Second submission 30 th November 2016

Transcription

1 Second submission 30 th November 2016 Key information details: Name of footprint: South East London Region: South East London (Bexley; Bromley; Greenwich; Lambeth; Lewisham; Southwark) Organisations within footprints: CCGs: Bexley; Bromley; Greenwich; Lambeth; Lewisham; Southwark LAs: Bexley; Bromley; Greenwich; Lambeth; Lewisham; Southwark Providers: Guy s and St Thomas' NHS FT; Kings College Hospital NHS FT; Lewisham and Greenwich NHS Trust; South London and Maudsley NHS FT; Oxleas NHS FT; Bromley Healthcare CIC; and Primary Care Providers; London Ambulance Service NHS Trust; Dartford and Gravesham NHS Trust are an associate organisation, but formally sit outside of the footprint. Version 3.0 dated 30 th November 2016 Page 1 of 43

2 Version Control Version Date Amendment Jun st version of LDR for NHS England Oct 2016 Multiple amendments - revised and updated from comments at IM&T Steering Group on 17 Oct Nov 16 Multiple amendments - revised and updated from comments at LDR Working Group on 16 Nov Nov 16 Financial estimate added, various updates after reviews by LDR Working Group Nov 16 Final version with amendments from LDR Workshop on 29 Nov 16 Contents Executive Summary... 3 Introduction... 5 Purpose of this document... 6 Endorsements and contributions... 6 Background... 7 Approach... 9 Strategic Context National Context Local Context Overview of the Future Digital landscape Strategy Strategic approach to delivery and resource Strategic approach to digital solutions Digital Maturity and Core Capabilities Readiness Capabilities The Internet of Things (IOT) Delivering the Local Digital Roadmap South East London Digital Alliance (SELDA) Resources Governance SEL LDR Principles Change management Benefits management Universal Capabilities LDR Objectives LDR Risks and Mitigation SEL LDR - Expanded Vision Page 2 of 43

3 Executive Summary South East London is setting itself an ambitious vision over the next five years and beyond, with organisations aiming to collaborate in delivering a digital revolution for its citizens. We aim to integrate our networks and systems wherever possible, utilising cloud based technology and solutions to make applications and systems more readily available across our footprint. We will engage with industry to understand current and future developments and, where appropriate, work with them to deliver cutting edge capabilities that will benefit our citizens and the professional men and women employed within our organisations. We will make being cared for and employed by our health and care organisations a better and more fulfilling experience for all. Our vision is to enable a channel shift, allowing care to be delivered closer to home whilst maximising on new innovations and technology to reduce footfall in GP surgeries, A&E and outpatients with the use of emerging technology that allows virtual consultations where appropriate. To achieve this we will: Use technology to enable the transformation of the delivery of care, ensuring that all care professionals and citizens of South East London are digitally connected and able to access information and services at any time and from anywhere Just as importantly, South East London will ensure that we share our experience, knowledge and developments with the other London LDRs, the wider NHS and Social Care to ensure that our achievements, as well as our mistakes, can be used to benefit all citizens of London and the United Kingdom. To meet this vision the organisations within the SEL LDR footprint have agreed to twelve aims that ensure that: 1. By using the most appropriate technology the LDR supports and enables the STP in delivering Community Based Care (CBC) through Local Care Networks (LCNs). 2. Every citizen will have access to their health and care data at any time and from any location in a secure manner. 3. Every health and care professional will have appropriate access to relevant and up to date citizen data at the Point of Care. 4. Our services are available through multi-channel mechanisms, ensuring every citizen can access services electronically as well as through more traditional methods. 5. Every citizen who has an appropriate condition or conditions, will be able to monitor their health and provide appropriate feedback and updates to an integrated care record. 6. Appropriate conditions will be monitored remotely using a variety of applications, telehealth, telecare and other connected devices to feed data back to an appropriate professional to ensure proactive and reactive care to be delivered in a timely manner. 7. We use population health management and risk stratification information to support and enable the delivery of more proactive direct care to our citizens alongside other processes (i.e. care quality reviews) to improve service delivery and quality. 8. Every citizen will be provided with the opportunity to have remote consultations throughout health and care as well as traditional face-to-face appointments and consultations. 9. Health and care professionals will have access to a shared infrastructure and will be able to access required systems at any NHS or Local Authority site in South East London. 10. Citizens will have access to free Wi-Fi at all NHS and Local Authority sites in South East London. 11. An appropriate support model for IM&T will be developed to support users across South East London. Page 3 of 43

