As the attention of council IT departments turns to health and social care integration and information sharing, the success of one Scottish collaboration could act as a model, delegates at Socitm Scotland conference heard yesterday.
NHS Ayrshire and Arran has worked with the area's councils since last year to run a customised shared system aimed at detecting situations where children are at risk of harm. Users of "AYRshare" - the NHS organisation plus North Ayrshire, East Ayrshire and South Ayshire councils - can create new shared case files based on a child's NHS number when a concern has been raised. Health and social care professionals can then quickly identify others working with the same child or family and co-ordinate risk assessment and action plans.
When the health body first looked at addressing this issue two years ago, a team led by eHealth programme manager John Barrett reviewed external options including adapting the FACE software system used by its health visitors; and Microsoft SharePoint. In the end they decided the old-fashioned route of in-house software development would be the best.
As is often the case with such projects, the hardest part was not developing the software and technology but changing organisational and staff cultures to enable collaboration, he said.
"Putting the system together and putting the infrastructure in place were not that difficult to do", Barrett told Socitm Scotland. "But all the councils had different ways of working, using different frameworks and documents that had been created around a child. Even the basic assessment document was different in each council."
Add to that four IT departments, four IT security officers, four lots of suppliers and four sets of different strategic objectives and the scale of the task is clear, said Barrett, though the organisations did also share some strategic objectives such as integrating health and social care and saving money. "We had to ensure we had a clear aim, build and maintain trust and overcome scepticism."
Next came the challenge of dealing with information management issues such as data protection and data security that have scuppered many a similar project before it even started.
The partners convened a sub-group to develop procedures and protocols for information governance, allowing the councils to connect to the NHS shared network N3, Barrett said. The key to acceptable sharing was ensuring that only those practitioners who had a legitimate interest in accessing information about that particular child could access it, with the network only allowing users to access AYRshare, not each others' systems. "It works on the principle that wherever possible, a professional should continue to work in their own system, but when they want, they push a button and that information is pushed across into AYRshare".
Cyber security was still an issue, as the management team found out when it employed a third party to try and hack into it not long before the system went live, Barrett said. "We found a few holes we had to plug."
A further challenge was usability, if a range of staff were going to be expected to add it to their busy workloads, Barrett said. "Because we knew we would have to train over 1,000 people in four different organisations, we had to make it easy to share and find information, and to identify key people involved with a particular child." The answer was to keep the interface as simple as possible - "it takes about an hour to train someone in how to use AYRshare."
The system has been live since March 2013, since when 3,173 children's records have been created, linked with 8,645 "significant events".
It is now increasingly being used to support teams around a child, for example as a platform to share documents ahead of team meetings and to share decisions afterwards, Barrett said. "It has moved well beyond what we had envisaged it would originally do."
Support from all the partner organisations' senior managers has been the key to its success, Barrett said. "We had strong and supportive leadership from all four organisations right from the beginning: senior managers who envisaged a simple and pragmatic approach to a solution that could be developed relatively quickly", he said. "And we were given the financial and staff resources to take project forward."
Next steps planned include adding access by other relevant organisations such as police and fire services, with whom discussions have already started, and there is also a need to expand use within existing organisations following frustrated feedback from some users that "not all my colleagues use AYRshare", Barrett said.
NHS Ayrshire and Arran has also held initial discussions with the Scottish Government about the possibility of organisations in other parts of Scotland using the same system, although "the feasibility of this and the delivery model require further discussion."
Overall, if the system helps to reduce the risk of harm to children it is doing its job, Barrett said. "Our overall objective is to make a difference to children and families - to make the service they received much more joined up."
To illustrate the potential of a joined-up approach he offered the powerful example of a teacher who had used AYRshare to express concern about a child's state of mind at school one day. As a result, a social worker visited the girl's house and was able to prevent the problem becoming worse. "We reduced the risk of self-harm by a 12-year-old girl, by sharing information."
Pictured: Dynamic Earth, venue for Socitm Scotland 2014.
Socitm Scotland 2014: www.socitmscotlandconf.co.uk