INFORMATION SHARING AGREEMENT Multi-Disciplinary Team (MDT): Service Information Sharing SCOPE NAME OF LEAD Multi-Disciplinary Team (MDT) for high risk people: this agreement is for the patient and management information required for the MDT service. APPLIES TO RELATED DOCUMENTS MONITORING & REVIEW PROCESS Please describe the monitoring and review process for this particular Agreement; include reference as to who will be involved and how any ad-hoc actions (e.g. queries, complaints etc.) will be handled. Reference numbers: 1. Overarching Multi Agency Information Sharing Protocol 2. MDT for Frail Elderly and LTC ISA Template: Data Request v9.0 This agreement will be reviewed on an annual basis however during the implementation it will be on an ongoing basis by the Information Governance Lead in each organisation using existing governance mechanisms. Any queries or complaints will be escalated and managed via the MDT Implementation Group which meets on a fortnightly basis. Version 9.0 final Oct 2014 1
TABLE OF CONTENTS 1. OVERVIEW... 3 1.1 WHAT IS TO BE SHARED?... 3 1.2 WHY IS THE INFORMATION BEING SHARED?... 3 1.3 LEGAL BASIS FOR INFORMATION SHARING... 4 2. SERVICE USER CONSIDERATIONS... 5 2.1 PRIVACY & CONFIDENTIALITY... 5 2.2 SERVICE USER CONSENT... 6 2.3 SERVICE USER AWARENESS & RIGHTS... 6 2.4 RIGHT OF ACCESS TO INFORMATION (Staff Groups/Organisation).. 6 3. INFORMATION SHARING PROCEDURES & PROCESSES... 9 3.1 METHODS AND FREQUENCY OF REQUESTING & TRANSFERRING INFORMATION... 9 3.2 FREQUENCY OF TRANSFER... 9 3.3 METHODS OF RECORDING, HOLDING, RETAINING & DISPOSAL OF INFORMATION... 10 4. Approval sheet 13 5. Appendix 5.1 List of Access arrangments to SystmOne 15 5.2 List of signatory organisations received 18 Version 9.0 final Oct 2014 2
Multi-Disciplinary Team (MDT): Service Information Sharing 1. OVERVIEW The Multi-Disciplinary Team (MDT) will be composed of staff from organisations involved in a persons health and wellbeing, namely: Organisations who may be involved at a later date but no signatory received: Staff from these organisations will work together to provide integrated support for people over 60 who are identified as high risk in terms of a potential hospital admission, based on ongoing risk stratification by GP practices. Staff involved in the GP practice MDT will meet at least monthly to monitor the wellbeing and care provision for these high risk patients, and pro-actively implement integrated care planning and packages with crisis support when needed. Information sharing is key to support the MDT development. As other services are planned, the best method for sharing information will be reviewed; the assumption is that these organisations will continue to use the same approach however these organisations may also look at tactical use of Systems within their organisations, on a read-only basis for example, and other solutions such as automatic messaging between systems. 1.1 WHAT IS TO BE SHARED? The information to be shared is: Patients demographic information Patients full healthcare plan Patient social care plan 1.2 WHY IS THE INFORMATION BEING SHARED? The aim of the service is to identify the most vulnerable people in state area aged over 60, and provide a multi-disciplinary team approach to their care in the community and at home where appropriate including selfmanagement, to avoid hospital admissions. This will benefit service users by providing: Multi-agency, coordinated care using a single care plan Version 9.0 final Oct 2014 3
A named care coordinator Access to a wide range of social care and voluntary sector services to support the persons wellbeing Care in the location of the service users choice where possible, ideally in their own home. Care monitoring and self-management to avoid crisis and increasing the risk of hospital admission. Crisis support when required with levels of escalation Wider availability of services including over seven days per week The information from each agency needs to be shared with the multidisciplinary teams in order to provide a joined up care plan covering all relevant, factual and proportionate information. 1.3 LEGAL BASIS FOR INFORMATION SHARING For organisations undertaking statutory duties please describe a) the legal basis that underpins this relationship (e.g. Crime & Disorder Act 1998, Children Act 1989 & 2004, etc.) and b) the requisite duties and powers (express and/or implied) arising from that will facilitate the lawful sharing of appropriate service user information. Include reference to any explicit limitations to information sharing and any other statutory and non-statutory regulations and guidance. The Data Protection Act 1998 (DPA) provides the legal basis for sharing information under which several conditions apply: The following Schedule 2 and Schedule 3 conditions of the Data Protection Act apply in support of this data sharing agreement. Schedule 2 Conditions: 2(1) The data subject has given his/her consent (this can be implied consent if there is sufficient fair processing information made available). 