Partnering with PRSB to accelerate standards adoption across the health and care system

The way we share and store our health and care information can directly impact the delivery of care plans and their outcomes. Standards are critical; ensuring information is recorded consistently and can be accessed by relevant professionals in the right place, at the right time. 

Their use has been pivotal to Yorkshire & Humber Care Record’s work in delivering more joined-up care by bringing important information from multiple clinical systems into one. Implementing the standards has enabled access to accurate, real-time data whenever and wherever needed. PRSB is supporting their mission through its Standards Partnership Scheme, which provides expert guidance and advice to health and care providers and suppliers as they implement the standards. 

Lee Rickles, Yorkshire & Humber Care Record Programme Director, said: “If we don’t have standards, how do we know we’re heading in the right direction?” He feels the scheme plays an important role in driving their adoption: “Having a PRSB partner badge that you can wear with pride is a good thing. It suggests that the organisation lives up to the principles and cultural requirements set by PRSB standards. It further encourages adoption of the standards to better connect and share information across health and care settings.” 

“Yorkshire & Humber Care Record is working with information stored in EPRs, social care systems and GP systems. We need to be able to find that information and present it. That’s quite a complex operation when you take into account all the different software suppliers we are working with, and the different ways each setting has configured them. But if all had been implemented according to the standards set out by PRSB, information could be shared between systems regardless, and interoperability would be far more achievable. In the absence of PRSB standards, we couldn’t have achieved the Yorkshire & Humber Care Record.”  

There is a common misconception that electronic systems can automatically solve any issues – whether it’s technical, about  information governance or general access to health and care records: “The PRSB sits in a neat gap where other agencies and bodies don’t yet exist. Their standards are the glue that links technology to governance and operations.”   

Joining the PRSB’s Standards Partnership Scheme has helped the Yorkshire & Humber Care Record gain further recognition for their work around compliance with standards. “We are consistent in using standards, and so being a PRSB partner provides additional recognition that we are doing what is classed as good practice. It helps show that we have a high level of competency and capability”, Lee adds.  

Demonstrating a commitment to standards creates a virtuous circle of best practice. Lee notes that while we can motivate health and care providers and systems suppliers to adopt standards, external support from key health and care organisations to communicate the value of standards, is still needed to achieve this. Lee adds: “The importance of using standards should be pushed further by NHS organisations, ICSs, ICBs, and national bodies. There also needs to be more communication around managing changes in standards. For example, the Care Programme Approach process is coming to an end, and so a new way of conducting mental health assessments will need defining, which may lead to some amendments in the existing standards.”  

The Yorkshire & Humber Care Record already implemented some of PRSB standards, such as About Me, Ambulance Handover to Emergency Care, Mental Health Inpatient Discharge, Personalised Care and Support Plan, and the Core Information Standard. Lee perceives the latter as having the biggest impact so far, as it sets clear expectations for information that needs to be included in the shared care record. The next step for the Yorkshire & Humber Care Record will be to enrol in conformance assessment against the relevant PRSB standards: “Conforming to standards shows your competence and capability. It also helps ensure that your system meets necessary requirements, and providers should view attainment of the Quality Mark in the same way as securing something like the Cyber Essentials badge.” 

Collaboration is key to the successful adoption of information standards. This is why PRSB developed the Standards Partnership Scheme, which supports suppliers, and now also providers, in implementing standards and advancing interoperability across health and social care. Yorkshire and Humber Care Record, which designed and built the Interweave technology providing health and care providers and citizens with access to care records, is one of the organisations that is benefitting from our partnership.  

Lee perceives the scheme as helpful in learning best practice from like-minded professionals and forming prosperous relationships: “Working with the PRSB leads to thought-provoking discourse which provides a range of different expert perspectives. The PRSB is adept at building effective and constructive relationships through the Standards Partnership Scheme.”   

Whether you’re a supplier or health and care provider, we can support you in your journey towards standards adoption and conformance. Find out more about PRSB’s Standards Partnership Scheme at https://theprsb.org/partnerscheme/. 

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 Responsible 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.