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Child protection database plans revived

27 December 2012   Linda Davidson

 A fresh £8.6m initiative to co-ordinate NHS and social services data to improve child protection has been announced by the government.

The Times and BBC News report that the system, due to be adopted by 2015, will ensure that accident and emergency staff can access information about a child's recent visits to hospitals around the country.

It will also record whether the young patient is the subject of any kind of protection plan drawn up by a social services department.

It is hoped that the system will support doctors' and nurses' existing efforts to detect non-accidental injury by alerting them to children brought to hospital for numerous emergency visits.

The system should also help to foil abusing parents who take injured children to different A&E departments to avoid detection.

The initiative is not the first of its kind. The Bichard Inquiry into the Soham murders recommended that information should be shared more effectively by agencies involved in the care of children.

Section 12 of the Children Act 2004 gave the health secretary the power to make regulations to require the establishment and operation of databases or index systems.

EHealth Insider reported extensively on the ContactPoint database which was set up by the Labour government to record information about all children in England.

The extensive and detailed nature of ContactPoint attracted criticism and the coalition government scrapped it after taking office.

Health minister, Dr Dan Poulter, moved to reassure caring parents that the new system would not affect families in which the children had one or two visits to A&E.

He told The Times: "This is something to make sure we protect really vulnerable children.

"Children fall over, they have accidents but it is the circumstances surrounding those accidents and the type of injuries that inform your opinion of whether that child may have been abused.

"So a couple of injuries running around in the garden or tripping over on the pavement is not something that would cause anybody any concern.

"But if there are repeated suspicious fractures that may be from pulling or tugging, or suspicious bruising, scalding of children: those are things that can build up a picture of a child that's potentially abused."

Dr Simon Eccles, medical director of NHS Connecting for Health and an A&E consultant, also interviewed in The Times, said he had no doubt that clinicians treating Victoria Climbie, a child who was murdered, would have behaved differently if they had been able to access the type of system proposed.

Victoria died after repeated abuse by her aunt and her aunt's boyfriend. The failure of different agencies involved in her care to share information was seen as a key factor in the case.


Related Articles:

News: ContactPoint to close on 6 August | 26 July 2010
News: ContactPoint to be replaced | 22 June 2010
7 News: Politicians question major IT projects | 27 April 2009
News: ContactPoint goes live | 26 January 2009
Last updated: 28 December 2012 07:22

© 2012 EHealth Media.


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Living in hope 85 weeks ago

The local version of Contactpoint, that was halted along with the National Contactpoint solution was based on building up a record of contacts with a child, this included GP, HV, SW, A&E, etc. once a threshold was reached, can't remember the number, eveyone who was flgged as being involved with the child was notified that there were significant contacts. No information was held such as if they were on plan. Simple concept, that was working, but was stopped.


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SCR

NeilB 85 weeks ago

GP practices are under no obligation to engage with the SCR project.

"Understand that a practice does not have to engage with the SCR programme. It is an 'opt in' scheme for practices."

"There is an expectation that practices will cooperate to offer their patients the SCR, in other words that practices will participate, but it is not a GP contractual requirement."

"If practices choose not to participate it is likely they will come under pressure from their PCTs and SHAs, though there is no mechanism that can enforce practice participation."

"Our position remains that the decision whether to proceed with SCR uploads rests with the GP practice."

British Medical Association


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Patient best interest

desperado 84 weeks ago

I have done a lot of work around SCR. It is a shadow of the useful system it could be, not least from the strong views of a very few entrenched GPs standing in the way at every step.

But the GPs who are involved in Out of Hours work in our area are right behind it now, as are the ED consultants for relevant patients. It saves them from having to guess the current medications from clues the patient can give (reminder of christmas charades ?).

I wouldnt go so far as anon, but I do wonder whether it is truly in the patients best interests for GPs to stop other hardworking NHS staff from having vital information at their fingerprints when the GP is tucked up in bed, or away on their holidays.

Of course shared access to the entire GP practice record would be even more joined up, and with patient consent that is happening in some places. Perhaps when patients have their own access as this government proposes, they will be able to cut through the barriers. It is their record really.

