Feature

posted 1 Jun 2006 in Volume 3 Issue 1

In good hands?

Vulnerable children have a right to expect the very best care and protection that their local social services department can offer. In order to deliver on that promise, local authorities are under pressure to capture and record all details of their cases electronically by October 2006.

By Jessica Twentyman

It took the death in 2000 of Victoria Climbié, an eight-year old girl living in East London, to make the UK government realise that something was seriously wrong with the way that social services departments were capturing, archiving and sharing details of their interactions with vulnerable ‘service users’.

Lord Laming’s inquiry into the horrific abuse and eventual death of Victoria at the hands of her great-aunt and her partner uncovered "a catalogue of administrative, managerial and professional failure by the services charged with her safety", he concluded.

In the ten months that she lived in various London boroughs, Victoria was known to no fewer than four social services departments, three housing departments and two specialist child protection teams of the Metropolitan Police. Furthermore, she was admitted to two different hospitals because of concerns that she was being deliberately harmed and was referred to a specialist children and families centre managed by the children’s charity, the National Society for the Prevention of Cruelty to Children (NSPCC).

In the borough of Ealing in West London, the practice guidance available to front-line staff when they came to deal with Victoria was so out of date that it pre-dated the Children Act, 1989 – legislation passed before Victoria was even born.

In Brent in North London, Victoria’s case was given no fewer than five ‘unique’ reference numbers. Retrieving files, Lord Laming was told, was "like the National Lottery, and with similar odds" of success.

In the seven months that Haringey, also in North London, was responsible for the protection of Victoria, the few conversations between her and her social worker hardly progressed beyond, "Hello, how are you?".

After her death, Haringey could not even secure Victoria’s file with the result that vitally important sections of it went missing.

Police, charities and hospital workers who also came into contact with Victoria similarly failed to record details of her case, or of their own observations and suspicions, with the result that follow-up action was never taken. Worst of all, Haringey Social Services closed Victoria’s case, deciding that no further action was needed, on the very day that she died.

It was against this background that the Department of Health conceived the Information for Social Care initiative. The idea was to create a more strategic approach to social care through IT. This would involve creating a nationwide system of electronic social care records (ESCR).

Each record in this system, it was envisaged, would represent an individual service user. Contained in each record would be all the data and information relating to the work of social services, health workers and police with that individual: letters, e-mails, visit schedules, social worker case notes, contact sheets, audiovisual records and computer records. This would eliminate the need for paper files, which are often inaccurate, unavailable or simply lost.

Under the December 2003 government white paper, ‘Defining the Electronic Social Care Record’, an ESCR needs to be capable of storing three types of information:

1) Structured information

Information typically recorded on forms, including:

Nationally used forms (such as those for children’s recording);
Local forms;
Forms completed by service users, such as self-referral or financial assessment forms.

On many of the forms, there will be coded data alongside the other recording. For example, most forms have at least the name, address and date of birth of the service user.

2) Unstructured information

This covers all other recording, including that originating outside the agency. This will include:

Letters;
E-mails;
Records of phone calls (both written or taped);
Notes of meetings;
Video clips.

3) Coded data

Coded data may form part of the structured recording and includes any data used for management and statistical reporting purposes. This might include, for example, the time taken to resolve an issue when a member of the public has reported concerns about the welfare of a particular child.

For the 150 UK councils that have social care responsibilities, deadlines for implementing the ESCR are looming. By October 2006, all live case files must be captured and held electronically.

Two other deadlines have already passed. From October 2005, councils were expected to be able to store documents in all new cases electronically. By April 2006, their systems for handling that had to be capable of holding audio and video files as well.

Tight schedule

For many, the tight schedule for meeting the targets has led to ‘quick fix’ approaches that will meet the minimum requirements for the electronic storage of social care records: the purchase, for example, of new scanning equipment and the storing of files on shared network drives.

Some have not even done that much, claims Simon Forster, sales and marketing director at Diagonal Solutions. "I’ve spoken to lots of social services directors and the reality is that they interpret the deadline as having their thoughts on these issues organised, rather than investing in IT to develop a system that meets current best-practice thinking in records management," he says.

