Fixing eyes on the goal

Communications and engagement manager Tony McDougal has been involved with the Dorset Care Record since its launch 5 years ago. In his farewell piece, he highlights the triumphs and frustrations encountered on the shared care record’s journey.

It’s been an amazing five years. A privilege to provide the communications, engagement and at times, training, for our shared care record. There have been many mountains to climb. Valleys to tumble into. But buoyed by an incredibly resilient and supportive team, we have become a mature and sought-after care record.

It hasn’t always been so. We hadn’t, perhaps naively, anticipated issues around consent. Every partner had a different opinion. Council adult services, well versed in asking for consent every time they saw a patient, were at odds with acute hospitals Emergency Departments. ED clinicians said it was impossible to ask for consent for someone being carried in unconscious on a Friday night.

It meant, at times, some fraught discussions, but light at the end of the tunnel came in the unlikely form of the GDPR legislation. The Information Commissioner’s Office (ICO) said the way forward was through taking a Discussion to View approach, meaning that at some point during the patient’s journey they would be asked if they were happy to have their records viewed by those treating them.

With a leaflet drop to every household in Dorset, a radio advertising campaign, case studies and mandatory training needed for every prospective DCR user, we were given the green light. We were on our way.

Our acute hospitals have been fantastic at getting feeds into the DCR, working tirelessly to ensure that demographics, encounters, radiology, allergies, and clinical correspondence (letters) were in the shared care record at the earliest opportunity, providing real support for our local authority and community health partners. Dorset County Hospital led the way delivering all their feed within less than two and a half years.

Local government reforms were another curveball that we weren’t anticipating. Dorset County Council became a unitary authority, Dorset Council, losing its district councils. Bournemouth Borough and Borough of Poole became Bournemouth Christchurch and Poole Council. It meant significant time and energy was spent on reorganisation. And with adult services in Poole using Care Director and Bournemouth on the Mosaic platform, considerable amalgamation was necessary. It meant that DCR moved down the priority list.

Indeed, our partner landscape has changed appreciably. Two of our acutes – Royal Bournemouth and Christchurch Hospitals and Poole Hospital – have become University Hospitals Dorset; there has been a reshaping of primary care and merging of GP practices along with a new NHS Dorset Integrated Care System.

With partners having separate aims and aspirations and travelling at different speeds, patience, mediation and goodwill has been needed to keep the care record moving forwards.

Covid hit us in ways that we couldn’t foresee. It meant engagement opportunities were limited to Teams discussions. Face to face gatherings, even with masks, were impossible. But the demise of hospital appointments meant a greater reliance on good records. And the launch of Single Sign On, direct from partner systems, meant that access to DCR was available at a touch of a button rather than through the more laborious portal system.

We lost a real digital and care record advocate in GP and NHS Dorset chief clinical information officer Craig Wakeham in the early days of Covid. The scale of the pandemic was extraordinary with virtually every family affected through illness or loss of loved ones.

It led to calls for Yeovil Hospital and community pharmacies to have access to the DCR, which we granted in 2020. Around 40% of inpatients to Yeovil are from Dorset and clinicians were struggling to get information about their past medication history. And pharmacists, such as David Rose, from Marnhull, were delighted: “You get answers to queries and you can sort out the problem – you don’t have to come back to it or chase for answers later if someone hasn’t got back to you.”

As the care record has matured and functionality developed, usage has grown. We are now seeing nearly 6,000 health and care professionals trained to use the DCR. Nearly 100,000 patient record views were recorded last month (Jan). Interest has grown from third parties, contracted to provide specialist support for our key partners.

It means that dementia specialists at Help and Care, drug and alcohol and veteran service staff at Avon and Wiltshire Mental Health Partnership and end of life nursing teams at two of our hospices have joined the care record. They see its value in the coordination of care for patients and their families. And that surely is the point of shared care records.

Covid’s sad legacy is of an ailing population who have been too frightened or not wanting to bother GPs and hospitals of their symptoms. Death rates continue to be well above the long-term average.

The need for shared care records, not just in Dorset, but sharing with Hampshire which we are hoping to achieve later this year, are vital.  This is an issue of health and social care inequality because the DCR is helping to deliver better care for all, including the poorest, who are often least well served by our current services.

There are things that I am very proud to have achieved:

• Being highly commended for our communications and engagement work around consent models and, separately, for our benefits work.
• Driving up the number of records accessed to 100,000 a month and getting nearly 6,000 trained users. This has been achieved through different communications channels – around 70 cases, 30 blogs and lots of face-to-face meetings
• Speaking at the King’s Fund breakfast session on getting the DCR to maturity – one of the scariest presentations of my life!

The drive for a national shared care record must not be lost. Putting it simply, data saves lives.