Of course with child protection, the sharing and consent is all rather more complex.


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to desperado - and anon

Mary Hawking 84 weeks ago

I think you may be confusing a number of different issues.

I'm a GP, and *if* the SCR had been limited (as the ECR was) to medication and adverse reactions *long-term* I think there might well have been a good deal of support for it.

Unfortunately, from the beginning, it was expected to become the vehicle for delivering a summary record - with no definition (unlike Wales) of what would or would not be included, *and* a consent model which could breach other legislation and common understandings of Confidentiality and Consent,

Shared access to the entire GP practice record would be "even more joined up": but are you - personally - prepared to have your entire cradle-to-grave record made available to large numbers of people working in "the largest employer in the world after the Chinese Army and the Indian Railways"?

I'm not.


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Demonstrates that GPs are NOT anything to do with the NHS

anon 84 weeks ago

This type of attitude is exactly that makes GPs unpopular in the wider NHS, while the rest of the system are working harder and harder with an extended scope for less reimbursement, GPs expect to have more of the NHS budget yet not accept any degree of management of the services they provide. This is exactly the concern many of us have with private contracting for NHS services where there is very little control over private organisations when things go wrong, e.g. care homes with unsafe and/or neglectful care, in some cases persecution of residents.

About time GPs are told if you wish to have reimbursement from the NHS that they HAVE to deliver to NHS standards, this is a democracy, but of the population as a whole not GPs dictating what they will or wont do, irrespective of their patients' needs. GPs may or may not have noticed that their "day of action" last year had little effect. Emergencies continued to be dealt with, patients continued to be cared for etc etc. If ambulance personnel or nurses were to withdraw their services there would be an immediate impact. GPs need to realise that if they don't tow the line their days may be numbered, the NHS runs many alternatives and many in the population do not even bother to register with a GP.


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The First Two Laws of IT Projects

just_instantiate 85 weeks ago

The first law of IT projects is that if a project results in a change that is visible outside of the IT department then it's not an IT project, it's a business change project.

The second law is that a business change project (see first law) should be defined in terms of business change and not in terms of technology. In particular, the word "data" and its derivatives (e.g. "database") should be banned from business change project titles.

Of course it might have something to do with the reporting, but this seems to be a classic contravention of laws one and two. The business change is "improving the sharing of information about children attending A&Es (etc)". There's nothing in that term that implies that a new database is the solution or even any part of the solution. It may emerge that, actually yes, the latter is the case(almost certainly not the former.) However, jumping to the conclusion, right at the point of naming the project, that a particular technology is needed is a classic symptom of database-itis - right up there with diabetes and obesity as the condition that is the biggest drain on NHS resources.


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Anyone making this work already?

lindad 85 weeks ago

The EHI archive on ContactPoint flags up some local information sharing schemes in various stages of development. Has anyone out there managed to set up a good local system that is used routinely? We would be pleased to hear from you.


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Be happy to share a process we have developed in Rotherham

Paul Chapman 83 weeks ago

In Rotherham for the last 4 years we have created a process linking and flowing information between the council and community childrens services. Also also gives visibility to A+E GP's and OOH staff.Happy to share the work we have done linking Swift and SystmOne. Clinicans love it as safeguading flag and information visible for all.


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Not contact point

CertaCitrus 84 weeks ago

The central databases for CHSP (Child Health Systems Programme) and SNS (Special Needs System) in Scotland have similarities to this CP database.

I wouldn't consider this an IT system, more an information system with large parts relying pre printed paper forms (for HCP's). It had central database problems as mentioned earlier on this thread (the board I was with, developed a portal within the PAS to make this information available to clinicians).

The clinical information content seemed quite detailed.

(As an IT person I would have liked to have seen the data capture forms incorporated into the PAS/EPR and the data/information/correspondence distributed via clinically coded CDA......)


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plain old telephone

desperado 85 weeks ago

Linda, yes we have in that we had a discussion with the child protection leads, agreed that any flag is fallable, and that the clinician should rely on their own training, judgement and suspicions, and that they know the relevant phone numbers of the several social services departments in and out of hours, who hold the master protection details.

