National Electronic Social Care Record Survey Report - 2006/07

National Electronic Social Care Record Survey Report - 2006/07

© Crown Copyright 2007

National ESCR Survey Report – 2006/07

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Contents 1 Executive Summary ............................................................................................4 2 Introduction..........................................................................................................8 3 Process, Response & Respondents....................................................................9 4 Structure & General Notes on the Analysis .........................................................9 5 ESCR Implementation .......................................................................................10

5.1 ESCR Implementation Overall ...................................................................10 5.2 Electronic Care Management Records.......................................................11

5.2.1 Extent of implementation 11 5.2.2 How records are held 11 5.2.3 Number of users and number of clients 12

5.3 Systems & Suppliers ..................................................................................14 5.3.1 ESCR Suppliers Overall 14 5.3.2 Suppliers By Service Area 15

5.4 Electronic Documents ................................................................................15 5.4.1 Document Management Suppliers 18

5.5 Issues.........................................................................................................19 5.6 Barriers.......................................................................................................20 5.7 Success Factors.........................................................................................21 5.8 Planned Developments ..............................................................................22

6 Integration .........................................................................................................23 6.1 Overall........................................................................................................23 6.2 Integration Within The Council ...................................................................23

6.2.1 Current & Planned Interfaces 24 6.2.2 Current Interfaces 25

6.3 Integration With Partner Agencies..............................................................25 6.4 Single Assessment Process.......................................................................27 6.5 Priorities for Integration ..............................................................................27 6.6 Integration Barriers And Issues ..................................................................28 6.7 Integration Successes ................................................................................29 6.8 N3 Connection ...........................................................................................30

6.8.1 Current Status 30 6.8.2 Successes & Difficulties 31 6.8.3 Plans 31

6.9 Use of NHS Number...................................................................................32 6.10 Mobile Working...........................................................................................33

7 Security And Information Governance...............................................................34 7.1 2-Factor Authentication ..............................................................................35 7.2 Role Based Access Controls......................................................................36

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7.3 Legitimate Relationships ............................................................................36 7.4 Access Procedures ....................................................................................37 7.5 Consent......................................................................................................37 7.6 Records Management ................................................................................38

8 Culture...............................................................................................................39 8.1 Issues.........................................................................................................39 8.2 System Use By Practitioners......................................................................40

9 Have Your Say ..................................................................................................41 9.1 How Relevant Is The Current ESCR Model? .............................................41 9.2 Issues For The ESCR Implementation Board ............................................42 9.3 Other Issues And Observations .................................................................45

A Appendix – Survey Questionnaire .....................................................................47



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1 Executive Summary This document presents the findings of a national survey of the status of Electronic Social Care Records (ESCR) in England. The survey was commissioned by the NHS Connecting for Health Electronic Social Care Record Implementation Board and the ADASS, with the support of David Behan, Director General for Social Care. The purpose of the Survey is to review overall progress, to identify areas where guidance might need to be refreshed and to help to guide future developments in this area. The survey was conducted using an on-line questionnaire. There was a tremendous response from Councils with Social Services Responsibilities (CSSRs). Responses received were open, frank and detailed. A total of 134 of the 150 authorities in England (89%) responded. We are very grateful to all those who made time to respond to the questionnaire and shared their experiences of ESCR implementation. This section summarises the key findings. Note that some responses were textual rather than quantifiable and for these it has only been possible to identify broad themes. Key Overall Themes Whilst the survey indicates progress is being made in implementing ESCR, key themes and issues include:

• Some way still to go to complete ESCR implementation, with issues raised including staff resistance, lack of a business case and competing priorities.

• Integration with the NHS and other agencies, including cultural and professional barriers, lack of IT solutions, data quality and IT standards.

• Skills and resource issues, including general IT literacy and resources available to implement IT systems.

ESCR Implementation ESCR encompasses both care management and document management systems, with the former used for structured and the latter for unstructured information. Analysing across the various questions relating to extent of ESCR implementation, the overall picture is that whilst almost all authorities have at least partially implemented electronic case management records (94% of respondents), fewer have widespread use of them (16% of respondents have fewer than 10 users). One of the main issues identified was social care staff resistance to moving from paper to electronic records. The extent of electronic document management system implementation is also lower, with only 13% of respondents having implemented scanning of external documents. A more detailed analysis is given below.

• Not all authorities have yet implemented electronic care management records. Of those responding, 78% fully hold care management records electronically, with the remainder having partially implemented, except for 2% which have not yet implemented. 4% (6 authorities did not respond to this question).

• Use of a single database spanning all ages still predominates (66% of those responding). However, 32% do not have a single database, with 14% having



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separate adult and children’s databases and the remainder (18%) having a variety of separate databases.

• There are indications that there is still relatively low usage of ESCR. 22 authorities have under 10 users and under 1,000 clients with records. Whilst 56% of CSSRs responding have over 70% of their practitioners directly inputting into the ESCR, 31% of CSSRs have under 50% of practitioners doing so.

• The ESCR market place is dominated by around 6 main suppliers, with two of these suppliers supplying over 70% of the CSSRs responding to the survey. 7 authorities have home grown or bespoke systems.

• Few Councils have fully implemented electronic document management systems, with 29% having implemented for internal documents and 13% for external documents. Very few (4%) authorities are holding audio and video recordings electronically, but 45% plan to do so.

• At least 60 authorities identified the main issues and barriers in relation to ESCR implementation as being: resources (availability of both people and funding), scanning documents, other corporate developments taking priority, suppliers, lack of a coherent national strategy and compliance regime, information sharing with other systems and data quality. The issues raised by authorities largely reflected the barriers, but in addition implementation issues and software usability problems were identified relating to ESCR and to electronic document management specifically.

• Authorities identified management support and user involvement as the key factors that had helped them to make progress, together with the ability to take risks, resource availability and having adequate infrastructure in place.

• The main planned developments in order of number of responses are electronic document management systems, children’s systems (e.g. Integrated Children’s System, e-CAF and Information Sharing Index), completing ESCR implementation and integration with NHS systems (e.g. SAP).

Integration The survey covered integration/interfacing of the ESCR with other systems both within the Council and with partner agencies.

• The level of integration or interfacing between ESCR and other systems is low.

• Within the Local Authority, the main interfaces are to business systems, largely finance, (18 responses), document management (5 responses, but some CSSRs have care management and document management systems from the same supplier and so would not need an interface), children’s systems (10 responses) and CRM (2 responses). Despite the relatively small number of interfaces in place, the number of different suppliers/systems involved is large.

• There are only a few interfaces in place to other agency systems (17 identified in responses) and these are mainly the NHS (mental health, community and child health systems), Connexions and Youth Offending Teams (YOTs). The majority of CSSRs (52%) are using computer systems to support the Single



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Assessment Process (SAP), with 43% using paper records. Of those using systems, only 26% have a shared SAP system with the NHS, the others are using a social care system or NHS system.

• CSSRs accord similar levels of priority to the various information sharing requirements (e-CAF, the Information Sharing Index, SAP, and mental health). Integrated teams, Care Trusts and Children’s Trusts were identified as particular drivers.

• The main barriers to integration are identified as being cultural/professional, availability of IT solutions, data quality, lack of standards and organisational/ structural.

• 40% of the authorities responding, have N3 (New NHS Network) connections, with a further 22% planning to implement links. Many authorities reported difficulties in obtaining N3 connections, with the main reason being a lengthy and cumbersome process on which it was difficult to get information or support.

