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www.england.nhs.uk
How we successfully
implemented CP-IS
London Borough of Hackney and Portsmouth Hospitals NHS Trust
How we successfully implemented CP-IS
Jeremy Tuck and Joanne Ridgley
PLENARY SESSION
27 April 2017
Before CP-IS was in place
• Extracting CP and LAC records from Frameworki / Mosaic
• We would do a Data Quality check on these
• Sending via Secure eMail as an attached spreadsheet
• Homerton Hospital (Foundation Trust) would then enter NHS
numbers (they would need to do this each time)
• Therefore only sharing with the Homerton
• Hackney would get no indication back about contact about whether
there had been any unscheduled contact elsewhere in the country
• This was meant to be done at least once a week, but even this was
hard – started slipping…several weeks
Difficulties to justify the project!
• Been a fast-follower for CP-IS since 2013
• Pressure for Business As Usual teams to simply ‘get on with it’
• Technically downplayed (it’s just a file being sent over secure FTP)
• Business case for the project ‘in itself’ did not stand up:
• Too many technical hurdles (e.g. N3 connection)
• Issues with code (need to upgrade Frameworki / Mosaic)
• Need to technically configure outside network
• Need to ensure there was a sustainable NHS Numbers
approach
• Prioritisation over other Mosaic work needed?
• Project Proposal – initially rejected by Children’s Services….
The City and Hackney
CCG Agenda:
Sharing data between
health
and
social care
Other CCG work (Health Information Exchange)
NOTE: In the break-out session later on we’ll go into more detail about
the broader health and social care information sharing agenda.
CCG based project
• City and Hackney’s CCG set up an IT Enabler Board
• Homerton has been the lead on the Health Information Exchange –
a consolidated view of a patient record
• Worked in partnership with the City of London
• Hackney bid for Health integration work
• Multi-faceted Hackney Project:
1) Child Protection Information Sharing (CP-IS)
2) Improving Mosaic for health/social care Integrated teams
3) Sustainable NHS Numbers
4) Integration between Mosaic and CCG Health portal (HIE)
Approach
Approach health integration platform – building blocks
Key building block – NHS Numbers
Broader Requirement for an NHS Number capability
• Pre-requisite for Child Protection Information Sharing (CP-IS)
• Health and Social Care (Safety and Quality) Act 2015
• Unique identifier
• The ‘duty to share’
• Our commitment in the IG Toolkit (part of N3 compliance)
• Safeguarding delays as the Trust re-enters data
• Unique reference for all data sharing in and with Health
• Other authorities – reliance on manual processes or access to RiO
• Wanted a simple solution controlled by the Council for data which is
ours
The TOOLS to access NHS Numbers
Spine Mini Services - tracing NHS Numbers
SMSP Spine Mini Service Provider
PDS Personal Demographics Service
Council
System
N3 “Spine”
Seamless within Mosaic
Seamless within Mosaic
Can you trace NHS Numbers using the PDS?
• Yes – for children’s records under CP-IS
• No – for anything else: NHS Digital need a legal basis to access PDS
• Presented an Issue Paper to the CCG
• Submission to IGARD on 20 March 2017
Practical implementation steps in the system that
made CPIS a success
CP-IS: opportunity to improve workflow
• Revised all CP and LAC workflows
• Agreed ‘First Access Screening Team’ were custodians of CP-IS
• Took all CYPS staff through Briefings
• Classroom training for FAST, Safeguarding and Review Team,
Placement Management Unit, Application Management
• Short Manuals for all – hardcopy and electronic
• Specific Manual on ‘notification failures’ for FAST & ICT
The ‘CP-IS notification Received’ work-step is created and completed
automatically through the CP-IS service to the CP-IS virtual worker. This will
create an automatic work-step of ‘CP-IS follow up’ which will be sent to the ‘CP-
IS virtual worker’ Incoming Work.
CP-IS Social Care Workflow (Mosaic work-steps)
The workers in the FAST team have an ‘act for’ to check the ‘CP-IS virtual
worker’ role daily.
The FAST team worker will start the ‘CP-IS follow up’ work-step in order
to triage the case to see if the case is open to an allocated team and
worker:
MASH or First Access team
The FAST Team worker check section 1 of
the CP-IS follow up form to ensure all
demographics have come through:
MASH or First Access team
The FAST team worker ensures the notification message has pulled
through and completes the questions in Section 2:
Checking notifications
If the case is allocated then the FAST team worker sends the Mandatory
request to the allocated worker and then saves and closes the work-step:
Open cases: CP-IS follow up process
The allocated worker will then complete Section 3 in the form
about their discussions with the NHS Healthcare worker:
Allocated workers
The allocated worker will then complete the Mandatory request:
The allocated worker will then complete the next action:
Then click the finish icon to complete work-step.
Allocated workers – mandatory requests
• Notifications come in for a year after a child is removed from a CPP or LAC
• If the case is closed completely to CYPS, the FAST worker will call the NHS
healthcare worker to discuss the case and complete section 4 (closed case
follow up) on the form.
• They will then send the Mandatory request to the FAST duty screening
manager to review the notification and add in their comments before
completing the work-step.
Closed Cases: CP-IS worker process
• For cases where the notification is sent out of hours (5pm – 9am
Monday to Thursday and Friday 5pm – 9am Monday), then these
are picked up on the next working day.
• This is because the CP-IS follow up is a notification message and
not a referral. If there were concerns then it is expected that the
NHS Healthcare Worker would have made a referral.
• The out of hours worker writes a case note and sends a case note
alert to the allocated worker and the Consultant Social Worker for
any discussions they may have with an NHS healthcare worker.
• The allocated worker is still responsible for completing the CP-IS
follow up work-step, they may choose to complete another phone
call or use the information provided to them by the out of hours
worker.
Out of hours contacts
• The CP-IS work-step is generated onto the expecting mothers record (due to
NHS Number), and this work-step will be referenced in case notes on the
unborn child/ren record for audit purposes.
• Once the unborn child has been born and has an NHS number of their own,
then the work-step will be automatically generated onto the child’s record
instead.
• Having the PDS tool has helped significantly with seeking the NHS number
within the first few days.
CP-IS follow up on Unborn Child
Once a record has the necessary information for it to be automatically
uploaded to CP-IS, the Person’s summary screen displays a message:
Note: ‘Unaccompanied Minors’ will not have an NHS number until they are
registered with a GP, therefore if they have a Looked After child status, but no
NHS number then they will have an error message until they have an NHS
number. The allocated worker is advised about this and they follow up.
Person Summary Screen Changes
Impact of CP-IS
Timeframe
Issues affecting the timeline:
• Improving workflow in Mosaic
• Setting in place a sustainable NHS Number tool
BENEFITS: CP-IS Case Studies
1. A notification for a looked after child was made following an
ambulance visit in South England, leading to a safeguarding
referral being made.
2. A child subject to a Child Protection Plan made an unscheduled
visit to A&E and was discharged. Social Care was made aware,
and would otherwise not have known, which resulted in a further
social care visit to check on the welfare of the child.
3. A child subject to a Child Protection Plan made an unscheduled
visit to A&E with a seemingly innocuous injury from an accident.
The social worker was made aware, was able to request access
to the discharge summary, and was able to check in on the
family. The social worked would have otherwise not known.
What worked well
• Checking & Incorporating all aspects of the NHS Digital plan
• Good governance: a project board
• Social Care representation constanty
• NHS Digital support – fortnightly meetings / calls (Mark Wright)
• Good engagement with Local trust (Homerton University Hospital)
• Good weekly team meetings (divided 30 min practice / 30 min tech)
• Communications strategy
• Regular updates
• Senior engagement constantly
• Having a broader technical strategy (e.g. the Building Blocks)
What could have been improved
• Understanding the way Mosaic needs to be configured
• Working through the process end-to-end (Trust needed to upgrade /
improve their own system, but only knew this at the end)
• PSN Compliance and network configuration genuinely were hard
work – but you can’t anticipate this: rather put in place your best
people
• Broader engagement around NHS Numbers (adults) with NHS
Digital
• Plan for the unexpected – OFSTED had a big impact on momentum
TIPS when starting an implementation
• Try and find a sustainable – longer term approach (building blocks)
• Engage with NHS Digital from the outset and throughout
• Engage with your supplier all the way through….
• Put in place a good team: esp. a practice lead
• Ensure you are technically and IG savvy
• Use the NHS Digital plan and structure it with tools you can use
• Try and bring a further benefit into to social care if you can (e.g. refresh of their
workflow)
• Get practitioners involved in the technical – don’t underestimate the value of informing
people: they need to know how it works
• Prepare a communication strategy
• Plan for technical network experts at the key times
• GO LIVE early if you can – so your project team can pick up issues
Contacts
Hackney Council:
• Lisa Aldridge ([email protected])
• Ross Tuckley ([email protected])
Independently
• Jeremy Tuck ([email protected])
• Joanne Ridgley ([email protected])
QAH Hospital
Portsmouth Hospitals NHS Trust
Child Protection – Information Sharing
Implementing CP-IS in the acute
health setting
Diane Urquhart
Named Nurse Safeguarding children
Portsmouth Hospitals NHS Trust
QAH Hospital
Portsmouth Hospitals NHS Trust
Portsmouth Hospitals NHS Trust
An overview of our services
1,200 beds, including cots- level 3 NICU
The Emergency Department at Queen Alexandra Hospital is
one of the busiest in the UK treating in excess of 132,000
patients each year
Maternity Services are responsible for the delivery of around
6,300 births per year, making it one of the largest maternity
services on the south coast
The Children’s Assessment Unit (CAU) manages over 9,000
emergency attendances each year.
QAH Hospital
Portsmouth Hospitals NHS Trust
Laying the
foundations
The preparation
stage
LSCB & LA establish joint implementation approach.
NHS Digital resources. What is available within your own organisation?
Executive leads. Letter of acceptance and commitment and support.
Smartcard access codes. Technical go-live date.
IT team crucial to review technical integration & functionality.
Information governance leads. Protocol reviews.
Where is the unscheduled care in your organisation? Get the teams involved.
QAH Hospital
Portsmouth Hospitals NHS Trust
CP-IS in our organisation.
We went live in the emergency department in Nov 2016
Paediatric assessment unit went live on 21 March 2017
Maternity planned for June 2017
The joint working enabled the LA
and the local healthcare settings to
go live in quick succession.
QAH Hospital
Portsmouth Hospitals NHS Trust
Phased approach – Who, when and how?
3 areas identified within PHT that offer unscheduled care.
Which area would create the greatest impact and benefit to
children?
All areas worked very differently.
Who could help me? What resources were available?
Which processes were in place already?
How can CP-IS complement the current pathways?
ED CAU Maternity Services.
QAH Hospital
Portsmouth Hospitals NHS Trust
The Emergency Department - working towards going live
• Team brief to key staff
work alongside towards
implementation.
• Process mapping from
Admission to discharge.
• Help the team to decide
how it will fit into their
area.
• Identify staff that will need access.
• Training sessions.
QAH Hospital
Portsmouth Hospitals NHS Trust
• Clear plan shared with all staff.
• Support at the frontline.
• Cleared time in diary to offer 1:1.
• Keeping everyone informed of
progress.
• Follow up and maintenance-
induction.
QAH Hospital
Portsmouth Hospitals NHS Trust
Building stronger
relationships with local
authorities.
Staff have a better
understanding of
assessing the child's
needs.
Better information
sharing.
Voice of the child.
Quick easy access.
More information
about children at the
frontline.
Building confidence in
clinicians asking the
right questions.
Looked after children
greater awareness of
the complex needs
and support in place.
What are the
benefits we have
seen?
QAH Hospital
Portsmouth Hospitals NHS Trust
Challenges:
• Staff support - yet another task
for them.
• Releasing staff to be trained.
Staff turnover.
• Unrealistic expectations of
system – change in
information.
• Real benefits to children?
• Time.
QAH Hospital
Portsmouth Hospitals NHS Trust
• Keep the vision before you.
• Don’t take resistance personally.
• Remain flexible.
• Highlight quick wins.
• Positive feedback to the front line.
• Keep it child centred.