FUNDAMENTOS PARA ESTABLECER LA CUANTÍA EN EL TIPO PENAL BÁSICO

B1: Leicester Health Care

i) Applications

During the period of the study, the Leicester Health Informatics Service was facing the challenge of facilitating all practices in migrating to accredited systems, predominantly from the EMIS vendor. At the same time, the Informatics Service was also harmonising multiple hospital systems. By October 2002 a new variant of the FIP Community Nursing application (called TCS) was also being rolled out across the city, in conjunction with the replacement of dumb terminals.

ii) End-user access

Typically each GP was reported to have 3.5 terminals notionally for themselves and their staff. This figure was confused by the larger than average number of branch surgeries in Leicester City which had additional terminals that were not used all the time. The 2001 local implementation strategy indicated that a recommendation had been made to introduce functionality within the GP systems to support integrated working across the primary care team in pilot mode before a full roll-out, anticipated for completion by 2003/04. Additional knowledge management functionality was introduced to support clinical governance. The introduction of functionality was viewed as increasing the pressure for additional end user access points.

iii) Internet access

All PCs used in the city were Internet-enabled and local, low cost, in-house training was available. However, there was no mandate to complete the formal training before using the Internet, and many professionals were known to learn from peers and informally. Various local Internet-related actions were outlined in the 2001 local strategy. Citizens could also access the Internet, and therefore NHS Direct Online, through terminals in various locations supported by Leicester County Council.

In order to address information provision for patients and staff, the following projects were being progressed that complemented and supported work on NHS Direct and Care Direct, the telephone triage systems:

further development of web-based delivery of information, including MAGNET with Leicestershire County Council;

enhanced library facilities and staff up-skilling to support knowledge management.

iv) Training

Training provision was predominantly system-specific and addressed ‗how to use certain systems‘ rather than general informatics awareness. By 2002, a training plan for the whole of the Leicester area, including the study site, had been produced with multi-agency stakeholder input and a large designated financial allocation attached. These training plan were still to be ratified and, if endorsed, progressed alongside the development of clinical learning networks, a University for Industry project, and the national NHS promotion of the European Computer Driving Licence for all health staff. Internet training was available in-house at low cost, but was not mandatory. Some professionals learnt on the job or through personal use. All PCs were Internet-enabled but there was no link between personal user name/ email address/ password, formal training and what functionality someone was permitted to use.

v) Privacy issues

The health community conducted a gap analysis on the BS7799 standard (relating to good practice) in 2001/2002 to determine compliance with data protection requirements. The Caldicott recommendations were being rolled out, but an unanticipated resource requirement in the field had necessitated Leicester Health Informatics Service staff supporting this process.

vi) Future IS plans

During the course of the project there were major amalgamations and re-organisations of the Leicester health organisations into the ‗Leicester Health Community‘. In line with these, Leicester health informatics support was delivered through a collective team that supported acute, community and primary care informatics. The informatics context in Leicester City was therefore both fluid and complex. As can be seen from this extract from the local strategy document at the time:

‗University Hospitals of Leicester NHS Trust (UHL) being a recent merger of three acute trusts, is faced with historic problems of system age and duplication. For example there are 3 PAS systems, 2 Order Communication systems, 3 systems for managing medical records, 3 radiology systems, 1 PACS and multiple e-mail systems. Most of the systems are old and in need of replacement, meaning that the Trust cannot effectively operate cross-site services.‘

During the study period, as part of the local strategy, the community hospitals implemented a new PAS system (through the Leicester and Rutland Healthcare Trust) and progressed a mental health information strategy to address the Mental Health National Service Framework. Once the University Hospitals of Leicester structure and that of the recently established Health Informatics Service were stabilised, Leicester intended to explore further cross-sectoral and collaborative informatics projects.

B2: Leicester Social Services

i) Applications

Leicester City, like Warwickshire, was using a modified version of CareFirst (newer version of CRMS), which started to be rolled out in May 2002. This application covered client information including CareTime for home care planning (implemented by July 2002), Financial functionality including that to cover home care invoicing to support independent home care, payment for Foster care (implemented in September 2002) and payments for Residential care and assessment (which went live in January 2003). The application did not include SAP, a submission for which was to go to the local implementation strategy board in due course. The system did include management of clients by the whole Social Services team. When a module went ‗live‘ it went live across the whole of Leicester, rather than one pilot location getting all functionality before any other.

Although the intention was that all staff did their own data input, in order to improve data accuracy, some were still using clerical assistants for data entry. However, central data quality checks were reported to be reducing as a result of direct staff input.

ii) End-user access

Between twenty and thirty locations had direct connections to the local intranet in Service Provider units, providing fast robust access to the applications systems. Homes for Older People had 15 (on dial-up access) that were used less frequently and therefore did not warrant the faster connections. Social Services staff teams in Leicester were well-defined by client cohorts, the only overlaps were traditional e.g. cross-overs between Learning Disabled and Physically Disabled. The service had a central informatics team of 12 to provide a Help Desk, training and central reports.

As described above, Social Work teams had end-user points for their manager, clerk and social workers. The end-user access points on the Desktop might be directly inter-linked or linked through other servers. These staff and their terminals were able to access CareFirst and the Local and County information systems. The Emergency Out of Hours Access Team also had home-based terminals, as did the home-based Emergency Duty Team for the whole County (approximately 20 terminals). There was reported to be no pressure from other staff for home access.

iii) Internet access

In Leicester, Internet-enablement was only introduced if a manager paid and authorised this. It was established by physical terminal location rather than personal password access.

The Social Services Department worked within County Council and e-government regulations and the pertinent legislation for the UK and European Community. It was reported by the Head of Information Systems for Social Services that, as the requirement for Citizens‘ access to Social Services emerged, systems would need changing/ mirroring, and information would probably be put on the Internet through the Leicester County Council portal. By the end of 2002, citizens could access the Internet through terminals in various locations supported by Leicester County Council but there was no citizen access to the Social Services systems locally, other than as references within collective local authority reports for information.

iv) Training

Training modules were being developed to cover CareTime for home care planning, financial functionality including that to cover home care invoicing to support independent home care, payment for Foster care and payments for Residential care and assessment. These were timed to coincide with implementation timelines. In total, it was estimated that 1,200 people would need to pass through the ongoing training programme for the CareFirst application.

v) Privacy issues

Leicester Social Services reported adherence to the privacy, confidentiality, security and data protection requirements of the Leicester County Council. These were, as with every other UK organisation, defined within the relevant European Directive.

vi) Future IS plans

Leicester Social Services reported that they had no short term plans for hand-held terminals, PDAs or and wireless links. The main strategy was to facilitate field workers entering data from their bases rather than whilst in the community or on domiciliary visits.