Whilst it is obviously the quality of care and capability of health and social care professionals that make the NHS great, it is becoming increasingly obvious that good information governance can make a material difference to both people’s lives and to the finances of the NHS. For example, there is a currently a drive towards personalising the NHS with individuals being given control of a health care budget allocated to them to be used to ensure that they get the right mix of clinical and social care (see “Patients handed money from NHS to fund treatments”, The Guardian, 9 July 2014“).
For a concept like this to work, notwithstanding the availability of clinical and social care services, it needs to be driven by the right information, made available to the right people at the right time – and this is where we, as information management professionals, need to be aware, interested and contributing to the debate. The key to providing correct and consistent care is underpinned by capturing and storing the right information in a care plan. This care plan is agreed with the clinical and social care team and contains information about a patient’s condition, medication, possible symptoms as well as medical history and even, in the case of those approaching the end of their lives, a preferred place to die. For a care plan to be an effective document, it will need to be:
● Available to the right people at the right time – obviously GPs but also out-of-hours, 111, ambulance and hospital services – allowing the provision of a fully integrated care service
● Protected from unauthorised access so that patient confidentiality is maintained
● Correct at all times with a full audit trail of changes to ensure the integrity of the information
All of which means, of course, that these care plans should be managed in line with core information governance and records management disciplines and built for long-term use. That way, they will support and underpin the clinical and social care work which makes a difference to people’s lives and we are likely to get fewer stories like that of Janet Tracey where there was a lack of clarity around the resuscitation requirements on her medical records (see “Clarity needed’ over resuscitation orders”, BBC Health News, 8 May 2014).
As usual, there will be many voices (which in the past has included mine) who will see this kind of arrangement – individually managed budgets, commercial technology provision – as a step on the way to privatising the NHS. However, it is probably more important and definitely less self-indulgent for us to first think about what having a well-managed integrated care plan means to someone who is, say, approaching the end of their life. With all agencies having secure access to an up-to-date, compliant care record, such a patient is much more likely to receive the consistent clinical and social care they need across the whole NHS, when they need it and it might also give them a much better chance of dying in a place of their choosing.
Information governance – it can be a matter of life and death.