NHS England - Transformation Directorate

Towards seamless working across health and care

Social care is increasingly able to access the vital information essential for better, safer care based on a holistic view of a person from the very start of the care relationship. As social care tunes into NHSmail and MS Teams to support better communications and collaboration across the wider multi-disciplinary team, Mandy Thorn, reflects on the opportunities and challenges posed by this welcome development.

Mandy Thorn

Mandy Thorn is Vice Chair of the National Care Association and Chair of Marches Care Ltd, a provider of nursing and dementia services. Mandy has managed both domiciliary and residential services during her 26 year career in social care and in 2014 was awarded an MBE for services to dementia.

I got into social care by accident when my mother became ill and I took over her roles managing the small residential care home and domiciliary care agency that she owned with my father.

Our care home adopted technology quite early on, and it has become an increasingly powerful tool over time. We learnt we need to involve the staff in the planning, implementation and delivery of introducing technology. Once we had learnt that lesson, it was easy. For residents, technology has opened up valuable opportunities to keep in contact with loved ones during the pandemic as well as giving them easy access to their records. For our staff, access to patient information, such as medical histories and care plans in the right place at the right time, shared securely and confidently across organisational boundaries, is transformational. For example, timely communication between health and care services ensures we have the staff and equipment we need to safely support people being discharged from hospital back to care homes.

My team provides nursing care, often to residents with complex health and care needs. These service users can be supported and cared for outside of hospital, but require 24 hour nursing supervision and are often unable to express their needs. These needs could include for example, the use of a certain type of sling to fit a hoist for a person who is an amputee, or the use of continuous oxygen therapy, which means we will need to order adequate oxygen as care homes do not have piped oxygen. For key details like these we rely on hospital records, relatives and staff involved in the person’s care to work together and communicate to provide a seamless and safe service that is really centred around that person. This is why I’m excited to read about NHSX’s support for digital social care records and the current work to accelerate the use of existing digital solutions such as the Summary Care Record and proxy access to GP records. By giving authorised social care staff fast and secure access to important health information, we can boost the care and support of those we care for.

The use of NHSmail, a secure email service, has been a game changer as it allows critical information to be shared electronically. It has taken a while for our NHS colleagues to realise that they can use it to communicate securely with social care staff and it’s fabulous. NHSmail allows individuals to be discharged into a care setting much more efficiently, without the need for a nurse or carer to physically attend the hospital to undertake an assessment. This has been especially helpful during COVID-19.

The COVID-19 pandemic has been a driver for rapid change and acceptance of technology across the sector and enabled care providers to safely look after care home residents without the physical presence of other professionals such as GPs and social workers. Staff in certain care homes, for example, monitor residents’ health and mobility by measuring vital signs and performing assessments which they share with GPs via an online portal. The GPs can then run virtual ward rounds to identify additional care requirements and escalate early signs of deterioration or sepsis.

But with technology and the access to information that it brings, there comes the responsibility to ensure that we use and manage data appropriately. Data sharing and data security have become priorities in the minds of commissioners and providers as care systems increasingly grant remote access to health and care professionals. Care providers have had to hold virtual clinics and consultations, undertake remote needs and mental capacity assessments, and routinely use NHSmail.

Staff need to understand data security and information governance. Social care providers are expected to comply with the standards set out in the recently published Data Security and Protection Toolkit to evidence that we are keeping our residents' data secure. Every day, the use of technology empowers my care worker colleagues to feel more involved and accountable for their actions as they are recorded in real time. These changes in expectations, in the ways in which we work and communicate, involve a huge practical, but also cultural, shift for health and care professionals to adapt to.

Our home was early to adopt the information governance toolkit and NHSmail, and we have been working to support better communication between the NHS and social care for over five years. It has been a process through which I have seen both the opportunities and the challenges first hand.

I know that to make sure we maintain the trust and confidence of those in our care, we also need to increase IG expertise and digital security awareness across the adult social care workforce. Staff need to understand the need for maintaining people’s confidentiality and balance this against the need to share relevant information when they need to for an individual’s care, for example, or for safeguarding reasons. They should know how to use secure systems for sharing confidential information and how to take precautions, such as using appropriate passwords, to keep information secure.

That is why I am so pleased and passionate about being a member of the NHSX Social Care IG Group; coming together with other sector leaders who understand how important this issue is for social care staff and the impact it will have on service users. We are joining forces to raise information governance up the agenda, to tackle the cultural barriers to data sharing between health and care and bring to life the real opportunity here, which is to improve outcomes and quality of life for those people entrusted to our care.