Informed, inspired care: Lessons from Lincolnshire

Lincolnshire Health and Care’s Gary James explains how the county’s new integrated Care Portal system aims to transform healthcare for an ageing and widely dispersed population.

Gary James sets out the benefits of the integrated Care Portal – Photo credit: LHAC

The challenges we are facing in Lincolnshire are the challenges faced by the UK as a whole.

As a healthcare system, we need to deliver sustainable services for a rapidly ageing population. In Lincolnshire almost 10% of the county is aged over 75 – much higher than the national average.

More than 14% of our population live in some of the most deprived areas of England and lifestyle conditions like heart disease and diabetes are forcing us to consider how and where we deliver services.

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Like many in the NHS, we’re trying to achieve all of this within a financial environment where budgets are increasingly stretched. In Lincolnshire, if we do nothing by 2020 we’ll have a deficit of more than £300m.   

Lincolnshire Health and Care (LHAC) brings together 13 health and social care organisations – including the county clinical commissioning groups (CCGs), acute trusts, mental health, community services – and the local authority. Together we’re responsible for the healthcare of more than 700,000 patients.

Individually and collectively we need to provide high-quality patient care, while delivering expected efficiencies, but we also need to be intelligent about how we change services.

Making arbitrary cuts often creates new problems that can cost more to fix further down the line, so at LHAC we’re taking a different approach – putting information sharing at the heart of our plans.

Clinical transformation

In Lincolnshire, some GP practices have diabetes prevalence in excess of 15% of the population, with patients regularly moving between different healthcare providers.

As a result, patient data can be fragmented even within one hospital, where there can be up to 50 sources of information that a clinician may need to call upon. Across the LHAC area, there are potentially hundreds of data sources all of which a clinician may need access too.

The Lincolnshire Care Portal is an end-to-end system that allows clinicians across Lincolnshire to view a shared patient care record, with important health details like current prescriptions, medical history, and details of current and past illnesses.  

The introduction of the Care Portal this year, supported by £1m initial funding from NHS England, has the potential to transform the way care is provided in Lincolnshire. 

The clinician can see the entire patient journey, as well as lab results, history of diagnoses and visits, procedures, discharge summaries, prescribed medications and more.

Based on InterSystems’ HealthShare, the Care Portal sits outside organisational silos. Operating in real-time, clinicians don’t just get a simple snapshot, they get a rich and ever changing portrait of a patient’s medical life.

Counting the cost

The driving force for LHAC is to identify programmes that will both improve outcomes and save money. We estimate that we will save up to £23m over five years from the initial implementation of the Care Portal, including the avoidance of duplicate tests and x-rays. But it could be more.

Importantly, it’s worth recognising that the majority of savings will be in time, rather than cash. As an example, a hospital pharmacist can take up to 30 minutes discussing a patient’s current and past drug regime. With the Care Portal this could be done in seconds.

The Care Portal will help clinicians and their teams work more efficiently. Clearly these efficiencies will have a monetary value, but more importantly the system frees the clinician up to treat more patients in the same time, having an impact on performance too.

Solid sharing

One of the most important challenges for local healthcare organisations is to work together.

Devolution in Manchester signals one potential future for local healthcare systems. Even if things don’t progress this far, the direction of travel within the NHS is one of increasing cooperation and integration.

LHAC brings together the entire health community in our area with a shared vision for the future. The structure of our partnership enables us to create system-wide, strategic change with clinicians at the centre. 

Our own research, and key policy drivers like the 2012 policy on healthcare information, the National Information Board’s strategy on interoperability and the NHS’s Five Year Forward view highlight the benefits of a shared care record.

It can reduce risk and improve decision making, as well as helping to avoid duplication and waste. Shared information can also be used as a basis for analysis, with detailed patient data used to inform better strategic decisions.

But the Five Year Forward View isn’t just a set of guidelines, it’s a shift in focus and one of culture. When we spoke to clinicians, they were already there, challenging us as leaders to provide the support – managerially and technologically – to enable them to change.

When we set out to create our portal, we were clear that any system needed to support and facilitate the creation of a 7-day NHS, powered by data.

On its own the Care Portal is unlikely to completely transform the way we work. But we view it as an important first step toward achieving our shared vision for LHAC.

Patient involvement

Crucially, we want patients to do more than just consent to their information being shared by healthcare professionals. The Care Portal democratises data, sharing it across systems – but its impact won’t end at the hospital or practice door. Our ultimate aim is to involve patients within their own care.

In the future, the new system will include an online portal that will allow all patients to view all their personal health information across multiple care providers, access test results, and see information about their medications.

In time, they will also be able to share their records with friends, family and care givers – putting patients in control of their own care.

Where the system can have a huge impact is in supporting shared care planning for conditions like diabetes, or end-of-life care where multidisciplinary teams are involved.

It’s easy to get carried away with possibilities. And, although the history of the NHS is full of stories of failed IT projects, we are confident that the technology we have now will allow us to move towards a more joined up healthcare system.

In developing the Care Portal we’re investing in our system, our staff and our patients. In so many cases the drive to save money can result in declining standards of care. In Lincolnshire we hope to show it doesn’t have to. 


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