Better Information Sharing (including Information Governance and Cyber Security,

NHSmail and Care ‘Passports’).

Care England Conference – 16th November 2017

Keith Strahan, Registered Social Worker, NHS Digital

keith.strahan@nhs.net

Contents

1. The Adult Social Care sector

2. Information Sharing?

3. Information Governance and Cyber Security for Care Providers

4. Digital Opportunities, including NHSmail offer

5. Care/Hospital ‘Passports’

Skills for Care’s ‘The state of the adult social care sector and workforce in England 2017’

The Adult Social Care Sector

Estimated Number of Adult Social Care jobs by employer

type

Example: A large company running multiple care homes would count once in these figures. Example: Each individual care home within a large care providing organisation will have been counted in this section.

Registered Nurses were one of the only jobs to see a significant decrease (down 8,500 or 16% since 2012).

Current Information sharing – Too often fax or post

Care Home 1 • First home to be rated outstanding by CQC • Information from hospital is routinely posted and reaches the Care Home anytime up to

a week after discharge.

Care Home 2 • Patient was discharged to a new Care Home. • The home did not receive timely discharge information and were not properly prepared

for when their new resident arrived at the home late in the evening. The patient’s leg had recently been amputated, she was immobile and very distressed.

Care Home 3 • Resident was discharged back to her Care Home for people with severe neurological

problems. • The discharge summary arrived 3 weeks later; stating the patient had MRSA! The Care

Home had not been aware… Please also this Professional Records Standards Body report. 10

Some of the

information

flows with

Care Homes...

Ambulances

Local Authority:

Adult Social Care

Commissioning

Voluntary Sector

Family/ Friends

Person/Carer GP Care Home

Community Nurse

Optometrist

Falls Service

Acute (e.g. urgent

care, outpatients, admissions)

Social Work Case Manager

Pharmacy

Care Navigator/ Multidisciplinary

team link

Mental Health Organisations

Occupational Therapists

Transport Service

Assisted

Technology: (e.g. Community

Equipment Services,

Telecare, Blue

Badge)

Safeguarding

vulnerable

adults

Police

Single Point Assessment

Prisons

Dentist

Dietician

Hospice/End of Life

Adult Social Care: Public and private

domiciliary services

CCG: Commissioning

Podiatrist

Physio

Local Authority: Housing

Other Local

Authority

Social Worker:

Duty Team

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July 2017

• The Government accepted the ten data security standards recommended by Dame Fiona Caldicott, the National Data Guardian for Health and Care.

October 2017

• Department of Health published 2017/18 Data Security and Protection Requirements with actions and key dates health and care organisations will be expected to follow.

• It outlined plans for the new The Data Security and Protection Toolkit which is replacing the Information Governance Toolkit (IG Toolkit) from April 2017.

November 2017

• The prototype Data Security and Protection Toolkit continues to be piloted. Care Homes and Domiciliary Care Providers are involved.

Data Security and Protection – Key Dates 2017/18

February 2018

• “All organisations will have access to the new Data Security and Protection Toolkit from January 2018 to 1. familiarise themselves with the approach to measuring implementation and compliance and 2. consider how they might apply to their organisation from April 2018”.

• “All organisations will now be required to complete the new Data Security and Protection Toolkit”. “Further guidance will be published to support organisations…”

April 2018

25th May 2018

• “The EU General Data Protection Regulation (GDPR), and Security of Network and Information Systems Directive, come into force”. This will increase the legislative data security and protection requirements on Health and Care organisations”.

Data Security and Protection – Key Dates

Sector led, IG and Cyber Security Guidance for Care Providers

What is it? • Sector-led guidance for Cyber Security and Information Governance;

specifically tailored to be accessible for Care Providers.

Who is writing it? • The Care Provider Alliance were procured by the Social Care

Programme in NHS Digital to write Guidance for their sector.

When? • The project is ongoing but will complement the Department of

Health’s recently published ‘Key Dates’.

8

In what ways can it help Care Providers?

9

• Reassurance

• CQC revised KLOEs (Key Lines of Enquiry) in place now

• Closer integration with NHS and LA colleagues

• Increasing use of Digital Technology

• Client confidentiality/confidence

• Staff confidentiality/confidence

• Better working practices

• Can lead to better INFORMATION SHARING…

What has been Completed and What still Needs to be Done?

12

• Project 1: Research Information Governance and Care Homes – completed.

• Project 2: Provide Care Provider Guidance for current Information Governance Toolkit – completed.

• Project 3: Publish ‘An Introduction to Cyber Security’.

• Project 4: Influence and provide new Guidance for Care Providers for the new Data Security and Protection Toolkit.