• 44 of the authorities responding record the NHS number and 61 have plans to do so. However, in 29 authorities the number is collected manually (i.e. obtained from the service user or healthcare professional), so recording is unlikely to be comprehensive. 14 authorities use the NHS Strategic Tracing Service (NSTS) with further 19 authorities planning to do so.1

• Although a high proportion of CSSRs have systems that support mobile devices (62%), 34% have actually implemented such devices and the proportion of staff using them is relatively low (57% have only 1 – 2% of staff using them and only 7 CSSRs have over 80%). The main devices currently in use are laptops and tablets, with a few authorities using digital pens.

Information Governance It was difficult to interpret the responses on information governance as there were contradictory answers given about the same systems and as some responses indicated mis-interpretation of the question.

• In summary 35% of authorities have at least one system that requires 2 factor authentication, 86% of authorities have systems have role based access controls, 44% support legitimate relationships and 42% support consent management. However, these responses do not mean that the systems comply with the NHS Care Records Service access controls.

• The main issues raised in this area were about information sharing protocols, legal admissibility of computer records and electronic signatures.

• The authorities responding to the questions about records management, indicated that they largely have records management policies in place covering both paper and electronic records and including retention (87) and destruction (79), subject access (94) and third party access (81) and archiving

1 [With NSTS due to cease next year, future plans will need to aim at using the successor Clinical Spine Application/Personal Demographic Service to access the NHS number.]



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(69). Fewer authorities have policies regarding multi-agency records (31) and destruction of paper records following scanning (39).

With hindsight the questions were perhaps too focussed on access control. IG covers a broader range of issues reflected in the Information Governance toolkit, including, for example, data quality, which was raised as an issue by some Councils. Culture Building effective electronic care records systems requires significant cultural change and re-engineering of processes and procedures. A high proportion of respondents (82%) agreed that there were cultural and organisational issues that need addressing. The main issues identified include social care staff resistance to moving from paper to electronic records, developing good recording practice, developing integrated working and associated information sharing with other agencies, IT literacy, developing efficient business processes supported by IT, change management and benefits. Relevance of the ESCR Model Many respondents consider that the ESCR model and strategy need to be refreshed to reflect changing policy and technology. Specific areas recommended for review include:

• Integrated working and associated information sharing needs with other partner agencies.

• Electronic Document Management (e.g. scanning, metadata) and mobile devices.

• Service user access.

• Fit with corporate developments, e.g. citizen focus, corporate EDRMS. Issues for ESCR Implementation Board Respondents recommended that the ESCR Implementation Board address the following main issues:

• Refreshing the ESCR strategy in light of changing requirements, such as integrated working. Providing a national source of guidance and a compliance regime to help ensure effective and comprehensive implementation.

• Communicating and sharing good practice and lessons learned.

• Working with central government to define a coherent strategy for integration across the DfES and NHS and other information sharing initiatives.

• Addressing barriers to integration with the NHS Care Records Service.

• Helping CSSRs to address funding and resourcing issues.



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2 Introduction The NHS Connecting for Health Electronic Social Care Record Implementation Board and the ADASS, with the support of David Behan, Director General for Social Care, commissioned a Survey of Electronic Social Care Records (ESCR) in England. The original guidance on implementing electronic social care records, contained in ‘Information for Social Care’, was issued by the Department of Health in 2001 and a definition of ESCR published in 20032. A definition of ESCR follows.

SEwdT

2

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©

‘The ESCR brings together all relevant information for a social care user in one place. It holds three types of information: 1. Documents/forms, including:

• national forms, such as those used for recording children’s information; • local forms; and • forms completed by service users, such as self-referral or financial

assessment forms. 2. Unstructured information which covers:

• letters; • emails; • records of phone calls; • meetings notes; and • video clips.’

3. Coded data which is mainly for management and statistical reports.

ince 2003, Councils with Social Services Responsibilities have been implementing SCRs. The Survey has been carried out to review overall progress, to identify areas here the guidance might need to be refreshed and to help to guide future evelopments in this area. he Survey, aims to establish:

• an aggregated summary of progress towards ESCR implementation nationally;

• what are the problems with implementation; • what constraints have been encountered; • to what extent is ESCR implementation facilitating information sharing

between children and adult and health and social care electronic records; • what examples of innovative good practice exist that could be held up for

others, and

Available on the DH website – ttp://www.dh.gov.uk/PolicyAndGuidance/InformationPolicy/InformationForSocialCare/fs/en

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• what needs to be done to complete the programme? This report sets out the findings of the Survey. It is also planned to hold some regional meetings, both to provide feedback and also to enable more detailed discussions about implementation issues.

3 Process, Response & Respondents The ADASS Information Management Group (IMG) compiled a questionnaire to which CSSRs were invited to respond, either on-line or via an email return. The questionnaire is provided in Appendix A. The questionnaire was accompanied by a covering letter from David Behan to Directors and was also disseminated via national and regional ADASS forums. It was emphasised that the information provided would be anonymised and would not be used to monitor progress of individual authorities. 132 authorities responded to the Survey, which make up 89% of the authorities in England. The Survey therefore provides a very comprehensive view. A survey can only give a superficial analysis of issues. Many of the responses to the survey raise further questions and a desire to investigate further. The ESCR Implementation Board are arranging a set of workshops which will be used to investigate key issues further with CSSRs. We are very grateful to all those who made time to respond to the questionnaire and shared their experiences of ESCR implementation with the project.

4 Structure & General Notes on the Analysis There are four analysis sections in the report, mirroring the main sections of the questionnaire which are:

• ESCR implementation

• Integration

• Security and information governance

• Culture

• ‘Have your say’ Each section includes the question itself, an analysis of the responses, including either a graph or table, and any further commentary, which is given in italics. The analysis is not identifiable to individual authorities. Some of the responses were textual and here, although analysis has been attempted, it can only provide a broad indication rather than being accurately quantified. In most analyses the denominator is the number of survey respondents (i.e. 134). Where this is not the case and another denominator is used, this is identified clearly in the text.



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5 ESCR Implementation

5.1 ESCR Implementation Overall

Q6. If you have implemented a full ESCR, how comprehensive is it?

If you have implemented an ESCR, how comprehensive is it? Response No of CSSRs All cases current and closed 7 All new cases recorded 11 New and current cases backloaded 14 New and current cases from date of implementation 26 No Response 76 Total 134

Only a small proportion of authorities (58 – less than half of the authorities that took part in the survey) answered the question about how comprehensive their ESCR was. Of those which answered, only 7, (12%), have fully implemented for all cases current and closed, 24% have records for new and current cases and have backloaded current cases, 45% have recorded new and current cases from the date of implementation and 19% have recorded new cases only.

Status of Organisations ESCR (for the 58 Organisations that answered Q6)

45%

19%

12%

24%

All cases current and closed

All new cases recorded

New and current casesbackloadedNew and current cases from dateof implementation

The above, indicates that scanning of previous case notes has only been carried out by a small proportion of authorities. Notes: The low response may be because of uncertainty about the definition of an ESCR and hence how to measure comprehensiveness.



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The responses to this question do not tally with the responses to the questions about electronic document management, and so should be treated with caution. It is not clear from the question whether respondents meant structured or unstructured information or both in their responses.

5.2 Electronic Care Management Records

5.2.1 Extent of implementation Q1. Do you hold electronic records for your service

users associated with the care management process?

78% of authorities hold care management records electronically, with a further 16% of authorities having partially implemented. Only 2% have not implemented electronic care management records, but 4% of authorities did not respond. The data is presented on the table and diagram below.

