For our latest interview, we spoke with Paul Henderson and Astrid Grant from Channel 3 Consulting, who shared their insights on Shared Care Records.
The discussion focused on benefits, challenges, the opportunities and the role of Shared Care Records in transforming services, as well as covering where Shared Care Records are going, the key areas for improvement, funding and distribution.
Paul began by providing some context on the current ICS landscape and the inherent value a Shared Care Record offers.
Paul: The health and care system has made great progress in understanding the needs of our population. We understand a lot about the challenges that people face. Sometimes those challenges are long-term structural things like education, housing, and in other cases those challenges are near-term; for example, having patients arriving at A&E in an ambulance needing immediate support. Access to the right data to make the right decisions at the right time is important. We’re in a situation, in the health and social care system, where data has been historically locked up in silos, and people have had to make decisions based on partial insight into their patients. It’s getting better, but it’s still a problem.
Shared Care Records are available and are helping. For example, many organisations can see primary care data in an acute setting. However, a regional challenge exists in connecting Shared Care Records, filling them with the right data, and making that data available.
Astrid: For me, the answer is very simple; right now, I live in Surrey, but I am currently in Nottingham – if I ended up in A&E here, they would probably know nothing about me because they don’t have access to most of my relevant information. They would have to rely on me telling them my history, provided I was conscious and able to do so, to supplement what is available in the national summary care record.
Providing full access to data has been a mission for the last 25 years, and we are still not there yet. In an ideal world, you would have one system across the country that everyone uses. However, that’s not how it works. Therefore you need something that brings all those factors together, and that is a Shared Care Record.
Tactically, some of the necessary investment has already been made; there is a Shared Care Record or multiple Shared Care Records in every ICB in the country. In a climate where there are difficulties with funding, it is important to use things we have already invested in and we need to focus more on how we get the records used to drive productivity. Shared Care Records can bring efficiency and help with those financial difficulties we are facing. In terms of challenges, some building blocks are missing; in social care, for example, much work is still done on paper. Many of the barriers centre around digital maturity; if you are an organisation that primarily uses paper, then with the best will in the world, you will not be able to put data into any digital system.
Paul: I think the most important word in this is ‘sometimes’. Sometimes, people make decisions based on having all the relevant information and data in front of them, in the right place at the right time, and they know exactly what to do. But it’s not always true. We need to create a culture where this is always the case. Access to data is like access to oxygen – it’s the thing that makes us live and breathe; we can’t be in a situation where we’ve not got access to the right amount of data.
To Astrid’s point, it’s not about technology, it’s about thinking digitally. If we learn the lessons from those organisations that do digital well, they tend to organise their service delivery so they focus on achieving the desired outcomes for the customer; they tend to have hybrid service models; they organise their process so they eliminate waste and they have a culture throughout their organisation that really buys in to all those principles.
What would a good Shared Care Record look like?
Astrid: For me, it’s a Shared Care Record that you don’t realise is there. In terms of user experience, you want to see all the data you need in one place in real time. From my perspective as a trained doctor, I don’t care how it gets there; I care that it’s there and that it just works.
Paul: If you imagine a world where doing things digitally means that you’re making a massive impact on your population and workforce, there are some things you would expect to see. Firstly, insights driving citizen health and population well-being; secondly, you would want to see that there is no waste in the investment you’ve got in data sharing; and lastly, you would expect to see effective service delivery. The question then becomes: what does a good Shared Care Record look like and how do you get there? There are three pillars of a successful strategy: data, digital and productivity. On that last note, productivity is about thinking on what you want to achieve through your investments, and not solely about spending money on IT.
NHS England is looking to define where Shared Care Records are going; what are the key areas of improvement/change in your view?
At this point, Astrid shared Channel 3 Consulting’s maturity model [below] to demonstrate the journey of healthcare organisations looking to implement a Shared Care Record and transform their services. As the Shared Care Record develops, the impact it has further increases. Astrid explained that most organisations have passed through stage one of the model, where they can access real-time data, albeit sometimes through multiple logins. Level two is real-time visibility of records in context, which many organisations have but only through “overly-complex tooling, duplicated efforts and cost.”
