Poor information sharing barrier to NHS integration – NAO

A report examining integration between the NHS and social care has identified poor information sharing as one of the greatest barriers.

The National Audit Office report was deeply critical of the £5.3 billion Better Care Fund, intended to promote better integration.

The fund, which pools NHS and social care money, was meant to drive hospital savings, and reduce emergency admissions and discharge delays.

Instead in the past five year, admissions and delays have risen and the Department of Health has increased spending on emergency services.

The Department was overly-optimistic about progress on integration and had “no compelling evidence” that it would led to savings and reduce hospital demand, the report said.

The report identified three “long-standing barriers” that had held up integration efforts for nearly 20 years.

“Local areas are finding these barriers difficult or impossible to overcome at the local level, and the Departments recognise that national approaches are required.”

These included reticence to share information, misaligned financial incentives, and workforce challenges.

The report found “local bodies found the regulatory framework confusing and there was insufficient support from the centre to tackle information governance issues”.

Local organisations were “unsure” about the legal requirements around sharing information.

“They found it difficult to track patients through different care settings, compare costs and establish whether integration was saving money.”

For instance, nearly a third of integration areas were not using NHS numbers as primary patient identified. This has been a legal requirement since October 2015.

The latest regional integration scheme, the sustainability and transformation plans, have had a big focus on information sharing, particularly through deploying share care records.

However, the report expressed scepticism about the viability of the plans while both social care and the NHS struggled with deteriorating finances.

About 83% of the £2.1 billion funding set aside for the plans in 2016/17 has been spent on plugging deficits rather than transforming services. This left little money remaining for information sharing technologies.

IT and information governance constraints had been repeatedly raised as a barrier to health and social care integration. The National Audit Office made similar points in a report in March, 2014.

A  study published in May last year raised similar issues with the Integrated Care and Support Pioneer Programme, one of string on NHS England integration schemes.

It found, while “technical problems, such as incompatible IT systems, were identified as making information sharing difficult, these were not seen as insurmountable. More problematic were issues of information governance, particularly in relation to accessing general practice data.”

Complaints about the NHS’s information governance toolkit in particular have been long standing. In a report published in July last year, Dame Fiona Caldicott described the toolkit as “tick box exercise” in need of a major overhaul.

NHS Digital have since committed to a “revamp” of the toolkit.