Council and PCT Forge Ahead with Integrated Working
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In 2003 Southampton City Council became an early adopter of the IT system
Paris, developed by community health and social care software provider in4tek, which enables the flow of information, in a secure environment, between service providers across all professional disciplines involved in the provision of health and social care. Their aim was to provide practitioners with the tools with which to restructure and improve working practices to the benefit of recipients of their services and foster closer working practices with health colleagues.
The implementation of the new system was focused on maximising direct practitioner usage instead of relying on administrative staff to manage the system. The various modules of Paris have been implemented in five stages, Children and Families, Adults, Adoption and Fostering, ICS and Financial Assessments, which is currently being implemented.
The Paris technology has enabled the Council to achieve greater integration with their PCT and they have worked together towards obtaining a code of connection to the NHS network. After a significant amount of work, which included submitting documentation on security features and in depth detail on what social services were working towards, this was achieved some sixteen months ago. The Council is now using Paris/Citrix to provide SAP assessments over NHSNet.
As a result, at a number of sites containing multi-agency teams across Southampton, health and social care staff are able to access health systems, the Paris social care system and other council systems through a single PC. The plan is, as the health and social care relationship continues to develop, to extend this to further sites in the PCT area in the near future.
As part of this process, and in response to health practitioners increasingly requesting access to Paris, or to data held on the system, the PCT and the Council will undertake a review of current practices to define various business cases and to establish protocols that will enable even greater and more effective partnership working and integration in the long term.
The IT project manager, Paul Worley, said, “We are all delighted with the degree of progress that has been achieved in our work with the PCT. The ease of access to information has enhanced the delivery of care tremendously, which is exactly what we have been working towards. The fact that we have multi-disciplinary teams, that health based personnel have embraced the Paris technology and that the various professions are becoming more enthusiastic about information sharing is a real achievement considering this is entirely new territory.”
Another area where the system has proved invaluable, Paul believes, and one that has helped influence the spread of integration, is the range of management information that the system can provide, and in particular user-run reports. As staff have gained in experience and confidence in the system, system reports that would have taken a week to produce previously are now being done in a matter of hours.
The Council and the PCT have experienced a great improvement in practice as more and more people are better informed about what they are doing. They are finding that professional silos are increasingly opening up to information sharing in order to support good service delivery.
According to Ann Francis, Children and Families lead in the implementation of ICS, the original resistance to change in the early post implementation stage has undergone a complete about turn. She explained, “The cultural shift from paper to electronic recording which also meant learning new skills was a major step.
“Becoming accustomed to the visibility of information and of the ease with which sensitive information was suddenly available was also very difficult. This led initially to the perception that accessibility equated with being less secure. Staff were so used to the limited accessibility inevitable with paper records.
“We now realise that this is not the case but it was a significant hurdle to navigate. It probably took about twelve months for the users in each division to not only accept the new technology but to realise the benefits of the system, to use it as a tool and take ownership of the system. Practitioners across health and social care now welcome the fact that information is accessible and easily available, they are making the system work for themselves.
“If there is any resistance it isn’t so much about using IT it is more about the appropriateness of certain information being logged onto an electronic record. There is some realism in having this discussion, as it is important to iron out any issues, particularly as we are still in the pioneering stage.”
Driven by the desire to share information more widely, and in light of increasing levels of requests from other departments, the Council is constantly widening the influence of the Paris system into many other areas of council business. This has led in particular to in-house .net developments for Housing, Traffic Management (to check blue badge details) and importantly the General Hospital, giving access to the Child Protection Register to cross reference A&E information.
Because of the sensitivity of the data on the system, the sharing of all information is being closely monitored and screened by the health and social care section and the IT auditor, and is subject to the Council’s Information Sharing Protocols and Guidelines.
With the development of their Single Assessment solution Southampton City Council has created electronic forms to enable practitioners to make assessments in the home on laptops and then download and integrate that information onto the Paris system. This was part of a project started some years ago to explore mobile technology that ended in March 2006.
Having investigated the available mobile working solutions, a decision was made to record the SAP information onto laptop and synchronise this into the Paris system on return to the work base. Currently thirty practitioners are using this system, it is working well and will be rolled out to other users as necessary.
With ever evolving improvements in mobile technology, for example 3G, the Council is pushing ahead with real time mobile working systems and according to Peter Coulson, the IT Solutions Development Group Manager the building blocks are in place to enable this to happen.
From an organisational viewpoint he went on to say, “Southampton, like all other authorities is undergoing extensive restructuring as a result of the establishment of Children’s Trusts. The development issues surrounding Children’s Services and Learning are placing additional demands upon care. Whereas the Adults link up with health, for example, had been known about, worked on, clarified and developed over a number of years in terms of business processes, currently the requirements for Children’s Services are still evolving.”
Ann Francis added, “Locally the new director of the newly formed Children’s Services and Learning Directorate, Clive Webster, is very clear that he would like to move towards a unified system across what is currently education and what is currently health and social care, in other words across the whole new Directorate. As we are currently using different systems work is underway to identify ways of making relevant information available across the whole of the directorate.
“In Children and Families the new integrated IT culture has now been welcomed and accepted. However, the ultimate structure of the new Directorate is still in development, and the implications for supporting IT systems is in the process of clarification. There is also ongoing work with partner agencies to meet the requirements of the Child Index and ISA. Whatever happens we are confident that we are supported by a system that can meet future needs.”
in4tek’s CEO, Tom Nawojczyk believes that what is being achieved by both the Southampton City Council and the PCT should not be underestimated. He said, “Both organisations have made very real progress, they have emphatically demonstrated the merits of deploying a single integrated system to support health and social care.
“I fully endorse and uphold Southampton’s approach, which benefits both the local population and staff, who can now make better more informed care decisions.”
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