For a working system you don't always need to implement IT, and whilst I was offering to try and link 'alerts' between systems, that was not felt to be bullet-proof. The history of numbers of relevant visits was considered a useful nugget to aid their thought processes.


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Bite size chunks...

Phoenix 85 weeks ago

Just back from the Christmas and New Year break and catching up fast with news and developments.

First of all can I wish all at EHI and readers a Happy New Year and very best wishes for 2013. Can I also thank EHI for an excellent service during 2012 and I look forward to a continuation of this during 2013.

One item particularly caught my attention over the Christmas and New Year break and that was in relation to a %u21Cnew Child Abuse alert system for Hospitals%u21D. I was left pondering the announcement on the day and immediate thoughts were how are %u21Cwe%u21D going to be able to do this given the state of technology and development at this time? My next thoughts turned to Victoria Climbe and some work I did with various agencies post the Lord Laming report%u226and then to the aborted Contact Point project. Some excellent work undertaken over the past 10 years but sadly little progress. This is by no means an easy problem to solve.

This morning I turned to the DH press release for further information. Alas the press release was understandably vague in terms of how this is to be achieved by 2015. I then turned to EHI for further insight and I have to say this has generated some really interesting comment. Most of this is good and positive but as one commentator notes %u21Cthere are still those who will be negative on any attempts to do positive work in this area%u21D. And let%u219s be honest, there is a crying need for positive and successful work in this area. Of that I am sure we all agree.

I then revisited the DH press release and specifically noted the following:

Doctors and nurses using the system, known as %u218Child Protection %u213 Information System%u219, in emergency departments or urgent care centres will be able to see if the children they treat:

%u222 are subject to a child protection plan or being looked after by the local authority

%u222 have frequently attended emergency departments or urgent care centres over a period of time

END QUOTE

So is this the core of the %u218brief%u219? Are we specifically talking about Children who are currently the subject of a Child Protection Plan? If so this task is made somewhat easier by the very nature of the defined population. The NSPCC last reported that there were 42,850 children in England who were on such a plan (March 2012).

So maybe the answer to the seemingly huge task is to take bite size chunks and start with this group of vulnerable children. Local Authorities maintain these %u218registers%u219 and this information is shared with the NHS. What we need is an immediate National system for holding such a flag and for staff in emergency departments or urgent care centres to have access to and to use this system. This would at least be a start.

Answers on a postcard for a suitable current National system for holding this flag...and it's not PDS.


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Has the business case and specifications been published anywhere?

Mary Hawking 85 weeks ago

Daniel Defoe says:"presumably, not only does the Business Case for the proposed "system" already address this, but the Detailed Statement of Need/Output-based Specification, or whatever document(s) predicate the decision that we shall have such a system address it too. "

I hope that they do - and that they exist.

Maybe reading these documents would let readers of EHI - and more importantly those involved in delivering, implementing (both technically and organisationally) and the tax-payers who will be paying for it - understand just what is proposed, and whether it is feasible and vfm.

I'm a GP and we have cheerfully adopted all sorts of IT in the practice and elsewhere without even thinking about it: EPRs (paperlite since 1997 - I think); registration, IOS and path links; ICE & COMMS ordering: voice recognition and digital dictation; remote access; practice website; EMIS (now Patient) Access; EPS1: even, less cheerfully, C&B and NHSMail - although I must admit both have improved!

Who knows? Show me a good business and use case with problems addressed, and I might even become a supporter of the project!


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re: a suitable current National system for holding this flag

mrtablet 85 weeks ago

Generally reducing complex, dynamic or arbitrary 'risk' profiles to a 'yes/no' flag on a system end in failure - especially those with strong confidentiality issues or potentially perjorative connotations.

Before we start designing a software solution please can someone describe the workflow of identifying potential abusers using the proposed system - precisely who does what and when?

Then having identified an 'at-risk' child - who intervenes for the first time to protect the child?

Also...

Who is to be held responsible if a case is missed?

Who is held responsible for erroneous data entry or allegations?

What right of appeal do parents have with respect to inclusion on such registers?

Who has read-only access to such registers?

Who has read-write access to such registers?

How can one start desiging software solutions until all these questions are answered?