Do you hold Electronic Records?

Response No of CSSRs Yes 104Partially 21No 3No Response 6

Total Number of authorities responding : 128 out of 134

Implementation of Electronic Care Management Systems

78%

16%

4% 2%

Full implementationPartial implementationNot implementedNo response

5.2.2 How records are held Q2 How are these records held? Specify ‘other’



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How are these records held No of CSSRs Single Comprehensive client Database 89Other (specify below) 24Adults and Children data held separately 19No Response 2

Total number of authorities responding : 132 out of 134 66% CSSRs hold their case management records in a single database covering all ages. 14% have separate databases for children and adults and 18% responded with ‘other’ and a textual explanation. In reviewing the text in the ‘other’ responses, the main categories that can be identified are:

Separate case management and electronic document management systems

7

Adult and children’s records held separately or becoming separate 5

A mixture of systems, e.g. separate SAP and care management systems, separate adoption and child protection systems

8

Separate systems but migrating to a single system 2

Shared drive rather than case management system 1

Hence, in total, around 32% of authorities responding have separate systems making up their ESCR. 5.2.3 Number of users and number of clients Q2 How are these records held?

Number of clients with an electronic social care record?

Number of users of the ESCR?

Responses were textual and some were expressed as percentages, so not all of them have been able to be analysed. As the absolute number is likely to vary with the size of the Local Authority, authorities were divided into bandings based on population size: small (up to 250,000), medium (250,001 to 500,000) and large (over 500000). The analysis is presented on the bar charts overleaf.



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Large Medium Small0

2

4

6

8

10

12

14

16

18

Num

ber o

f Org

anis

atio

ns

Population Size

Number of Users of the ESCR within an Organisation

> 3000

2,001 - 3000

1,001 - 2,000

501 - 1,000

201 - 500

101 - 200

1 - 100

No Response

The highest number of ESCR users in an organisation was 5168 (this was for an Organisation in the Large Band) and it was 2000 (for Medium and Small).

Large Medium Small0

2

4

6

8

10

12

14

16

Num

ber o

f Org

anis

atio

ns

Population Size

Number of Clients with an Electronic Social Care Record

> 200,000

100,001 - 200,000

50,001 - 100,000

20,0001 - 50000

10,001 - 20,000

5,001 - 10,000

1,001 - 5,000

0 - 1,000

No Response

The highest number of clients with an ESCR was 876,308 (this was for an Organisation in the Large Band) and it was 208,716 for Medium and 140,000 for Small.



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Without knowing the number of potential users and clients it is difficult to draw firm conclusions from the above. However, it indicates that there is still relatively low usage of ESCR (i.e. number of users is under 100 in 22 CSSRs). Section 8, Culture, provides more analysis of use by practitioners. National statistics indicate that there are around 1.7 million adults receiving social care in England. In a future survey a question could be posed about the number of adults with a current electronic care record (i.e. excluding old cases), to identify the proportion of adults with electronic care records.

5.3 ESCR Systems & Suppliers

Q3. List all the systems that form part of the electronic social care record and names of suppliers:

Indicate service user area if separate

5.3.1 ESCR Suppliers Overall An analysis of ESCR systems suppliers is listed on the table below, together with the number of authorities using their systems.

Breakdown of the Number of CSSRs that use the following Suppliers’ Systems

Supplier No Of CSSRs % of Respondents (134) OLM 49 37%

Anite 47 35%

Careworks 18 13%

Corelogic 17 13%

Liquid Logic 12 9%

Social Software 12 9%

Capita/EMS 5 4%

In4Tek 5 4% In-house/bespoke 7 5%

Other suppliers were named by fewer than 5 authorities, but some of these were providers of more specialist systems, e.g. home care or adoption. It was difficult to identify in-house/bespoke systems accurately, but from the responses, we estimate that there are 7 CSSRs with in-house/bespoke care management systems. Other authorities have some in-house or bespoke systems for specific modules. Given the response to the questionnaire was not a hundred per cent, this does not represent the total number of users that a supplier has, but provides a broad indication of market share.



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Some authorities also listed their business, CRM or integration software, but as this was not the question asked and responses only came from a small number of authorities, they have not been analysed. It may be that authorities interpreted the question differently and that some only included the main care management system, whilst others included all systems used with clients. Hence the number of Capita EMS and Social Software YOIS systems may be under-represented from the survey. 5.3.2 Suppliers By Service Area The main suppliers, by service area are listed on the table below. The numbers include all types of system (care management, document management and specialist modules):

Supplier All Adults Children MH OP YO Other Anite 37 11 19 1 4

OLM 33 6 8 2 6

In-house/bespoke 23 15 9 4 1 5

CoreLogic 11 4 4 1

Careworks 5 1 4 8

Liquid Logic 2 4 6 3

In4Tek 4 2

Social Software 6

Capita 5

Note that, given the response to the questionnaire was not a hundred per cent of all CSSRs in England, this does not represent the total number of users that a supplier has, but provides a broad indication of market share. The table above helps to differentiate between general care management systems and those focused on supporting specific services, e.g. Capita’s education system, Social Software’s youth offending system and Liquid Logic’s ICS and SAP systems.

5.4 Electronic Document Management Systems

Q4a Are all the documents which you create electronically retrievable?

Only 29% CSSRs have fully implemented EDMS for documents created internally, 42% have partially implemented and 10% are piloting or 17% planning implementation.



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Are all docs created elec retrievable No of CSSRs %

Fully Implemented 39 29%No System in Place or Planned 2 1%Partial Implementation 56 42%Pilot Stage 14 10 %Planned 23 17%


0%

20%

40%

60%

80%

100%

% of Organisations

% of Organisations with Electronically Created Documents

Planned

Pilot Stage

Partial Implementation

No System in Place orPlanned

Fully Implemented

Q4b Are all the documents which you receive electronically retrievable?

CSSRs were also asked about the proportion of documents received from outside the authority which were scanned in and held electronically. Fewer authorities reported that they have fully implemented document scanning and storage (13%). 35% have partially implemented and 16% are piloting or 32% planning implementation.

Are all docs received elec retrievable? No of CSSRs % Fully Implemented 17 13%No System in Place or Planned 6 4%Partial Implementation 47 35%Pilot Stage 21 16%Planned 43 32%




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0%

20%

40%

60%

80%

100%

No of Org's

% of Organisations who receive documents that are Electronically Retrievable

Planned

Pilot Stage



Fully Implemented

Q5 Do your records include audio and visual recordings?

Although it formed part of the original ESCR specification published by DH in 20033, very few authorities include audio or visual recordings in their records (4%). 16% have partially implemented and 6% are piloting or 45% planning implementation.

Do records include audio and visual recordings? No of CSSRs %

Fully Implemented 6 4%No System in Place or Planned 38 28%Partial Implementation 22 16%Pilot Stage 8 6%Planned 60 45%


0%

20%

40%

60%

80%

100%

% of organisations

% of Organisations who receive documents that Electronically Retrievable

Planned

Pilot Stage



Fully Implemented

3 Defining the Electronic Social Care Record, DH, December 2003.



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Q7. Does the management of your documents include metadata facilities?

Authorities were asked whether they held metadata on their documents, which could be used in electronic document management. 63% reported that they did and 22% did not have these facilities.

