MASH evaluation

1. MASH evaluation Stephen Curtis

2. What is the Multi Agency Information Sharing Hub (MASH)? The MASH provides a service to frontline practitioners, helping them gain a broader understanding of individuals and families. It offers a comprehensive picture of family composition based on partners accumulated involvement with a family. It informs practitioners of other agencies and practitioners working with individuals in the family. It shows a simple overview of key events and interventions for all family members. The aim is to deliver complex information in a simple format

3. What issues led to the development of the MASH? • TheMASH concept was developed in order to resolve known information sharing issues, for example: • Information sharing tends to happen on an ad hoc basis and is not underpinned by systematic cross-agency processes. • Different organisational cultures can be a barrier to information sharing. • Staff don’t always understand what they can and can’t share. • Arrangements have not been put in place to make decisions between partners about what can be shared, and how. • Guidance is full of jargon, inaccessible and difficult to put into practice.

4. A three month pilot commenced on 8th October 2012, it involved: A co-located multi agency team (the Hub) who have: An understanding of the agency (its culture, business and operation) Access to the systems, records and people who create the information, and The skills to translate the information into a form that is suitable for the request being made. A low tech, manual solution to enable an iterative approach to the development of outputs and processes Two sets of Early Years practitioners working with children and families across Hinckley and Market Harborough Health Visiting Teams Sure Start Children’s Centres The pilot was extended to include the emerging Supporting Leicestershire Families Service and the Common Assessment Framework (CAF) Team. What was piloted?

5. During the Pilot, the Hub team compiled and collated information from a range of information systems: Frameworki(CYPS Social Care) SSIS (A&C Social Care) Capita (CYPS Education) CAF Database (Common Assessment Framework) Careworks(Youth Offending) SystmOne(Leicestershire Partnership Trust) Information regarding Community Safety, Housing and Benefits was also received remotely from Hinckley & Bosworth Borough Council Hub access to these systems was limited to maintain the safety of partners’ information The focus was delivering a concise understanding of each family, not exhaustive detail. Contact details of other practitioners working with the family offered requestors an appropriate avenue to build upon these foundations with other professionals. What was piloted?

6. Focused on agreed success criteria for the MASH: Practitioners are using the MASH in the way it was designed and for the purposes anticipated Feedback from practitioners demonstrates clear benefits to practitioners and families. Information sharing is improved and consistent. Feedback and Outputs support a conclusion that the MASH model has a sound basis for continuation and expansion Legislative basis for information sharing across partners is agreed Family summary/genogram meets the needs of the Supporting Families programme Information from source systems is managed in accordance with agreed standards / processes. About the evaluation: An analysis of requests received 22 pre-pilot questionnaires 9 semi-structured interviews with practitioners and managers across the services and areas Feedback sought from senior managers. About the evaluation

7. Evaluation results – pilot phase 40 requests for information 15 from Children’s Centres (12 of those from Hinckley), 5 from Health visitors, 12 from SLF, 8 from CAF Average turnaround time is just over 5 days 12 requests with consent received for health information; 1 family refused; 27 did not seek consent

8. Overarching messages Practitioners who have used the MASH report that it is easy to use and the outputs help them to make well informed decisions about how best to engage with a family. Practitioners who have used the MASH report that it improves their efficiency. Spending less time seeking information and more time acting on it. The pilot has delivered consistent outputs to practitioners. Regardless of agency or locality, the same systems are interrogated and the summary is compiled to an agreed standard. Evidence shows the MASH works best when embedded into practitioner processes. Supporting Leicestershire Families practitioners already consider the MASH to be a key step in their process. More robust communication with staff is needed to ensure that they understand why information sharing is important, as well how the MASH can support them. The biggest barriers to practitioners using the MASH are rooted in culture(localised concerns about sharing information) and capability(Levels of IT Literacy).

9. Practitioners get the information they need Practitioners report that they get the information that they need about a family, in a timely manner “The genogram is really useful because it gives you the make up of the whole family” Sure Start practitioner “All the information has been relevant” SLF practitioner “More comprehensive, more rounded information earlier in the process of… working with a family” Locality Manager, Sure Start “Easy to read… provides information at a glance” Sure Start practitioner “About 40% of reports provide information which we did not already have” Sure Start practitioner “Reinforces and validates decisions” Locality Manager, Sure Start “Me and the family went through [the report] and were able to agree what actions we both wanted to address” SLF practitioner “[Using previous processes] we wouldn’t get half this stuff until six months down the line” SLF practitioner “I haven’t had a client where it would be useful to seek a MASH… I already know the families and work with them” Health Visitor “[Our practitioners] are working with families that they already know and have the background information from” Health Visitor

10. Practitioners contact other professionals Practitioners contact other professionals involved with a family “It does [prompt contact], particularly around social care involvement” Sure Start practitioner “You can pre-plan with other practitioners. So even before you go to see the family you can have those conversations with people who have already worked with the family” SLF practitioner “The potential for bringing together practitioners is tremendous” Health Visitor “Some practitioners, especially in social care, are not any easier to track down” Sure Start practitioner “There has been some resistance with some professionals [not in the pilot] about what we need to know” Sure Start practitioner Practitioners report a reduction in time to get information “It saves us all the donkey work… it saves us a job of having to ring round and find out where they’re registered” Sure Start practitioner “This would take us quite a long time to get if we were getting it how we’ve always done” SLF practitioner “Without the MASH there would be capacity issues… we would have to manage [the process] very differently… and therefore there would be a delay in service for families” Sure Start practitioner

