Horizontal Integration

Extending the reach of health and social care services through horizontal applications

A decade or so ago, organisational boundaries were well established and personnel were sure of their place. Health and social care agencies enjoyed a straightforward relationship with their patients and service users, their regulators and suppliers. Internally too, rigid hierarchies created a well recognised chain of command. The ensuing years have seen the gradual transformation of this landscape, driven by a combination of increased public expectation and the government’s vision for both greater quality and efficiency in public service delivery.

The need for a tighter co-ordination of efforts from health and social care agencies has been integrated into a range of government initiatives - designed to streamline services around the patient or service user. To achieve this, structures have been remodelled to create multi agency teams operating across a range of organisations. This horizontal integration of information across multiple agencies is demonstrated in the Single Assessment Process, where multi agency teams have been created across Primary, Secondary and Social Care organisations with an increasing use of pooled budgets and joint funded posts. The ‘Our Health, Our Care, Our Say’ White Paper reinforces this approach with the use of Integrated Care Plans for adults from 2008 onwards.

Horizontal integration has been a pre-requisite across Children’s Social Services for some time. In 2003 the Information Sharing and Assessment initiative (now replaced by eCAF) was announced to enable agencies including health care, education and social services to work in collaboration.

In addition, the recent introduction of an Integrated Children’s System into Local Authorities will hold a holistic view of a child’s needs by combining information from health, education and social care. In a further development of this approach, the national ContactPoint initiative scheduled to begin roll out in 2008 will involve access to information by a wide range of professionals involved in the care and protection of vulnerable children.

These new organisational models with their greater reach, demand a new technological approach – the horizontal application. Attempting to expand the use across a number of organisations of an IT system originally designed to meet a single organisation’s requirements just won’t work. Such ‘line of business’ applications are not sufficiently scalable. Neither do they have the granularity of security to ensure access to information in line with agreed information sharing protocols and patient or service users’ consents.

Previous drawbacks to the implementation of cross agency systems have been the need to enter data into different systems – e.g. primary care, social care, mental heath, to ensure the integrity of information held in local systems. Horizontal applications with their in built integration capabilities mean users do not have to double key information but merely enter it once and partner agency systems are automatically updated. By way of example, the PROTOCOL eSAP system, deployed via CFH, has in excess of 8,000 users who access the system from 80 plus organisations, is available on a 24 x 7 basis and integrates information from health and social care systems.

There is often the view that cultural barriers and differences in terminology used by agencies can impede the efforts of joint working. However a system that highlights clear areas of actions and responsibilities across involved professionals can act as the catalyst to promote joint working.

The increasing plethora of Government initiatives necessitating multi-agency working across health and social care, gives a clear indication that horizontal integration is here to stay. Future requirements will no doubt look to integrate additional public services such as housing, education, the police and the 3^rd sector. The challenge will be to ensure that emerging horizontal technologies are scalable enough to cope with increasing data volumes and have the adequate granularity of security features in place to ensure that this shared data is seen by only those authorised to do so.

Denise Harrison
Sales & Marketing
Director Liquidlogic