Harry Evans

At this year’s NHS Confederation conference Simon Stevens confirmed the eight areas in England chosen to evolve their sustainability and transformation partnerships into accountable care systems (ACSs). This move to ACSs – first announced by NHS England in its Next steps document – represents the next stage in integrating local health systems to deliver better, more co-ordinated care for their local populations.

To integrate effectively, it is not enough for organisations to speak to one another, their IT systems need to be able to communicate too. In the United States, where accountable care is further ahead in its development, good IT systems are seen as essential (though not sufficient on their own) to delivering on the promise of better health outcomes.

So investing in technology will be a crucial success factor for ACSs, but in an environment where money is tight, the benefits of technology need to be clearly articulated. Investment needs to be focused on where it will have most impact on delivering the triple aim of improving patient experience, improving population health, and reducing costs.

At the heart of this is the shared care record. Shared care records overcome the problem of IT systems in different NHS organisations being unable to communicate, by creating a detailed digital patient record accessible to everyone involved in a patient’s care whether they are working in primary, community, secondary, or even social care.

The eight emerging ACSs all have plans to develop shared care records, but progress is varied. Dorset has commissioned the development of a shared care record, and will begin implementing it later this year. In Berkshire, the Connected Care programme is already being rolled out across the local health and care system.

In other parts of the country, shared care records are beginning to deliver benefits. Greater Manchester is starting to use its shared care record to identify the fraction of its population who use a third of emergency care provision and find more cost-effective ways of supporting them. Bristol’s Connecting Care programme is delivering significant benefits for clinicians, for example, by reducing the amount of time spent undertaking pre-operative assessments.

In the future, areas with shared care records will be at an advantage when it comes to delivering on their responsibilities to their population.

• Shared care records will allow a rich understanding of the local population. Detailed patient information available from these records would allow more complex and accurate risk modelling across a local population, identifying high-risk patients who need closer attention from services.
• Sharing records could also give a more complete picture of a patient’s journey across different services. Currently, services know what happens to a patient within their organisation, but have little idea about what happens beyond that. This makes it hard to know the best way of organise services to deliver care for the population, including where a new model of care could be considered to improve care and use of resources.
• Shared care records can also directly benefit patients: patient-facing records are one example of this, but other potential benefits include engaging people with long-term conditions in self-management, or clinicians remotely interacting with patients with long-term conditions to understand whether they need further support.
• But it should be remembered that at their heart shared care records are about achieving a better experience and better care for the patient. Shared records are designed to ensure that an individual does not need to tell their story again and again to different clinicians. This can improve safety and efficiency, but also makes what is often a difficult time for patients more tolerable.

Delivering these benefits requires three things: the appropriate technology, the right governance structure and a culture of adoption. Appropriate governance involves complex negotiation with different organisations, while promoting a culture in which staff recognise the benefits of using technology and are engaged in its development is challenging, especially when a number of organisations are involved. But there’s more: as last year’s Wachter Review highlighted, making full use of this data means investing in people with the skills and time to make that possible. Realising the potential of shared care records will require strategy, maintenance and dedicated people and time.

Despite these challenges, the benefits of sharing information are clear. Getting a shared care record in place and used successfully, and consistently, requires many of the same collaborative practices – infrastructure, governance and culture – that are needed to create an effective accountable care system. Shared care records are also a facilitator for many of the changes accountable care systems hope to bring about, such as more integrated care and earlier intervention for high-risk patients. If sharing information is seen as an optional extra, too expensive or too hard to be implemented by emerging integrated systems, we might question whether we are being too optimistic about the ambitions for accountable care in England.

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