INFORMATION SHARING AGREEMENT

Lifestyle Support Programme Physical Activity Referrals to

WhitfieldValley Centre (Chell Area Family Action Group ~ CAFAG)

Date of First Issue: August 2011 / Author / Post Responsible for Review: Senior Health Improvement Specialist /Professional Manager (Lifestyle Programme)
Date of Last Reviewed: N/A / Version: 1.0
Date of Next Review: April 2012 / No of Pages:plus appendices

CONSULTATION AND RATIFICATION SCHEDULE

Name and Title of Individual / Date Consulted
Information Governance & Information Security Officer
Information Governance Manager, Stoke on Trent PCT
Head of Information, Stoke on Trent PCT
Lifestyle Support Programme Strategic Group
Caldicott Guardian, Stoke on Trent PCT
Lifestyle Support Programme Operational Group
Name of Committee / Date of Committee

VERSION CONTROL

Stoke on Trent NHS Primary Care Trust
Version / Date / Comments

TABLE OF CONTENTS

INFORMATION SHARING AGREEMENT

Lifestyle Support Programme Physical Activity Referrals

Introduction / BackgroundPg 3

Scope of the protocolPg 4

Purpose of the protocolPg 4

Objectives of the protocolPg 4

Management of the protocolPg 4

Parties (agencies/organisations) to the ProtocolPg 5

Powers/Legal RequirementsPg 5

Information QualityPg 6

Process: Pg 7

Roles & responsibilities (Designated Officers)Pg 9

Monitoring & BreachesPg 9

Review of Information Sharing AgreementPg 10

Indemnity / Security GuaranteesPg 11

TrainingPg 12

SignaturesPg 13

AppendicesPg14

Introduction / Background

The Lifestyle Programme (LP) is a NHS Stoke on Trent initiative which has been introduced across the City of Stoke on Trent. The programme will identify and support those people with, or at high risk of developing, cardiovascular disease (CVD). The programme has many elements and relies on a number of key partners for successful delivery.

A key element of the LP is the offer to clients of a 20 week physical activity programme. This programme is delivered by specialist personnel employed by Whitfield Valley Centre(CAFAG). The nature of the role of these specialist staff requires them to have a sound understanding of the health status of clients referred to them so that they can devise an appropriate physical activity package and offer suitable support. Physical activity referral has been in situ in Stoke on Trent for a number of years with the principals from the process of referral being based on the National Quality Assurance Framework for Exercise Referral Systems (DH; March 2001).

Scope of the protocol

This agreement is made between NHS Stoke on Trent(PCT) and Whitfield Valley Centre (CAFAG). The agreement relates to the management of information provided to the Whitfield Valley Centre (CAFAG)by the PCT and Voluntary Action Stoke on Trent (VAST – an agent of NHS Stoke on Trent) pertainingto clients referred for physical activities. All client information shared via the referral process is encompassed by this agreement.

Purpose of the protocol

The purpose of this ISA is to ensure that all parties involved in accessingLifestyle Programme client referral information are fully aware of the necessities of and the principles required by data protection measures and information governance / controls. The agreement ensures that all parties are aware of their organisational responsibilities and obligations, to ensure the reliability and security of all information shared.

The information relating to clients referred for physical activities has to be shared with the Whitfield Valley Centre (CAFAG)so that clients need’s can be assessed and appropriatelyskilled members of staff can develop physical activity programmes that meet the needs of clients and enable them to access health improving physical activities.The Lifestyle Support Service(VAST), are responsible for initiating the physical activity referral for clients. The Lifestyle Support Service will supply Whitfield Valley Centre (CAFAG)with a copy of the Lifestyle Programme Referral Form so that the physical activity delivery personnel can develop an appropriate physical activity programme for the client.

Objectives of the protocol

This agreement will ensure we achieve the following objectives:

  • To provide clarity regarding information management within the scope of this agreement.
  • To ensure compliance with all current Information Management legislation.
  • To provide an audit trail for information relating to the scope of this agreement.

