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Improving information-sharing in practice

Philip Dyer
Regional Implementation Coordinator
Department for Children, Schools and Families

Frontline health workers, including practice nurses, health visitors, community nurses and school nurses, often have to make case-by-case decisions on what personal patient information they should give to other practitioners to ensure that the patient receives the right care and support, at the right time. This can include GPs, social workers, and those in housing, education, childcare or youth support.

Information-sharing is at the centre of the government's goal to improve outcomes for all. Information-sharing and collaborative working enables a more complete picture of a person's needs, which allows for earlier and more effective intervention. This, in turn, leads to faster and more coordinated delivery of services, which improves the service experience. 

Practice example
A young patient attends a surgery for immunisation ahead of a trip abroad. When giving the injection, the nurse notices a smell of alcohol from the boy. When questioned, he dismisses it as nothing, saying that is was something he spilled on himself in a chemistry lesson at school and does not want to discuss it further.
 
The nurse continues to talk to the boy and he admits that he is drinking alcohol occasionally when he feels unhappy, but no one else knows. He is not in contact with any other services. She encourages him to talk to his parents about it but he is adamant that he cannot and that she should not talk to them  about him. The nurse explains to the boy about the local youth support service and eventually he agrees to her making contact on his behalf. With his consent, she contacts the team and shares what she has learned about the boy. This information and contact with the youth support team could lead to an appropriate intervention to address the issue before it got any worse.

But achieving this is not always easy, and it is clear that nurses face certain barriers when trying to share information in a timely and effective way, especially when communication involves practitioners in another agency or service. This was recognised by Lord Laming in his recent review of children's services, The Protection of Children in England: A Progress Report.1 According to his report, despite considerable progress in integrated working, there remain significant problems in the day-to-day reality of working across organisational boundaries and cultures.

Guidance
Having the confidence and the support to know when and how to share patient information, and with whom, is essential. To enable this, the government has refreshed its cross-sector information-sharing guidance and it was republished in October 2008 as Information Sharing: Guidance For Practitioners and Managers.2

The new guidance aims to help those working in health and other sectors to understand how to share information legally and professionally when liaising with children, young people, adults or families. While this is not a panacea, it goes some way to providing nurses with practical advice and examples.
The document supports good practice, which can be especially important in cases of early intervention and preventative work where information-sharing decisions may be less clear than in safeguarding or child protection situations.

The guidance (available to download online and to order by post, see Resource) sets out clear and simple processes for nurses to follow in the form of seven key questions about information-sharing. These give a step-by-step guide about what to share, with whom and when. These seven key questions are complemented by seven golden rules, and will help support decision-making so practitioners can be more confident that information is being shared legally and professionally (see Boxes 1 and 2).

[[Box 1 prof]]

[[Box 2 prof]]

As well as the guidance for practitioners and managers, the package of information sharing resources includes a pocket guide, a credit card-sized quick reference, case examples, fact sheets, posters, training materials for local adaptation and use, and an introductory training course on CD. When combined with clear organisational support for good practice in information sharing, as explained below, these resources help to empower practitioners by giving them clarity about when they can share information lawfully.

A wide variety of stakeholders from health and other sectors were involved in the development of the guidance. The Department of Health was one of many government departments who helped to develop the guidance and clear it for publication at ministerial level. Health bodies, such as the Royal College of Midwives and the Royal College of Nursing, are among the 30 organisations to have formally endorsed it.  

Dispelling myths
In addition to following these guidelines it is important that nurses understand some of the common barriers that can prevent effective information sharing. One such barrier is the existence of myths and common misunderstandings that remain within some organisations.

Data Protection Act
It is a widely held myth that The Data Protection Act (DPA) 1998 is a barrier to sharing information; in actual fact, the opposite is true. The DPA provides a framework to ensure that personal information is shared appropriately and confidently by practitioners and is there to support practitioners and their managers in making decisions about information sharing.

Formal agreements
There is no need for a formal agreement or protocol between organisations before a frontline practitioner can share information about a person. In many cases, this type of agreement can slow the effective management of case-by-case information sharing that all practitioners find necessary. While formal agreements can be useful to bring people together to discuss information sharing, they are only useful in situations where the information to be shared can be fully defined in advance. They do not replace professional judgement in the case-by-case decisions that have to be made.