0

20

40

60

80

100

Yes No Response No

Number of Organisations whose document management includes Metadata facilities

Note that some authorities raised metadata as an issue, both in terms of system functionality to support use of metadata (e.g. for searching for documents) and the need for standards in this area. 5.4.1 Document Management Suppliers Some authorities use document management systems from suppliers other than their care management system supplier. The main document management systems/suppliers noted in responses were:

Supplier Number of CSSRs OLM/Square 3 (CareStore) 14

Anite (@Work/ICLipse) 13

Opentext 7

Diagonal (Wisdom) 6

Trojan 5

Idox 3

Other document management suppliers were mentioned, but each by only 1 or 2 authorities.



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5.5 Issues

Q2 How are these records held?

Current issues (if any):

Councils provided textual responses about current issues. These have been analysed as far as possible into categories or types of issue, with the main ones being included in the table below. Note that it was difficult given the brevity of some responses to understand what the specific issues were and where this was the case, the issue was not included in the analysis.

Issue/Number of CSSRs reporting Examples Given ESCR – total of 34 Implementation issues – 13 Usability/functionality – 13 Children’s issues specifically – 6 Reporting issues specifically – 2

paper files still used as the main record or only partial recording, with some parts of the record remaining on paper. some use of separate systems e.g. adult protection, SAP, etc. ICS and e-CAF cumbersome

Integration/interfacing – total 28 Integration/interfacing: General – 5 With other Council systems – 8 Between care management & DMS – 7 With other agencies – 8

separate children’s records, CMS and purchasing and finance. poor integration between DMS and care management. mental health staff using separate NHS applications. Avoiding multiple separate applications and retaining a single ESCR database.

Document Management – total of 24 Implementation issues - 15 scale and cost of scanning task Usability/functionality - 9 searching capability, metadata,

integration with social care system

Supplier delivery – 7 delays in software delivery, performance and stability. reporting and data warehouse.

Information governance – 6 legal admissibility of records, electronic signatures, archiving historical case files

Access/lack of infrastructure – 5 remote access, lack of PCs, access by service providers.



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Issue/Number of CSSRs reporting Examples Given Lack of resources – 5

Organisational – 4 service re-organisation, lack of management support.

Data quality – 3

5.6 Barriers

Q11 What barriers have you encountered in making progress towards full ESCR compliance?

Authorities were asked to identify potential barriers to making progress from a checklist and also had the opportunity to add others which they had identified as barriers in their own organisation. The bar-chart below identifies the responses to the checklist. Resources will identified by the largest proportion of authorities, followed by scanning/back scanning, culture, other corporate developments, suppliers and lack of national strategy and compliance regime.

Data Q

uality

Inadequate infrastructure

Lack of Managem

entSupport

Lack of national strategyand com

pliance framew

ork

Lack understanding ofESCR requirem

ents

Legal admissibility

Links with other system

s

Other corporate

developments

Resources (Funding)

Resources (People)

Scanning/back scanning

Software e.g. ease of use

Suppliers

User Involvem

ent

Culture

0102030

4050

60

7080

90

Bariers in making progress towards a full ESCR

Yes

No

No Response

An analysis of the other main types of barriers identified by authorities was carried out. Most of the barriers identified as additional were actually included in the checklist, but authorities provided further local detail, for example about the impact on them. The main barriers highlighted in this section were the lack of national guidance, software, e.g. usability, competing priorities, resources/funding and cultural change. New barriers identified were data quality (3 responses) and complexity and other problems in implementing EDRMS (8 responses). Some issues were expanded on



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(e.g. in relation to links with other systems: specific issues in engaging the NHS, information governance in relation to NPfIT, delays in NPfIT implementation, difficulties using the ICS and competing priorities and differing standards between DH and DfES integration projects were mentioned.)

5.7 Success Factors

Q12. What has helped you progress?

Authorities were asked to comment on success factors, either by selecting from a checklist or adding their own. The barchart below identifies the responses to the checklist. By far the main factors were management and user involvement and support.

Ability to take risks

Adequate infrastructure

Availability of resources

Confidence in software

Managem

ent Support

National strategy and

leadership

Users Involvem

ent

Suppliers

Data Q

uality

0

20

40

60

80

100

120

Success Factors that have helped towards implementing a full ESCR

Yes

No

No Response

An analysis of other things that Councils identified as helping their progress is given on the table below. Note that these were textual responses, which have been collated into specific categories, and so give a broad indication only. Some responses were included in the checklist, but the Councils provided further local details. For example,

Success Factor Number of CSSRs Commitment and motivation of key individuals/ groups and their involvement in the project

13

Individual or team skills and having dedicated, skilled resources available

7

Having a business or user focus, e.g. understanding the impact on business processes, engaging users in this work

7

Partnership with other Local Authorities, e.g. ADASS IMG, others using the same system

5



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Success Factor Number of CSSRs Good project management disciplines and structures

5

5.8 Planned Developments


Planned developments:

Councils provided textual responses and these have been collated as far as possible into broad types of development, with the main ones being included in the table below.

Planned Developments Number CSSRs responding

Electronic document management systems, including implementing, upgrading, interfacing to care management, scanning

41

Childrens Systems, including implementing ICS and separate children’s systems

27

Electronic social care records, including completing implementation, adding new modules, replacing systems

20

e-SAP, including implementing e-SAP, CAF for adults, integration 15

Integration with NHS systems, including specific systems, e.g. Rio, Protocol, PCT using social care system and implementing a common repository

12

e-CAF for Children – implementing and linking to ESCR 10

Information Sharing Index/ Children’s Index 9

Finance, including integration, implementing new system, upgrading

8

Implementing mobile devices 6

The analysis needs to be treated with caution as it can at best only provide a partial picture, indicative of the main areas of development. Note that:

a) It was difficult given the brevity of some responses to understand what the specific plans were and where this was the case, the issue was not included in the analysis.



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b) The numbers of responses do not tally with numbers of authorities responding in the other sections of the questionnaire on plans to do things, e.g. plans to implement mobile devices, NHS number, etc.

6 Integration

6.1 Overall

Q8. Are your ESCR systems currently integrated/interfaced with any other systems?

Do you have plans for future integration projects?

The survey asked questions about the extent to which CSSRs have implemented or plan to implement interfaces with other systems, both within the Council and with other agencies. Of the 134 respondents, 82 have implemented interfaces to other systems and 42 have not done so – 10 did not respond. 83% have firm plans for future integration projects.

Number of Organisations with systems that are currently interfaced with any other systems

0

10

20

30

40

50

60

70

80

90

Yes

No

No Response

6.2 Integration Within The Council

Please list current and planned projects:

Social Care System Name

Systems within your authority

Systems in partner agencies

Any other systems (Please Specify)

Current/Planned



27/04/2007/ Final

6.2.1 Current & Planned Interfaces A relatively low proportion of CSSRs have or plan interfaces to other Council systems. The main interfaces are to business systems, including financials and HR, (40 responses), children’ systems (37) EDRMS and EDMS (32), education systems (28) and CRM (20). Please see table below for details.

