Community health services discovery report

Community health services discovery report

Overview

There are over 800 community healthcare providers in the UK, including NHS trusts, Community Interest Companies (CICs), voluntary services, and private providers. The sector has historically faced underinvestment in digital infrastructure, making it extremely difficult to provide integrated care effectively.

A digital team, part of the Community Transformation Programme, was set up to help with digital transformation projects across the NHS in England. Their goal is to help community health services make the most of digital technology, especially since the COVID-19 pandemic.

The main principles include valuing the experiences of patients and staff, recognising the need to address health inequalities and increase digital inclusion at the same time as helping organisations adapt to change.

 

Project overview

In August 2023, the PRSB (Professional Record Standards Body) was commissioned to review information standards within community healthcare services. The aim was to identify the necessary information standards for supporting direct care within community healthcare services by addressing the following key points:

  • identifying universal and service-specific information standards
  • pinpointing gaps
  • prioritising new standards.

Consultations with front line staff and the public revealed significant challenges in accessing up-to-date, patient-centred information, particularly at the frontline of care.

Despite some existing standards, they often fell short in meeting the specific needs of community health services. A notable gap identified was the absence of a standardised community health services care record, hindering effective information sharing and care coordination.

Recommendations

Following PRSB consultation, addressing the lack of shared information emerged as the top concern for stakeholders. Suggestions include supporting shared care records and developing community care record systems to improve information exchange.

Recommendations also include creating a roadmap for implementing standards in community health care services, using existing standards like the Core Information Standard, and incorporating care assessments and specialist clinical standards such as for diabetes. Also extending technical standards like GP Connect and UK Core FHIR specifications to community care records should be included in implementation plans. Tailored guidance for system suppliers and comprehensive support packages for care providers are also proposed to help with implementation.

Additionally, recommendations include standardising patient engagement portals and aligning the community services dataset with selected standards. Follow-up actions are advised to address survey responses related to local data sharing and standards development.

If acted upon, these recommendations would foster a cohesive and efficient healthcare information-sharing ecosystem between community services and other services in other care settings.

Final report

Publication date: April 2024

Community health services discovery report

people supporting each other in group

CHAT theory also explicitly addresses five areas which if addressed systematically will help overcome stakeholder differences in pursuit of the common goal:

1. Understanding the artefacts that characterise the group and its activity.
• The artefacts might be clinical settings or the forms and templates used to capture and share information. During the pilot we heard about hard copy Dialog response forms; locally generated templates for collating information from different systems; letters and emails to GPs; images, poems or other non-text artefacts that service users might want to include in their ‘about me’ or care plan.

2. Understanding the multi-views of the group. Such groups are always a community of multiple points of view, traditions and interests. 
• Different participants in the group will have different roles and will bring to the group and their roles their own histories, language, and ‘rules’. During our Stocktake preparations and workshops we worked with psychiatrists, mental health nurses, occupational therapists, social workers, transformation leads and voluntary sector representatives, all professions and interests with their own language, approaches professional ‘rules’ but united in their interest in care plans, care planning.

3. Activity systems (like the ICSs) take shape and get transformed over periods of time. ‘Historicity’ is a term coined to express how the group’s problems and potentials can only be understood against their own history. 

 

• ‘We’ve always done it this way’, ‘that didn’t work before’, ‘it’s always like this’, ‘it wasn’t always like this’, ‘they are changing things again’, are all typical statements that often frustrate those charged with overseeing change initiatives. Without addressing the experiences that lie behind such comments you risk repeating mistakes of the past, alienating your stakeholders or just not understanding the real starting point for your transformation project. This is particularly the case for the implementation of the PCSP standard, the success of which will be largely reliant on point-of-care practices and information protocols as well as having systems which are user friendly and appropriately configured.

4. The central role of contradictions as sources of change and development. Contradictions are not the same as problems or conflicts. Contradictions are historically accumulating structural tensions within and between activity systems. Collectively addressing contradictions in how policy, practice, culture and technology interact will empower teams to find genuinely novel solutions for apparently intractable challenges, like interoperability and shared care plan/planning. 

This links to the fifth principle that:

5. the possibility of expansive transformations in activity systems. As the contradictions of an activity system are aggravated, some individual participants begin to question and deviate from its established norms. In some cases, this escalates into collaborative envisioning and a deliberate collective change effort. “An expansive transformation is accomplished when the object and motive of the activity are re-conceptualised to embrace a radically wider horizon of possibilities than in the previous mode of the activity.”