Lessons learnt from the Leicestershire Multi Agency Information Sharing Hub - Stephen Curtis, Leicestershire County Council

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Presentation on lessons from the Leicestershire Multi Agency Information Sharing Hub, given at the Improving Information Sharing and Management project dissemination event at the LGA in London on May 24th 2013. Presented by Stephen Curtis, Strategy & Policy Manager in Leicestershire County Council's Strategic Information & Technology Function.

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  • The MASH isn’t a safeguarding hub – there is a lot of interest in those, but that’s not what Leicestershire has developed. It isn’t a big IT system, procured from a commercial supplier. It isn’t a straightforward and easy process, without any issues!
  • Designed to address the issues that Leicestershire understand as being barriers – ad hoc sharing, conflicting cultures, confusing guidance. Ultimately, the MASH is a co-located team of enthusiastic people with expertise, committed to resolving the issue. The idea for the MASH came from having a good understanding of what the problem is.
  • This is what the MASH actually looks like – its strength is its simplicity. This gave confidence to partners to ‘have a go’ without having to commit to a longer term plan, costing lots of money. The MASH supports a number of agreed services (Children’s Centres, Health Visitors, SLF). When a practitioner thinks they would benefit from having an overview of who is in the family, and how they have interacted with services over the last 5 years, they make a request for information via secure email. Partner organisations have agreed that they are able to share information in these circumstances, and the team come from different organisations (LPT and LCC) so they review the systems they are able to access, and using their professional expertise, extract relevant information and pass it to an analyst who collates the material and puts it into a report.
  • And this is what is created. Things can change quickly in families, so the report is clearly marked as being valid only on the day of production. It also puts details of other practitioners right at the front – we respect the expertise of practitioners and want to make it easier for them to talk to one another directly to decide how best to support a family.
  • This is a genogram – essentially a family tree. This is drawn from scratch by the analyst, so it can be 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. There’s a key which apparently gets easier to remember the more you use it, but you can see that there is information on school attendance, CAF etc.
  • Finally, there is a narrative which sets out the facts that are in the report – it’s just another way into the same information, there are no opinions and practitioners are left to draw their own conclusions from the data. In this example, the narrative is organised by individual. However, in the pilot phase, some practitioners asked for the narrative to be chronological but cover all family members. Because the system is a manual prototype, that change could be made and tested straight away, and it received positive feedback – both the change itself, and the fact that the change could be made so easily. SO – what are the lessons that IISaM have been able to take from the MASH? (You can read more detail in the case study on the website)
  • The MASH is a really simple idea which is easy to express, and which seems like common sense. In Leicestershire’s case, this big idea was particularly successful because of having senior level endorsement, alongside the commitment and perseverance to get out there and persuade other partner agencies to get on board. This made it possible for individuals to champion the idea within their own organisations and drive things forward.
  • The pilot phase covered two areas within Leicestershire – Market Harborough, and Hinckley & Bosworth – and was limited to a small number of services. This reduced the risk and meant that the concept could be proved before expanding. As the MASH is an example of true multi-agency working, it required change in a number of the partner organisations, and this can’t be rushed. Related to both of these issues was the importance of getting the right governance. Leicestershire and its partners have spent a lot of time getting their governance right, which meant that when the time came to agree, for example, the proposed legal basis for the information sharing, there was a forum to discuss and agree it.
  • It takes time to get partners on board. It takes time to develop the design, and refine it with practitioners. It takes time to get engagement at all levels within an organisation.
  • The project team held requirements with representatives from all levels of an organisation – senior leaders, team managers and practitioners themselves. The closer you get to the frontline, the closer you get to the truth of how things actually work, so the design will evolve to respond to that! This also helps to build engagement throughout an organisation.
  • People go on holiday, get ill or a policy initiative arrives out of the blue. Finances get held up, new problems emerge and you start having arguments about whether it’s possible to have a fax machine. Resolving the issues will take a while and you just have to keep plodding on.
  • There is a big phase of the programme which just involves methodically ensuring that everything is in place. By keeping the MASH low tech, this enabled changes to be made at short notice. The requirements could keep evolving as new issues emerged. Getting staff on board took time – they volunteered, so were likely to be open to the idea! Their training needed to be agreed – not necessarily the same, but equivalents needed to be established (e.g. NHS IG toolkit, LCC info security module) Getting the office sorted – desks, computers, secure email addresses for everyone Documenting the agreed legal rationale and signing it off Keeping communications going – with practitioners, and thinking about how to communicate with service users. Agreeing a single information leaflet proved a big step forward.
  • Keep the solution low tech, at least at first. This enables things to be piloted and tested quickly, building confidence across the partnership. Keep the family itself in mind – how would they want this explained? How would they feel about their information being shared?
  • If you are taking a pilot approach, you need to think about how to evaluate progress. The MASH team keep an issues log, have regular meetings with partner agencies and undertook interviews and surveys at the end of the pilot phase. Gathering evidence also provides a chance for reflection, both for users of the MASH, and for the team themselves. The evidence gathered can be used to engage with new partners, to identify issues and to continue to improve.
  • This is some of the evidence gathered during the evaluation process. The customers of the MASH (practitioners) are telling the team that they get the information they need, when they need it, and that it is making a difference for families.
  • Lessons learnt from the Leicestershire Multi Agency Information Sharing Hub - Stephen Curtis, Leicestershire County Council

    1. 1. Lessons Learned from theLeicestershire Multi-agencySharing HubStephen CurtisLeicestershire County Council
    2. 2. Practitioners report that they get the information that theyneed about a family, in a timely manner“The genogram is really useful because it gives you the make up of the wholefamily” Sure Start practitioner“All the information has been relevant” SLF practitioner“More comprehensive, more rounded information earlier in the process of…working with a family” Locality Manager, Sure Start“Easy to read… provides information at a glance” Sure Start practitioner“About 40% of reports provide information which we did not already have” SureStart practitioner“Reinforces and validates decisions” Locality Manager, Sure Start“Me and the family went through [the report] and were able to agree whatactions we both wanted to address” SLF practitioner“[Using previous processes] we wouldn’t get half this stuff until six months downthe line” SLF practitioner
    3. 3. Lessons Learned from theLeicestershire Multi-agencySharing HubStephen CurtisLeicestershire County Council

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