Systems to which ESCR is/planned to be interfaced Number of CSSRs Business (financials and HR) 40

Children (Total)

• Young Offenders/Connexions

• e-CAF

• Children’s Index/ISA/ISI

• Integrated Children’s System

• Adopters

• EMS

37 6 7 8 13 2 1

Electronic document/records management 32

Education 28

CRM 20

Housing 6

Care monitoring (home/residential care) 5

Equipment 1

Criminal Justice 1

LLPG 2

Others 26

The CSSR interfaces were to a large number of different systems. There were 55 different suppliers identified in the responses, although there may be more as some responses did not name the supplier/system. The main suppliers named include: EMS (21), Liquid Logic (10), Oracle (7), Lagan (4), TCO (4), SAP (enterprise management) (4), YOIS (4). The remaining suppliers had three or fewer interfaces, with many having only one. In addition others mentioned interfaces between Anite and OLM care management and EDMS solutions. Please note that It was difficult to interpret the responses and hence the analysis provided above provides only a broad assessment of the main areas of integration, both current and planned, with those systems which could not be identified included in an ‘other’ category. In retrospect, it would have been useful to include categories, e.g. financials, CRM, SAP, housing, etc, as the textual responses were difficult to analyse, for example, where an in-house system was named, but without specifying the type of system. There may be some duplication, e.g. ESCR interface to SAP and



27/04/2007/ Final

SAP interface to ESCR both included. Also, the questions did not define ‘planned’ so planned may be ‘aspirational’ rather than having firm plans in place. 6.2.2 Current Interfaces The number of systems to which ESCR is currently interfaced is set out in the table below:

Systems to which ESCR is currently interfaced Number of CSSRs Business (financials and HR), including, named systems: Cedar, OLAS, Oracle e-business, TCO and SAP

18

Children, including named systems: EMS, Charms, Safetynet, YOIS/UMIS and ICS

10

Electronic document/records management (where EDMS procured from supplier other than care management supplier)

5

CRM, including, named systems: Lagan

2

Housing and supporting people, including named systems: Orchard

2

Care monitoring (home/residential care), including named systems: CM2000

1

Criminal Justice 1

SAP, including named systems: Protocol

2

Others, including named systems: Multivue

2

The number of interfaces is currently low, even between care management and financial software. Many more authorities plan interfaces (see 5.2.1, above, than have them in place). Some authorities did not name the supplier/system but just the type, e.g. financials. Any of the named suppliers were mentioned by only 1 to 3 authorities. Any interfaces where the system being interfaced was not identified have not been included in the above analysis. No information was obtained on the type of interface (e.g. batch or real-time).

6.3 Integration With Partner Agencies




27/04/2007/ Final





Current/Planned

There were relatively few external interfaces identified as being in existence or planned. The main ones identified were with the NHS (42), of which there were 14 with mental health systems and 7 with PCT community and/or child health systems. Other agencies to which authorities had/planned system interfaces included: Connexions (3), YOIS (2), integrated community equipment store (2), voluntary agencies (1). Some others also mentioned education, but this duplicated ‘internal’ interfaces responses. Differentiating current interfaces from planned ones, the numbers fall to 17, including 2 where the health staff are using a CSSR system, rather than there actually being an interface. The only named systems to which there are interfaces in place are Liquid Logic SAP Protocol and the Carebase and Ascribe EPEX mental health systems. A number of suppliers, where interfaces are planned were named. The suppliers/systems named included:

Mental Health • Ascribe – Epex

• Maracis

• Care Notes

• iSoft PIMS

• Carebase

• Jade

Community/Primary Health • CSE Servelec – Rio

• EMIS

Other NHS • LSP solutions, e.g. iSoft Lorenzo

General/ not specified • Protocol

• Ciber

• Ryogens

• Insight

• Multivue



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6.4 Single Assessment Process

Q8a. What system do you use for the Single Assessment Process (SAP)?

The survey sought information on what information systems were being used for the Single Assessment Process (SAP requires integrated working between health and social care professionals). The majority (56%) of respondents are using computer systems, but of these only 26% have a shared SAP system, the remaining 36% use the social services system or (10%) use an NHS system. 28% responded ‘other’. The remaining authorities, 44%, use paper records. 5% did not respond.

SAP Systems in use

13%

19%

5%44%

14%5%

Shared SAPsystemESCR

NHS System

Paper records

Other

No Response

The survey did not ask whether where authorities were using the social services system this system was also being used by health colleagues, although in some other responses a few authorities mentioned health staff either considering or using the social care system for SAP.

6.5 Priorities for Integration

Q19. What are your priorities for implementing information sharing with other agencies? (Please rank them)

Order of priority Status

e-CAF for Children

Children’s index

e-SAP or e-CAF for Adults



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NHS Mental Health Services

Other (Please specify)

Authorities prioritised areas for integration work. From their responses, weighted totals were calculated, which identify very little difference in the priority ratings overall.

Priorities for implementing information sharing

Weighted Value

e-CAF for Children 289NHS Mental Health Services 265e-SAP or e-CAF for Adults 263Information Sharing Index 258Other 86

From an analysis of the priorities assigned to each of the integration projects, the Information Sharing Index (Children’s Index) comes out as the top priority for more CSSRs than the others, followed by e-SAP/CAF for adults and mental health services.

Prioritisation of Information Sharing

0

5

10

15

20

25

30

35

40

45

e-CAF for Children Childrens index e-SAP or e-CAFfor Adults

NHS MentalHealth Services

Other (Pleasespecify)

Priority 1

Priority 2

Priority 3

Priority 4

Priority 5

6.6 Integration Barriers And Issues

Q20. What are the main barriers to progressing information sharing with other agencies?



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Authorities were asked to indicate the main issues or barriers to information sharing with other agencies. They did so against a checklist of potential barriers and also had the opportunity to add their own. The main barriers in order of number of authorities were cultural and professional issues, followed by information governance and availability of IT solutions, then data quality, lack of information exchange standards and organisational/structural. All of these were identified as barriers by more than 60 authorities.

Barriers - Information Sharing

0

10

20

30

40

50

60

70

80

90

100

Data Q

uality

Cultural/professionalbarriers

Lack of managem

entsupport

Organisational/structural

Availability of IT

solutions

Lack of information

exchange standards

Information governance

issues

Yes

No

No Response

6.7 Integration Successes

Q20a. If you have progressed information sharing successfully please highlight any lessons that may help other Authorities

Authorities were asked to share any lessons that might help other authorities progress information sharing successfully. From an analysis of the textual responses the most frequent lessons are listed on the table below.

Factor Quotes/Comments Information Sharing Protocols The North East London ISP was

mentioned by several.

Management Support The need for top level support from all partner agencies.

Sharing systems and infrastructure with the NHS

Examples given were generally of the NHS using social care management systems. ‘It is easier to give others access to your own system than to exchange information’



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Factor Quotes/Comments Joint teams Joint teams and co-located staff

Practitioner involvement Involvement of practitioners in the project team was very helpful.

Building relationships, engaging stakeholders and communications

Communication with and appropriate representation from all stakeholders.

Strong project management Dedicate project management personnel. Having realistic timescales, clear goals and agreed systems for resolving issues. Involve information governance early.

Infrastructure issues Plan for long lead-times for infrastructure

Some authorities also mentioned specific integration work that they had undertaken or were undertaking.

6.8 N3 Connection

6.8.1 Current Status Q9. Do you have an N3 connection?

Is it uni-directional or bi-directional

Of the 134 respondents, 53 have connections to the N3 NHS network and 29 have firm plans to implement these links, the remaining 50 did not have a connection and 2 responses were blank.

