Confusion over information-sharing agreements at a local level is a major barrier to effective joining up of health and social care, the UK’s spending watchdog has said.
The NAO has said that many local level care providers find the regulatory framework around information-sharing confusing – Photo credit: Pixabay
In its report Health and Social Care Integration, published today, the National Audit Office looked at existing attempts to achieve integration of care provision across England, and identified a range of issues and barriers that still remain.
The aim of integration is to put patients at the centre of care in a way that overcomes the organisational, legal and regulatory boundaries, and reduces multiple trips to care providers or unreliable transitions to other parts of the system.
It involves three central government organisations – the Department of Health, the Department for Communities and Local Government and NHS England – as well as a range of local public service providers, and a crucial part will be the effective sharing of patient data so each person has am accurate, well-protected digital care record.
However, the NAO identified “reticence over information-sharing” as one of the three main barriers – the others being misaligned financial incentives and workforce challenges – that the government has failed to systematically address.
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In its report, the watchdog said that its fieldwork had identified a lack of understanding at the local level about whether and how patient data could be linked, with many finding the regulatory framework “confusing” and a barrier to integration.
“They found it difficult to track patients through different care settings, compare costs and establish whether integration was saving money,” the report said.
For instance, the NAO said that, despite some improvements in 2015-16, nearly a third of local areas are not using the NHS number as the main way of identifying patients.
Use of this number is part of allowing patients to have a digital, integrated care record that can be easily moved throughout the system, with all professionals being able to access the right patient’s records.
The NAO added that there was “insufficient support from the centre to tackle information governance issues” at this level, and that the departments lacked work streams that bring together, monitor and evaluate work on various initiatives to address the problems.
According to the report, DH had told the NAO that it “recognised it had not done enough to explain the rules around information governance”, adding that it had commissioned a report from the National Data Guardian on the issue.
The NAO, meanwhile, said that central government needed to consider whether local areas need more support and guidance to help facilitate local level data-sharing or whether a national approach would be more appropriate.
Commenting on the report, Jos Creese, an independent digital consultant, said that it was right to raise the issue of information-sharing, but that efforts needed to go beyond the three organisations.
“NHS Digital and the Government Digital Service should be focusing on this, too,” he told PublicTechnology.
This, he said, was because the integration of health and social care needs a distributed system, and a more complex framework of controls and management, that would require a broader look at digital care as a single, national initiative.
Creese added that – although the digital exemplar programmes being funded by NHS England were worthwhile, and would likely be beneficial in terms of shared learning – the time for research was coming to the end. “We need to act now,” he said.