6(1) The processing is necessary for the purposes of legitimate interests pursued by the data controller or by the third party or parties to whom the data are disclosed, except where the processing is unwarranted in any particular case by reason of prejudice to the rights and freedoms or legitimate interests of the data subject. Schedule 3 Conditions 8 (1) The processing is necessary for medical purposes and is undertaken by: (a) a health professional, or Version 9.0 final Oct 2014 4
(b) a person who in the circumstances owes a duty of confidentiality which is equivalent to that which would arise if that person were a health professional. (2) In this paragraph medical purposes includes the purposes of preventative medicine, medical diagnosis, medical research, the provision of care and treatment and the management of healthcare services. The relevant organisations each have the legal responsibility for ensuring that the confidentiality and integrity of the data are in compliance with the DPA. 2. SERVICE USER CONSIDERATIONS 2.1 PRIVACY & CONFIDENTIALITY The sharing of information is required between the organisations in order to provide appropriate and safe care to some of the most high risk people. The multi-disciplinary team approach will provide care in the community and at home where appropriate to avoid hospital admissions, as detailed in section 1.2. By signing this ISA all signatory organisations confirm that they comply with the following: Organisations are registered with the Information Commissioners Office (Notification) All organisational contracts contain data protection and confidentiality clauses, all staff sign these. There are organisational policies / procedures in place for processing and handling personal information and information security both for paper and computer records. Fair processing notices are available advising people how their information is handled. Compliance or working towards with the NHS Information Governance toolkit for NHS and local authorities. Annual training for staff on Data Protection and confidentiality procedures including handling of personal data for the purpose of this sharing agreement. Within the MDT each client will have a named team of staff involved in their care as documented in the Care Plan. Version 9.0 final Oct 2014 5
2.2 SERVICE USER CONSENT Consent to be involved in the MDT is required by service users. The consent status is recorded in the Care Plan document by the GP practice following all consultations with the patient, and on Systems. Initially explicit consent is needed, informed consent will be recorded on Systems and case records. This consent status will be shared with the partner agencies at the MDT monthly meetings and also using the Care Planning documentation ( UPA1 and UPA2 ). If the service user is deemed to lack capacity then the lead professional discussing their initial care will take a best interest decision under the Mental Capacity Act 2005. 2.3 SERVICE USER AWARENESS & RIGHTS GP practices must gain explicit patient consent for a person to be included in the MDT and their information subsequently shared, and this will be recorded in the Systems, patient notes and Care Plan (see section 2.2). All organisations that are involved will provide fair processing notices ensuring all of the other agencies are identified (as listed in section 1). 2.4 RIGHT OF ACCESS TO INFORMATION (Staff Groups/Organisation) The information will be accessed by the following staff groups: Organisation (enter Org name) Staff Group Primarily: Community Matrons Assistant Practitioners District Nurses Geriatricians Occupational Therapists Physiotherapists Speech and Language Therapists Health Care Assistant (enter Org name) Social Care Workers Business Support Officers (enter Org name) Mental health Crisis team Mental health Liaison team Community Mental Health Team Version 9.0 final Oct 2014 6