% of Organisations with an N3 Connection

40%

37%

22%

1%

Yes

No

Firm Plan

No Response



27/04/2007/ Final

Of these, 56 either had or planned bi-directional connections, 10 had uni-directional connections and 68 gave no response/not applicable. 6.8.2 Successes & Difficulties Q9. Please let us know of difficulties or

successes in obtaining your connection

Respondents were asked to comment on difficulties or successes in connecting to NHS networks. 7 respondents noted that NHS partners had helped in progressing N3 connections. Others reported difficulties in N3 connection, as identified on the table below:

Issue Number Comments (Examples) Funding/ resources 13 ‘Difficulty making the case for connecting to

the NHS’ ‘Cost of connection/rental is borne by Councils’

Lengthy and complex process

15 ‘Lengthy bureaucratic delays….’ ‘There were huge delays (18 months) between placing the order and installation’ ‘It took 11 months’

Technical & security problems

9 ‘Numerous technical difficulties’

Link not being used 6 … have struggled getting local health partners to make use of the connectivity it offers us.’

6.8.3 Plans Q9 If you do not have an N3 connection what

are your plans for NHS connectivity?

Respondents without N3 connections were asked about their plans for connecting to NHS networks. Many reported that N3 connection was under consideration or being planned, a few reported that they had no plans. The table below groups the main types of responses.

Plans for connecting to N3 NumberPlanning/Considering/Beginning to implement 20

Have a connection, but not to N3 (e.g. N2, shared private network, VPN connection, connection to local NHS COIN)

17

No plans 7

Plan to use London Public Secure Network (LPSN), with gateway to N3 6

Considering Government Connects 5



27/04/2007/ Final

Note that if the 17 respondents with a connection to NHS networks are added to those with N3 connections, then a total of 70 authorities have connections of some form to NHS networks.

6.9 Use of NHS Number

Q9 Do you hold the NHS number as part of the client record on the ESCR?

The survey indicates recording of the NHS number on social care systems is relatively low, but many CSSRs have plans to begin recording. 44 CSSRs hold the NHS number on the ESCR, with a further 61 planning to do so.

Do you hold the NHS No on the ESCR? No of CSSRs %

Yes 44 33%Planned 61 46%No 23 17%No Response 6 4%

Total number of responses : 128 out of 134

Proportion of Organsations Holding the NHS Number

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

No Response

No

Planned

Yes

Q9 How do you obtain the NHS number?

Of those authorities responding to this question, the table below identifies the main ways of obtaining the NHS number currently.



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How NHS # Obtained Number of CSSRs Comments Manual 29 Obtained from various sources:

service user, health professional, as part of the SAP process or on referral

National Strategic Tracing Service (NSTS)

14 To be replaced by 2008 with NHS CFH Personal Demographics Service.

Exeter 3 As above

Interface to MH Trust system (Carebase)

1

Not specified 2

Note that some authorities stated use of two approaches simultaneously, e.g. NSTS and asking service user. In these cases, the response has been included in both categories. Of those authorities responding to this question, the table below identifies the main ways that they are planning to obtain the NHS number. (Note that some responses stated this in the present, so it may be that they are already using these approaches).

Plans To Obtain NHS # Number of CSSRs Manual 15

National Strategic Tracing Service (NSTS)

19

Not yet decided/not specified

15

6.10 Mobile Working

Q10. Do any of your systems (specify) support mobile working?

The survey indicates that whilst a high proportion of authorities (62%) reported that their systems could support the use of mobile devices, the number of users is still relatively small. Only 34% authorities reported having implemented mobile devices of which 57% have only between 1% and 20% of their staff using them. Only 7 authorities (15%) have over 80% of their staff using mobile devices.



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Percentage of Organisations who have implemented a mobile device and the number of staff using the device

11%

57%

11%2%4%15%

0%/Ambiguous/No Response

1%-20%

21%-40%41%-60%

61%-80%

81%-100%

Most authorities (86%) have or are planning to implement a combination of mobile devices. Tablets or laptops are the most frequently used devices (34 authorities), although a few (3) use digital pens and (8) plan to implement.

Organisations use of Mobile Devices

0

5

10

15

20

25

30

35

40

Combination

Digital P

ens

Laptops

PDAs

Tablet

s

No

of O

rgan

isat

ions

Implemented

Planned

No Plans/Not Applicable

Not Stated

An analysis was carried out of mobile device use by client group (e.g. all clients, adults, children). The majority of authorities are using the devices across all clients and there is no client group specific pattern. An analysis was carried out of mobile device use by supplier and all the main suppliers identified in section 4.3.1 are used with mobile devices. Many of the respondents used the category ‘combination’ so it was not possible to analyse which type of devices were being used.

7 Security And Information Governance Questions were asked about information governance, with particular reference to the IG controls in use in the NHS Care Records Service.



27/04/2007/ Final

7.1 2-Factor Authentication

Q16. Does access to your systems require 2 factor authentication? (E.g. PIN and smartcard) – please list all systems

35% of CSSRs reported that at least one of their systems requires 2 factor-authentication (e.g. password or PIN, plus smart card or token) to access it, with a further 9% planning to implement this type of access.

Does access to your systems require 2 factor authentication? Number of CSSRs

Yes 47Planned 12No 48No Response 27

Total number of responses : 107 out of 134

% of Organsations with Systems requiring 2 factor authenitication

35%

9%36%

20%

Yes

Planned

No

No Response

The responses identified systems where 2 factor authentication was required, but an analysis of this was contradictory with some respondents saying that it was and others that it was not for the same system. Some responses indicated that they had interpreted 2 factor authentication incorrectly, e.g. user name and password. Others mentioned the use of an RSA token when staff were accessing the system from outside the Council networks, but not when staff were accessing from within the network. Given the above, we have not included an analysis of the systems requiring 2 factor authentication and suggest that it may be better to obtain this information from system suppliers.



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7.2 Role Based Access Controls

Q17. Do your systems support role based access? (I.e. access to functions based on roles) – please list all systems

As might be expected, most authorities’ systems, (86%) have role based access controls (i.e. where access to functions is based on roles).

Number of CSSRs with a system that supports Role Based Access Response No of CSSRs % of CSSRs


7.3 Legitimate Relationships

Q18. Do your systems support legitimate relationships? (I.e. access to individual client records based on a user having a direct care relationship with the client)- please list all systems

44% of authorities’ systems support the concept of legitimate relationships (i.e. access to individual client records based on a user having a direct care relationship with the client).

Number of CSSRs with a System that Supports Legitimate Relationships

Response No of CSSRs % of CSSRs


The responses identified systems which supported Legitimate Relationships. Again there were contradictions between responses in relation to the same system/supplier and so these responses have not been analysed in detail. However, responses indicated that all the main ESCR systems support legitimate relationships. Contradictory responses may result from different software versions or extent of use of functionality.



27/04/2007/ Final

7.4 Access Procedures

Q21 Do you have formal procedures to authorise access from external agencies?

54% of authorities have formal procedures for authorising access from external agencies and 46% do not have such procedures. This may indicate the number of authorities which allow other agencies to access their systems, although if paper and IT based systems are included then you would expect all authorities to have such procedures. The response may depend on the way that the question was interpreted.

7.5 Consent

Q22. Can your systems manage the consent process?

(Please list all systems)

Authorities were asked whether their systems could support recording of an individual’s consent to share information with other agencies and enable access to information to be controlled based on the consent given. 57 agencies reported that their systems were able to do this and 17 agencies that they planned to implement consent processes.

Status of Organisations ability to Manage the Consent Process

42%

13%13%

13%

19%

YES

Partial

Planned

No

No Response

Again there were contradictory responses to the question about whether systems managed the consent process in relation to the same systems. However, it appears from the responses that the main ESCR systems support the consent process. Contradictory responses may result from different software versions or extent of use of functionality.



27/04/2007/ Final

7.6 Records Management

Q.23. Does your records management policy include/cover:

Schedules for record retention?

