Case Study - Digital Health & Care Record

Enabling the Digital Health & Care Record for Wales

The Digital Health & Care Record for Wales epitomises the connected and collaborative system that the NDR programme enables. A joined up approach to health and care will further allow services to be centred around the patient which will enable them to receive the support they need, regardless of the complexities of their situation. The NDR programme is bridging the data gap and bringing this ambition into existence.

As time passes, more and more stories should resemble that of Lewis, one of coordinated care and ongoing support.

Click through the tiles below to see how the Digital Health & Care Record can support Lewis and ensure services are centred around his needs.

The National Data Resource Programme, the NDR, is transforming Health and Care in Wales through a more connected and collaborative system. Let’s explore how the NDR can support the Digital Health & Care Record for Wales in enabling a holistic and personalised care experience for Lewis.

Lewis is getting older, and since his fall at home not long ago, he has been on a Care Plan. He also cares for his wife, Bethan, who is living with dementia. A remote motion sensor was installed in their house to alert family or a 24/7 monitoring centre should either of them have a fall or not be following their usual movement patterns.

One day, Lewis is feeling very tired and hasn’t left the bedroom. He receives a call from a remote monitoring centre operator. Lewis is not speaking clearly on the phone and his Digital Health & Care Record identifies him as being at risk of a stroke. An ambulance is called and his close family informed.

The ambulance service already have Lewis’ key details from his Digital Record. The hospital is pre-warned and plans are immediately put in place to support Bethan while Lewis is gone. Lewis is taken straight in for treatment.

Whilst Lewis is being treated his Hospital Social Worker begins putting together an updated Care Plan using the existing details from Lewis and Bethan’s Digital Health & Care Records.

An Occupational Therapist (OT) also assesses what support is needed at home in order for Lewis to be discharged. The OT can see Lewis’ Care Plan and works with the Social Worker and family to make sure it fits his needs.

By the time Lewis is medically fit for discharge he already has a joined up Care Plan in place so he can go home to Bethan without delay. His family have been fully engaged in this preparation. He can see in his Health & Care Portal that appointments have been scheduled in for him and prescription reminders set.

When Lewis gets home, some assistive equipment has already been installed and a care worker arranged to provide support a few times a week. The Occupational Therapist soon visits to check the equipment is appropriate. They speak with Lewis’ Care Worker to see how he is getting on and check Lewis' priority outcomes with him now he's at home.

Lewis sees a range of health professionals who work together to help him recover from the stroke. After each visit, his Digital Health & Care Record is updated so that everyone has a single, up to date, view of Lewis’ progress. Lewis can keep track of this himself too via the Health and Care Portal.

As Lewis continues to recover, the reablement team also visit to put longer term support in place so that Lewis feels comfortable and capable of continuing to look after Bethan. Lewis enjoys getting back to cooking and even does some gardening for the first time in years.

His Care Coordinator recommends a charity volunteering service that can help Lewis with shopping, gardening and caring for Bethan. It’s nice to have the extra company and takes some strain off his own caring responsibilities.

A few months on, Lewis and Bethan now have a strong support network in place to keep them happy and healthy. Without the joined up work from health and social care, enabled by the NDR, Lewis and Bethan could have been facing a very different situation.

What is the Digital Health and Care Record?

Digital technologies and online services have become part of our daily lives. Having good information which drives better decision making is key to delivering an excellent service to patients and improving their care. The Digital Health & Care Record will create a trusted and linked ‘master’ record for patients, a single source of the truth that can be used across care settings to minimise duplicate data collection processes, make relevant information available when required and help reduce slow paper based transfer of information. These are just a small number of benefits that can be derived from the Digital Health and Care record.

How will the NDR help?


Improving patient experience – patients increasingly want more transparency regarding how their care is organised, wanting to be more involved and made aware of how they can monitor and manage their own care. This can be realised through patient applications that utilise the Digital Health & Care Record, such as the Patient Portal.


Improving care coordination across settings – having a Digital Health & Care Record across care settings will help care providers understand patients better and reduce the burden of data collection every time a patient interacts with a care provider. If the social care sector knows the activity of the Health sector they can coordinate efforts and make better joined up decision for their patients.


Supporting paperless working – information transferred on paper is slow, creates an administrative burden and is more prone to unintended human error. Digitising the health and care record will make it easier and faster to record patient information, share this with the right providers and improve allocation of resources. It is also better for the environment and less prone to error.


Enabling more care close to home – when key services know more about the patients they provide services for in advance of speaking with them, they can improve their decision making. Patients increasingly want care closer to home and the NDR can enable this by making information available more rapidly to the areas that require them.