4 12. The LDR supports the business and organisational change identified by the SEL STP as well as the strategies of health and care organisations within the LDR footprint. However, this all needs to be tempered by the knowledge that not every citizen is equally able to use modern technologies. Their needs in this evolving digital era still need to be met. Health and care services must cater for all citizens who access their services whether they are in their early twenties and living life via their smartphone or in their seventies and still reliant on face-to-face interactions. Organisations within South East London, under the Our Healthier South East London (OHSEL) transformation programme, have a proven track record of working together to develop and deliver new models of care and service redesign. The SEL LDR will build upon this structure and established relationships to deliver the enablers that will allow the SEL STP to meet its ambitions for health and care. We will create a South East London Digital Alliance governed by the South East London Digital Board with two new South East London wide roles, a South East London Chief Information Officer (SEL CIO) and a South East London Chief Clinical Information Officer (SEL CCIO) to oversee, prioritise and drive delivery. At a high level the SEL LDR focuses on: Being paper-free at the point of care by 2020; Digitally enabled self-care empowering patients in the management of their care; Real-time data analytics at the point of care; Whole systems intelligence to support population health and effective commissioning and research Achieving financial sustainability and improving outcomes will require us to introduce new models of care that are fully enabled by technology. Our plans will: Reduce our reliance on traditional face to face models of care in primary care and outpatient settings in favour of digital alternatives. Streamline referral, access to diagnostic services and the delivery of care in our hospitals by making the processes of care delivery paperless at the point of care Ensure that every interaction with the patient counts by making greater use of algorithmic decision support tools for clinicians working in all care settings Improve our ability to provide co-ordinated, pro-active, care delivery to the most vulnerable people by consolidating and connecting up the many electronic record systems that exist today. Many of our patients will continue to receive care from a number of different health and care providers some of which operate outside our local geography and if we are to move from existing models of faceto-face care, we will also need to make it easy for patients to make greater use of digital services. To this end, we will work with other STP footprints in London to connect the capital. Pursuing this common goal will allow us to (both) simplify and connect our existing systems infrastructure in a way that supports the way that care is delivered to our patients. We have agreed to work across SEL to share information between the Local Care Record and Connect Care systems and have submitted an estates, technology and transformation bid to fund this work. Moving forward in this way locally provides the pace required that will support the clinical transformation in SEL. In parallel we will look to collaborate with other STP footprints with the aim of interoperability. This may mean establishing collective governance and utilising national funding sources where we can: Page 4 of 43

5 At a local level, we will invest in technology leadership and support for change management. We will seek to exploit nationally and regionally provided technology services wherever we can. Working regionally, we will seek to connect the patient once, and to connect clinicians to all of the data that they need to deliver safe and well co-ordinated care. We have devised realistic two year targets to within the LDR: Within 1 year To have simplified the process of administering information sharing through the use of the pan-london data controller. To have connected our systems to a pan-london information exchange architecture and to have enabled the electronic sharing of electronic documents. Whilst this will deliver immediate clinical benefits it will also reduce postage costs. To be fully utilising e referral and demonstrating improvements in cancer treatment targets. To have developed a partnership model for informatics delivery that makes best use of specialist technology skills both within and across STP footprints. Within 2 years To have enabled real time information exchange to support the care of people at the end of their lives and in so doing save (our share) of 150m savings potentially achieved through reductions in unwanted admissions to hospital. To have connected the patient and allowed them to exchange information via connected digital apps of their choice. To have universally deployed digital alternatives to face to face care in primary care and outpatient settings. In conclusion, the SEL LDR aims to ensure that appropriate structures, digital capabilities, systems and infrastructure are developed and deployed to achieve the health and care goals set out in the SEL STP, support each commissioner and provider s strategic plans; and ensure that current and future planning is aligned with national and regional objectives. Introduction The world is changing and both health and care need to change with it. In an era when individuals can take total control of their banking via their smartphone; where people can shop for any item they need from the comfort of their home; with everyday life being shared in microscopic detail through social media applications ; where even the home can be connected via the Internet of Things (IoT) 1 so that individuals can control their environment household appliances, smart meters, lighting or heating wherever they may be; healthcare lags years behind in almost every detail. Using social media and the internet alone to engage with citizens does not make organisations digitally mature, it is how those organisations exploit growing technology to improve citizen experience and how citizens access and interact with the services provided by organisations that will count in the future. Health and care needs to step up, be more proactive and take advantage of emerging technologies, whilst creating a stable environment for health and care professionals to work in. 1 Surrey and Borders Partnership NHS Trust implementing an innovative project to monitor and gather information on Dementia patients by connecting devices using the IoT ( Page 5 of 43