That is understandable: conservative figures suggest that a typical social services department has somewhere between ten million and 15 million existing paper-based records needing to be converted into electronic format.

In order to store those records in a way that meets government deadlines, social services departments need to implement a records management system that complies with the UK’s National Archives standard for record management (TNA 2002). Most TNA 2002-compliant records management systems offer a file plan – a set of labels that describe the information structure of an organisation.

In order to provide a good fit for social services departments, records management software suppliers, such as Diagonal, Tower Software and Vignette, have designed a specific file plan for them. This, in turn, needs to be integrated with a social services department’s existing client index system.

It is a huge task, says Carl Hancox of Leicestershire Social Services (LSS). "We’ve looked at the government deadlines and decided they’re not very realistic. This is a huge change and involves a long-term investment. We’d rather get it right than meet a deadline."

With the goal of ‘getting it right’, LSS has used web services technology to integrate its existing client index system with the Diagonal Wisdom Document and Record Management system. That has created an information platform that meets all the ESCR guidelines as laid out by the government.

For example, when a new service user is entered into the index system, the required electronic case file folder structure is automatically created within the Wisdom file plan. Because of the way the integration is being implemented, LSS users can continue using the familiar client index system interface, Hancox explains, with all the document and record management functions taking place in the background.

This approach minimises training and change management requirements and enables secure remote access to electronic case files from any council location, as well as enabling mobile offline working using laptops or tablet PCs. "For example, social workers visiting a service user in their own home can download blank or partially completed electronic forms and fill them in off-site, then automatically synchronise the data when reconnecting to the council network," he says.

At present, LSS is coming to the end of the pilot stage for the new system and is now rolling it out to end users. The first service to have access to the system will be Leicestershire’s adult social care unit. The learning disabilities unit will have access to the system by March 2007, and social workers within the council’s children’s social care services will have access some time after that date.

Way ahead

Research suggests that Leicestershire is way ahead of other local authorities on its electronic social care record plans. An October 2005 survey conducted by Community Care magazine revealed that only a quarter of children’s service staff believed that their departments would be ready to go live with electronic records by the deadlines laid down by the government. Eight per cent still did not have access to a computer, despite more than half believing that an ESCR system would be the best place to store serious child protection concerns.

Another barrier to the implementation of ESCR remains the serious question that need to be answered of data protection. Councils must decide who has access to case data, and how to maintain client confidentiality and security. To make matters more complex, as part of the National Health Service’s (NHS) national programme for IT and the plan set out in ‘Every Child Matters’, the government’s response to the Climbié murder, each social services department is expected to be able to share its data with both the education sector and the NHS.

It is still unclear exactly how the various electronic social care records

of each council will integrate with the NHS’s Care Records Service. The NHS programme has deliberately avoided getting bogged down in social care, considering that it has enough on its plate as it is just computerising the UK’s patient care records. At present, full integration with social care is not on the timetable until 2010.

Some government policies require data to be shared between health and social services before that date. One is the single assessment process, the plan for the NHS and social care services to share assessments of clients’ needs. The idea is to avoid making repeated visits to the same home just to collect facts that another organisation already has on file.

"One of the major problems is that the different departments that exist under the children’s services banner have conflicting agendas. This makes it difficult to agree on what the new frameworks should look like, where resources should be allocated and who is ultimately accountable," says David Loyd-Hearn, a consultant at public services systems integrator Serco and himself a former social care practitioner.

Another problem, he says, is that culturally, professionals have been used to applying discretion when it comes to their client’s situation and closely guarding the information surrounding them – often told to them in confidence. "There are fears around the lack of understanding of the Data Protection Act and this does not help the situation," he reports.

At many local authorities, strategic directors have been appointed to help provide direction to this issue, says Loyd-Hearn.

They will need to convince those within their charge of the merits in the ways information can shared in a protective environment."Giving people the opportunity to experience and move towards a plan of shared working practices is the key to generating trust and building effective partnerships," he says.