11. Operational processes are easy to use Practitioners report that the operational processes are easy to use and meet appropriate timescales “The process is straightforward” Health Visitor “It’s one of the simplest forms we use” SLF practitioner “It’s a really good turnaround to get this information” SLF practitioner “A week’s feeling really comfortable for me… we’re not an emergency service” Sure Start practitioner “There were initially some issues about GCSx access” Sure Start practitioner “It works as well as it can. It’s on Systm1 and everything on Systm1 is a challenge” Locality Manager, Health Visiting “The negative stuff has more been around the bureaucracy of… setting up the secure email” Locality Manager, Sure Start “The process is problematic for me because it’s new and I’m not comfortable with it” Health Visitor “I need greater clarity about consent” Health Visitor “Found the form very cumbersome… maybe because I’m new to the process” Health Visitor “If it was on Frameworki, any other worker coming in could save so much trouble” SLF practitioner

12. Practitioners know when to request a family summary Practitioners report they are confident about when to request a family summary “You don’t know until you start doing it” Sure Start practitioner “I’m quite clear, and if unsure I’d ring the MASH directly” Health Visitor “Immediately made a request!” SLF practitioner “[If SLF allocations process was live] it would’ve been done for all our families” SLF practitioner “Staff can see that it is useful, it’s just getting them into the habit and giving them the confidence in doing it” Locality Manager, Health Visiting “We need to think about where a MASH request fits into standard operating procedures, to prompt practitioners to ask themselves whether a request is appropriate” Locality Manager, Health Visiting

13. Outputs meet the needs of SLF Family summary and genogram meet the needs of the SLF programme “[After the family gave consent to share health information] their summary went from three practitioners to, I think, twelve… Before [seeing the health information] I didn’t have a clue what was going on, because they were confused themselves” SLF practitioner. “Excellent, really… fantastic” SLF practitioner. “A lot of families really struggle to tell you what’s happened… it’s quite personal, it’s their lives and when we say what we know [through the family summary report] it’s almost a sigh of relief to them, ‘Thank God I’ve not got to go through all this [again]’” SLF practitioner. “It’s refreshing that [the MASH] are open to continuing improvement… usually new things come and and [we’re told] ‘this is the way it’s going to happen.’ But it doesn’t always work… this has been tailored to our needs” SLF practitioner. “You’ve exceeded [our expectations with] the changes we suggested” SLF practitioner. On not being able to save the reports: “Fair enough, it’s only valid [for a short time] but so are our assessments, but they need to be logged… it’s a reference point” SLF practitioner. “If it was on Frameworki, any other working coming in [to support the family] could save so much trouble [understanding their history and circumstances” SLF practitioner.

14. Continued commitment to MASH Senior managers express continued commitment to the delivery of the MASH process “I believe the approach we are adopting remains the right approach. I think it is important that practitioners have a full background history of the scenario they are going into and that this information is appropriately shared and at the forefront of practitioners’ thinking. I also think it a very valuable aid for practitioners to have this chronology and background history summarised for them in a very easy to understand format - which I believe we have got.” LCC manager “It should benefit clients as they don’t have to keep repeating their story about who is involved and what they are doing. It will also help coordinate care, and prevent duplication of services.” Leicestershire Partnership NHS Trust manager “[I believe] the MASH is a really good concept… it gives a lot of benefit for frontline staff, and ultimately for the families we work with” LCC manager

15. Lessons learnt By engaging frontline practitioners earlier in the project, particularly asking them to help define the problems around information sharing as well as potential solutions, we may have increased their sense that MASH outputs match their needs, thereby encouraging greater commitment to ‘trying out’ a new process. Each service partner should consider designating a single, named contact who is empowered to make decisions and progress decisions with regard to the MASH. During the design and development stages, all partners should be willing to acknowledge and address internal issues which may affect implementation, such as issues with existing technology, staff capability, data quality etc. Communications at all levels (including practitioners outside the initial launch area) should be resourced appropriately and regularly maintained. Each partner should take responsibility to cascading agreed, shared messages throughout their organisation. Partners should explore further ways of achieving value from the information collated in the family summary report, such as making it available to other groups of professionals, using it to inform referral processes, storing it within case management systems, or using it as part of commissioning services.

16. Recommendations to SIMG / SLF Board Recommendations It is recommended that: The MASH is transitioned from pilot stage into a business as usual service. Organisations confirm their commitment to using and developing the MASH. Pooled budget funding is sought to support the information analyst post. Partner organisations commit to providing appropriate resources for the MASH. The MASH is expanded to include additional information sources and organisations, on a countywide basis. Each service using the MASH should aim to run a single process to request, receive and use family summary reports. Organisations should consider the need to change operational processes to embed the MASH into day-to-day operations. Two short to medium term priorities are agreed: 1) To support Supporting Leicestershire Families 2) To extend the service provided to Early Years to cover the whole county A detailed implementation plan is developed and managed by the MASH Board. A further progress report is delivered in six months.

17. Considerations Agreement to the roll out of the partnership MASH service will require engagement with all District Councils, and specifically: How the MASH project can best engage with Districts Extending the current model to all Districts (a virtual involvement in the hub, rather than co-location) The need to agree a core set of District information Putting in place operational arrangements for handling information requests from the MASH Identifying the benefits for District Councils How can Housing Associations be engaged Note that requests for family summaries from the MASH are being incorporated into the SLF referral process