Archiving

Destruction of records

Management of Shared (multi-agency) records

Subject Access

Third party access

Disposal/retention of paper copy after scanning?

Quite a number of authorities left this section of the survey blank. Of those responding, the majority of authorities have records management policies that cover all records, both paper and electronic. Of these policies, 94 authorities cover subject access, 87 cover record retention, 81 cover third party access, 79 cover destruction and 69 cover archiving. Fewer authorities (31) cover sharing of multi-agency records and 39 cover disposal/retention of paper records when they have been scanned electronically, which probably reflects the extent to which such arrangements are in place in a local authority.

Number of Organisations whose Record Mangament include:

0

10

20

30

40

50

60

70

80

90

100

Archiving Destruction ofrecords

Disposal/retentionof paper copy

after scanning?

Management ofshared (multi-

agency) records

Schedules forrecord retention?

Subject access Third partyaccess

All recordsPaper records onlyElectronic records onlyNot coveredNo Response



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8 Culture

8.1 Issues

Q14. Do you think there are areas of organisational/operational culture that need to be addressed?

If yes, which areas?

A high proportion of respondents agreed that there are areas of organisational or cultural development which need to be addressed.

% of Organisations believing that there are areas of organisational or cultural development which need to

be addressed

82%

14%4%

Yes

No

No Response

Of those responding ‘yes’, further textual comments were made about the type of issue. These have been collated and are set out in the table below, providing a broad indication of the main types of issue.

Cultural Issue Number Comments (Examples) Cultural change – paper to IT (general)

39 Overcoming reliance on paper. Resistance to change and to the use of IT. Building confidence in using IT systems.

Cultural change – paper to IT (professionals)

16 Overcoming concerns about de-skilling and making performance more visible. Not seen as part of the role. Practitioner vs administrative roles.



27/04/2007/ Final

Cultural Issue Number Comments (Examples) Information Governance 27 Information sharing, data quality (person-

centred, accurate and timely recording), confidentiality, security, etc. Staff understanding and ownership of responsibilities in relation to the above. Good recording practice.

Training 22 Increasing IT literacy amongst managers, practitioners and administrative staff. Skills in the use of information (managers). Use of applications.

Business processes 17 Developing efficient processes using IT. Changing working practices and job roles (e.g. administrative job change through scanning). Increasing mobility and flexibility.

Change management 12 Change management processes and capabilities need to be improved.

Benefits 10 Understanding the benefits of IT and its value. Business ownership. Benefits management.

Working with the NHS 9 Joint teams and integrated working. Different cultures. Information sharing protocols.

8.2 System Use By Practitioners

Q15. What percentage of data is input directly by practitioners?

56% of CSSRs have 70% or more practitioners inputting data directly, 19% of CSSRs have 50% to 70% of practitioners and 31% of CSSRs have under 50%, with 6% of CSSRs having less than 10%.



27/04/2007/ Final

0

5

10

15

20

25

30

Number of Organisations falling into each % range for data input directly by practitoners

90% and Over

81%-90%

71%-80%

61%-70%

51%-60%

41%-50%

31%-40%

21%-30%

11%-20%

0%-10%

No Response/Ambiguous

The survey did not ask questions about non-practitioner use. In any future survey it might be interesting to find out about the extent of non-practitioner use, including the extent to which clients have access to their records.

9 Have Your Say

9.1 How Relevant Is The Current ESCR Model?

Q13. Do you feel that the current model for ESCR is still relevant? (If no, what are the issues?)

The original specification for ESCR was published in 2003 and has not been updated since then. Some CSSRs identified the need for the ESCR profile to be raised and the aims and scope to be clarified. CSSRs identified the areas where the ESCR model would need to be revised to reflect changing policy (e.g. DH ‘Our Health, Our Care, Our Say’ and DfES ‘Every Child Matters’) and technology. These include:

Area For Review Number Comments (Examples) Information sharing/integrated working with other agencies

30 Adults services working more closely with the NHS and links with the NHS Care Records Service. Children’ s services



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Area For Review Number Comments (Examples) Electronic document management

7 The scope of and business case for scanning. Metadata standards. Differing views on scope – video and voice and documents vs. data and workflow.

Service user access 4 e.g. self assessment

Fit with corporate developments

4 e.g. citizen focus, CRM, EDRMS

Other areas of the ESCR guidance needing review which were identified by individual CSSRs include: data quality, business efficiencies, inclusion of e-GIF standards, mobile working, real-time monitoring and programme/project management.

9.2 Issues For The ESCR Implementation Board

Q24. What are the main issues you would like the ESCR Implementation Board to address?

The survey asked CSSRs about the main issues which they would like the ESCR Implementation Board to address. The main responses have been categorised and are given in the table below. Again, given the textual nature of the responses, this analysis can give only a broad indication of the main issues.

Issue Number Comments (Examples)



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Issue Number Comments (Examples) ESCR strategy, guidance and compliance

43 ‘Re-energising the move to ESCR, it no longer appears to be a national priority.’ ‘Provide clear definition for what constitutes ESCR’ ‘…And defining the pathway and milestones…’ ‘How the ESCR moves forward in the light of the ‘split’ between adults and children’s services.. ‘Review the ESCR with regard to ICS, SAP, e-CAF and in particular the NHS CRS…’ ‘Cross-boundary/authority working’ ‘The different drivers for social care being part of a Care Trust …. and children’s social care part of a Children’s Trust’ ‘Review back-scanning requirement’.. ‘…lack of performance assessment…’ ‘Current ESCR systems are difficult for service users to use, e.g. assessments..’

ESCR communications and sharing good practice

14 ‘To disseminate good practice actively’ ‘Can we develop processes for joint developments, ‘do once and share’ and work at regional/cluster level?’ ‘Feedback from beacon authorites..’ ‘Local centres of excellence where ESCR has progressed well.’ ‘More practical guidance on implementation.’ ‘Good case studies..’ ‘National point of contact for ESCR and a forum/knowledgebase for sharing ideas.’

Integration with NHS Connecting For Health

40 ‘Links to NHS CFH specific deliverables, timescales and targets’ ‘NHS CFH tools need to be able to share bi-directionally with local authorities.’ ‘Defining how integrated teams can be supported..’



27/04/2007/ Final

Issue Number Comments (Examples) Wider integration and standards (e-Gov)

31 ‘Need alignment of all e-information deadlines, e.g. ICS, ESCR, integrating with health….’ ‘Models/guidance for integrating/interfacing with other agencies ‘Ensuring a strategic link between a range of national ICT initiatives and standards… Ensuring this is recognised at wider Corporate levels.’

Resources and funding 33 ‘IT developments in social care are complicated, time-consuming and expensive and the funding streams currently available in this area are generally inadequate…’ ‘Identifying resource implications and advocating for increased ring-fenced funding…’ ‘A clear business case that justifies the extent of expenditure on ESCR’

Supplier liaison and assurance

15 ‘Closer working with s/w suppliers to ensure that their releases match targets and good practice.’’ ‘Approval scheme for software suppliers offering an ESCR solution.’’ ‘System specifications are shared and agreed with suppliers…’ ‘Good communication with the IT suppliers…’

Information governance and information sharing

38 ‘Provide central guidance/policies on information sharing’ ‘IG toolkit – especially one that could be adopted corporately’ (i.e. not just for social care but for other care services in the CSSR and aligned, where relevant to wider LA IG standards). ‘Defined policy on the legal admissibility of electronic documents….’ ‘Clarify the requirement for 2-factor authentication and liaise with suppliers to progress this… ‘Setting standards for data security, e.g. in relation to mobile working’’



27/04/2007/ Final

Issue Number Comments (Examples) Records management 10 ‘File plan guidance and further clarity about

expectations for transfer of records between authorities.’ ‘A national policy on document retention and destruction’ ‘National advice on data subject access requests…’

Cultural change 4 ‘More support for cultural change’ ‘Changes to national terms and conditions for social workers to be competent in the use of technology.’

