The neighbourhood beyond the hospital door

Integrated care must extend beyond hospital walls so that health information follows people across services, writes Laura Thompson, director of health and integrated care at The Access Group

We've talked about integrated care for years and everyone agrees it is the right thing to do and the right aspiration.

But for many people, the day-to-day experience still feels far from joined up.

Debs Teale has used mental and physical health services since she was eight and has spent five decades retelling her story to each new team she meets.

When the different services supporting a person can't share that story between them, the person has to carry it from appointment to appointment, from service to service. When they can't do it themselves, their family does it for them. And if not them, then who?

Neighbourhood health service

The current direction of healthcare was set more than a year ago. The NHS 10 year health plan called for a shift from hospital to community and the Neighbourhood Health Service is a way to deliver it.

With the first 43 test sites now live, delivery has started. This summer the NHS reached a milestone it had worked towards for years with every acute hospital trust now running an electronic patient record (EPR) or putting one in.

Inside the hospital, this is fantastic progress, albeit with further usability and maturity still to improve. But beyond the hospitals' doors we're still searching for solutions.

Much of a person's continuing care never enters an acute hospital. It sits with a GP, a district nurse, a care worker, a pharmacist, mental health services, even a local charity.

An acute trust therefore cannot deliver neighbourhood health on its own, however good its record system.

The point is not which EPR a trust has bought but how far a person's information travels once they leave the building, and how safely it reaches whoever is supporting them wherever they are seen next.

Sharing patient data

We're not starting from scratch. Every region now has a shared care record joining data across hospitals, general practice, community services and social care and the single patient record has been announced by the government/

Social care, mental health, community services and the voluntary sector each run their own systems with its own rules and its own duties of confidentiality, built up over years, decades even.

The aim should not be to move all of it onto one platform but instead to let those systems share information, securely and safely, sending the right detail to the right person proactively rather than waiting for someone to go looking for any recent updates.

Plenty of data already exists. What is missing is the means to share it well, and the trust needed to do so.

Data needs to be insightful, it should be useful, useable and used. Data should lead to insights which must enable action.

This means we need interoperability, shared standards, clear information governance and consent people can understand. This is what turns stored records into something a clinician or a care worker can use to improve services and outcomes.

Building trust

Some places already show how this works. In Sutton, connected sensors in people's homes pick up changes in daily routine early. A community team can then step in before a fall happens or before a missed dose becomes an emergency.

In parts of the Midlands, community and mental health teams can see a person's information across several separate systems in one view. Each detail carries a clear line back to its source, and a half hour search becomes a couple of minutes because professionals use a record more readily when they can trace where each entry came from.

In a growing number of neighbourhoods, social prescribing tools now link a GP straight to the voluntary organisations nearby. The referral is tracked and the outcome fed back.

And for someone managing a long-term condition, a voluntary or faith organisation might be their most constant relationship. A neighbourhood model that leaves it out of the information flow is not considering the whole person.

People share more when they can see who holds their information and why, so trust has to be built in from the start, not added at the end. A connection that is secure and easy to explain will be used more than a large system people don't trust.

The system needs to consider all these elements with many acute trusts now sitting within provider collaboratives and integrated care partnerships.

A trust's digital strategy can no longer stop at its own front door, instead it must reach the places where care happens, across numerous organisations that will never share one record.

Every neighbourhood health plan should be considering whether a person's information moves with them safely, across every boundary including into the voluntary sector. Where the answer is no, that is where to start reviewing processes and relationships.

For someone like Debs, success is not defined by a new platform or a bigger record. It's walking into any service and being met by people who already know her story, so she never has to start again at the next door.

Acute health has spent a decade sorting out its own systems, and there's still work to do, but that work can't stop at the hospital door. Our thinking cannot stop there either.