Multi agency working in Leicestershire - Liz Clark, Leicestershire County Council
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Presentation at the Improving Information Sharing & Management dissemination event at the LGA in London on May 24th. Presentation by Liz Clark, Assistant Director for Information and Technology, Leicestershire County Council.
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Multi agency working in Leicestershire - Liz Clark, Leicestershire County Council
- 1. Multi-agency working The people factor Liz Clark Assistant Director Leicestershire County Council
- 2. Multi agency information sharing - The People Factor Liz Clark Leicestershire County Council
- 3. “Council offices destroyed by fire”
- 5. …lead to better information sharing ?
- 6. “Council offices destroyed by fire”
- 8. • Drug user • Not registered with a GP • Regularly stops over and shares rooms with younger children •Pregnant • In on/off relationship with father-to- be • Allows her boyfriend to stop over and use drugs in the home • Unemployed • No qualifications • Wanted to be a hairdresser but discouraged from working in case family loses benefits entitlement • Previous request for alternative accommodation turned down as low priority •Smoking cannabis •Being referred to Adult Mental Health by GP • Frequently late for school • Often arrives at school inadequately clothed, hungry and dirty • Is on an ABC for anti-social behaviour • Regular truant from school • A permanent case for his exclusion is due soon • Constantly placed in front of television with little interaction from the rest of the family • Does not attend local Children’s Centre • Seen wandering around estate without appropriate shoes and clothing • Has Attention Deficit Disorder (ADD) • Frequently late for school • Often arrives at school inadequately clothed, hungry and dirty • Bullied at school about their appearance • Seen wandering around estate without appropriate shoes and clothing •Mental Health referral being sent to Child & Adolescent Mental Health Services • Owes money to loan shark • Alcohol dependant • Suffers from anxiety and depression • Suspected victim of domestic abuse by Jason and in previous relationships • Mistrusts public services and worries she might lose her children • Unaware of support available • Ignores the advice from her GP • Poor literacy • Mobility problems •Often sleeps-in and unable to help the children get ready for school •Known to IAPT Service (ref-anxiety and depression) • Large rent arrears • County Court Judgement • Benefits dependant • Family has poor diet • The children have a better relationship with their grandparents • Live in poorly maintained 3 bed Council house • Multiple calls to Council for repairs to property • Neighbour complaints about the condition of the house, noise, rubbish and vermin sightings at the property • £12 per week reduction in Housing and Council Tax Benefits to recoup overpaid benefits after receiving a caution for not declaring previous partners living at the property • Drug dealer • In and out of prison • Regularly stops over and shares rooms with younger children • Regularly violates terms of his probation order and visits the property
- 9. Why dont people share ?
- 10. Why don’t people share ? • Don’t know what to share • Lack of trust in other agencies • Fear of consequences • Complex language • Don’t know how to share • Interpretation of information • Conflicting guidance • Lack of training • Legislation
- 11. • IMAGE
- 13. The MASH
- 16. • “[Using previous processes] we wouldn’t get half this stuff until six months down the line” SLF practitioner. • “Excellent, really… fantastic” SLF practitioner. • “A lot of families really struggle to tell you what’s happened… it’s quite personal, it’s their lives and when we say what we know [through the family summary report] it’s almost a sigh of relief to them, ‘Thank God I’ve not got to go through all this [again]’” SLF practitioner. • “It’s refreshing that [the MASH] are open to continuing improvement… usually new things come and and [we’re told] ‘this is the way it’s going to happen.’ But it doesn’t always work… this has been tailored to our needs” SLF practitioner
- 17. What made it possible ?
- 18. Tackle the Barriers • Took the decision about what to share and how to share away from practitioners • Addressed the IG issues upfront • Put a systematic process in place • Provided training
- 19. Focus on Outcomes • Use case studies • Identify the benefits • Make it real • Seek endorsement
- 21. Engage at all levels • Board level • Operational managers • Practitioners • Information Governance professionals
- 22. Get the governance right • Strategic IM group • Multi agency representation • Senior level nominations • Task and Finish for IG work • Focus on IM capabilities
- 23. IM Capabilities IM Practices Information Retention and DisposalInformation Sharing Information Quality Information Search and Retrieval Information Security Information is shared with confidence and purpose Information Storage Agencies work collaboratively Efficient and effective ways of working are applied One version of the truth is maintained Consistent standards are applied Secure information management environment IM OutcomesShared systems and processes are used Improved access to information and services Improved access to services Barriers to sharing are overcome Improved outcomes for service users Efficiency savings made Early interventions are performed Service user needs are understood and met Improved levels of confidence in agencies
- 24. Spread the message • Make it relevant • Keep it simple • Identify the benefits • Find others to champion the cause!
- 25. Final thoughts…. • Not about legislation, not about technology. It ‘s about people and culture. • It’s too important to leave it all to IG professionals. • Get information sharing on the agenda at the most senior levels. • Make it relevant (find the ‘burning platform’). • Keep it simple. • Find out what the benefits are for partners. • Keep talking about it. Use the IISaM toolkit!!