6 Health and care organisations in South East London are committed to introducing and developing technology that will change the way care is delivered. This document is the starting point for the journey that organisations, staff and citizens will take over the next 5 years to use technology effectively in the delivery of care. This journey will require a robust but flexible governance structure to enable health and care organisations to work together to deliver the technology enablers that will allow clinicians to change the way they deliver care and to reduce patient footfall by providing technology that allows more care to be delivered in the community. The new models of care will be driven by South East London s Sustainability and Transformation Plan and the LDR must support the STP in achieving its objectives. The LDR will therefore form a key enabling work stream within the STP and will report to the STP Quartet Governance Group and take direction for the Clinical and Productivity work streams within the STP. The SEL LDR footprint comprises six Clinical Commissioning Groups (CCGs) including NHS Bexley CCG, NHS Bromley CCG, NHS Greenwich CCG, NHS Lambeth CCG, NHS Lewisham CCG and NHS Southwark CCG; four acute trusts including Guy s and Thomas' NHS FT, Kings College Hospital NHS FT, Lewisham and Greenwich NHS Trust, Dartford and Gravesham NHS Trust 2 ; South London and Maudsley NHS FT; Oxleas NHS FT; Bromley Healthcare CIC; Primary Care Providers; London Ambulance Service NHS Trust; and the six Local Authorities of Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark. The footprint covers GP practices and delivers health and social care services to a population of 1.8 million citizens. Purpose of this document This document sets out the South East London Local Digital Roadmap (SEL LDR) high-level vision for the future of technology across South East London s health and care economy to enable delivery of the Five Year Forward View (FYFV). It identifies the strategic, national and local objectives that must be delivered to fulfil that vision. The document has been developed alongside the South East London Sustainability Transformation Plan (SEL STP) to ensure that the LDR can deliver the digital transformation required to meet the needs and objectives of the SEL STP. The document also takes into consideration the strategic objectives and IT strategies of organisations within South East London whilst considering the future needs of pan-london digital priorities such as the London Health Information Exchange (HIE). The target audience for the document includes the participant s senior management teams, their governing board members, NHS England, senior primary and secondary care clinicians, care organisations, patient interest groups and residents within the South East London health and care economy. The SEL LDR is not intended to be a replacement for individual organisations IM&T strategies but provides a consolidated view of the plans required to meet the natinal objective to become paper free at the point of care 4 and to support the delivery of the SEL STP. Endorsements and contributions Once the six boroughs of South East London had established a planning footprint for both the STP and LDR it became clear the STP would be the main driver for service transformation across the region. Our STP has been communicated to the STP Executive Group, our Committee in Common group and the Health and Wellbeing Board. The LDR has been widely communicated either as a supporting document of the STP or as a stand-alone document. The agreed sign off process of our LDR is via the 2 Dartford and Gravesham NHS FT are an associate organisation but formally sit within another LDR footprint 3 Taken from NHS England data provided in November NHS England s Five Year Forward View dated Oct 14 Page 6 of 43

7 SEL Digital Board with visibility provided to the Health and Wellbeing Board, prior to submission to NHS England for final endorsement. The SEL LDR has been developed in line with the already established Our Healthier South East London partnership. The contributing organisations are: CCGs: Bexley; Bromley; Greenwich; Lambeth; Lewisham; Southwark LAs: Bexley; Bromley; Greenwich; Lambeth; Lewisham; Southwark Providers: Guy s and St Thomas' NHS FT; Kings College Hospital NHS FT; Lewisham and Greenwich NHS Trust; South London and Maudsley NHS FT; Oxleas NHS FT; Bromley Healthcare CIC; and Primary Care Providers; London Ambulance Service NHS Trust; Dartford and Gravesham NHS Trust are an associate organisation, but formally sit outside of the footprint. There are five Hospices who provide care in SEL, 3 provide care for adults, Greenwich & Bexley Community Hospice (Greenwich and Bexley boroughs), St Christopher s Hospice (Lambeth, Southwark, Lewisham and Bromley) and Royal Trinity Hospice (Lambeth) whilst 2 provide care for children, Demelza (LSL, Greenwich and Bromley), Ellenor (Bexley). The Hospices have a range of services including providing support in their inpatient units, specialist community provision, personal care services, and provide support in hospitals, care homes and prisons. Early engagement with the hospices has shown an interest across all in improving intra-operability and connectivity with other clinical systems, particularly between acute hospitals, primary care and community nursing. There is also some interest in working more collaboratively between hospices to enable better product development and to ensure economies of scale in procurement. It is important to ensure that the hospices are considered in the development and delivery of the LDR to ensure we maximise opportunities for connectivity, efficiency and investment across the whole health sector. Background In October 2014 the Five Year Forward View (FYFV) was published and set out a new shared vision for the future of a transformed heath and care system based around new models of care. It also describes harnessing the information revolution to enable a sustainable NHS. Subsequently, the National Information Board published their Personalised Health and Care 2020 A Framework for Action and describes the development of local roadmaps for digital interoperability as part of implementing the framework. the publication of Delivering the Forward View: NHS planning guidance signalled a vision of being Paper-free at the Point of Care by Central to the planning of this ambition is the Local Digital Roadmap (LDR). Within this document it states that each LDR Footprint must outline their vision to deliver a fully interoperable digital health and care system by The FYFV made a clear case for change based on three key areas: The health and wellbeing gap The care and quality gap The funding and efficiency gap Whilst our STP sets out how we will meet these challenges, the use of enabling digital technology is vital in achieving this. Our LDR therefore provides a golden thread as to how technology will support and bring to life the STP s plans. Page 7 of 43