Management of the protocol

This agreement is the responsibility of the Operational Group (Lifestyle Programme), a group with defined Terms of Reference, an agreed membership and clearly stated Aims and Objectives (appendices 1).

Only the agreed quorum of the Operational Group can approve an update of this agreement.

Ultimate oversight responsibility lies with the Lifestyle Programme Strategic Group.

Parties (agencies/organisations) to the Protocol

Parties include:

  • NHS Stokeon Trent,Health Improvement Team, Lifestyle Support Programme, Heron House, 120 Grove Road, Stoke on Trent, ST44LX. Lead Officer – Chris Leese, Programme Manager. Contact number – 01782 298053.
  • Whitfied Valley Centre (CAFAG), Fegg Hayes Road, Stoke on Trent, ST6 6QR. Lead Officer – Linda Hamnett, Centre Manager. Contact number – 01782 878843.
  • Voluntary Action Stoke on Trent (VAST), The Dudson Centre, Hope Street, Hanley, Stoke-on-Trent, ST1 5DD. Lead Officer – Andrew Thompson, Operations Manager. Contact number – 01782 683030.

VAST are the umbrella organisation hosting the Lifestyle Support Service with a management agreement in place with NHS Stoke on Trent. Lifestyle Support Service personnel hold Honorary Contracts with NHS Stoke on Trent.

NHS Stoke on Trent will provide patient information to their acting agents, the Lifestyle Support Service (VAST), via agreed primary care referral routes. The Lifestyle Support Service will then consult with the patient / client and develop an appropriate health improvement plan which may require onward referral to, and information sharing with the Whitfield Valley Centre CAFAG).

Information shared with the Whitfield Valley Centre (CAFAG) will be in the format of a faxed Lifestyle ProgrammeReferral Form. This form will provideall required information to enable physical activity personnel to develop personalised physical activity programmes.

Powers/Legal Requirements

This agreement provides the formal structure for the sharing, management and storage of person identifiable information in line with the Data Protection Act 1998. All parties are Data Protection Registered with relevant authorities.Data Protection Registration numbers appear below:

  • NHS Stoke on Trent –Z9698759
  • Voluntary Action Stoke on Trent –Z6086369
  • Whitfield Valley Centre (CAFAG) –Z6948021

Information Quality

Prior toinformation being shared with any partner the referral form content will be assessedby a PCT representative eg general practitioner, practice nurse or primary prevention team member.The referring representative is responsible for ensuring the information is complete and quality standards are met ie readability, relevant information recorded, all information being current and accurate.

Information will be supplied via theLifestyle Programme Referral Form (see appendices 2) via fax to a fully compliant Safe Haven. The information contained in the Lifestyle Programme Referral Form includes: patient details, medical status and current medication. It also includes the signature of the referring person and a signature, plus agreement to participate and consent to share personal details,from the participating client. The referral form contains client identifiable information which is sensitive in nature.

Safe Haven fax machines are located:

  • NHS Stoke on Trent Safe Haven Fax is located in the Programme Administration Office, Ground Floor, Heron House and is supervised by the Lifestyle Support Programme Administrator – Safe Haven Fax number:01782 298054
  • The Safe Haven Fax for the Lifestyle Support Service is located in the Lifestyle Service Managers office at the Dudson Centre and is supervised by the Lifestyle Service Manager – Safe Haven Fax number: 01782 683177
  • The Safe Haven Fax for the Whitfield Valley Centre (CAFAG) is located in the Admin Office and is supervised by the Centre Manager, nominated LPInstructor and Administration Assistant. The nominated LP Instructor (Steve James) will manage the referral information on a day to day basis. Safe Haven Fax number: 01782 868999.

A copy of the completed Lifestyle Programme Referral Form will be held on the Patient Records System at each referring practice for reference.

All received information should be stored in locked and secure storage. When information is received by VAST at Bentilee it will be stored in the Lifestyle Support Service Manager’s office in a locked filing cabinet. When received by the Whitfield Valley Centre (CAFAG) the information will be collected and stored by the nominated LP Instructor (Steve James) or the Centre Manager,or Administration Assistant,and stored in a locked storage cupboard in the General Office.

