Table 1 Factors hindering the wider use of GIS and the exchange of geo-information within the NHS. Summary of the main factors hindering the wider use of GIS within NHS organisations, and precluding adequate spatial data exchange and collaboration between the NHS and other organisations and local authorities.

• Work-time constraints, and insufficient staff and financial resources to implement systems fully and to undertake data exchange duties with other organisations

• Lack of skills and insufficient training or guidance

Spatial data and metadata issues

• Lack of digital data in appropriate formats

• Problems ensuring data quality

• Data confidentiality issues and the currently ambiguous criteria to conform to data confidentiality requirements

• Lack of a service-level agreement with Ordnance Survey (or other providers) for NHS organisations to be able to access base digital data

• Organisations not being aware of data held by other organisations (lack of a comprehensive and up-to-date central metadata catalogue or clearinghouse)

Geospatial awareness, strategy and policy issues

• Limited awareness of the benefits of geo-information and joined-up working arrangements

• Lack of demand from within some organisations to the use of GIS (directors not being aware of value of GIS rather than not being committed to GIS)

• Lack of a clear GIS strategy and of a clear organisational policy for exchanging data