Councils and NHS trusts in the South West of England are
the first to share information, but contract
problems have already made their project a year late.
The 13 different agencies that signed the information sharing
contract on 1 September last year had reason to celebrate: theirs
was the first large group of public sector bodies that had made a
legally binding commitment to share information over a common IT
infrastructure.
South-West Peninsula Partnership, a group of local councils and
NHS trusts, signed a licence to use a hosted social care
application to share information about the hundreds of thousands of
adults who use their services every year.
The 13 agencies also agreed to interface their existing social
care systems - they use a variety of different suppliers - with the
hosted application to make information sharing electronic.
Devon and Cornwall's councils and NHS trusts have been quicker
to share information than the public sector in the rest of England.
Nowhere else in England has seen
both health and local government agree to share data on so many
people and across county boundaries. Information sharing was
identified as one of the priorities for local government in the
Transformational Government Annual Report 2006 - the most
recent IT strategy document from Whitehall's CIO Council. Although
central government has set up a committee to promote information
sharing, too few agencies share data electronically. The committee
was supposed to publish a report on information sharing in July
last year. It has yet to be released.
Although the information-sharing contract has been signed, the
South-West Peninsula Partnership's progress has been slow. Back in
June 2006, Keri Storey, the deputy director of health and social
care for Devon County Council and Exeter Primary Care Trust,
predicted that the contract would be signed in August that year.
IBM and Esprit, which are providing the hosting services and the
software respectively, have been preferred bidders since March
2006.
The contract was originally expected to cover 20 agencies
working in Devon and Cornwall. The 10 NHS trusts have all stayed
with the project, but seven councils have yet to sign up.
The complexity of drafting a contract for so many different
public sector agencies is the reason for the delay, says Marisa
Smyth of Devon County Council's social care information systems
team. "We are further behind than we would like to be. It took us
longer to set up the contract than we originally anticipated and
that was because of the complexity in arranging the contract," she
says.
Important progress has been made in agreeing what information
everyone should collect and what should be shared. Each agency has
been using a toolset - a set of forms commonly used by both social
workers and health professionals - for the last 12 months. By using
the same forms, the agencies are collecting the same information.
The 13 different IT departments involved in the project will be
able to send the same information to the hosted application as soon
as the electronic interfaces are built.
More importantly the IT departments will be able to start work
on the project knowing that the end users in their organisations
have approved the type of information that will be shared. "We are
already using a shared toolset so everyone working in health and
social care [in the 13 organisations] is asking the same questions
and collecting the same data," says Smyth. "We have used the
toolset for well over 12 months now. At Devon County Council, we
have put the toolset into our main social care IT system CareFirst
electronically." The Carefirst application is supplied by OLM.
The agencies took a long time to agree on the toolset that they
would all use. "It took a minimum of six months to agree what
toolset we should all use. The agencies looked at a number of
different assessment tools," says Smyth. All 13 agencies decided to
use forms from a company called Functional Analysis in the Care
Environment (Face). Both NHS trusts and social services departments
were providing a better standard of care after 12 months of
collecting the same data and sharing some paper records, according
to David Johnstone, Devon County Council's director of adult and
community services. "The scheme showed us that sharing information
greatly improved communication between health and social care
teams. The outcome was less duplication, less repetition and more
focus from staff. As a result our patients and clients have been
getting the right care packages to meet their needs."
Electronic information sharing will start when the councils
build interfaces between their own social care systems and the
hosted application, called
Sharecare, from Esprit Two of the three councils in the
partnership - Devon County Council and Plymouth City Council - use
OLM's Carefirst application. They plan to cooperate over the
development of the interface with Sharecare. The other council,
Cornwall County Council, uses another application to manage social
services. It expects to be the first agency to go live with a link
to Sharecare in mid-May. Confusingly, Cornwall's interface with the
hosted application is being developed jointly with Torbay Council,
which has not joined the partnership. "Cornwall and Torbay have the
same requirements," says Smyth. Torbay has yet to confirm that it
will join the partnership.
