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.