Archived decisions

1 Background

1.1 The Nursing Care Investment Strategy Programme Board has commissioned 10 nursing homes to be built in Hampshire, to develop additional nursing care capacity by creating up to 500 new places by 2006 and has been developed by the health and social care community in Hampshire.

This has been supported by the development of a clinical Governance strategy for nursing and residential care to ensure that overall systems of accountabilities and assurances are put in place and to set standards for care and practice.

It will be important to set up appropriate IT systems, and here there are three components: first, the nurse call system (approved by the Executive Member for Social Care on 24 September). Second, the infrastructural costs of IT provision to any new Council building housing the number of administration staff and management. This includes the telephony and IT2000 fees to access core Council systems such as SAPR3 and Microsoft Office and provision for nursing staff to access guidance material and care practice materials. These costs total £231,000 per year plus £185,000 of capital set-up costs and are funded from existing budgets. Third, the specific home, care and staff management IT system for these homes, which is the subject of this report. The total cost of the schemes can be contained within Social Services Revenue and Capital budget.

1.2 Over the course of the next few years, there will be an increasing demand for IT based records for the following, non exhaustive list of reasons:

· Health Care Professionals' access - £8bn National Programme for IT (NPfIT) developments in the NHS are underway to link up Hospitals, GP's and Chemists to provide an integrated patient record system, which will improve the service experience for the public and improve upon the costly inefficiencies currently experienced within Health.

· Freedom of Information - expected volumes of interest in personal details will necessitate records being stored electronically in order to facilitate the otherwise very expensive process of establishing the full extent of records being held.

· e-Government - momentum for `e-enablement' of a wide range of local government services, to the extent that BVPI 157 is being linked heavily with the Comprehensive Performance Assessments by the Office of the Deputy Prime Minister.

· Risk management - IT systems, especially those of the type proposed for Nursing Care, are designed to provide a workflow or prompt for staff to ensure that the correct care is provided at the correct time according to the agreed care plans. This of course extends to the drug / medication regimes which will be a function within Nursing Homes, but is importantly also covering the basic care functions.

1.3 Additional benefits include:

· Avoidance of the costs of document storage and administration;

· More efficient processes and improved data accuracy;

· Enabling the achievement of a full electronic social care and health record.

1.4 It is expected that the systems will also be suitable for use in other residential care homes. Implementation to those homes will require the payment of an additional licence fee. The cost is not included in the estimated figures in section 5 since there are as yet no budget or detailed plans to implement this functionality.

1.5 These decisions support four of the Aims of the Corporate Strategy: Aim 1 (Maximising Life Opportunities by assisting timely delivery of caring services); Aim 2 (Stewardship of the Environment by minimising the use of paper within the service); Aim 5 (Improving Services) by improving the productivity of staff; and Aim 6 (Developing Councillors and Staff by enabling staff with the appropriate systems and resources in delivering appropriate services).

2 IT System Requirements Summary

2.1 The IT system is required to have the following functionality and capability:

2.2 Resident Care Management

In order to adhere to regulatory requirements there are a number of records which Nursing Homes must keep for their residents. It should be noted that in existing Social Services Care homes the majority of the statutory records are held on paper, but the increased level of reporting due to the increased care being provided necessitates further support.

The core functionality requires:

· Needs Assessments, including

o Assessment information

o Needs information

o Dynamic care plan

· Treatments Provided

· Personal Details

· Entering and Leaving the Home

· Accidents and Incidents

· Medication Records

2.3 Home Management

In order to adhere to regulatory requirements and ensure the smooth running of the Nursing Home there are a number of records that must be kept. These records should be available for inspectors to view upon request and will include:

· Terms and Conditions

· Building Checks

· Food Safety Checks

· Visitor Records

· Accidents and Incidents

· Administration

2.4 Staff management

In addition to the resident and home management records, data will also need to be held regarding staff management. Staff records will need to cover:

· Duty Rotas

· Employment Records

· Employee Training and Assessments

· Employee Communications

3. Equalities

The proposal has been evaluated to be in accord with requirements of the Equality Standard for Local Government and the Corporate Equalities Plan and Race Scheme.