Consent
Although obtaining the consent of the person involved is best practice and should be carried out where possible, information can be shared without consent if, in the practitioner's judgement and based on the facts of the case, there is sufficient public interest to share without that consent. For example, this may be where there is risk of significant harm to a child or young person, there is risk of serious harm to an adult, or where it is necessary to prevent, detect or prosecute a serious crime. In some circumstances, consent should not be sought; for example, where it places a child or adult at increased risk of serious harm or where there is a statutory duty or court order to share the information.

Research and consultation by various agencies have shown that, contrary to some practitioners' fears, children, young people and families feel that it is acceptable for practitioners to share information about them if it results in getting the help they need. But they also want to be fully involved and informed throughout.

Information technology tools
It is important to say that IT tools, such as ContactPoint, eCAFand National eCAF, do not change any of the rules or considerations for information sharing at the frontline. Whether information is obtained verbally, recorded on paper or stored on an IT system, all of the same considerations apply when it comes to making decisions about information sharing.

Given the nature of patient confidentiality, and the naturally cautious approach to sensitive information that nurses should rightly have, it is understandable how misunderstandings and uncertainty remain.  However, it is important, if information is to be shared in a timely and effective way, that barriers such as these are addressed. While practitioners have a role in this, they also need the full support of their managers and the organisations they work within.

Guidance is not enough
While providing guidance for practitioners can go some way to ensuring effective information sharing between organisations, more needs to be done by managers to embed a culture of support. There is growing understanding among those on the frontline, but there are still issues around confidence in
sharing information. 

Part of the problem is that many practitioners, including nurses, are reluctant to share information because they fear how organisations might treat them if their judgement is questioned. Nurses need to understand their organisation's position and commitment to information sharing. They also need to have confidence in the continued support of their organisation where they have used their professional judgement and shared information professionally. If staff feel that they may be undermined, it is unlikely they will confidently share information.

As a result, organisation policies and managers at all levels need to ensure that they are promoting and supporting good practice in information sharing. This will give those working with patients the confidence they need to ensure the right information is passed to the right person at the right time to ensure the best possible outcome for patients. These topics are covered in the information-sharing factsheet Embedding Good Practice, which managers may find useful.3

Training and education
Training and education, supported by local or organisational policies, play a key part in raising the confidence of practitioners to make information- sharing decisions. If you have not received training, ask if it is available locally. In addition, it is important to ensure that reception and administrative staff are included in information-sharing training as they normally have access to personal information about service users.

To facilitate this, the Department for Children, Schools and Families (DCSF) has produced core training materials as downloadable slides with delivery notes for local tailoring and use. The DCSF has also worked in partnership with Barnardo's to make available an introductory training course on CD. It is up to organisations and their partners to make use of these materials and ensure that their training courses include and are following up with opportunities for multiagency discussion and reflective learning.

Conclusion
It is clear that information sharing is the cornerstone of ensuring that children, young people and families get the best possible services and have the opportunity to achieve their full potential. While there are barriers in achieving effective collaboration across organisations and professions, everyone in the nursing profession must use their professional judgement and the guidelines available to pass on vital information to colleagues. Meanwhile, managers must ensure they support their staff. Only with the support of those running organisations can nurses achieve the best for their patients. l

References
1. Lord Laming. The Protection of Children in England: A Progress Report. London: The Stationery Office; 2009. Available from: http://publications.everychildmatters.gov.uk/eOrderingDownload/HC-330.pdf
2. Department for Children, Schools and Families. Information Sharing: Guidance For Practitioners and Managers. London: DCSF; 2006.
3. Department for Children, Schools and Families. Information Sharing Fact sheet: Embedding Good Practice. London: DCSF; 2009.

Resource
Department for Children, Schools and Families (DCSF)
For more on information sharing, or to order or
download copies of the guidance or other materials, visit the DCSF website:
W: www.dcsf.gov.uk/ecm/informationsharing

To order copies of Information Sharing: Guidance For Practitioners and Managers:
Post: Department for Children, Schools and Families Publications, PO Box 5050, Sherwood Park, Annesley, Nottingham NG15 ODJ
Tel: 0845 60 222 60; Fax 0845 60 333 60
Textphone 0845 60 555 60
Quote Information Sharing: Guidance for Practitioners and Managers (ref 00807-2008BKT-EN)