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Desparado

in arduis fidelis 84 weeks ago

The problem with that arguement is that every patient was informed under the National SCR PIP (Patient Information Programme) 18 months to two years ago that unless they did not want an SCR created they had to do nothing, which would mean that if a Practice were to "dissent" they are obliged to inform all of their patients that they will not be having an SCR created and the reason why - so where a practice has not done this then their patients working on the information they have been given by the PIP would not know to take their Practice to task.


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The problem will never be solved

Daniel Defoe 85 weeks ago

I do love an academic debate...

Of course, no "IT system/solution" will solve the problem of child abuse. But you're right, of course, Mr T that if we are going to have a system, we need to address the points you raise above and, presumably, not only does the Business Case for the proposed "system" already address this, but the Detailed Statement of Need/Output-based Specification, or whatever document(s) predicate the decision that we shall have such a system address it too. But I'm still concerned that some of us healthcare professionals seem to be saying that we shouldn't implement any enabling IT until everybody has agreed that it's perfect. At the moment, we have 10 percent of nothing which has any universal use in identifying abuse and then addressing the prevention issue. Let's not wait for the IT to be perfect because if we do, it'll be another NPfIT - something which will never happen.


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It's not PDS - what about SCR

anon 85 weeks ago

Whilst I agree that PDS is definitely NOT the place to be holding information of this sort, the summary care record should be. Indeed there are some that would say that the SCR has been de-scoped to the point of being of little clinical use outside emergency care. There needs to be a national repository for the patient care plan, in detail with the ability for any legitimate participant in care to update it (including the patient).

This would be an obvious candidate place for this information, given that a Child Protection Plan is just another type of care plan.

However this also highlights the need to consider seriously the scope of what is available to whom, for any type of plan and the controls that are in place. A CPP may be in place because of an abusive parent, yet a parent would normally be a legitimate representative of a child with access to their record?? The same might apply to safeguarding vulnerable adults where carers MAY be the subject of suspicion. Ah and while we are mentioning vulnerable adults, why are they not being included in the scope of this work as invariably the same principles would apply and the infrastructure changes would be very similar. But as has been seen by the response (or lack of it) to flagrant abuse in care homes, this group are not at the forefront of ministers minds. Or is it the fact that this is the private sector failing to deliver safe and effective care that is conveniently being largely ignored while public sector organisations are being torn apart??


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policy and reality

desperado 85 weeks ago

Simon, I don't know of any informed patient challenging it at a dissenting practice, but I do know that the enabling steps necessitate the practice agreeing to a go live, and doing some real work in ensuring that all the staff are using smartcards, and that depending on the system, relevant action is taken on any backlog queues. It can't just be turned on for one patient on demand !


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(if his GP practice has chosen to allow SCR creation) - really

in arduis fidelis 85 weeks ago

I think you'll find that under the NHS constitution it is not a GP Practice decision for an SCR to be created for a patient but actually a patient choice/decision/right. If a patient insists on having an SCR created and the GP Practice clinical system has the capability to upload an SCR the Practice cannot deny their patient that right.


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National need - really ?

desperado 85 weeks ago

Tony Blair on holiday in Scunthorpe sharing his SCR with informed consent with the MIU nurse (if his GP practice has chosen to allow SCR creation) is a bit different to a family in crisis. And whose SCR record do you put the alert onto ?

Whilst families may be mobile between care options over a limited geography, wouldn't it be good to just get Social Care within a geography communicating efficiently with the non-elective care providers in their vicinity ? A lot of the heat around national databases comes from the loss of human scale and simplification or overlooking of local circumstance.

If the data owners can name at least all the departments that they share data with, surely there is a better chance of realistic progress than creating some behemoth at the centre.


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Whose system is it anyway

desperado 85 weeks ago

Minor Injuries units didn't get a mention above, Mary made reference to OOH and WIC, but add to that paramedics at scene, there are a plethora of first contact points besides the shiny Emergency Departments where immediate decisions are needed from clinicians in the absence of a comprehensive and accurate record.

