information, with the • Immunisations
person’s consent.
• Patient view also is on the way…Summary Care Records Viewing & Creation
Impact
• Over 55.2 million
(96%) patient records • Reduced
containing; allergies, medication errors
mediations and Use
• Reduced
adverse reactions. • At current rates SCRs consultation time
• Over 99% of GP are likely to be • Increase
~142,500
Practices in England viewed over 7 SCR views
availability of
million times in person’s medical
weekly
Creation
2018 historyOverall Plan – Social Care Providers • A sector-led approach, targeting compliance with the Toolkit, deploying NHSmail, later Summary Care Records and any other relevant national products to support local and regional information sharing initiatives. • Concentrate on quick wins with specific flagship Care Providers and Social Care Demonstrators who can influence and cascade information to others from their sector, so the benefits can be shared and spread. • Use the above to guide and drive locations based on geographical clusters and where good partnership working already exists. • Concurrently, widespread Toolkit training should take place as soonas possible, bringing in areas that are further behind and need more time.
5. NHS Digital Social Care Programme
NHS Digital: Social Care Programme • Sector-led solutions, building on the work already undertaken with the Data Security and Protection Toolkit, NHSmail and SCR. • Six projects so far (see next slide) designed to stimulate and demonstrate what is possible within the sector in the short to medium-term • 80% of programme funding directly invested in frontline social care through care providers and local government • Focus on innovators and early adopters to build strong foundations for sharing knowledge and replicating approaches cross-sector • Exploiting existing technology, not developing new services https://digital.nhs.uk/about-nhs-digital/our-work/transforming-health-and-care-through-technology/integrated-care-domain-d/social- care-programme Questions scp.general@nhs.net
NHS Digital: Social Care Programme 1. Assessment, Discharge and Withdrawal Notices (formal notifications under the Care Act) ➢ Funding for seven local authorities to digitise statutory elements of the discharge process between health and local authorities. 2. Social Care Digital Innovation Programme ➢ Funding for 12 local authorities to support innovative uses of digital technology in the design and delivery of adult social care. 3. Predictive Analytics ➢ Explore and demonstrate the use of predictive analytics to predict or prevent long-term social care need. Demonstrators to announced shortly. 4. Demonstrators – Health into Social Care (including Care Providers) ➢ Adopting or develop digital products and services to transfer information from clinical into social care settings e.g. medical discharge summary. Demonstrators to announced shortly. 5. Demonstrators – Social Care (including Care Providers) into Health ➢ Investigating what information currently flows from adult social care into health, and what is needed. Demonstrators to announced shortly. 6. Social Care Provider Support and Engagement ➢ To develop a sector-owned and managed support for care providers building on work already undertaken by the programme (see next slide)
Sector-led Support Service • To support Community Pharmacists with IT, Information Governance, etc., a ‘one stop shop’ web portal has been set up (on the Pharmaceutical Services Negotiating Committee. • We are aiming for a similar sector-led resource adapted for Care Providers. • To include a Helpdesk in year 1 as content develops. • Also will include case studies, model IT contracts etc., supporting innovation and technology in the widest sense. Delivery Date: • Web portal live Autumn 2018
6. Care Passports
Care/Hospital ‘Passports’ - Background • All too frequently, people feel Victoria’s Story overwhelmed with the amount of https://www.mencap.org.uk/advice-and-support/health/our-health-guides information and the number of professionals with whom they come into contact. • Some people also have significant communication issues and detailing their story can be difficult and frustrating. • On occasions, lack of understanding by staff has led to significant harm.
Care/Hospital ‘Passports’ • Owned by the individual, Care/Hospital ‘Passports’ have been developed to support people with complex/profound needs; including learning disabilities and dementia. • They also help provide staff with immediate and important information for safe and appropriate care, as well as promoting a positive experience for the person. • Examples of when they are used include: - Admission to hospital for any planned or unplanned assessment; - Discharge from hospital; - Attendance at outpatient appointments and - For many other significant appointments and meetings not related to health
Formatting of ‘Passports’ • In the main, paper-based ‘Passports’ are currently the norm with the passports remaining with the individual and theircarer e.g. unpaid relative/friend, parent if a child. • In some areas, editable PDFs are used. • In a few localities, the carers/parents are encouraged to email a much shorter version of the ‘passport’ (almost a minimum data set) to the hospital before the person is admitted.
Integrated Hospital Transfer Pathway: The Sutton Vanguard “Red Bag” Initiative
Better Information Sharing - The Sutton Vanguard “Red Bag” Initiative
https://www.england.nhs.uk/publication/redbag/
A type of ‘Care/Hospital Passport’Care/Hospital ‘Passports’
SO LIKE THIS BUT DIGITAL…HOW? (Thanks to STANDEX forsharing)
“Reasonable Adjustments” • NHS England have commissioned development of a national reasonable adjustment flag to indicate the potential adjustments to care for patients under the Equality Act (2010) • Includes people with learning disability, physical/sensory disability and other relevant conditions (dementia, cancer, HIV etc). Potentially applies to 20% of people. • The lack of provision of reasonable adjustments has been cited as a significant cause for the premature mortality of patients with learning disability • It is proposed that the “flag” will be stored nationally on the NHS Spine, as flags will be created and accessed by multiple care providers, in multiple care settings. • Piloting of the solution in Summary Care Records viewer during winter 2018/19. • Feedback from pilot to inform future development and national rollout. It is expected that in the longer term, all clinical systems will be integrated with the national flag. • The role of passports and relationship with reasonable adjustments will be explored.
Matthew…
https://theprsb.org/aboutus/videos-2/‘About Me’
• In the Digital Care and Support Planning Standard (out for endorsement) from the
Professional Records Standards Body (PRSB) an ‘About Me’ heading is prominent.
• It is described as, ‘proportionate information’ which ‘should always be at the forefront
of each plan’ (please see below from the final document).
About Me
About Me This is a record of the things that an individual feels it is important to
communicate about their needs, strengths, values and preferences,
etc. to others providing support and care.
Supported Where relevant, this is a record of name, relationship/role and
to write contact details of the person who supported the individual to write
this by this section e.g. carer, family member, advocate, professional.
Date This is a record of the date that this information was last updated.Relationship
between
‘About Me’,
Plans and
mainRecord
Taken from the Digital Care and Support
Planning Standard Report from the
Professional Records Standards Body(PRSB).Proposed Care Passport Project: RIX Research and Media and & Surrey and Borders Partnership (SABP) Co-Production project development • Professional Records Standards Body (PRSB) involvement • Implementation trial with small sample to model whole-system approach • Introduction of ‘Multimedia Advocacy’ approach • Exploring standardisation across person-centred records (Passports, Care Plans, etc. etc.) • Evaluative research of impacts for service users and systems - benefits and efficiencies • 3 site pilot (including Care Homes) to map cross service implementation • Findings to be shared with the sector
Many Thanks
keith.strahan@nhs.netYou can also read