Case study: Bradford Social Services

Ian Sampson, e-care manager at Bradford Social Services, knows more than most about the importance of record keeping when working with vulnerable members of society.

A former Detective Chief Inspector, Sampson was a policeman for thirty years and was directly involved in developing police systems within the force, before his retirement from the force in November 2001.

In the three years he has been at Bradford Social Services, he has seen a major change

in attitudes towards the use of computers. "When I joined, Bradford was rather behind the times. Social workers had very little computer access," he recalls. "But we went from 15 social workers to one PC in early 2003 to a ratio of one-to-one by early 2005. Now we have 750 client devices in total, including PCs, laptops and tablet computers."

At the same time, Sampson has overseen a service-wide adoption of server-based software to handle management and administrative functions. When he joined the Council in 2003, the Oracle-based SWIFT social care system, developed by Anite, was being installed. SWIFT helps social care practitioners tackle the challenges and issues posed by new operational practices and constantly changing legislation, while also providing an extensive and flexible database for all aspects of record keeping. The SWIFT system for Bradford went live in April 2003.

The second phase in building an integrated children’s service for Bradford’s social workers was to install a document management system. While SWIFT provided the council with the ability to record and access structured information, a document management system was required to handle information contained in letters and other written material. The council selected CareStore, which became operational in October 2004.

According to Sampson, the third and final stage was, "to find a means of inputting and outputting information to and from both SWIFT and CareStore to front-line social care workers, and other relevant agencies. We recognised that we needed an electronic forms system to capture and deliver information."

Ebase Technologies’ ‘software development framework’ was therefore installed at Bradford in 2005 with the plan to start developing a series of electronic forms, integrated with its back-end databases. However, according to Ian Sampson, his team quickly saw that the product offered far more than just the ability to develop e-forms. "We had previously tried to use our own in-house Oracle reporting skills to develop user-friendly web-based outputs from SWIFT. Although we’d proved the concept, we knew that we didn’t have the right delivery mechanism. When we saw what Ebase could do, we knew we had the answer."

Shifting its view of what Ebase could be used for, Sampson’s team is now working on the development of a portal which will provide social care workers with browser-based access to records and reports, core applications and favourite network links.

Access levels and authentication will be handled by SWIFT with the Ebase software providing a front-end to all the information which is appropriate for the individual user. Several standard reports are being developed to help the social workers carry out their everyday duties, with considerable emphasis being placed on clarity of navigation, automatic population of the basic information (drawn directly from SWIFT) and the use of design techniques to improve efficiency and avoid errors.

ESCR: The schedule

Any Council with Social Services responsibilities needs to comply with the ESCR implementation timetable as follows:

Target 1: October 2005

All new documents created or received for new cases are now to be made electronically retrievable.

Target 2: April 2006

Audio and video documents for all new cases must be stored and retrieved in electronic format.

Target 3: October 2006

All new and pre-existing documents, including audio and video, for current cases, must be retrievable electronically.

ESCR: The Benefits

According to the government publication, ‘Defining the Electronic Social Care Record’, having a record in electronic format can enhance the responsiveness of services in a number of ways:

It makes managing the volume of material to be recorded easier;
Records can be available 24 hours a day, seven days a week;
Records can be accessed from remote locations (ie: you do not have to be in the office where the physical records are stored in order to get hold of the record);
Several people within an organisation may access and update records at the same time, for example an occupational therapist and social worker may work together to support a service user; a fostering-specialist worker may work with a child’s social worker, this can only be achieved with sharable electronic records;
Selected material from records may be shared more easily with partner agencies where services are delivered by a number of organisations;
Service users can more easily be provided with access to their own record;
Records can be transferred between local authorities when service users move, enabling a more consistent, continuous service to be maintained;
Establishing common standards of recording should enable staff moving between jobs or covering for colleagues to more easily familiarise themselves with the record they are working on, and so provide a better service;
Additional security can be provided, with backups, rather than just one file.