And they often all use different primary recording systems (some still paper). Talking to our lead on Child Protection, and offering to attempt something between local agencies, she was reluctant. The "every child matters" means that clinicians must be alert to signs of non-accidental harm in any child that presents, and as Paul above says, the existence of a database may not have helped Victoria, or other children especially if the absence of an alert lulls the clinician into thinking 'no problem here'.

Many will say they haven't time to go off to other IT systems, if there are issues they will be busy ringing social services, trying to calm or stabilise the child and to prevent the carer from leaving the department with them, and recording their own findings.

Central single issue databases superimposed onto the service have long been very disruptive and poor at linking to the local primary records.

Positive patient identification would require ID cards or a national database of irises to compare against. Whilst we live in a CCTV saturated country, we have quaint notions that we don't have to pass identity.

The reasons gain-Sayers on here suggest these IT solutions will not work are because, as enthusiasts for spending valuable tax money wisely, and for promoting appropriate IT, this is one of very few ways to talk to those at the centre with madcap schemes.


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not as easy as that

Paul Cundy 86 weeks ago

I echo the other comments but for different reasons.

Firstly i would support any mechanism to reduce abuse. I am not criticising this announcement because of any reflex behaviour.

Victoria Climbie attended A/E on three occasions during her brief life in the UK. Once at the Central Middx and twice at North Middx, the second attendance at North Middx being her final one from which she was admitted and then died. So would Mr Poulter's allowable two vists before suspicion is raised be an issue. Yes on the face of it this new system would not have alerted them to Victoria's peril as she had had only two attendances and the first was recorded as being scabies.

Dr Eccles says that had the clinicians be aware they would have been alerted. At both attendances at A/E before her final one clinicians raised the question of NAI but she was still sent home. So the evidence for his suggestion is erroneous. NAI was raised in the abscence of this system.

Abusive carers are unlikely to present to health services, this is a known fact, they avoid exposure, for obvious reasons. Do we think that highlighting this system is likely to make them be less or more evasive. Will it tie into private doctors and visiting services, will it tie into culturally diverse healthcare delivery services, will it tie in visits from the shaman's? No the unintended consequence of publicising this system is to probably make abusers less llikely to seek conventional healthcare.

And if they do attend they are likely to use false names and addresses , simply adding furtehr lies to the lies they already use when explaining away their childs injuries.

As the NSPCC spokesperson said its people who detect child abuse not systems.

I applaud the sentiment but i think this will do nothing.

The Climbie report's conclusions were stark - she was failed not by any system but by the clinicians who failed to corrctly diagnose NAI, the social workers who failed to supervise her adequately and by police officers who did not do their duty when visiting.

No end of IT will sove those problems.

Regards

Paul C


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Damned if you do/don't

Daniel Defoe 85 weeks ago

You're right Paul; IT will not solve the problem. But that's no reason not to implement some IT. We have solutions now which ought to eliminate the "identity" problem - iris and fingerprint recognition for instance - to help the "alias" issue. And yes, we'll never get round the fact that having credible IT will put off habitual offenders from taking their charges to healthcare institutions. But at the moment we have little, if anything in place to help identify minors and others who might be in need of special care and protection, so whatever we implement now will be better than the nothing we have.


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not wanting to appear rude but

Paul Cundy 85 weeks ago

"IT will not solve the problem. But that's no reason not to implement some IT."

This must surely be quote of the year?

Paul C


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re: Damned if you do/don't

mrtablet 85 weeks ago

I'm afraid there are several extraordinarily good reasons "not to implement some IT".

Let's assume

1. abusers don't give fake demographics

2. have the means and motivation to cover the increasing distances between the dwindling number NHS A&E departments which remain open

Won't some record of attendances already be in primary care electronic records?

However let's assume this proposed database is the only source of such information?

Whose job is it to look at the list of attendances (applying objective criteria ho ho) and ACT upon any suspicion? Whatever the action threshhold for "above normal bumps and bruises" - the accusation will grievously injure the lives of many wholly innocent and happy families!

This proposed system also embeds the dangerously naive assumption that child abuse is only to be discovered after repeated episodes of serious injury, fractures, burns etc. More often child abuse manifests as repeat attendances by an unhappy child with non-specific symptoms like abdominal pain or headache with subtle or no signs of physical assault.