4. Indicative Timescales - Now being re-planned

Work Item: Complete by:

Procurement End October 04

Implementation Early December 04

Training December / January 05

Live Use / First Homes Open January 05

5 Indicative Costs

5.1 The following table indicates the capital and revenue implications, as currently estimated.

	Estimate for IT System
ONE-OFF Costs (Capital)	£000
IT System
- External	61
- IT Services *	287
Total	348
RECURRING Costs (Revenue)	Per Annum £'000
IT System
- External	16
- IT Services **	321
Total	337

* Comprising procurement costs, installation costs, configuration / set-up costs

** Comprising hosting, wireless network equipment service, device rental and logon fees

5.2 These costs may need minor alteration for out of hours support (if needed) and disaster recovery: these items are still under discussion. The total cost - revenue and capital - over four years (relevant for contract sizing purposes) will be £1,341,000.

5.3 Costs of the software are estimated at £108,225, comprising £61,225 capital purchase cost and £16,000 per annum for annual maintenance/ licence fees over the project period. The costs of implementation on suitable devices and networks are separate from this procurement, will be conducted through IT Services Department (ITS) and are summarised above. These costs are still under review and represent maximum estimates for the purpose of decision-making:

5.4.1 As with any new Council building, there are infrastructure costs of IT provision including the telephony and IT2000 fees to access core Council systems such as SAPR3 and Microsoft Office. For Nursing Homes this would include provision for nursing staff to access guidance material and care practice materials. These costs total £231,000 per year plus £185,000 of capital set-up costs and are funded from existing budgets

The additional capital spend required to implement the system is currently estimated at £348,000, of which £250,000 is to be contributed by the Strategic Health Authority and the bulk of the balance from existing NCIS budgets over the first two years.

5.4.2 The additional revenue spend estimate to run the IT management system each year is £337,000, although this only reaches this level from year 3 onwards (2006/07). The total revenue spend therefore at that time will be £337,000 per annum plus revenue costs identified in 5.4.1 which totals £568,000. Of this amount £247,000 is currently funded in the budget, leaving a balance of £321,000 per annum to be covered within departmental budgets.

5.5 Please note that the Nurse Call system, previously approved by the Executive Member for Social Care is being implemented.

6 Benefits

6.1 Benefits for this product are not defined primarily in financial terms but in the delivery of the capability to meet the various regulatory and functional needs of this new and service.

6.2 That said, the indicative and comparative costs of providing paper based administration and the resultant requirement for archiving space and stationery fulfilment are not examined in detail but are estimated as recurring costs of:

Administration Staff, including on-costs, 1 per home £ 207,000

Minimum IT provision £ 29,000

Support and Training £ 37,000

Total £ 273,000

This £273,000 per year compares with recurring cost of £337,000 / year for the IT solution.

7 Next steps

7.1 Complete procurement process

7.2 Complete discussions / negotiations on service offer and price from ITS

7.2 Commence Implementation Stage

8 Other options considered and rejected

8.1 A paper-based solution has been rejected as inappropriate and insufficient fit to purpose. This was based on the complexity of the system, requiring a potentially unmanageable archiving and retrieval system, carrying risk of damage and loss in transit, handling and storage. The wide range of functions to be carried out in the system and the reporting required from it would require significant administrative resource to comply simply with mandatory reporting, let alone standard management reporting.

8.2 Implementation of an enhancement to SWIFT was considered and rejected as too complex and expensive. The availability of a suitable version of SWIFT to enable this extension will not allow adequate time for development.

9 Recommendation

9.1 That the recommendation of the Social Care Executive is accepted and that the procurement of an appropriate IT system for Nursing Care Homes be approved.

Section 100 D - Local Government Act 1972 - Background Documents

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1. Published works

2. Documents which disclose exempt or confidential information as defined in the Act

NONE