Project 1: Research Information Governance and Care Homes

• Care Homes only were in scope for this report (other Care Providers must be considered in the future).

• Using members of the Care Provider Alliance and wider partnerships to distribute Survey.

• Over 200 homes replied….

Published figures for Information Governance

Toolkit: Care Homes

0.6% 2.55%

96.78%

0%

10%

60%

50%

40%

30%

20%

70%

80%

90%

Completed In Progress Not started

100%

15

Project 1: Research - Key Recommendations

• All communication around information governance compliance needs to be in language relevant to Care Providers.

• Trade Associations have a key role to play.

• Role of Quality Assurance, Policy and Procedure suppliers to the sector is crucial and they need to be engaged – and guided.

• In the Adult Care Sector, bring together the work being done by different Government organisations into IT and IG skills.

• Investment in enabling this journey for Care Providers is essential – learning lessons from other sectors who received funding e.g. Community Pharmacy.

Project 2: Provide Care Provider Guidance for current IG Toolkit

17

• Limited launch of documentation to support current IG toolkit.

• Circulated to Care Home Vanguards and others with a pressing need to go live in the short term e.g. working towards immediate NHSmail implementation.

• Advice is to wait for the new Data Security and Protection Toolkit in April 2018 (see Department of Health’s ‘Key Dates’) - if possible.

Project 3: An Introduction to Cyber Security Guidance

20

• Care Providers can and have already been targeted by cyber criminals; there is a misconception that it only happens to large organisations.

• This guidance is supported by the Cyber Aware Team at the Home Office, the National Cyber Security Centre, Skills for Care, etc.

• It includes links to trusted websites for more information.

• It can be found on the Care Provider Alliance website from start of December 17.

Project 3: Using Key Cyber Security Websites…

Project 4: Influence and provide new Guidance for Care Providers for the new

'Data Security and Protection Toolkit’

18

• The Care Provider Alliance is working to make the new Toolkit (in prototype at present) more straightforward, relevant and proportionate for Care Providers.

• Interim guidance for Care Providers will be available in January 2018, to help start the implementation of your information governance systems.

• Final version of this guidance will be released to coincide with the realise of the Data Security and Protection Toolkit from April 2018.

Project 4: Influence and provide new Guidance for Care Providers for the new Data Security and Protection Toolkit

• NHS Digital, in conjunction with Health Education England, is developing Data Security Awareness Training.

• Designed to inform, educate and upskill different groups of staff.

• The Care Provider Alliance have been working towards making this tool more appropriate for Care Providers as well as highlighting the links required to Skills for Care.

• In addition, the NHS Digital/Health Education England Digital Ready Workforce programme have commissioned free workshops for social care leaders on cyber security, GDPR and information governance.

Digital Opportunities, including NHSmail Build on existing good practice… • Being part of local integration plans -

Including NHS and Local Authorities. •

• Learning lessons from elsewhere - Hospices and Community Pharmacy - the latter already use NHSmail and Summary Care Record.

• Accessing ‘Health’ record - e.g. GP System or Summary Care Record by potentially using the Health and Social Care Network (HSCN).

• Using Secure email e.g. NHSmail - Sharing information across organisational and geographical boundaries. - NHSmail collaborative tools included e.g. Directory, Skype for Business.

11

NHSmail offer for Care Homes

A. NHSmail is available for Care Homes • There is a requirement to complete a baseline assessment on the current IG Toolkit.

B. Working with NHSmail Team on various activities to support adoption • Ongoing dialogue with Care Homes, Care Home Vanguards, Commissioners, etc. • Signposting to IG Guidance and timescales of Data Security and Protection Toolkit . • A number of organisations already shown interest

C. Three Routes for Rollout • Local Sponsorship - CCGs/CSU administer accounts. • Self Management - For Care Home Chains etc. For example, Swanton Group has

recently gone live, approx. 25 homes. Others to follow. • National Administration Service - Removes reliance on finding local sponsor and

provides on-going support so making adoption easier. Pilot sites wanted in January 18.

21

IT Support for Care Providers?

• To support Community Pharmacists with IT, Information Governance, etc., a ‘one stop shop’ resource has been set up (on the Pharmaceutical Services Negotiating Committee website).

• We are aiming for a similar ‘one stop shop’, adapted for Care Providers (with helplines).

• Aware other support will be needed on the ground/regionally and this is also being investigated (investment permitting). What are your ideas?

Victoria’s Story https://www.mencap.org.uk/advice-and-support/health/our-health-guides

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• All too frequently, people feel overwhelmed with the amount of information and the number of professionals with whom they come into contact.

