New PRSB member spotlight: CIO Network

PRSB is delighted to welcome the CIO Network as a new member. The organisation brings together chief information officers to support their development as clinical information leaders, and promote their involvement in advancing health and social care services.

Lee Rickles, Yorkshire & Humber Care Record Programme Director and CIO Network Advisory Board Member, perceives standards as pivotal to achieving integrated care: “If we didn’t have standards, how could we measure whether we are compliant, and how could we understand variability? They help us achieve assurance in what we do.”

Imagine storing and sharing data from across 74 organisations, including 22 acute trusts and over 700 GP practices. Under Lee’s guidance, that’s exactly what the Yorkshire & Humber Care Record achieved. He sees the implementation of standards as key to this connectivity: “Standards allow us to understand how the information can be shared and linked together. Without consistent standards explaining what we mean by the clinical information, we would have struggled to join everything up.”

Chief information officers are the ones that initiate a journey towards a more integrated health and care data system – and the PRSB can support them in doing so. “The reason why I think CIOs should be involved in the development of standards is that they are the glue that links clinical services operations, governance teams and technology together. Operational clinical colleagues aren’t necessarily aware of the standards that relate to technology – it’s the CIO community that is generally more aware. When somebody wants to change the processes, introduce new systems or carry out a data aggregation of a digital twin, CIOs are the leaders in these types of conversations. We are involved in how standards will work in practice and how they will fit into the operational process. Being a PRSB member gives the CIO Network an early insight into how standards should be adopted.”

However, the successful adoption of information standards does not rely on one party, but a multifaceted collaboration between health and care professionals, national bodies and systems suppliers. “The reality of implementing standards jointly is complex. I think that the upcoming legislation mandating use of the Personalised Care and Support Plan standard will help enable implementation”, says Lee. Another way to accelerate this adoption is communicating the value of standards and how they are designed to improve lives.

In order to ensure that the use of standards is consistent across different settings, and that they help achieve integrated care, we need interoperability. “Yorkshire & Humber Care Record is a federated system – we don’t have loads of data about everything in a big new database. We hold information in EPRs, social care systems and GP systems – what we need to be able to do is find it and then present it. This is quite a complex operation with nearly every different type of software supplier. Standards around interoperability are absolutely key for our success”, explains Lee.

Speaking about the benefits of the PRSB membership, Lee highlights that it enables him to have meaningful conversations with specific communities, such as pharmacies, when it comes to implementing standards. The current challenge for him at the Yorkshire & Humber Care Record is to make sure that there is always consistent information, with the right person, at the right time, using the right standards – and the PRSB can help facilitate all of this.

Find out more about becoming a PRSB member.

Lee Rickles is a fellow of the BCS, FEDPI Leading Practitioner, CHIME Certificated Health Chief Information Officer and alumnus of the Digital Academy. He has three decades of transformation and programme management experience. His first decade focused on UK military aircraft projects and for the last two decades, he has focused on digital transformation in the NHS. He is currently leading the Yorkshire & Humber Care Record development to provide an open platform shared care record and population health systems. He is the Senior Responible Owner for the mental health digital transformation of Humber & North Yorkshire ICS. He is also the CIO of Humber Teaching NHS Foundation Trust who have been award the status as a project innovator as part of the NHS digital aspirant plus programme. Lee likes to read, is a keen runner and a children’s football coach and referee.

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Personalised care and support planning for people with severe mental illness

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides more detailed explanations about each element of the plan, including advice on how the planning process might be best conducted.
These questions might form a checklist for current plans to be compared with. 

1. Does the plan include an About Me section in which the service user, in their own words, can indicate the information they want to be available about their lives, their values, their interests, and priorities, available for all those who may care for them?
2. Is the approach to developing a care plan patient centred and engaging, allowing plans to be based on patient priorities goals, and aspirations, along with the actions they plan to take and the support that they will receive?
3. Is there space for a “formulation” to be recorded in which the person receiving care and the professionals who provide it, share and record the personal meaning and the origins of the person’s difficulties?
4. Are relevant procedures and therapies recorded?
5. Where relevant, are one or more contingency plans included for anticipatable disruptions, exacerbations, or deterioration, and do they include advice on what to do and points of contact for those called upon to respond?
6. Where relevant are additional supporting plans incorporated, (an example being an “educational and health plan” for someone with a neurodevelopment disorder)
7. Is a version of the plan available to a service user (if they wish to have it) in a form and format that they can understand and find to be of value?
8. How is a version of the plan available to the GP and other key parts of the health and care system?

Work conducted by PRSB and partners recently has looked specifically at the suitability of this approach to the development and documentation of care and support plans for people with Severe Mental Illness. This resulted in an updated version of the standard (v1.4), for use by any service and for any group of service users, but with some modifications to ensure that it meets the needs of this community. The approach to a patient centred process of identifying goals, hopes, and values, and the support needed to achieve them, is fully compatible with and can be conducted using, specific tools in use in mental health, such as DIALOG, DIALOG+, and ReQoL, for example. 

Where analysis indicates the need for improvement in the content and process of personalised care and support planning for patients with Severe Mental Illness, specific improvement projects should be instituted to co-design with service users and their representatives, and the relevant staff groups, new approaches, and documentation that would be of value in delivering improvement. The toolkit includes a range of existing resources that could be used to engage in this improvement work, including signposting to relevant existing approaches informed by patient experience-based design.

Moving to a single holistic plan

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides A key development, consistent with national policy on support for Personalised Care across all health and care sectors, is the move towards an individual with complex needs having a single, integrated, care plan, rather than a series of plans developed by different parts of the health and social care system in isolation of one another. For a patient with severe mental illness, the related concerns and challenges might form a very prominent part of such an integrated plan; many will also have concurrent health challenges and needs. The intention is that the relevant services work together to plan and wrap support around the patient and their family in an integrated way, rather than as a series of sequential or disconnected encounters in which the service user or their friends and family have to adopt the role of the integrator.

A starting point would be to agree priority groups of service users who may already have more than one care plan because they need care from more than one part of the system of health and social care. This could be initiated by looking at service users registered with some sentinel practices or PCNs. Alternatively, the approach might focus initially on people with defined co-morbidity or risk that entails collaborative care with agencies beyond specialist mental health services.

The focus here is on the process of care planning and agreement on what should be shared, rather than solely on the technology used;

1. What is the process to agree which professional will initiate care planning and act as the “lead point of contact” for the service user?
2. Will initial plans be agreed with the service user in joint consultations or sequentially? Where and how will they be conducted?
3. What will be the process to agree the elements of the plans which should be available to professionals and potential authorised users beyond the immediate care teams, (A&E services, Ambulance Services, Social services, etc.) with the service user’s consent?
4. How will elements of the plan be updated following consultations in a way which is proportionate, to allow contact and progress notes to be maintained by the service conducting the consultation, whilst avoiding unnecessary work for partners in care if there is no significant change to the personalised care and support plan?
5. What are the implications for workload, logistics, and administration arising out of these decisions?

The answers to these questions and others will best be elicited through focused joint working, grounded in real, or at least realistic examples. This will entail process mapping, and co-design with a range of professionals, service users, and families. Resources from the toolkit and outputs from the Simulation element of this project will be valuable. Some organisations would adopt an approach such as a Rapid Process Improvement Workshop, planned over several weeks and conducted over a number of sequential days, to develop prototype ways of working that could be tested in the field.