Electronic Up Heaval

    You know you had your hands on it yesterday, but in the space of
    24 hours that critical piece of paper has vanished. Panic sets in.
    What on earth did you do with it? Could you really have been so
    stupid as to throw it away? Five minutes and a frantic rummage
    later, you finally locate it, hiding under a book.

    We’ve all experienced such paper-panic, but for social services
    staff, misplaced papers are soon to be a thing of the past. By
    October this year all social services departments must be able to
    electronically store information about new service users, and by
    October 2006 this needs to have been extended to all current cases.
    The aim eventually is for all documents in every case to be kept
    electronically.

    In theory, the electronic social care record (ESCR) is set to
    revolutionise the way services are run. Service users’ details will
    be available in one place, including statutory recording forms,
    financial assessments, letters, e-mails, and notes from meetings.
    These records will be available 24/7 and practitioners will not
    need to be in the office to access them. Different workers will be
    able to update records at the same time and being able to access
    electronic records will help new and temporary staff to get up to
    speed.

    Anyone familiar with social services bureaucracy will be fully
    aware of the enormity of the task involved in transferring all
    documents into an electronic system. Councils are at different
    stages of the process but it seems that a fair number have made
    good progress towards meeting the government’s targets. In August
    last year a survey of 93 English authorities found that nearly half
    were able to electronically store and retrieve social care records.
    By contrast the government had anticipated that only 20 per cent of
    social services departments would be doing this by October
    2004.

    That’s not to say that implementing the ESCR has been easy. Mike
    Custance, head of information systems at Hackney social services
    department, was seconded to the Department of Health to work on the
    ESCR project. He says that introducing the electronic record
    requires a dramatic shift from practitioners.

    “It’s a culture change from handwriting on bits of paper to
    recording on a computer system. That’s a big change,” he
    says.
    As in other authorities, the paper file is currently the prime
    source of information in Hackney. While staff record details
    electronically they then tend to print them off and file the
    papers.

    About one third of files in Hackney cannot be found straightaway.
    An electronic retrieval system should significantly improve this
    statistic, but in order to be able to use it effectively, staff
    need the necessary IT skills. Custance says that more recently
    qualified staff use the new technology confidently but those who
    have been in the workplace for longer have more difficulties with
    it.

    Ultimately, the implementation of the ESCR means that more
    practitioners will need to carry laptops with them on visits and
    the practicalities of this need careful consideration.

    “There are parts of Hackney we don’t want people to take a laptop
    out to on a dark winter’s evening,” says Custance.

    Each local authority will have its own electronic demons to face.
    In East Sussex, all new users of older people and physical
    disabilities services in one part of the county, Eastbourne, now
    have their records kept electronically. When the system was
    introduced, practitioners had to grapple with a software
    crisis.

    “Basically, the software wasn’t ready to go. For three or four
    months it was absolute bedlam as we had scanned all the files but
    couldn’t get into the records,” says Ray Hart, assistant director
    in the social services finance and business support team.
    Two years ago the council started scanning old paper records into
    the system and has so far scanned 17,000 adult files and 20,000
    financial assessment files. But the scale of the process has been
    overwhelming. Four people have been employed solely to scan in
    documents and, although about 500 files are completed each week, it
    still cannot be done fast enough.

    As for practitioners, they can see the potential of the ESCR system
    but are “going through the pain”, says Hart – and they are not
    alone with having concerns.

    “The admin staff are deeply worried about what we’re doing. They
    can’t see any work for them in the future,” he says.

    The plan in East Sussex is to roll out the ESCR to children’s
    services by the summer. Meanwhile, Hart has advice for other
    authorities: “Start now. Two years on it’s amazing how much we
    haven’t done. Work out how much you have got to do. When you look
    at how many files are in your offices and the data around them –
    it’s huge.”

    ERIC IS A ‘GODSEND’  FOR GLOUCESTERSHIRE 
    By October 2004 Gloucestershire Council had introduced electronic
    social care records for all new service users in children’s and
    adults’ services. The system, Electronic Records for Integrated
    Care – or Eric as it is fondly known – was piloted in seven areas
    before being rolled out to about 650 practitioners. 

    Eric builds on the previous client service system – the Star system
    – but requires more of an  internet-style navigation. Information
    can be typed directly into the system or forms can be inputted
    using one of the 50 scanners that have been installed around the
    county. A unique bar code identifies the service user and after a
    document has been completed and filed in the system it cannot be
    altered.

    In addition to introducing electronic records for new service
    users, it was decided that documents could be added electronically
    to existing service user files provided all the case information
    had been scanned into the system. Fine for adults’ services where
    case files tend to be 20-50 pages long, but not so easy
    elsewhere.

    “We underestimated just how thick the files for children were. If a
    looked-after young person has been in care since birth there could
    easily be 1,500-2,000 pages,” says Alan Miles, the council’s ESCR
    project manager.

    Consequently it was decided that, in large cases, paper files would
    remain until the final referral, from which point the records would
    be electronic.

    The next phase of implementation will see support staff brought on
    board with the ESCR. At present the council is continuing to run a
    dual recording system with paper social care records also
    kept.

    From a practitioner’s view, Eric has made the job easier, says
    Kathryn Atty, assistant home care organiser at the council.

    “For what I have to do it’s been a godsend,” she says. She often
    needs to retrieve data in her job and Eric provides her with all
    the stuff that would normally be in a paper file, including the
    user history and care plan. 

    Using Eric has also made things clearer. “I don’t have to worry
    about hand-written care plans and when I have to fax agencies or
    other providers there’s a good clean copy, so that makes
    communication easier,” she says.

    Atty says she would not want to go back to the old system. “I can
    pull up information in 30 seconds. Before it could take me five
    minutes.”

    Her advice to other practitioners? “Just stick with it because it’s
    worth it.”

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