The government's plans to redraw the local government map in
Devon have not helped. Devon already has three councils that
provide social services to adults: the county council, Plymouth
City Council and Torbay Council. A fourth council, Exeter, was
selected by Whitehall to provide social services to both adults and
children in the city from April 2009. Exeter City Council passed
successive central government tests for its suitability as a social
services authority throughout 2007 only for Whitehall to halt the
process at the end of the year shortly after the county council
threatened to sue Exeter if it continued to seek independence as a
unitary authority.
Pete Edwards, Exeter City Council's elected leader was furious
when central government withdrew support. "We are urgently seeking
a meeting with ministers to understand the reasoning behind the
decision," he says. "We put forward a strong and compelling case
for unitary government in Exeter which will deliver better
services, value for money and local accountability. We believe we
met the government's criteria and there is no suggestion that a
unitary Exeter should not be created.
"We regret the delay to a unitary authority for Exeter. We are,
however, confident that we will achieve our objective of a unitary
Exeter," says Edwards. Exeter City Council's chief executive,
Philip Bostock, says: "We are obviously frustrated by this decision
as we passionately believe in a unitary authority based on the
city, and any delay to achieving this is obviously a setback. We
are, however, confident of overcoming this further obstacle in
reaching the goal that so many in Exeter support."
The bitterness caused by Exeter's ill-fated bid to provide
social services within the city boundaries, especially the threat
of a legal challenge from the county council, might make
cooperation between Exeter and the other local authorities in the
area less likely in future. Cornwall County Council does not suffer
from the same problem: it is the only council in the county to
provide social services. However, in 2006, Storey says that the
partnership was expected to include the six district councils in
Cornwall. These councils - Caradon, Carrick, Kerrier, North
Cornwall and Penwith district councils, plus Restormel Borough
Council - are no longer expected to share information with the 13
agencies in the partnership.
The 13 members of the partnership are Cornwall County Council,
Cornwall & Isles of Scilly Primary Care Trust, Devon County
Council, Devon Doctors, Devon Primary Care Trust, Northern Devon
Healthcare Trust, Plymouth City Council, Plymouth Primary Care
Trust, Royal Cornwall Hospitals Trust, Royal Devon and Exeter
Foundation Trust, South Devon Healthcare Foundation Trust, South
Western Ambulance Service Trust, and the Torbay Care Trust. The
members have yet to disclose how much the contracts with IBM and
Esprit are worth and how much they will spend on the information
sharing project.
Nobody knows how many people's medical and social care records
are held by the members of the partnership, but there is little
doubt that the project is the largest example of information
sharing in England's public sector. Smyth says that Devon County
Council alone holds the records of "tens of thousands of social
care clients". More than 1,000 employees have access to Devon's
Carefirst system. Those figures will be repeated across the other
12 agencies in the partnership. Each person will have to give
consent before their information can be uploaded to Sharecare
through an IBM Websphere application server and a
SQL Server database.
People will be able to give two types of consent: they can give
permission for basic information to be uploaded to ShareCare or
they can opt for more detailed information including confidential
medical details to be uploaded.
Some key details of the project have yet to be finalised. The
partnership has yet to decide whether to automatically combine two
sets of records on the same person that are currently held by
different agencies. "There might be some automatic matching, but we
would need to work out the details. Some of this detail is what's
being worked through and they obviously did not want to get into
too much detail until the contract was signed," says Smyth.
"For the children's system, the government keeps giving out
changed requirements so there's a whole lot of integration work to
do in the next few years," she says. "Over the last two years, we
have moved every child [who had a social care record] on to the
Integrated Children's System (ICS). The ICS regulations state how
we must hold the data and it makes social workers responsible for
maintaining the data. We still held data before the introduction of
ICS, but we held it in paper case files. Now the case file is held
electronically in a structured way."
The devolved governments in Northern Ireland, Scotland and Wales
are already further ahead with information sharing than the big
English authorities.
The Northern Irish authorities have agreed to an extensive shared
services programme. England's local authorities have a long way
to go before they can achieve the information sharing ambitions set
out in the Transformational Government annual report. Devon and
Cornwall's project, political disputes aside, is a rare attempt to
make large-scale information sharing work in the public sector.