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Joining forces

Working in partnership is now the official mantra for education, social care, health, criminal justice, housing and recreation. But what is happening to improve integration of children's services? Raymond Ross finds out

A cross-sector approach to children's services, as set out in the Scottish Executive's For Scotland's Children report in October 2001, means managing change.

One of the most vexing challenges is to track children across all the services they encounter, such as education, health, social care, housing, criminal justice and recreation. As part of the national eCare programme, the Grampian area - Aberdeen, Aberdeenshire and Moray - is developing an integrated children's service record (ICSR) for information to be shared between agencies. It will feature at Children in Scotland's annual conference next week in Aberdeen.

The eCare programme, which is part of the Scottish Executive's Modernising Government initiative, is about better and more integrated care, advice and assistance. With the individual's consent, it enables information to be shared securely between professionals - teachers, doctors, nurses and social workers -in public and voluntary agencies, using computer technology.

The eCare programme is supported by the Executive's modernising government initiative and the Aberdeen pilot, which started last November, expects to know next month if their application for the third round of funding has been successful.

It is designed to give people easier access to their own information, to reduce the amount of time they spend repeating information already given to another person or agency, and to give practitioners a holistic view before making an assessment.

The pan-Grampian eCare project is leading on delivering the electronic ICSR. It is closely linked to an eCare pilot scheme in Glasgow which is concentrating on developing electronic assessment and a personal care record, while Dumfries and Galloway is piloting the assessment framework developed by Glasgow to allow agencies to share information. Lanarkshire is focusing on electronic information sharing for child protection and children at risk.

"There will be eCare stores in each health board area and ICSRs will sit on each store," says Arlene Stuart, the pan-Grampian eCare project manager.

"This will mean quick access to information instead of one professional having to phone another and another, if they even know who to phone.

"Which school is the child at? Does he or she have a social worker? What's the name of the social worker? Who's their doctor? And so on. All the key relevant and up-to-date information will be on the ICSR."

A child with complex needs could be seen by 10 people all asking for the same information, she points out. "This uses up time for both the families and practitioners and can be upsetting for the families." Having an electronic integrated record should save this.

It should also help to highlight potential problems and aid early intervention.

"Suppose a pupil's attendance deteriorates," says Miss Stuart. "The system should flag up questions. Is the pupil ill? Do they need additional support? Do the parents need additional support?

"It's about raising flags and issues to give the full picture, the holistic view, and that should be an aid to early intervention."

Sharing information on a need-to-know basis and storing it electronically does raise questions of legality and confidentiality. Consent will be needed from the children as well as their parents or carers. Public information leaflets will be planned once the project has clear guidelines on data protection and gaining of consent.

The records would be stored within the protocols of NHS boards and behind electronic firewalls, with restricted access. The data would include a child's name, address, date of birth, legal status and so on, school details (name, contact teacher, support for learning teacher, attendance record and so on), medical matters (doctor, relevant diagnosis and so on) and social care information (name of social worker, assessments and so on), although the details are still being ironed out. This should make inter-agency and cross-sector contact easier.

This is just the beginning, however. Extending the report to improve child protection, for example, would have to involve the police and perhaps other authorities. Barnardo's Scotland has expressed a strong interest in becoming involved.

"Integration is not just about local authorities and health boards. It's cross-sectoral and must involve voluntary agencies because of their huge input into care from the early years on," says Miss Stuart. "Our aim is to work to common procedures across the whole of the north east in time."

Miss Stuart described the ICSR project as a "mini-Mercedes" at the moment.

"We're looking at the shortfalls and problems of sharing information and trying to establish the exact details of what the dataset for sharing will be.

"That said, the future is integrated children's services and we see eCare as a vital support to that. It's about being smart, making the best use of time and resources, avoiding waste and repetition.

"eCare will provide a holistic view of needs so that they can be addressed effectively.

"It is about getting the right information to the right person at the right time."

Although the project could not function without computers, Miss Stuart emphasises that it is not an information technology project. "It is an operational support project driven by organisational development considerations and enabled by new technology. But without the technical toolkit, we would have no project. It's crucial we implement and develop the technology within the right framework.

"In short, it's about people. It's about communication, communication, communication."


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