Information Sharing and Decision-Making Across NHS MDT Pathways
Safe and effective Clinical Pathways, MDTs & Integrated Practice depend on how information is shared, interpreted and acted on across Service Models & Care Pathways. In many community services, failures attributed to “capacity” or “complexity” are in fact information failures: missing context, delayed updates, undocumented decisions, or uncertainty about what information should be shared and when.
This article focuses on the operational reality of MDT information sharing: how teams ensure the right information reaches the right people at the right time, how decisions are recorded defensibly, and how governance arrangements protect both individuals and organisations.
Why information sharing is a delivery issue, not an IT issue
MDTs often have access to multiple systems, but access alone does not guarantee safe practice. Common risks arise when:
- Key information is held in parallel systems without reconciliation.
- Decisions are discussed verbally but not recorded consistently.
- Risk information is buried in narrative notes rather than surfaced in action plans.
- Staff are unclear about lawful bases for sharing information in escalation scenarios.
Operationally effective MDTs design information flows around the pathway journey, not around organisational boundaries.
What “good” MDT information flow looks like in practice
Across NHS community pathways, strong MDT information sharing usually includes:
- A shared minimum dataset for MDT discussion (risk factors, current plan, triggers, recent changes).
- Standardised decision recording capturing rationale, actions, owners and review points.
- Clear escalation information that is visible and easy to act on.
- Timely updates following contact, deterioration or non-engagement.
The aim is not comprehensive data capture, but clarity: anyone joining the case should quickly understand the current risks, decisions made, and next actions.
Operational Example 1: Frailty MDT managing rapid deterioration
Context: A frailty pathway supports people with fluctuating needs and frequent service touchpoints. Risk escalates quickly if information is delayed.
Support approach: The MDT agrees a single-page “MDT snapshot” used for every discussion, including functional status, recent changes, medication risks, safeguarding flags and carer capacity.
Day-to-day delivery detail: After each MDT, the coordinator updates the snapshot within 24 hours and flags any changes to the wider team. Escalation triggers (e.g. two falls in seven days) are highlighted visually, not buried in notes. Verbal decisions are not considered complete until recorded.
How effectiveness is evidenced: The service evidences reduced delays in response to deterioration, fewer missed escalations, and improved audit scores for decision clarity. Case audits show consistent documentation of risk and rationale.
Operational Example 2: Reablement MDT aligning health and social care records
Context: A reablement pathway spans NHS and local authority systems, creating duplication and information gaps.
Support approach: The MDT defines a core information set that must be present in both records: goals, review date, risks, safeguarding status and escalation contacts.
Day-to-day delivery detail: The named coordinator checks record alignment weekly and resolves discrepancies. When plans change, updates are communicated via agreed channels rather than relying on staff “finding” information later.
How effectiveness is evidenced: Evidence includes fewer failed handovers, reduced complaints linked to communication breakdown, and improved timeliness of reviews. Commissioners receive summary data showing reduced duplication and clearer accountability.
Operational Example 3: Mental health MDT documenting shared risk decisions
Context: Community mental health MDTs often make complex shared decisions under uncertainty.
Support approach: The MDT adopts a decision record format that explicitly documents risk formulation, protective factors and agreed actions.
Day-to-day delivery detail: Decisions involving increased risk tolerance are time-limited and include a review trigger. Non-attendance is documented as a risk factor, not a neutral event.
How effectiveness is evidenced: Quality reviews demonstrate consistent documentation of risk decisions and timely review. Inspectors can see how information informed action.
Governance controls that support safe information sharing
Effective governance focuses on usability and assurance:
- Clear lawful basis guidance embedded in practice, not just policy.
- Routine audits of MDT decision records.
- Supervision that tests information quality, not just activity.
- Learning loops from incidents linked to information failures.
Commissioner expectation
Commissioner expectation: Commissioners expect MDTs to demonstrate that information sharing supports safe, timely decision-making. This includes evidence that key risks are visible, decisions are recorded, and information failures are identified and corrected.
Regulator / Inspector expectation (CQC)
Regulator / Inspector expectation (CQC): Inspectors will look for clear, consistent information sharing that enables joined-up care. Poor documentation, unclear decisions or unmanaged information risk are viewed as safety concerns.