9.3 Other Issues And Observations

Q24.

Any other comment/observations /issues you wish to raise?

54 authorities added further comments and observations in this section. It was difficult to analyse given the breadth of comments, but key themes raised elsewhere in the survey were re-iterated again in response to this question. An analysis of the responses follows:

Issue Number Comments (Examples) ESCR strategy, resourcing and timetable

23 ESCR definition needs updating, e.g. adults and children and mobile working. The need for central leadership, additional (ring-fenced) funding, realistic timescales and performance assessment to ensure delivery.

Information sharing with other agencies

21 Lack of overall vision and alignment between different central initiatives (DH and DfES). NHS CFH timetable, issues with access, social care not a priority. Need for central information sharing policies. Standards, e.g. identifiers, use of NHS # Sharing records between LAs.



27/04/2007/ Final

Issue Number Comments (Examples) Comments on questionnaire

10 Insufficient space to respond to some questions, some definitions unclear and open to different interpretations, difficulties covering different status in adults and children in single questionnaire.

Additional information on other questions

12 Note – it has not been possible to include in analysis.

Information on local projects

4 Status and examples were given.

Records management 5 National agreement needed on legal admissibility of computer records. Need for national retention/destruction policies, including digital information.

Workforce development 3 Need for more emphasis on workforce development and increasing IT literacy of social care staff.

Sharing lessons 2 Support network



27/04/2007/ Final

A Appendix – Survey Questionnaire

Electronic Social Care Record National Survey 2006 Introduction The Department of Health’s ESCR Implementation Board is conducting a national survey of Local Authority progress in implementing the ESCR. The outcome of this survey will provide us with information about progress and problems encountered. It will help in identifying if further guidance is required to facilitate implementation. It will also help us to know the extent to which ESCR implementation in children and adult services is compatible and the extent to which integration with NHS information systems has been incorporated into ESCR implementation programmes. The survey is intended, therefore, to provide as wide a picture as possible. Please include consideration of systems for ICS, SAP, CAF and any other developments as appropriate. Your participation in this survey is vital to the ongoing development of the Electronic Social Care Record and we would like to thank you in advance for completing the survey. Please note your response to the questionnaire will not be made available outside the survey team and attributable information will not be published. The results of the survey will be published in a fully anonymised form. None of the information will be used to evaluate any Local Authority’s individual progress. Its purpose is to get an overall picture of the extent and pattern of ESCR implementation across the country. The survey findings will be published, including via ADASS and NHS Connecting for Health websites. Contributors will be notified when the analysis is available. To enable us to analyse the information correctly we must have only one return from each Local Authority covering all departments and systems. Could you therefore please ensure that you collate comments and submit a single response. To help in collating comments you may want to download an electronic copy of the survey form. You can do so by clicking here. If there are any questions concerning the use of the questionnaire, please email [email protected] or phone the help desk on 01483 226910. Please complete this questionnaire online at www.escr.org.uk by Friday 12th January. Kathryn Hudson National Director for Social Care Department of Health

Co-chairperson of ESCR implementation Board


mailto:[email protected]


27/04/2007/ Final

The Electronic Social Care Record Survey 2006 Your details

Name:

Local Authority:

Role:

Email:

Phone Number:

Section A – About Your Systems

Q1. Do you hold electronic records for your service users associated with the care management process?


Specify ‘other’

Current issues (if any):

Planned developments:

Number of clients with an electronic social care record?

Number of users of the ESCR?

Q3. List all the systems that form part of the electronic social care record and names of suppliers:

Indicate service user area if separate

System & Purpose Supplier Service Area



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Q4a Are all the documents which you create electronically retrievable?

Q4b Are all the documents which you receive electronically retrievable?

Q5 Do your records include audio and visual recordings?

Q6. If you have implemented a full ESCR, how comprehensive is it?

Q7. Does the management of your documents include metadata facilities?

Section B – Integration and Connections

Q8. Are your ESCR systems currently integrated/interfaced with any other systems?

Do you have plans for future integration projects?






Current/Planned

Q8a. What system do you use for the Single Assessment Process (SAP)?

Q9. Do you have an N3 connection?



27/04/2007/ Final

Is it uni-directional or bi-directional

Please let us know of difficulties or successes in obtaining your connection

If you do not have an N3 connection what are your plans for NHS connectivity?

Do you hold the NHS number as part of the client record on the ESCR?

How do you obtain the NHS number?

Q10. Do any of your systems (specify) support mobile working?

System Supplier Service Area Operational function supported

Type of Devices e.g. Pens/Tablets

% of staff using devices

Status

Section C – Implementation learning

Q11 What barriers have you encountered in making progress towards full ESCR compliance?

User involvement

Lack of management support

Resources (People)

Resources (Funding)

Other corporate developments

Culture

Lack understanding of ESCR requirements

Lack of national strategy and compliance framework

Software, e.g. ease of use

Suppliers

Inadequate infrastructure



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Data quality

Scanning/back scanning

Legal admissibility

Links with other systems

(Please add as many additional items as required)

Please add any other comments about barriers

Q12. What has helped you progress?

Users involvement

Management support

National strategy and leadership

Availability of resources

Ability to take risks

Confidence in software

Suppliers

Adequate infrastructure

Data quality

(Please add as many additional items as required)

Please add any other comments about what has helped you to progress

Q13. Do you feel that the current model for ESCR is still relevant? (If no, what are the issues?)



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Section D – Culture

Q14. Do you think there are areas of organisational/operational culture that need to be addressed?

If yes, which areas?

Q15. What percentage of data is input directly by practitioners?

Section E - Security and Information Governance

Q16. Does access to your systems require 2 factor authentication? (E.g. PIN and smartcard) – please list all systems

System

Q17. & Q18.

Do your systems support role based access? (I.e. access to functions based on roles) – please list all systems

Do your systems support legitimate relationships? (I.e. access to individual client records based on a user having a direct care relationship with the client)- please list all systems

System Role Based Access Legitimate Relationships

Q19. What are your priorities for implementing information sharing with other agencies? (Please rank them)



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Order of priority Status

e-CAF for Children

Children’s index

e-SAP or e-CAF for Adults

NHS Mental Health Services


Q20. What are the main barriers to progressing information sharing with other agencies?

If you have progressed information sharing successfully with other agencies please also complete Q20a

Barrier/challenge Any specific agency?

Cultural/professional barriers

Lack of management support

Organisational/structural

Availability of IT solutions

Lack of information exchange standards

Information governance issues

Data Quality


Q20a. If you have progressed information sharing successfully please highlight any lessons that may help other Authorities

Q21 Do you have formal procedures to authorise access from external agencies?

Q22. Can your systems manage the consent process?

(Please list all systems)



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System

Q.23. Does your records management policy include/cover:

Schedules for record retention?

Archiving

Destruction of records

Management of Shared (multi-agency) records

Subject Access

Third party access

Disposal/retention of paper copy after scanning?

Section F – Have your say Q24. What are the main issues you would like the ESCR Implementation

Board to address?

Any other comment/observations /issues you wish to raise?