- 26. Multi-agency working The people factor Liz Clark Assistant Director Leicestershire County Council
Editor's Notes
- Talk today about how we’ve approached information sharing in Leics Not overcome all of the issues, but we’ve made some progress Importantly IS is now high on the agenda at a senior level Want to talk about what we’ve done to make that possible Start with two important events -
- First is a fire which took place on May 30 th 2008 Offices of Melton Borough Council Made everyone think about their BC plans. Bold decisions also provided some opportunities…
- Second, more prosaic, was a Review of Information Governance amongst the key partner organisations which we undertook about 2 years ago… Outcome of that was –
- New offices of Melton Borough Council The fire literally provided a Burning Platform Melton response – use this as an opportunity for co-location and multi agency working. Opportunity to think about IM issues to make co-location work.
- In 2010 Series of workshop with all agencies directly and indirectly involved in co-location project. 50 – 60 people – practitioners, managers, GPs, local schools, DH, ICO Explore the extent of information sharing, what worked and what didn’t work.
- Created a ficticious family – The Buttons. Only gave part of the family picture and the scenario to each agency – as would happen in real life. Began by asking them, in the organisation groups – given the info they had, how would they have responded. We then mixed up the groups, so that people from differnet orgs brought together. Now had a more complete picture and asked again, with the new information – how they would respond. Profound exercise, and responses were very different .
- In the follow up event, With the same people We focussed on the barriers. With the experience of the exercise, we asked them about what prevented them from sharing information
- Didn’t know what they were allowed to share. And even if they did – uncomfortable about practically how they should share it. A number of different routes, which varied from org to org. Fear of the consequences of sharing inappropriately – internal sanction Feeling that they didn’t know how the information would be handled if it was shared with another org. What came across was the amount of guidance - Sunflowers Lack of training - Sheep dip And then there was confusion about what legislation allows or not. Balance of risk was perceived to be heavily on the side of not sharing
- What emerged very strongly was - Heavy reliance on informal networks. Trust is based on existing relationships. These break down when someone leaves.
- So when TF came along, good understanding of the barriers. and the right arrangements in place to tackle the IG issues. A reformed IM group Right organisations More strategic Right representation Senior level Also means that discussions about IS have a home….can join up. Challenge from our SLF Programme was to ‘dare to share’ and to not let DP ‘get in the way’. Sense of urgency, but not a lot of clarity about what people wanted to share…they just knew they needed to share something!
- As response was to think about a simple solution to meet the needs of front-line practitioners. We wanted something simple that addressed the barriers that we’d previously identified. Not going to go into detail about the MASH because colleague speaking later
- This is part of the Family Summary that the MASH produces This is a genogram – tailored for each case, and the MASH team can work out from their records who fits within the family. This means that other generations, such as grandparents, can be included, or if the parents are separated, they can still be represented within – it doesn’t just have to mean household.
- There’s also a timeline for each family member, showing their interactions with services.
- Evaluation – some direct quotes Highlight the real tangible benefits to practitioners and the families they are working with. Quotes are worth much more than any theoretical benefits we might promise. Endorsement
- Now expanding MASH Useful to reflect on what we think made it possible to make progress
- Effort into understanding the barriers - designed a solution to address them. MASH replaces individual practitioner decisions about what to share, when to share and how to share. It builds information sharing into their business processes, but doesn’t take away the need for practitioners to talk to each other – it just means they have a better starting point. We considered the information sharing / data protection / IG issues up front. Don’t have to be thought through each time. Where it worked best, its been built into business processes.
- Referral made by a primary school teacher for a child exhibiting very challenging behaviour in school. Number of fixed term exclusions. Referral made reference to previous social care involvement and an impending court case. Family Summary provided a much broader picture of the family – Mum and child moved to the County a year ago. Within previous 2 years child had been subject to a Child Protection plan because of abuse by mum’s then partner. In addition, Child’s birth father had died from alcohol related illness and two older siblings had left family to live independently. Clear from chronology that deterioration in behaviour coincided with court case for former partner.
- A quote from a practitioner about the family summary – ‘ Mine was massive, it went from three practitioners to, I think twelve practitioners. Before I did not have a clue what was going on, which services; because they were confused themselves…. … They had so many appointments they didn’t know what appointment was for what thing … …You’ve got audiology, speech and language, all kinds of different things; they were getting confused themselves… …but when we put the names in front of them, “Oh yeah, I remember that name” and “Oh, they discharged from that”’ RL : (There’s enough information) for us to have the (right) conversations’
- Need to get buy in at all levels. Were able to get IS on agenda of senior partnership meetings, chief exec level representation. How ? – by making it a conversation about benefits, by linking it directly to current issues and programmes and by speaking in plain english Operational managers – fortunate in finding a pilot area where service managers working together between Children’s Health and Children’s Centres. IS working in some localities but not others – symptomatic of individual professional networks . Provided platform to trial the MASH and a more systematic approach. Interesting lesson in designing the process / requirements – practitioners closer to the reality. Need to recognise that you can’t just tell people that this new tool is available – have to talk to them, understand their concerns, their culture – e.g. HVs Its about change management. And finally, but by no means least – really important to get the IG people engaged and in the right mind set.
- SIMG - Key partners. Leicester City, districts, health trust, police, voluntary sector, job centre plus. ICO. .Senior representation. Using that group to work consistently together, to focus on IM capabilities, aligning IM policies where its appropriate. Get service leads to work with the IG people in their own org, as well as working with them direct.
- Comes from some which we did with Loughborough University, looking at IM outcomes, and the IM practices and IM capabilities. About making good IM practices relevant Helping to see the links between IM skills and capabilities, good IM practices and outcomes
- Lost count of the number of groups we gone to talk to about the MASH. Now at the point where people are starting to come to us to talk about using the MASH