• Some people also have significant communication issues and detailing their story can be difficult and frustrating.

• On occasions, lack of understanding by staff has led to significant harm.

Care/Hospital ‘Passports’ - Background

Care/Hospital ‘Passports’

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• Owned by the individual, Care/Hospital ‘Passports’ have been developed to support people with complex/profound needs; including learning disabilities and dementia.

• They also help provide staff with immediate and important information for safe and appropriate care, as well as promoting a positive experience for the person.

• Examples of when they are used include: - Admission to hospital for any planned or unplanned assessment; - Discharge from hospital; - Attendance at outpatient appointments and - For many other significant appointments and meetings not related to health

24

Care/Hospital ‘Passports’

Integrated Hospital Transfer Pathway: The Sutton Vanguard “Red Bag” Initiative

25

Integrated Hospital Transfer Pathway: The Sutton Vanguard “Red Bag” Initiative

26

Formatting of ‘Passports’

27

• In the main, paper-based ‘Passports’ are currently the norm with the passports remaining with the individual and their carer e.g. unpaid relative/friend, parent if a child.

• In some areas, editable PDFs are used and, in a few localities, the

carers/parents are encouraged to email a much shorter version of the ‘passport’ (almost a minimum data set) to the hospital before the person is admitted.

Electronic ‘Passports’ - Wikis

28

• Wikis are simple, accessible, secure and easy to build personal websites.

• They can be used to create multimedia person-centred plans that use pictures, words, video and sound to capture the voice, skills, aspirations and needs of the individual.

• Also a useful tool for parents/carers who often have to repeat the story to numerous professionals and staff.

Shane’s Story

Electronic ‘Passports’ - My Health Guide

29

• People with learning disabilities are benefiting from an app highlighting essential information; using video, audio, images and text in a single format.

• Also allows those using the app to share selected information with carers and health and care professionals.

• Boxes can be created to store important information e.g. in a special ‘Important Things About Me’ box.

Matthew’s Story

“Reasonable Adjustments”

30

• Under the Equality Act 2010, service providers must consider the needs of people

with disabilities in the way they organise their buildings, policies and services http://rcnhca.org.uk/equality-diversity-and-rights/anti-discriminatory-practice/reasonable-adjustments-for-people-with-disabilities/

• NHS Digital are investigating the delivery of a nationally available flag, accessible

by NHS staff, that will identify: - If a person has been identified by their GP practice, or other appropriate care providers, as being eligible for “reasonable adjustments” in care due to their learning disability. - The “reasonable adjustments” in care required by the person as a result of their disability

• It is proposed that the “flag” will be stored nationally on the NHS Spine, as flags will be created, managed (updated, removed) and accessed by multiple care providers, in multiple care settings.

• FHIR (a technical standard for exchanging electronic records) interactions will create and manage the content of the flag.

PROFESSIONAL RECORDS STANDARD BODY (PRSB): PRIORITIES

Delivered or in development

Identified as a priority for new standard

Person-centred care and shared decision

making

• Apps, personal health records (PHRs),

integrating these with care records

• Shared decision making

Integrated care and repositories

• Integrated digital care and support plan

• Specialist content for care plans

• Child health events

• Maternity health record

• Integrated care records

Safety

• Clinical incident reporting

• Icons

Data for audit, research & precision

medicine

• Specialty standards

• Genotypic/phenotypic standards

• Standards for recording diagnoses

Transfers of care

• Discharge summary

• Crisis care

• Emergency care discharge summary

• Mental health discharge summary

• Ambulance handover

• Outpatient letters

• Admissions

• Discharge to community pharmacy

• Referrals

• Acute to acute transfer

Social Care

• Discharge to Care Homes

• Hospital/Care Passports

• Safeguarding - Adults and

Children

Foundations

• SNOMED CT/DM+D

• Pathology

• Scanning paper records/document

naming

• National opt out

• Dose syntax

Plan Being led by those that use ‘passports’ and working with organisations like the Care Provider Alliance and the Professional Records Standards Body:

1. Survey (using multimedia) the views of those that use ‘Passports’.

2. Learn lessons from the existing electronic solutions.

3. Investigate need for greater standardisation and standards to facilitate electronic solutions (without losing the individual dimension of each ‘passport’).

4. See how national IT projects can support e.g. Summary Care Record.

5. Help accelerate adoption and ensure this information is accessible across organisational boundaries, complimenting health and care records.

6. Highlight the benefits of ‘About Me’ information in ALL records.

LIKE THIS

(Thanks to STANDEX for sharing)

Many Thanks

keith.strahan@nhs.net