Astrid: Regarding improvement, it’s about asking what we want to improve and how the Shared Care Record enables that, versus saying, ‘let’s bring in more and more data and hope it’s useful.’ Because what ends up happening is you get information overload; you’re not necessarily using information efficiently, people don’t want to use it anymore, and the moment you lose that adoption, it’s hard to bring that back.
We need to focus more on the outcomes and what you want to change because we could argue we have done a lot to bring care teams together. One of the most significant issues we face nationally is information governance and how we can break that barrier to help move things forward.
Paul: I think Astrid is absolutely right; what you’re describing is the very mixed landscape we’ve got in the UK at the moment. Thinking back to the NHSX priorities to digitise, connect and transform services, we are halfway there in many cases. That is an outstanding achievement, but there is more to do. Having the right data embedded in operational and clinical workflow is going to be key; clinicians don’t have time to go hunting for data; they don’t have time to sift through volumes of data to work out what’s relevant to them and what they need right now in order to best help that patient sat in A&E. Wouldn’t it be great to have a system where all patient information is shared across organisations, enabling clinicians to make the best decisions and boost productivity? These are the things we hear from the frontlines, and it is an achievable goal in the short-medium term.
Astrid: One point I would like to emphasise is that at the Shared Care Record summit this year, during John Farenden’s session, he asked if people felt that a national strategy for interoperability was needed because there isn’t necessarily a joined-up approach to data sharing nationally. This is something that I think it would be very helpful to explore and the overwhelming answer in the room was definitely yes. Of course, data standards need more work for this to happen, and it was great to see people talking about the importance of that.
The other point I wanted to make was about the ambulance service; when you think about how paramedics work, giving them access to a Shared Care Record is a no-brainer. The problem they have in that mixed economy is that different organisations have varied ways of sharing information, and so in many cases they would have to guess which ICB would have the information most relevant to their patient at that moment. It’s about pushing the boundaries, not just around how you would use Shared Care Records to change what you do, but how far you share information beyond the organisational boundaries of your ICB and region.
Let’s discuss funding and distribution; what are the key areas of focus?
Paul: I think Shared Care Records evangelists need to win the argument that it’s a benefit, not a cost. If they are going to win the argument that it is a benefit, there are lots of examples. Astrid mentioned the Shared Care Record summit – there was a keynote about how a child’s death could have been avoided if data had been shared. The benefits argument is very clear; nobody will say, ‘you’re alright, I don’t need any data.’ But there are also cash-releasing savings from taking cost out of the effort of sharing data and improving productivity as a result.
If you were thinking of making that argument, one of the places you might start would be looking at the rationalisation of contracts for Shared Care Records across an ICB. If you’ve got two, you only need one, for example. If you get that right, the next questions are who pays and what is provided centrally. There are central initiatives that we could use more clarity on- for example, the future of the summary care record, the future of the national care record locator service and the work being done centrally on standards for interoperability.
How can Shared Care Records really transform services?
Paul: We need to think differently about how Shared Care Records are of value, and to start with the need of citizens. Initially Shared Care Records were about freeing up data and making data available at the point of care. But the opportunity is really to rethink how that how we use data to enable citizens to more easily access support from health and care staff, or other public and private services that can help them live better lives..
Imagine a world where as a citizen you can control your own data. You have your health and care records, social care, housing, employment data like cards in a wallet, and you use these cards to share your data with people you need help from. If the care system worked back from this premise then it may think differently about how Shared Care Records need to evolve.
Astrid: In terms of thinking differently, the challenge is to bridge the gap between where the country is now, the building blocks that are missing and the vision – that’s a big shift. How do we gradually get people up the maturity curve to the level? There are tactical things to leverage the Shared Care Record to transform services, and questions to ask. For example, can we use the Shared Care Record to manage demand and capacity using that shared data?
In terms of our maturity model, and the next step (step five), I think people are craving a shared national vision on what the future looks like for Shared Care Records. Right now, are we ambitious enough?
Paul: If you think differently and start with the end in mind, you ask yourself – how can I get the most productivity out of this data? Part of the answer is to put it in the hands of peopleand enable them to take a stronger role in data sharing.
