Challenge
The contract was awarded in 2016 to The Phoenix Partnership (TPP), supplier of SystmOne. The North East London Commissioning Support Unit (NEL CSU) Health and Justice team was then commissioned to manage the preparations for a new system and delivery of new functionality, with the overarching aim of to supporting the goal of equivalency of care between the detained estate (DE) and care provided in the community.
The DE clinical system was stand-alone and, in the main, disconnected from the rest of the NHS. As well as several upgrades, optimal use of the system was necessary to prepare for connection to the NHS Data Spine. This included standardised methods of data capture to support clear and concise record keeping, use of data to assist clinical decision making and to allow NHS England to report on performance against key indicators, national guidelines and best practice, e.g., National Institute of Clinical Excellence (NICE) guidelines.
NEL CSU embarked upon an ambitious programme of work to identify data quality (DQ) issues and to aid DE healthcare providers across all places of detention, i.e. Adult Prisons, Youth Offender Institutions, Secure Training Centres, Secure Children’s Homes, Short Term Holding Facilities and Immigration Removal Centres, to improve their DQ standards in keeping with national standards and to manage associated projects as part of the HJIS programme of work.
The NEL CSU HJIS team transferred to NECS in November 2021.
Our response
Initially the main body of work centred around improving DQ to implement the first connection to the NHS Data Spine via the Personal Demographics Service (PDS) and to enhance compliance with the Health and Justice Indicators of Performance (HJIPS) used by NHS England to assess performance in the adult prison sector of the DE. Early issues with the HJIPs would eventually lead to recognition that standard clinical templates were needed to both assess patients and to record the correct outcome data for both treatment and reporting purposes.
The following PDS compliance targets needed to be met:
- Each patient needed an NHS Number to enable PDS matching with their record in community
- DE healthcare staff needed to use smartcards to access the clinical system and conversion of sites to Position Based Access Control (PBAC) enablement in SystmOne i.e., all staff of similar derivations e.g., nurses, doctors, admin staff and managers etc. would have the same system access permissions regardless of which DE establishment they worked in
- Duplicate patient records needed to be resolved so that each patient had only one record on the system. It was acknowledged that a few historic issues may remain
- SystmOne Task Management needed improvement to reduce the number of open tasks which impacted system performance and could lead to delays in deploying new functionality such as PDS.
Additional targets were developed to help improve routine processes. In the years following the implementations of PDS and the first iteration of the NHS National Clinical Templates, several other pieces of functionality and assessment tools have been implemented. These changes helped the DQ improvement work to progress and encouraged more efficient ways of completing patient assessments and reliable forms of data capture. These include the development and deployment of the following:
- Secure Estate Assessment Tool (SEAT) – A later iteration of NHS NCTs – 2019
- General Medical Services (GMS) Data Auditing – Monthly data dashboarding to prepare for the onboarding of GMS Registration in the DE – 2020/2022
- Comprehensive Health Assessment Tool (CHAT) – A SystmOne compatible version of the assessments require in the Children and Young Persons estate – 2020
- Female SEAT – Created after serious case review into baby deaths in female places of detention – 2022
- Immigration Removal Centre Assessment Toolkit (IRCAT) – A later iteration of NHS NCTs specifically for IRCs and STHFs – 2023
- National SystmOne Health Checks – Implemented to cleanse the system of persistent DQ issues – 2023
- SystmOne DQ Audits – Designed to continue the work initiated by the Health Checks and to prepare sites for the onboarding of Methasoft Methadone dispensing system and the NHS Electronic Referral Services – 2022/2023.
Throughout this timeline, DQ projects have been executed and revisited to ensure continued compliance; this is why noticeable retention of indicators is present throughout the different audit dashboards.
It is also important to recognise that national data reporting requirements have changed. As well as the indicators themselves, this has fundamentally changed the way in which NECS is required to capture data. The best example of this is the move away from HJIP reporting via manual data collections using Excel, towards the use of strategic reporting extracts that feed directly into data warehousing and are presented as comprehensive data dashboards. This is the first data processing solution of its kind for the detained estate in England.
Outcomes
If we can return to the original indicators used to improve data quality and assemble the building blocks needed for Spine connectivity:
- Current English NHS number coverage now exceeds its new target of 90% – with a national average of 97%.
- Active users using smartcards to access SystmOne in the DE securely – 86% Q4 2021/2.
- By 2019, sites had reduced duplicate records by over 900,000 with almost 50% of sites operating at zero duplicates:
- Currently almost 70% sites operate with an average of zero duplicates and the remaining sites have less than 10 which are historic issues which cannot be resolved unless the patient returns to the secure estate.
- Currently 93% of sites are meeting the target of less than 750 open Tasks.
- In September 2017, the first set of national templates were deployed across the secure and detained estate:
- Baseline DQ audits in April 2018 show 68% of sites were meeting the 80% compliance target for Reception screening and 39% for Secondary screening
- By the end of the 2021/22 financial year, 96% of sites were meeting the 80% compliance target for Reception screening and 83% for Secondary screening.
The clinical system in the secure and detained estate has seen significant improvements via the following system upgrades:
- Implementation of PDS – 2018
- Implementation of improved medication prescribing and administration modules 2018/2019
- Implementation of the Summary Care Record viewer allowing clinicians to see summary of community clinical data for the first time – 2019
- Implementation of GMS Registrations including GP2GP electronic records transfers, local allocation of NHS Numbers and uploading summary data to the Summary Care Record – 2020/2022
- Preparatory work underway to implement SystmOne Integrated Methasoft Methadone Dispensing System 2022/2023 ongoing
- Preparatory work underway to implement SystmOne Integrated Electronic Referral Services – 2022/2023 ongoing.
None of these upgrades would be possible without undergoing assessment and improvement in data quality to ensure that the English DE was prepared for change. These additions to the original DE iteration of SystmOne combined the data quality improvement has had a real impact the electronic patient record in the DE. There is now far greater visibility of community clinical data in the detained estate and DE clinical data in community settings. There is still work to be undertaken, for example NECS is working with sites to improve their clinical template production and management and work is underway to improve summarisation of clinical records.
“The support supplied by NECS is very easy to access and use. The follow up training and courses themselves are very explanatory, useful and the ability to come to the videos as and when needed is very reassuring. The assistance provided is very thorough and understandable and there is a continuous availability to have further assistance if any queries arise, all the steps are explained very clearly.”