Paul is absolutely correct - to solve this problem - if indeed it can be solved while maintaining civil liberties for a law abiding majority (@Daniel - iris recognition are you serious?!) - is about professionals having and using the correct skills.

This database IMO would be just another source of (poor) circumstantial evidence of abuse. It will either be ignored or used by dysfunctional professionals to kick the can down the road.


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First things first: where do you get good quality data?

Mary Hawking 86 weeks ago

Doesn't anyone in the DH follow EHI?

There was a long discussion this year on the quality - or lack of it - in A&E reports received in general practice: walk-in centres are as bad and OOH varies (but not Coded): so how will this database be populated?

Look at the problems - and discuss how anyone in A&E or a walk-in or OOH setting would enter - or use - data.

Problem 1 - A&E data quality poor

Problem 2 - child abuse includes non-accidental injury - *and a lot else*

Problem 3 - vast majority of child non-GP attendances for minor illness or injury with absolutely no reason to suspect abuse or neglect

Problem 4 - inconsistent check-lists and data entry in different organisations

Problem 5 - TECHNICAL - extraction of anything meaningful out of this mess of inconsistent/incomplete data to alert people seeing many children to the ones who are potential victims of abuse or neglect.

oh, and Problem 6 - you won't know who has attended a lot of times unless you record every single attendance..

Might it be an idea to look at the lessons of ContactPoint *before* announcing plans for a repetition of a cut-down version?


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De ja vu revisited

Dave Kelsall 86 weeks ago

I can only echo anon's comments. The Laming report into Victoria Climbi called for this all those years ago. The Labour government fudged and delayed before coming up with ContactPoint which was ill-conceived and badly managed.

In our area, due to cuts in local authority budgets, we are being forced to separate joint social service and health teams and go back to silo working. The brand new social services system is designed around "financials" not care delivery and they couldn't afford an interface engine to enable systems within social services to communicate - let alone interoperate with the diverse range of health systems within the local health community.

In my view, the rhetoric, Informatics Strategy, Acts of Parliament and headline grabbing announcements say one thing, the reality on the ground is quite different - mainly due to Mr Pickles' reduction to local authority income.


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Dj vu

anon 86 weeks ago

Typical of this government, ditch the improvements made by the last government then rebrand any good ideas as their own. 5 year delay and wonder how realistic the costings are, given that the headline figure is just 4% of the ContactPoint implementation costs alone, 7 years ago. The real cost of course are the children who have suffered and died in the mean time. It is concerning how fragmented NHS and social service data services are becoming, it is hard to know how many of these services remain synchronised and integrated into current/future processes and systems.

So far little progress has been made on the true interoperability of detailed clinical information across care sectors have been delivered, further fragmentation is unlikely to speed this progress.


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And why deja vu

in arduis fidelis 86 weeks ago

Because as is evidenced on this site regularly, there are plenty of people giving reasons as to why it can't be done or promoting their own vested interest projects, but not enough people saying lets get on and make this work for the benefit of our patients. I've seen more things with the potential to do so much good halted because of this sort of attitude in my 7 years working with the NHS than I saw in the whole of my 22 year career in the Royal Army Medical Corps.


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In my opinion

in arduis fidelis 85 weeks ago

Yes it is Mary, my mother worked in Child Welfare Services right up until she retired and to reference "The extensive and detailed nature of ContactPoint attracted criticism", we had endless discussions about Contact Point and both agreed that if the people that had put all of their efforts in to pointing out its failings had channeled that in to trying to make it work the benefits would have far outweighed the costs. Odd isn't it that now something new is to be introduced the questions are being raised as to why was Contact Point scrapped in the first place, interestingly I am hearing these concerns raised by people that complained about Contact Point. As to driving this kind of harm underground, so does that mean we are all happy to allow these people to hide their crimes in and using the system that is supposed to stop them! surely the more tools we use to prevent them from playing the system the harder it becomes for them to hide what they are doing, as long as tools such as this are used to support and not substitute.


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to And why deja vu

Mary Hawking 86 weeks ago

is this, in your opinion, one of them?


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