Encompass - Here to Revolutionise Northern Ireland's NHS!

my journey of conscious uncoupling from nhs midwifery May 10, 2024

Up until I scrolled my way to an instagram post selling me the idea of a ‘digital revolution'  in health care yesterday, it had been my intention to write about the importance of friends.

Our friend Philipp aka German Phil decided to take a spontaneous trip to Belfast from Munich and we got to spend a precious few hours with him over the weekend. When Phil and I met he was twenty years of age and I was twenty-five and if you’ve read my post Fifty Reflections’, you’ll know that that’s exactly half a lifetime ago for me.

German Phil and I both came to Northern Ireland as volunteers. It was in the late nineties, back in the day when Germany still had conscription for young men. Men who were opposed to military service had a right to conscientious objection. Instead of serving 12 months in the military, they could do 18 months in alternative civilian service and they could do that in a charity abroad via an organisation called 'Eirene'. Women were exempt from conscription but they could volunteer their services if they chose to and that’s what I did. I felt it was every bit my responsibility to contribute to a better world as it was that of my male friends'. Given this premise, there were by far more men in the various charities across Ireland and Northern Ireland than women and so I found myself at an Eirene retreat in Dundrum with a five months old baby and about a dozen conscientious objectors. Half of them had only arrived like Phil and the other half were about to leave after having completed their service. I had completed my service but I was staying to live in Belfast with Gerald, my baby's daddy, to see if we could make a life of it (and we have).

Because this was strictly an Eirene event, Gerald couldn’t come with us and so Phil, whom I had only met that day, offered to take Lena for an hour or two in the afternoon so I could take a nap after an unsettled night with her. She just snuggled up to him in her Didymos sling and although she had been fighting sleep lying next to me in our dorm she fell asleep easily being carried around by Phil. That was the beginning of our friendship.

After the retreat my cohort of volunteers left to resume their lives back in Germany. I was so happy that Philip had his voluntary service ahead of him and even happier when he was offered a job at his charity and decided to stay. For just over fifteen years he was a constant figure in our family. Many of Lena’s childhood memories include Phil. He and Gerald and Lena used to spend days at the beach when I was called to births as a midwife on Sundays and Easters and other special occasions. Phil was always there and then he left to move back to Munich.

We visited once in the years leading up to the global standstill.

And now that the world is in motion again as people remember how we used to live our lives before 2020, Phil, too, packed his bags and came to see us.

It was a weekend of cake and cream and one of our special dinners for guests: homemade Pizza and carrot salad.

Philipp is back home in Munich by now and he has left us with some exciting plans and prospects. Maybe soon I will share with you my thoughts on the importance of those who have witnessed us through the seasons of our lives but this week I must talk about the ‘digital revolution' that is about to hit further areas in the health and social care trusts of Northern Ireland.

Encompass.

Encompass is being rolled out by Digital Health and Care NI (DHCNI) and yesterday I came across a post on Instagram where a doctor referred to it as a 'Cultural Revolution'. I looked at it several times to confirm that that truly was what the doctor had said (which it was) and then I couldn't help but feel a tad uneasy given that the only reference for 'Cultural Revolution' that I have led the people of China into a decade of chaos, violence, suffering and death under Mao Zedong in the late 1960s. 

I can just about cope with the notion of a 'digital revolution' but please let's leave a 'cultural revolution' alone given the dark connotations. 

My sense of unease had me take a look at what Encompass promises to be and here's what I found and what I think about it:

DHCNI is the ‘data and technology lead to the health and social care system in Northern Ireland’. Their mission, in their own words, ‘ is to harness the power of digital to improve health and care for our population, while improving working practices for all HSC staff’.

My first question: 'Digital' what? Has 'digital' progressed from adjective to noun (not according to the online Oxford dictionary but please do correct me!)

Encompass aims to streamline the user experience by providing an interface between the various parts that make up an episode of care. Your nurse, midwife, doctor. physiotherapist, pharmacist, dietician and whoever else needs to be involved can see ‘you’ at the click of one button. Your active prescriptions, your blood results, x-rays and other screening tests will be visible in your digital record and you, yourself, will also be able to access it and interact with it. The old and clunky systems that are currently in use will eventually be discontinued and this is meant to free up staff time; time that they can spend with you.

There’s an interview with community nurses on the promotional platform for Encompass and they welcome the ease of use and the fact that they no longer have to schlep charts from house to house. Keeping our information stored away digitally is overall easier; and centralising the digital system in use means that everyone has access to your data at the same time; practitioners can add information in real time as your story unfolds.

So far so good!

According to the community nurses in the video there’s more time for their patients as a result. They love Encompass!

In their online information leaflet the DHCNI tell us that encompass will improve patient care because staff will save time not having to locate paper files. Apparently there won't be any need anymore for duplication of records which will be music to the ears of any midwife I am sure! I remember well the frustration at having to document giving a pharmaceutical drug in two different places in your handheld record and in three places if it was given in labour. 

We are also told that digitally stored data is safer than data stored on paper; digital storing of data, according to the DHCNI, ensures that only those who need to see your file will actually see it.

Sounds great doesn’t it?

