Estrategia de cobertura

Having considered the scenario situations, professionals were finally questioned more generally 0% 20% 40% 60% 80% 100%

Multi disciplinary assessment Told colleagues formally

Circulated memo E-mailed round Told manager Informed team members Told colleages informally

GPP HS SS

5.6.1 Key Areas of General Information Needs

Moving away from the scenarios, respondents were asked to consider a range of information that someone in their situation might need. A list was developed through interviews with professionals, voluntary groups and others involved with the care of older people [see Appendix 3, questionnaire]. For each item, individuals were asked whether they had information already or could find it if needed; required information but didn't know where to find it; or didn‘t require this type of information. The second category provided a measure of unmet need.

The level of unmet need for different staff groups is shown in Figure 5.30. The items mentioned by an individual was categorised as either ‗All Social Care‘, ‗All Health Care' or ‗Both‘. Clearly the staff groups reporting the greatest information needs are in primary care, with 60% of GPs and 53% of other practice staff reporting that they need information but don‘t know where to find it; the information needed is either all held by Social Care or both Health and Social Care staff. In contrast, just one in four community nurses reported information gaps, and these mainly related to information from the Social Care sector. Very few social care staff reported unmet information needs; fewer than 10% reported that they needed information from healthcare staff but couldn‘t access this. Thus, it would appear that there is a clear imbalance between the two sectors in terms of information needs, and that the gap is greatest in general practices.

Figure 5.30: Unmet information needs by likely source of information

0% 10% 20% 30% 40% 50% 60% 70% GP GPN CN CH SW SC Social H&S Health

5.6.2 Key Areas for General Information Sharing by Professionals

Professionals were next asked their opinion on the main areas where they considered information could best be sharedamong professionals. This list was once again developed through interviews and items were clustered into six broad areas: 'informing other professional groups'; 'informing patients/clients or carers'; 'improving care for the patient'; 'improving work structure, better use of resources or time'; 'reducing work stress for self or colleagues'; and improving co-ordination of care'. The findings are displayed in Figure 5.31 for general practice staff (GPP), community health staff (HS), and social care staff (SS). Clearly, the perceived benefits of sharing information are high for all six areas, with little difference between staff groups, although social care staff emphasise informing other professional groups and patients/clients or carers more, whereas general practice staff are most likely to emphasise improving the co-ordination of care and work structure, and community NHS staff improving patient care and informing patients or carers.

Figure 5.31: Key areas for information sharing by professional group

5.6.3 Professionals' Overall Rating of Inter-Agency Communication

Professionals were asked to rate general inter-agency communication, in relation to different professional groups, based on their own work experience. The results are shown in Figure 5.32. Clearly GPs and social workers were least likely to rate existing communications as 'excellent' or 'good'. In general, community nurses and nursing auxiliaries/ health care assistants were most likely to report good communications (although still less than 50% of each group). Even though social workers did not rate existing communications as good, they largely rated them as 'reasonable' with few individuals reporting them as 'poor'. GPs were most likely to rate inter-agency communication as poor. Figure 5.32: General professional communication ratings by professional group

0% 20% 40% 60% 80% 100% GP GPN CN CH SW SC Poor Reasonable Good Excellent

The overall picture in terms of quality of inter-agency communication combined with unmet information needs (see Figure 5.30) indicates that practice staff report problems in accessing information and the quality of communication. Other groups such as social workers may give inter- agency communication a low rating but do not appear to have major unmet information needs (Figure 5.30).

75% 80% 85% 90% 95% 100% Informing other professional groups

Informing patients/clients or carers Improving care of the patient

Improving work structure Reducing work stress Improving co-ordination of care

GPP HS SS

5.6.4 Professionals’ Reasons for Inter-Agency Communication Ratings

Respondents were asked to explain the rating they had given for inter-agency communication; 80% of the sample provided further information based on their own work experiences. Professionals gave a variety of reasons for their views. These comments were coded for content and categorised under two main headings:

(i) Human communication related issues: All the sample included comments related to this topic. These covered the following:

Importance of networking and/ or knowledge of who to contact in the event of needing information. Importance of regular meetings between different professional groups

Difficulties in contacting various professional groups – especially an issue with shift work and professionals working part-time hours / problems with delay of information reaching relevant professionals

Time and persistence needed to communicate and gain access to information needed Some people could be ‗protective‘ about sharing information / ‗not my job‘

Communication hindered by conflicting priorities of professional groups Not knowing who is already involved/ duplication of working in practice Low morale

Complexity of multi-disciplinary working in practice Records incorrect or people forgetting to complete forms

Communication between primary care and secondary care (hospital) interface. Hospital discharge issues and concerns around discharge summary

Communication systems and relationships with other professionals, both the negative and positive aspects of inter-agency work

(ii) Technology related issues: Only a small percentage of professionals (< 15%) provided comments related to technology:

Too many different computer systems are in use and this is affecting communication across health and social care

Computer system perceived as too complicated to help the professionals in their work Teams using different computer systems, even in the same professional group

Other methods thought to be useful (e.g. greater possible use of fax) but professionals concerned about the problem of informed consent and confidentiality

Thus, the majority of issues impacting on inter-agency communication are human and organisational, rather than technology related.