Information received will be complete and fully legible.If information is missing or is illegible, the receiving member of staff should inform the sender as soon as it is practical so that swift action can be taken to correct the issue. If it is not possible to contact the sender the Lifestyle Support Service Manager should be contacted so that they are aware of the missing information and informed of the action required to ensure quality standards are met. It is appropriate to inform the Primary Prevention Team Professional Lead if missing information is medical in nature so that they can engage primary care partners. It is important that this task is conducted by a named person, minimising differing interpretation methods and approaches being utilised and also ensuring that the sender has a named, familiar point of contact.

The named lead persons are:

  • NHS Stoke on Trent Primary Prevention Team Professional Leads – Yvonne Mawby / Linda Picariello Tel: 01782 298175
  • VAST Lifestyle Support Service Manager – Marion Beloe Tel: 01782 231372
  • The Whitfield Valley Centre (CAFAG) Centre Manager–Linda Hamnett Tel: 01782 878843

Shared information should only be accessed by named individuals. A complete record / register of those who have access rights should be maintained by the organisational Lead Officer (details on page9).The following individuals will require access:

  • Professional Manager for the Lifestyle Programme (PCT)
  • Health Improvement Specialist (Lifestyle Programme - PCT)
  • Lifestyle Programme Administrator (PCT)
  • Lifestyle Support Service Manager (VAST)
  • Lifestyle Coach Team member (VAST)
  • Centre Manager Whitfield Valley Centre (CAFAG)
  • Nominated LP Instructor (Steve James)Whitfield Valley Centre (CAFAG)
  • Primary Prevention Team membersNHS Stoke on Trent

Alteration of and additions to the register should only be approved by the Lead Officer for each organisation.The register should be assigned a named supervisor, kept secure and if possible located on a secure electronic drive which ensures limited access.

The Professional Manager for the Lifestyle Support Programme will keep the PCT’s copy of the Register on the N:drive in a restricted file location.

Whitfield Valley Centre Manager will keep the Registeron XXXXfile on the XXXXserver in a restricted file location.

The Lifestyle Support Service Manager will have access to the Register details via the PCT N: drive and will advise the Professional Manager of any additions / amendments required to ensure the Register is current.

Process

Information received via official fax should only be used for the purposes it is intended ie to inform the Lifestyle Coach of personal information and health status of clients referred to the Lifestyle Support Programme and the Physical Activity Delivery Team of the referred clients personal information, medical status and current medication if referred to the physical activity component.

As already discussed information will be shared using one method:

  • Official fax sent to a Safe Haven fax machine

The recording of all decisions in relation to the information shared should be kept by a named person – as designated by the Lead Officer for each organisation. This information will inform the audit process and or Freedom of Information requests.

Access to the information will be by those who appear on the Access Register. It is the responsibility of the Lead Officer (of each organisation) to ensure only those who have a right to access the information shared do so.

Client information is sensitive, highly privileged and confidential. It should only be used for the purposes previously discussed. Client information cannot be used for any other purpose ie mail shot, cold calling, sharing with third parties or shared internally to individuals or organisations outside of the scope of the Lifestyle Programme.

Information Sharing Procedure Steps:

  • Primary prevention team or general practice staff member fax the Lifestyle Programme Referral Form to Safe Haven Fax at Heron House. LP Administrator records receipt of form and forwards to Lifestyle Support Service Manager (LSSM) via fax.
  • LP Administrator contacts LSSM and informs of intention to fax information and seeks assurance that they will be available to receive it. Information sent via fax must include official header indicating number of pages sent. LSSM confirms receipt of fax with LP Administrator detailing number of pages received via e-mail or phone.
  • LSSM reviews the information received, checks for quality and assigns a Lifestyle Coach to the client. Client information is passed to a Lifestyle Coach by hand. Handing over of client details must be done in an envelope marked ‘private & confidential’.
  • If required, client information is shared with the Whitfield Valley Centre (CAFAG) via fax totheWhitfield Valley Centre (CAFAG) safe haven. Prior to sending information the Lifestyle Coach will ensure that the client has consented to sharing their personal information with an accredited provider using the agreed information sharing consent as per LP Referral Form.
  • Information sent via fax must include official header indicating number of pages sent.
  • Fax collected and recorded as received by LP the responsible person from the Whitfield Valley Centre.Responsible person confirms receipt of fax with LSSM detailing number of pages received via e-mail or phone.
  • A simple Log System must be used to keep a record of faxes sent and received. Log System will include date, time, sender and number of pages received. This Log System is the responsibility of the Named Officers as they appear on page 7 & 8 of this agreement and must be kept secure.
  • Faxed information is stored in the locked cupboard in the Administration Office.
  • Information received by the LiSP Instructor must be stored in secure, locked storage on site applying Caldicott Principles in it’s protection and management,be accessible by named members of staff only and not removed from the site for any reason other than to return it to NHS Stoke on Trent for archiving.
  • Information will require sharing back up the chain of referral once the client has completed or stopped attending the physical activity programme. The information shared will include:
  • Successful / non completion of 20 week physical activity programme
  • Type of activities attended and record of 3 x a week adherence
  • Clients level of satisfaction of their engagement with the programme
  • Timely reporting of any problems or issues
  • The format of reporting will be in a simple letter addressed to the Lifestyle Support Service Manager and copied to the ‘Original’ referring NHS representative (as indicated on the Lifestyle Programme Referral Form). See appendices 3 for information to be included in letter.
  • If a client has a negative reaction to any activity they undertake, it should be verbally reported immediately to the LP Instructor and the Whitfield Valley Centre Manager. Information relating to an episode as above will also be verbally reported immediately to the Senior Health Improvement Specialist (Lead Commissioner)at the NHS Stoke on Trent. A written report will be required discussing the issue and action taken to reduce / alleviate the reaction observed. The PCT Incident Reporting Procedure (appendices 6) should be followed. All internal Whitfield Valley Centre (CAFAG)Accident and Health and Safety reporting will be expected to be followed.
  • If a serious event occurs (including near death or death) the PCT Incident Reporting procedure MUSTbe followed.

Roles & responsibilities (Designated Officers)

The Operational Group (LP) is responsible for the management of this agreement with individual officers nominated to take the lead on specific aspects of it’s practical use.

The Strategic Board (LP) is the principal oversight and control group with the power to make decisions if a breach of data protection is identified.

The Senior Health Improvement Specialist (Lead Commissioner)is responsible for managing the day to day operation of this agreement and auditing activity. Any changes to the agreement must be shared and agreed with the Senior Health Improvement Specialist so that amendments can be formally approved at Operational Group level and the Strategic Group informed.

The Head of Operations has overall responsibility for this agreement on behalf of Voluntary Action Stoke on Trent.

The Centre Manager has overall responsibility for this agreement on behalf of the Whitfield Valley Centre (CAFAG).

Monitoring & Breaches

The Senior Health Improvement Specialist (Commissioning Lead)is responsible for the monitoring of this agreement and will audit against this agreementby visiting partners and taking a ‘snapshot’ or thorough audit of each element contained herein.

Snapshot audits will be undertaken with at least 24 hrs notice being given to the organisation about to be audited. There will be at least 1 ‘snapshot’ audit per year. A thorough audit will only be undertaken when at least 2 weeks notice has been provided, allowing adequate time for the responsible personnel to prepare the required information and ensure all requirements of this agreement are to hand during the audit visit. At least one thorough audit will take place in any 12 month period.

Following the audit a brief report will be shared with partners informing them of successful compliance with the agreement criteria and / or any changes / action required to improve compliance or where compliance has been breached.

The reports will be shared with the Operation Group who will then share them with the Strategic Board if appropriate.

If a breach of data protection is discovered, swift and appropriate action will be taken to minimise the impact of the breach and a notification of the breach will be immediately issued to the Senior Health Improvement Specialist (Commissioning Lead). The Chair of the Strategic Boardwill then be informed so that a strategic response to the breach can be developed and actioned. If required the PCT Information Governance Lead and Caldicott Guardian will also be informed.