Joining Up Is Hard To Do

Technology has an important role to play in the realising the ideal of “joined up” public services, but progress has been slow. SA Mathieson explores the problems and the potential.

Specialist IT consultant, Stephen Howes, has encountered offices where staff have two terminals on their desks: one connected to the health network and the other to the local authority.

Hard to believe? The parallel existence of the two IT systems illustrate well the two major problems of bringing different public sector agencies’ systems together: interoperability and the issue of privacy and patient/client consent to share data.

Mr Howes, a business development consultant for Socitm Consulting, the consultancy branch of the Society of Information Technology Management specialises in public sector IT. He says that health and social services staff often work in the same offices to aid co-operation, but their computers are less likely to talk to one another effectively.

“The development of systems to share information is less advanced,” he says. “There are examples where staff have two terminals on their desks, one connected to the health network and one to the local authority.”

Yet social services is an area ripe for integration with healthcare and the pressure is on for improved information sharing, especially since the inquiry into the death of eight year old Victoria Climbie, who died of neglect and abuse inflicted by her great aunt Marie-Therese Kuoao, and Kuoao’s partner, Carl Manning. The inquiry report made numerous recommendations about good practice in record keeping and information sharing among the agencies concerned with child protection which authorities are due to act on.

Child protection is one of the few areas where consent and privacy issues between agencies can generally be overridden to safeguard the interests of children and young people at risk, but problems still remain.

Mr Howes says that the NHS Information Authority sets strict rules on data access protocols, whereas local authority rules vary. Along with difficulties in linking technologies, this means that few information sharing projects have gone beyond the pilot stage, even in priority areas such as children-at-risk and the elderly. A few authorities are making progress: Lambeth, for example, is working on a shared system for London covering children-at-risk.

One area that looks slightly more promising is mental health. “The care lends itself to a combined approach,” says Mr Howes. Socitm Consulting is working with the London Borough of Harrow and Harrow Primary Care Trust and North-west London Mental Health Service Trust on a unified health and social services system for mental health patients. The first phase of this went live in February, and is should be finished by August.

Organisational structures seem to work in favour of information sharing too. Mental health services are usually delivered by dedicated NHS trusts, covering large geographical areas that often match up with local government. The primary and secondary care trusts rarely match up as neatly.

Yet mental health services face a stiff challenge in the area of consent for sharing data and protection of patient and client privacy. A report from the government’s in-house management consultancy, the Performance and Innovation Unit (PIU), last year reported on how information sharing could benefit the citizen.

While it noted potential benefits in areas such as anonymised data in research, the report’s section on healthcare focused mainly on privacy issues. Even in the introduction, prime minister Tony Blair, noted that health records were “very personal and needed to be treated very sensitively.”

As the Harrow project shows, however, it is possible to make progress. The potential gains in efficiency and service improvements are great and, for children like Victoria Climbie, improved information sharing could be lifesaving.

(C) SA Mathieson 2003