NMAHP challenges – a digital perspective


By Mark Fleming – Nurse Consultant Digital Services /Mental Health, NHS Ayrshire and Arran and Clinical Lead NMAHPs Digital Health and Care- Scottish Government


Follow me on Twitter:  @markfleming1  or E-mail me at: mark.fleming@nhs.net

Blogs are an interesting concept, a way of writing that can be chatty, academic and a good way of sharing experiences. This series of Blogs for Digital Health Week 2018 by our National Digital NMAHP leadership team gives a perspective on their views of the digital health and care world, their personal achievements, and their challenges in the Digital Health and Care world.

In my time, I’ve written a few blogs on my personal Digital journey. One blog series reflects my journey on an Immersion study tour I had of several hospitals in the Chicago area of the United States, a fabulous experience which also highlighted the difference between our health economies and the Digital investment differences between the two.  The ayrshirehealth blog series gave an interesting perspective on healthcare provision in Ayrshire, and on a few occasions I blogged about my own digital journey. These were on the topics of Nursing Revalidation and eHealth , Service Redesigna day in the life of a digital health clinical leader,  and (my favourite) on whether Digital Health is an Evolution or a Revolution. My conclusion on that front is that it was an evolution rather than revolution, as we need to work together and take all of the stakeholders along with us on the journey.

Health and Social Care Integration

Away from my government role, I have a Nurse Consultant role for our digital services in NHS Ayrshire and Arran. As a Registered Nurse, I’m professionally aligned to the Lead Nurse (Associate Nurse Director) within the Integrated Joint Board that provides a lead role in Mental Health (my speciality); but the Health and Social Care Partnership also provides a wide spectrum of care across many specialties within North Ayrshire.

North Ayrshire Health and Social Care Partnership were one of the first to form, and they have a very close relationship with the other two partnerships in Ayrshire as well as the services provided within our acute hospital services. Ayrshire has a model that sees partnerships taking a lead role, with the North partnership having a lead for Mental Health and Learning Disability Services.

The recent Audit Scotland report on Health and Social Care Integration indicated that Councils and NHS Boards could support integration better by improving information and data sharing arrangements in order to improve access to information to support provision of care and service monitoring and planning. We hope that we have moved a long way in improving this across Ayrshire. We met with the data protection and Information Governance leads from the partners, and reviewed the information sharing protocols. We then met with our initial site to integrate the services to operationalise this. At this point many of the cultural and professional behaviours were exposed, and we had to work through these challenges as we developed our plans. As we evolved this we also developed a guidance document that could be used by other services across Ayrshire as they moved along the integration journey. We are happy to share these findings and guides for local adaptation. Key aspects, though, were:

  • Effective Staff training for all NHS and councils staff on data protection and IT security
  • Informing citizens in a variety of ways about the changes and what information will be shared and with whom
  • Explore the professional and contractual aspects of information sharing
  • Developing IT systems with role-based access controls and making systems available to staff that need them to provide care
  • Developing the infrastructure to support access to systems from NHS and Council sites
  • Aligning care and clinical pathways to reduce duplication of data collection
  • Understanding performance reporting requirements for the integrated services
  • Exploring the use of information sharing portals.

We have not fully implemented all of the above, but these are the key principles that we are working towards as we digitally support the integration agenda.

People always say ‘if only we had one single system that can do everything then all of these issues would be sorted’. I have a slightly different perspective on this, as I feel that approach will in essence potentially reduce system functionality for some professionals and we will all just migrate to the lowest common denominator of functionality. This is evident between health and social care systems, where social workers and care managers have key roles in managing care budgets and often buying services from the independent sector for citizens; they need robust finance systems to manage these resources which many NHS clinical staff will not require. It would be great if we could have a system that could do this as well as provide complex decision support to nurses to prescribe medications and support the administration of them. To me, the best of options is embedded in the approach that will be adopted over the next five to ten years by the Scottish Government as part of their Digital Health and Care Strategy.

The Strategy, which is specifically designed to be about health and social care integration, has already led to changes in the way that governance and strategy is evolving within NHS Boards and their partners. New governance arrangements are evolving across the country. Our local NHS Board in Ayrshire have consulted widely across the development of our local strategy to support the national one and are currently exploring how our action plans can support the service transformation programmes that will deliver health and social care integration.

As integration drives the care from hospital to community-based environments there are huge opportunities for integrated community services to implement new systems, or enhance the use of systems currently in use by primary care services. Our Ayrshire approach includes access to our Clinical Portal and the extension of the use of our EMIS and Care partner systems across community services and specialist child and mental health services. These digital records make it easier to manage care in both a scheduled way across our services, but also when information is needed at the time of unscheduled presentations clinicians have a much wider range of information about the patient readily at hand in order to support their decision making and where possible prevent admission to hospital.

The Technology Enabled Care Programme across Scotland has seen many projects develop how technology can support patients in their self-management but also utilise the technology to generate efficiencies within our services. Our challenge in all of this is to integrate it into our evolving care pathways but also to scale the projects up and make the technology a component of our business as usual.

Community working also requires the development of an agile workforce.  Recent contractual agreements in Scotland between the government and Microsoft will see the move to upgraded infrastructure which supports the use of Windows 10 devices and will encourage a move towards Microsoft office 365. This will support easier information sharing and will also lead to improved availability of agile devices to support community based working. This will allow staff to move from a traditional desktop environment to devices which support collection of data in homes and clinics but also engage patient better in care planning and self management.

It’s exciting times for Digital across our integrating Health and Social Care services, and I encourage our Nurses, Midwives and Allied Health Professional to embrace the technologies available to them and get more involved in the implementation and development. Only by hearing the practitioners’ voices will we effectively utilise digital resources to support clinical care effectively.

I am happy to offer any advice by email and will happily discuss any of these aspects across Twitter. Please follow our #dnmahp for all things NMAHP digital.

Mark-FlemingBy Mark Fleming – Nurse Consultant Digital Services /Mental Health, NHS Ayrshire and Arran and Clinical Lead NMAHPs Digital Health and Care- Scottish Government

Follow me on Twitter:  @markfleming1

E-mail me at: mark.fleming@nhs.net


N.B: All of this week’s blogs are also available via Scotland’s new Digital Health and Care Website If you’ve not visited yet, why not take a look at it now and tell us what you think of it via the online survey.


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