In Patient Services (enter Org name) All practice staff involved for high risk patients relevant to this ISA. (enter Org name) Voluntary Sector MDT Coordinators Information will be accessed on a need to know basis, e.g. a Community Matron would not be expected to routinely access patient notes from a GP practice they are not aligned to. The MDT team members will be sent by secure email (see Section 3.1) the NHS number, date of birth, full name contact details and care plan of the patients to be reviewed in advance of the monthly practice meeting by the respective GP practice. On electronic Systems an ambulance icon will identify a person in the MDT pathway. The organisations will utilise current management and procedures to prevent unauthorised access/disclosure. 2.4.1 Levels of Access Access Principle: all levels of access detailed below are granted on a need to know basis. Where access is granted at any level, this should be restricted to those parts of the records that are linked to a specific purpose and staff should not access records which are not specifically required. There will be five levels of access relevant to the MDT to detail how information is accessed and recorded: 1. Staff in the MDT who require ongoing and full access to computerised and paper records. 2. Staff in the MDT who require ongoing specified access to computerised and paper records. 3. Staff that are co-working and can have full access to computerised and paper records for the duration of their involvement as co-workers. 4. Staff who do not meet the above three criteria, but can gain access to computerised records by making a request to the team and demonstrating that they have a need to know. 5. A request can be made for a Record File Transfer within the signatory organisations to the MDT. The table in Appendix 1 gives the detail of the access levels for individual MDT posts, groups and teams. Version 9.0 final Oct 2014 7
Colleagues from all organisations should also refer to the Multi Agency Information Sharing Protocol and their own organisation s procedures for confidentiality and access to records about living individuals. Access arrangements apply to computerised records and to any manual records held by the MDT members. For computerised records, the system will be the primary electronic recording system currently used by GP and NHS staff. Local Authority will use their electronic system, Mental Health and the voluntary sector will use their own secure systems. 2.4.2 Definitions. 2.4.1.1 The following staff have been identified as being a part of the MDT Team: Staff or Group GP practice Manager General Practitioners GP Practice Nurses Community Nursing Staff Geriatricians Social Workers Community Psychiatric Nurses Liaison Nurses Consultant Psychiatrists Voluntary Sector MDT Coordinators Organisation (s) GP Practices GP practices GP practices NHS NHS LA MHT MHT MHT 2.4.1.2 Co-workers A co-worker is defined as a practitioner from any organisational team who is not a member of the core MDT team and who is working to provide specialist assessment or subsequent specialist intervention for a time-limited period" Administrative Staff Business Support Officers Manager Assistant Practitioner District Nurses Speech and Language Therapists Health Care Assistants Occupational Therapists/Occupational Therapy Assistants Physiotherapists Diagnostic staff Dieticians/Falls Service All organisations Version 9.0 final Oct 2014 8
Specialist Nurses Domiciliary Care Intermediate Care Service Safeguarding Team Social Work Assistants Reablement Team Wardens/Housing Chief Executive Access for other co-workers will be agreed on a need to know basis by all organisations. 3. INFORMATION SHARING PROCEDURES & PROCESSES 3.1 METHODS AND FREQUENCY OF REQUESTING & TRANSFERRING INFORMATION The patient records required will be identified by the GP practice. The MDT members external to the GP practice will be notified of the patients for monthly review by secure email as follows: NHS LA Organisation Method Secure email: NHS.net mail Secure email: MHT Voluntary Sector LA NHSMail Secure email ideally NHS.net but alternative secure email sources are available. NHSmail Information will be added to the patient record between monthly meetings; For NHS staff who can access the community electronic system this will be added direct to the system. For other NHS, MHT, voluntary sector and LA staff who cannot access Secondary care electromnic systems this information will be sent as an attachment using secure email (as above), for uploading into the relevant system. 3.2 FREQUENCY OF TRANSFER Version 9.0 final Oct 2014 9
