Regional Implementation Co-ordinator
Department for Children, Schools and Families
For the past five years, Philip has been involved with the Every Child Matters programme in the North East of England. As part of a national team, Philip's role is to support local authorities and partner organisations providing services to children, as they implement and deploy a range of business processes and systems, to support integrated working practices. Philip recently presented at the Nursing in Practice Event in Newcastle
Information sharing is at the centre of the government's goal to improve outcomes for all. This is a fact underlined by programmes such as Every Child Matters, the child health strategy Healthy Lives: Brighter Futures and the Think Family: Improving the Life Chances of Families at Risk initiative. Under these schemes, more people working in healthcare are being asked to share relevant patient information with colleagues from other agencies such as schools, youth support teams, social care and justice departments where appropriate.
And it is not just the government that recognises the need for effective information sharing. In his recent review of children's services, Lord Laming made it clear that, despite considerable progress in integrated working, significant problems remain in the day-to-day reality of working across organisational boundaries and cultures.(1)
With a remit that includes managing personnel, developing strategic plans and sharing best practice from across the healthcare sector, practice managers play a key role in supporting their practice staff to understand and act upon the principles behind information sharing.
As a result, managers need to make effective information sharing and collaborative working a top priority and work towards embedding it within their practices. This will enable practitioners across all sectors to get 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 co-ordinated delivery of services, which improves the service experience and the potential for improved outcomes.
To illustrate what is meant by information sharing, let's look at an example. In the context of a GP practice, a young patient may attend 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 spilt on himself in chemistry class 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.
Convincing staff to share details of personal issues with other practitioners can sometimes feel counterintuitive to a workforce that prides itself on patient confidentiality. As any GP or nurse will tell you, case information is subject to legal and ethical obligations of confidentiality and should not be disclosed without the patient's consent. To overcome this, managers need to be aware of – and share with staff – the correct information-sharing guidance and procedures.
The latest cross-government information sharing guidance was published in October 2008 and aims to help those working in health, and other sectors, understand how to share information legally and professionally when liaising with children, young people, adults or families.(2) While this is not a panacea, it goes some way to providing practice workers with practical advice
Information Sharing: guidance for practitioners and managers 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 – sets out clear and simple processes for practice staff to follow in the form of seven key questions about information sharing. These give a step-by-step guide about how to decide whether to share, what to share and with whom. 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 Box 1).
A wide variety of stakeholders from health and other sectors were involved in the development of the guidance. It was approved for publication at Cabinet level by 14 government departments, including the Department of Health. It has also been formally endorsed by the Royal College of Nursing and the Royal College of General Practitioners, among 30 other organisations.
In addition to following these guidelines, it is important that practice managers understand some of the common barriers that can prevent effective information sharing and ensure these are addressed within their practices. One such barrier is the existence of myths and common misunderstandings that remain within some organisations.
For example, it is widely held that the Data Protection Act (DPA) 1998 is a barrier to sharing information, but 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.
Secondly, there is no need for a formal agreement or protocol between organisations before a frontline practitioner can share information about a person. In fact, in many cases this type of agreement can slow the case-by-case decision-making and 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. As endorsed by the Information Commissioner's Office, information-sharing protocols are not a substitute for the professional judgement an experienced practitioner will use in the case-by-case decisions that have to be made, and should not be used to replace that judgement.
Although obtaining the consent of the person involved is best practice and should be obtained when possible, information can be shared without consent if, in the practitioner's judgement 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. Also, in some circumstances consent should not be sought – for example, where seeking consent could place a child at increased risk of significant harm or an adult at increased risk of serious harm, or where there is a statutory duty or court order to share the information.
Finally, it is important to say that tools such as ContactPoint (the secure online directory for those working with children and young people), the Common Assessment Framework (CAF) and National eCAF – the single national IT system to support CAF – 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.
How to embed information sharing
While providing guidance for practitioners and dispelling myths can go some way to ensuring effective information sharing between organisations, more needs to be done by organisations such as GP surgeries to embed a culture of support.
Part of the problem is that many practitioners are reluctant to share information because they fear how managers might treat them if their judgement is subsequently questioned by a patient or other practitioner. Practice staff 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 when they should.
It is important to provide appropriate information and training on information sharing for practitioners, managers and advisers in addition to ensuring effective supervision and support in developing practitioners' professional judgement in making information-sharing decisions.
In addition, 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.
This could include ensuring appropriate references are made to information sharing in performance management frameworks and proactively monitoring performance in information sharing. It can also mean providing access to infrastructure and systems, such as secure email, to support secure information sharing.
Ideally, these would be part of an overarching information-sharing governance framework. This framework must recognise the importance of professional judgement in information sharing at the frontline, make explicit the organisation's position on and commitment to information sharing, and should focus on how to improve practice in information sharing within and between agencies. These topics are outlined in Information Sharing: guidance for practitioners and managers and in the information sharing factsheet Embedding Good Practice, which is available as part of the guidance materials mentioned above (see Resource).
In conclusion, it is clear that information sharing is the cornerstone of ensuring that people 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, all practice staff must use their professional judgement and the guidelines available, to pass on vital and relevant information to colleagues when appropriate. Meanwhile, managers must ensure they promote good practice and support their staff. Only with the support of those running organisations can nurses, GPs and other staff achieve the best for their patients.
1. The 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; 2008. Available from: http://www.everychildmatters.gov.uk/_files/116ABBC875E8FEE7BC1E03F534A1E...
Information Sharing: guidance for practitioners and managers is an updated version of information-sharing guidance published in 2006, extended to cover practitioners working with adults and families as well as those working with children and young people. For more on information sharing, or to order or download copies of the guidance or other materials, go to: