The Francis report said existing arrangements for collection and analysis of patient information were unable to identify problems at Mid Staffordshire. Chris Alderson reviews the improvements being sought
Chapter 26 of the Francis report contains detailed recommendations as to how information gathering and sharing within the NHS should change.
Many of these recommendations relate to remedying the defects in how information had been used historically. A number of them deal with the need for quality accounts to relate to information that produces a genuine reflection of the quality of care provided by the organisation, and for like for like comparisons to be made between organisations.
The report also supports the move towards publicising surgical outcome information for consultants.
There is a considerable convergence of the recommendations made in the second Francis report and the objectives set out in the earlier Department of Health policy document The Power of Information.
In its response to the Francis report, the government has highlighted the importance of the Health and Social Care Information Centre, and that the NHS must have regard to its advice and guidance on data collection. This gives the centre a key role in setting common standards of monitoring and data collection.
‘A patient is only likely to discover incorrect information in their records after they have been discharged’
More focus is placed on obtaining information from patients on the quality of their care − and acknowledging the drawbacks of relying on surveys conducted while patients are still feeling vulnerable.
Feedback gleaned when the patient is still in hospital is unlikely to be candid, given possible fears that critical comments they make might affect ongoing care.
Systems for seeking the views of patients shortly after their discharge are felt to be much more useful. Consumers are familiar with customer service calls, and it is perhaps surprising that the same approach has not been widely adopted within the NHS.
Fundamental IT changes
Other recommendations are likely to require more fundamental changes to information management systems. In particular, there is encouragement to adopt electronic records management systems, which follows similar encouragement from the DH.
Recommendation 244 in the Francis report sets out key expectations of systems, based on examples of best practice already in use in some NHS institutions, and based on an assessment of the functionality such systems ought to be able to provide.
Ideas include designing systems to flag up information required for safe and effective care, to alert supervisors where expected actions have not occurred, or where an entry is likely to be inaccurate.
‘Where electronic patient information systems are being introduced, patients should be ale to access their notes in real time and be able to enter comments’
Given the complex issues surrounding the use of patient identifiable data for quality improvement activities not related to direct patient care, such as performance management and audit, the report recommends that IT systems should be developed to capture the relevant information in an anonymised form. This would avoid the need for information to be collected separately, thus saving staff time, as well as making the information available for analysis much more quickly.
Patient access to records
Some recommendations will involve rather more work by way of a culture change. The Francis report advocates a considerable improvement around patient access to information about them.
At present, a patient wishing to gain access to their medical records is commonly required to make a subject access request under the Data Protection Act 1998, which will often involve a payment of up to £50 and will commonly take several weeks to be processed. A patient is therefore only likely to discover incorrect information in their records after they have been discharged; even then, the correction of mistakes is a lengthy − and sometimes contentious − bureaucratic process.
‘Francis’ recommendations place great emphasis upon the wider dissemination of information’
The Francis report rightly identifies this situation as an anachronism in an era when many people use online banking. It is therefore recommended, where electronic patient information systems are being introduced, that patients should be given the ability to access their notes in real time and be able to enter comments. While online access to GP records is already an objective, such functionality should be extended to hospital records.
While the recommendations do not require the widespread move to electronic patient records, given the focus of gathering and sharing information relating to the quality of care, it is difficult to see how the improvements sought could be delivered without heavy reliance on IT.
Common IT standards
Rather than imposing a single, common IT system, as has previously been attempted, the recommendations emphasise systems that work to a common set of standards, which are capable of communicating with each other, to ensure the same information is collected for each NHS body.
‘A failure to share information can have a detrimental effect on patient safety at an organisational level, as well as at patient level’
As well as improvements in how NHS organisations gather and share information, the recommendations place great emphasis upon the wider dissemination of information. Statistics on the effectiveness of treatment are to be gathered, together with detailed information from complaints and serious untoward incidents.
It is also proposed that this information should be made public in a suitably anonymised form. The Francis recommendations complement the second Caldicott review’s conclusions − a failure to share information can have a detrimental effect on patient safety at an organisational level, as well as at patient level.
The Francis report should not be viewed in isolation. It forms part of a continuum of plans for improvement in how the NHS uses its information, so those looking to update their information systems will have to bear in mind other developments, including the Caldicott review and DH strategies.
The drive away from paper based record systems continues. With funding to support the move towards electronic systems available through the Safer Hospitals, Safer Wards project, any NHS provider organisation not currently planning to migrate to an electronic patient records system should look at the matter urgently.
Equally, those developing IT systems for use by the NHS should be looking to incorporate the functionality recommended by the Francis report to ensure they are fit for purpose in the post-Mid Staffordshire landscape.
Chris Alderson is a partner at health and social enterprise law firm Hempsons