Information will be routinely shared between the partners on a need to know basis to support health and social care needs. Interim transfers will take place as per section 3.1. 3.3 METHODS OF RECORDING, HOLDING, RETAINING & DISPOSAL OF INFORMATION The service user information will be entered and stored on the relevant organisations systems as per business practice as follows: Existing data procedures will be utilised using current arrangements within each organisation. Recording, transfer and storage will take place as per section 3.1; retention and disposal will be completed as per local policies and procedures. By signing this ISA all signatory organisations confirm that they comply with the following: Any systems personal information is held on are secure with individual login and passwords for access and full audit trails to identify who has accessed what. All personal information is processed in line with the Data Protection Act 1998 principles, this includes, obtaining, holding, storing, transferring, retention and disposal. 3.4 Subject Access Requests procedure Subject Access Requests will utilise existing procedures with each organisation. Freedom of Information Requests, Complaints and Incidents Requests will utilise existing procedures with each organisation. Where an incident occurs across agencies, it will be the IG lead within the agency where the incident occurs who will initiate investigations and communictaions. Where lessons learnt from incidents occur these must be shared across all agency IG leads and if necessary a review of this ISA will be completed. 3.6 Review Mechanism. This agreement will be reviewed in January 2015. Any changes that directly impact this ISA will trigger an automatic review of this document. The following table details the proposed Dataflow Review Programme; Lead Lead Reviewer Version 9.0 final Oct 2014 10
organisation coordinating the review Version 9.0 final Oct 2014 11
Information Sharing Agreement Darlington MDT APPROVAL Signed by, for and on behalf of : Organisation Name Position Contact Details i.e. - Phone No. - Email Signature Date Version 9.0 final Oct 2014 12
Appendix 1 - Access to Information Arrangements for MDT Team access to Systems (Information Type: - all information relating to service users of the MDT Team.) Staff Group Who Purpose they need to know Access arrangements 1 GP practice Manager (enter Org name) Administration relating to healthcare management Level 1 Access 2 General Practitioners To facilitate effective record keeping and 3 GP Practice Nurses decision making in relation to contacts with the MDT. Community Matrons To facilitate and record input into records for the MDT Team Geriatricians Level 1 Access to Update access to record case notes. Level 1 Access to Level 2 Access to Social Workers and associated business support officers Community Psychiatric Nurses (including Liaison) Consultant Psychiatrists Level 1 Access to Level 2 Access to Level 1 Access to Level 2 Access to Level 1 Access to Level 2 Access to Open and Closed Cases Level 5 Access Voluntary Sector MDT Coordinator Staff Group Purpose they need to know Access arrangements Administrative Staff All org s To facilitate and record input into cases Level 1 Access open to Intermediate MDT Team. Level 3 Access Version 9.0 final Oct 2014 13
Voluntary Sector: Level 4 Access Assistant Practitioners Support to Community Matrons Level 1 Access to District Nurses Referral to MDT team especially outside Level 1 Access to of operational hours. Speech and Language Therapists Hospital Front of House Service for Level 3 Access to referrals Occupational Therapists/Occupational Hospital Front of House Service for Level 3 Access to Therapy Assistants referrals Physiotherapists Hospital Front of House Service for Level 3 Access to referrals Occupational Therapy Team Hospital Front of House Service for Level 3 Access to referrals Diagnostic staff Hospital Front of House Service for Level 3 Access to referrals Intermediate Care Service Support to Community Matrons and Level 3 Access to Social Care Dieticians/Falls Service Support to Community Matrons Level 3 Access to Specialist Nurses Support to Community Matrons and Level 3 Access to Geriatricians IT System Administrators Backoffice processing of data Level 4 Access to Safeguarding Teams Incident management Level 2 access to Older People/Physical Disability & Support to Social Workers, Community Level 3 Access to Sensory Impairment Teams Matrons and Geriatricians Reablement Team Social Care - Casework Level 3 Access to Wardens/Housing Support to Community Matrons and Social Care in cohort healthcare Level 5 access Version 9.0 final Oct 2014 14
Chief Executive Support to voluntary sector MDT Coordinators. Level 5 access Version 9.0 final Oct 2014 15
Information Sharing Agreement - Darlington MDT Signatory sheet. Organisation Authorised Signatory Name and title Date Signed Contact details LA NHS Foundation Trust Primary Healthcare Clinical Commissioning Group (CCG) Mential Health Foundation Trust ( Voluntary sector Voluntary sector Voluntary sector Version 9.0 final Oct 2014 16