Agenda item

Purpose of the report:

To acquaint the Adults and Health Select Committee with the proposal for the Surrey Care Record and to seek opinion and guidance on considerations around implementation of Phase One of the initiative.

Declarations of Interests:

None

Witnesses:

Steve Abbott, Chief Information Officer and IM&T Programme Director, Surrey Heartlands Health & Care Partnership

Helyn Clack, Cabinet Member for Health, Surrey County Council

Tony Delaney, Communications Manager, Surrey Heartlands Health & Care Partnership

Nick Markwick, Surrey Coalition of Disabled People

Sarah Parker, Director of Transformation, Surrey Heartlands Health & Care Partnership

Matt Parris, Deputy CEO, Healthwatch Surrey

Key points raised during the discussion:

1.     The report was introduced by officers from Surrey Heartlands Health and Care Partnership who informed Select Committee Members that the aspiration for the Surrey Care Record was to give healthcare professionals the information required to make the best possible decisions by enabling them to access patient data and information. Members heard that the implementation of the Surrey Care Record would take place in several stages. The proposal to make GP medical records available to clinicians at A&E departments within the Surrey Heartlands STP footprint and East Surrey CCG areas was the first phase of this project.

2.     Witnesses stated that information governance procedures were currently being developed to accompany the implementation of the first phase of the Surrey Care Record to ensure that patient information would be stored and shared safely. Discussions were underway with partners and stakeholders from across the healthcare community within the Surrey Heartlands and East Surrey areas to consult them in the development of robust information governance procedures.

3.     The Select Committee was advised that a 12-week engagement period would soon commence and which aimed to make people aware of the introduction of the Surrey Care Record and their right to opt out of sharing some or all of their medical information. The engagement period would include leafleting households within the Surrey Heartlands and East Surrey area, asking GPs and other relevant stakeholders to disseminate information on their established communications channels as well as making use of online platforms such as social media.

4.     Members heard that the introduction of the Surrey Care Record was just one element of integrating how care was delivered and one strand of the digital strategy to create a unified health and social care system under the aegis of Surrey Heartlands Health and Care Partnership. The aspiration was to integrate health and social care records during a future phase of the development of the Surrey Care Record.

5.     The Committee enquired about the decision by officers to proceed on an opt-out rather than an opt-in basis for including patients within the Surrey Care Record and stressed that engagement would have to be exceptionally widespread to ensure that all residents within the footprint were given sufficient opportunity to opt-out of their medical records being shared through the Surrey Care Record. Witnesses advised that this had been determined in consultation with GPs who felt that the SCR should be introduced on an opt-out basis. There would also be significant additional cost associated with requiring residents to opt-in and so this had also impacted on the decision. Officers further highlighted that a significant amount of work had been done on developing the communications and engagement plan around the SCR and stressed that there were a significant number of ways that residents could be made aware of the right to opt-out of the SCR. This would include dropping over a million leaflets across the Surrey Heartlands and East Surrey area informing residents about the SCR and explaining how to opt-out if they wished to do so.

6.     Members asked whether there was any appetite to focus particular attention on communicating with those who frequently use acute services to make sure that they are aware of the introduction of the SCR. Concern was expressed that often people don’t pay attention to leaflets that they receive through the door or don’t use social media which may hamper efforts to inform residents of their right to opt out. Witnesses stressed that a significant amount of research had been conducted by Surrey Heartlands to design leaflets that would attract residents’ attention. The NHS logo was both well-known and trusted and so would be displayed prominently on the leaflets to encourage people to read them. Committee Members were further informed that half a million leaflets would be dropped initially followed by a further half a million a few weeks later in order to maximise dissemination.

7.     Further information was sought on the role of GPs in making their patients aware of the introduction of the SCR and Members asked whether doctors’ surgeries were geared up to respond to questions about that their patients may have about the SCR. The Committee received confirmation that GP surgeries would be given literature that could give to patients which explained what the SCR and directed them to where they could find out more.

8.     Select Committee Members asked whether contact had been made with day centres and community hubs to use their channels in order to cascade information to key groups. Witnesses confirmed that they had been in contact with a range of stakeholder groups and had asked them to disseminate information about the SCR through their communication channels. The Committee was advised, however, that it was those individuals who had little contact with the health and social care community that were hardest to reach.

