Child Health Information Services (CHIS) are local active clinical care records of all the children in an area, ideally containing information about an individual child's public health interventions, particularly screening, immunisations and outcomes of the 0 to 5 healthy child programme (including the mandated review points), and where relevant information for use in the safeguarding of children.
CHIS have three components:
- a child health records department (CHRD) – staff and estate
- an IT system, the Child Health Information Service System (CHISS)
- a personal child health record (PCHR), otherwise known as the Red Book.
Why are CHIS needed?
CHIS records are available to relevant health care professional such as health visitors and school nurses to help them do their jobs – holding data relevant to the 0 to 5 and 5 to 19 year healthy child programmes and public health interventions. Most CHIS play a critical role in the scheduling for immunisations and health visitor appointments; sending out letters to parents, recording and monitoring of public health programmes. In addition CHIS often provide vital information to local safeguarding teams.
CHIS are the definitive source of immunisation uptake and coverage data within England and, as such, are essential to limiting the spread of communicable diseases - supplying the statistics used in the cover of vaccination evaluated rapidly (COVER) programme which evaluates childhood immunisation in England. COVER information can be useful (fore example, during an outbreak of a disease for which some children may/ may not be immunised) and provide a population-perspective for all the public health programmes, enabling effective targeting of services.
Importantly the child health record held within local CHIS follows the child and family when they move GP or move area and provides a failsafe to ensure that all children, including those not registered with a GP, have been offered and have access to vital public health services.
Who commissions CHIS?
NHS England (via its 13 regional teams and heads of public health commissioning) commission the overall CHIS as part of the Public Health Section 7a Agreement – service specification 28. The providers of CHIS are responsible for the commissioning of the CHIS IT systems. These systems are not commissioned by NHS England. Guidance for the CHIS IT system providers, the Output Based Specification, has been published by Public Health England.
Why does CHIS concern local authorities?
Local government is responsible for commissioning school nursing and will be responsible for the 0 to 5 healthy child programme (delivered by health visiting and family nurse partnership (FNP) services) from October 2015. These services and staff have a pivotal role in the delivery of public health interventions for children, and information held by the CHIS service will support delivery as outlined above. To evidence the delivery it is the responsibility of the providers of the 0 to 5 healthy child services to report on outcomes and activity – including the five mandated touch points. They will do so by gathering information from all the relevant CHIS systems plus other clinical systems as required.
Local government is not responsible for CHIS and does not have a remit to gather data directly from CHIS, unless special arrangements are in place such as separate and agreed contracts with CHIS providers. It should be noted that some CHIS providers can be in the same or different providers to those delivering health visiting or FNP services, and it is the responsibility of the 0 to 5 healthy child providers to ensure they have adequate data flows to evidence delivery.
How good are local CHIS providers?
In general the local CHIS are very good at registering new births and setting up an individual child record. They will usually have an automatic electronic link to the local maternity services, enabling automatic notification of new births, allowing for the scheduling (and re-scheduling) of the relevant public health interventions.
Interoperability, to other clinical IT systems remains an issue for many CHIS as they require information from primary care service, health visiting and FNP services and movers in and out of area etc, to inform the child records.
As part of its responsibility as commissioners of CHIS, NHS England has implemented a CHIS Improvement programme to mitigate risks and issues that arise from the lack of interoperability in order to improve the quality of service delivery.