I wonder what would happen if anyone declined moving to Encompass? Would the service be able to facilitate that? I remember many years ago, when I was working as a midwifery sister in a midwife led unit one of the mums didn't want her information captured on NIMATS (Northern Ireland Maternity System) and initially the question arose about how to navigate her care. One of my managers thought that she 'couldn't decline' this which I thought was ludicrous. After all we were midwives with a code of conduct and the woman had requested our care. We could hardly turn her away on the basis of her not wanting her data entered into a central data base. A call to our legal team confirmed that we would have to find ways of working around this issue with her. As a public service we needed to accommodate her and respect her wishes. The only thing we could not offer her without any digital data trail were bloods. The labs wouldn't have been able to process them. We explained what all the bloods were for and gave her the choice to accept or decline. The labs gave us the option to keep the results on their system only without passing them over to ECR (Electronic Care Record - a system that sounds like it has some similarities with Encompass).

This mum was worried about a digital data breach at the time. She knew that there had been one in NHS England and it made her worried. She preferred to keep her information analog and I can understand that.

Digital data breaches do happen and  when they do, more people tend to be affected by them at any one time than in the case of someone losing a briefcase full of hand-written patient records, say. And when all of the information is stored in the same place, then all of the information is visible in case of a breach.

There are advantages and disadvantages to everything and those who are driving the change generally focus on selling us the advantages. That’s how the great world spins, we all have our biases.

Although I know all the reasons why a cautious approach to giving away my data to be stored as ones and zeros forever more would be advisable, I am not personally averse to having my health information entered into Encompass. I know that most of it is already captured digitally and there do seem to be undeniable advantages to streamlining the systems. I know this because I know of the waste of time and frustration that comes with not having it streamlined. 

I would also feel that denying a transfer of my health data to Encompass would reveal a double standard, really, given that I willingly volunteer a lot of it via social media, my various store cards, my phone in my pocket, google maps, apple pay or the credit card that has almost replaced any use of cash ever. Little by little I've allowed myself to be nudged here in the name of progress. I know that I am desensitised to accepting a digital thumbprint and I take full responsibility for that. Paying everything with the credit card sounded like a great idea when I found out that there’s a cashback deal on it. According to my bank, I have ‘earned’ over £4000 since opening the card back in 2012 by simply paying everything with my card (the black one).

Back in 2012 the world seemed a lot more innocent to me. I didn't see much of an issue with making good use of modern technology. Some of my friends have resisted credit cards and mobile phones to this day, though, and had I done that, I would feel differently about giving it all up to Encompass. 

The events of the last four years have changed my perspective of our governments and though I will happily have my data moved to Encompass I can see why others may not want to. And I am not holding my breath on the promise of a new and better digitally (and hopefully not culturally) revolutionised NHS.

The official line is that Encompass will make things safer and more effective and that's a promise that hasn't come good before ('Safe and Effective' anyone?).

I am asking myself if I really believe that the time that staff are going to save is going to go straight back into time with NHS service users and I don't (but I am happy to be proven wrong!).

Years ago I read a study that found that midwives spent 52% of their time keeping records and only 48% of the time with their clients. I am wondering how many percent of time we can make back by using Encompass. And then I am wondering if a government that was poised to dismiss tens of thousands of NHS frontline staff in England for declining a certain government approved injection would rather cut back on a percentage of their medical staff to make good on the initial investment into the software than giving the time to us, its clients. 

My sense of distrust towards my employer as a registered midwife was a driving factor for giving my registration back to the Nursing and Midwifery Council, you can read about it in my blog 'The Day The Bubble Burst'I give a timeline about axing of staff during a time of increased need in the social care sector in this post. 

The fact that thousands of care workers in the private sector were dismissed for being apprehensive about accepting an newly released pharmaceutical seems unbelievable now that AstraZeneca have admitted that their variant of the injection caused 'rare' blood clots and low platelet counts. The company has made a 'commercial decision' just last week to withdraw it after having been hit by a class action law suit for causing death and permanent injury. I am guessing that the 'commercial decision' is based on the potential legal cost that could be drawn from continued distribution of the drug as much as the official company line which goes something like 'there's a surplus of available options on the market'. 

I digress.

It looks like the DHCNI is here to stay and that 'going digital' is the future of 'health care'. I just hope that this isn't the first step towards accepting to be 'cared' for by AI and robotic phlebotomists. And I hope that midwives get to spend the extra time with women because I know that that's what most of my former colleagues want more than anything else; time to do what they came to do.

Meanwhile at Essentially Birth we continue to embrace the power of Zoom and Kajabi so that I can support you wherever you are. To book a one-to-one online consultation or to enquire about how I can support you digitally, just send me an email to [email protected] 

If you are in Northern Ireland, come and see me for a pregnancy or postnatal massage or come for face to face sessions either one-to-one or in the upcoming workshops that I am co-hosting over the next few weeks.

Check out Making Sense of Birth in Dungannon and Born Through Yoga in Belfast. Any questions, just email me.

Would you like more of my writing? You can! I have written a book called¬†'7 Secrets Every Pregnant Woman Needs To Hear Before Giving Birth: The New Midwife‚Äôs R.O.A.D. To Birth‚ĄĘ Hypnobirth System'.¬†

It offers perspective on common misperceptions about pregnancy, birth and risk and it gives you my R.O.A.D. To Birth hypnobirth system that my clients have used for years. It shows you how to Recognise and Release your Fears, Overcome obstacles, Accept what you can't control and Do the work. 

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