9.     Members enquired as to whether there were examples from other local authorities that could be used to tailor the most effective way of engaging with patients. Officers stated that the SCR was being introduced as part of a national programme which provided numerous examples of best practice that could be drawn from. Indeed work had taken place with other areas that had introduced a shared care record to understand what lessons learned around their communications campaigns.

10.  Attention was drawn to the fact that the SCR was a phased programme with the circle of healthcare professionals able to access patient records widening with each of the stage of the project. Members asked whether further communication would take place with residents at each stage of the project to make them aware of the widening scope of the SCR. Officers emphasised that patient information would only be accessible by health care providers within the County and by acute trusts neighbouring Surrey to take account of patient flows. Officers indicated that they were unsure whether the further communication was planned with residents around the implementation of later phases but confirmed that they would provide a written response to the Select Committee on this question once they had consulted with Surrey Heartlands’ Caldicott Guardians.

11.  Further clarity was sought on the sharing of patient information with acute hospitals outside of the Surrey Heartlands and East Surrey area. Would patient data be made accessible to clinicians at Frimley Park Hospital, for example. The Committee was advised that patient information would not be made available to acute providers outside of the area covered by the SCR as standard but that there would be a facility in place for hospitals to request this information.

12.  Discussions returned to the decision taken by Surrey Heartlands to operate the SCR on an opt-out basis. Members stated that the ability for healthcare organisations to easily share patient information would improve care while contributing towards the financial sustainability of the care system and should therefore be viewed as a good news story. Officers highlighted the importance of striking the right balance between privacy and the advantages that could be derived from sharing patient information across healthcare providers. The Committee was further informed that many people were surprised by the fact that their information was not already shared between across organisational boundaries within NHS England. The Deputy CEO of Healthwatch Surrey confirmed that their research indicated that there was widespread support for sharing health records between healthcare professionals although highlighted that there was less support for sharing with social care professionals and that this made raising awareness amongst groups using social care services particularly important (e.g. older people, those with Learning Disabilities).

13.  Officers were asked about the budget allocation for engaging with residents around the introduction of the SCR and were asked for clarity on what residents would actually see from the communications campaign. Committee Members heard that an initial budget of £75k had been made available for the communications campaign although it would be possible to supplement this due to some additional funding that had been made available by NHS England. It was highlighted that the available budget gave Surrey Heartlands the capacity to conduct a communications campaign that encompassed a wide range of mediums for engaging with residents enabling them to make an informed decision on whether or not to opt-out of the SCR.

14.  The Cabinet Member for Health expressed her support for the introduction of the SCR, emphasising the benefits it could provide in integrating patient care. She also highlighted that there was a role for Members in promoting awareness during their contacts with residents. The Cabinet Member further highlighted the role of Local Committees in ensuring that residents understood their rights in relation to the introduction of the SCR.

15.  The Committee heard from the Director of Surrey Coalition of Disabled People who asked about the adoption of the accessible information standard for communicating with residents around the SCR particularly those with visual impairments. Witnesses confirmed that an Equalities Impact Assessment was undertaken in relation to communication and engagement around the SCR which ensured that the information provided would be accessible.

16.  Further clarity was sought from the Committee on whether residents would be able opt-out of their medical records being shared through the SCR after it had been implemented and if children would be given the opportunity to opt-out of the SCR once they turned 16. Members received confirmation that the SCR included a facility for residents to opt-out at any time as well as giving them the capacity to choose which elements of their medical information would be shared through the integrated care record. In terms of whether children turning 16 would be made aware of their ability to opt-out of the SCR, witnesses confirmed that they would consult with GP leads on introducing a right to decide mechanism into the system and that they would report back on this to the Committee.

Recommendations:

The Adults and Health Select Committee recommended:

i.       that patients be incorporated into Surrey Care Record on an opt-in rather than an opt-out basis. 

ii.      a clear audit trail should be maintained for when patients have agreed to their records being shared; and

iii.     that consent should be actively sought from children for their information to be shared as part of the Surrey Care Record once they reach 16.