8 In SEL we elected to align both the LDR and STP in the same planning footprint. We are building on the already established South East London Strategic Planning Group (SPG) and Our Healthier South East London (OHSEL) transformation programme. This forms a strong foundation for planning, building on existing relationships and governance; however, the scope has been expanded to include all Commissioner, Provider and Local Authority organisations to cover heath and care serving the population of South East London. The STP and LDR have been produced in conjunction with each other, within the same central resource team, whilst engaging with all key partners and stakeholders throughout the process. This includes other London STP footprints, the Healthy London Partnership (HLP), Health Innovation Network (HIN), King s Health Partner s (KHP) Academic Health Science Centre and NHS England, as well as all organisations included in the South East London Footprint. As part of the LDR s alignment with the STP, the roadmap has matched the five STP priorities with five LDR priorities. STP Priorities Developing consistent and high quality community based care (CBC) and prevention Improving quality and reducing variation across both physical and mental health Reducing cost through provider collaboration Developing sustainable specialised services Changing how we work together to deliver the transformation required Figure 1: SEL LDR priorities LDR Priorities Ensure that both the care professional and the citizen are digitally connected within the community and throughout the care pathway Providing the right information, at the right time and in the right place, consistently and accurately from across health and care systems through an integrated digital care record Provide the technology to enable providers to collaborate seamlessly across organisations and throughout the care pathway Ensure that technology is able to evolve and develop to meet the needs and demands of health and care, whilst providing analytical and reporting capabilities to support joint commissioning and population health reports Ensuring Information Technology capacity is focussed on delivering the change and transformation required collaboratively, whilst ensuring the workforce is trained and upskilled in the use of technology The vision we share across South East London is of seamless collaborative working to achieve improved and consistent patient care, better prevention and greater efficiencies whilst placing the citizen at the heart of our planning. In the digital space this will be achieved by a channel shift with the focus being to support SEL s Community Based Care (CBC) model by enabling the transformation in the delivery of care closer to home through the use of technology. To achieve this the LDR aims to enable citizens to access both services and their information digitally, whilst heath and care workers can securely access and enter the information they need at the point of care to provide better care for the patient. The LDR s vision is to: Use technology to enable the transformation of the delivery of care, ensuring that all care professionals and citizens of South East London are digitally connected and able to access information and services at any time and from anywhere An expanded vision statement is available at Annex A. Page 8 of 43

9 The primary digital opportunities of focus for transforming services and improving outcomes for our population are outlined in our LDR through: Transforming Primary and Community Based Care (CBC) by exploiting mobile technologies, enhancing infrastructure to support our Local Care Networks and deploying appropriate technologies to enable remote monitoring, self-monitoring and virtual consultations Transforming Integrated Urgent Care by optimising the interoperability of existing systems and exploiting new opportunities Digitally supporting the optimisation of workforce from back office functions to bank and agency staff in order to drive efficiency and maximise productivity Interoperability of health and care We aim to achieve our vision by connecting data and making it available anytime and from anywhere, transforming Primary and CBC through Local Care Networks, improving access to services and Self- Care through the Integrated Urgent Care model and Clinical Hubs, a Citizen Account, joint commissioning and promoting the use of connected applications. The LDR outlines a shared vision for the South East London region which will be used for future planning whilst outlining opportunities for system wide collaboration whilst supporting the delivery of our Sustainability and Transformation Plan. Approach In developing the LDR we have used central programme resources from the existing OHSEL transformation programme to co-ordinate and develop the narrative and supporting documentation. This same team was also tasked with developing the SEL STP. We have used existing resources from CCGs and providers to gather relevant information whilst holding a series of workshops with the wider stakeholder group, including patient representatives, to ensure alignment to the key transformation themes of the SEL STP. A dedicated LDR Delivery Team was created whilst the IM&T Steering Group provided an assurance and editorial role for the LDR. A Responsibility Assignment matrix was produced to detail the responsibility of individual key stakeholders and the table below shows key stages of the assurance process. Figure 2: STP and LDR Assurance Process Page 9 of 43

10 SEL LDR governance The governance structure for the LDR has undergone several reviews and changes since the LDR process started. A governance structure has been developed to minimise bureaucracy whilst maintaining visibility of the work being done by organisations locally as well as those pieces of work to be delivered strategically. SEL will establish two new roles, the SEL Chief Information Officer (SEL CIO) and the SEL Chief Clinical Information Officer (SEL CCIO) to oversee the delivery of the LDR and ensure co-operation across the footprint. Further detail on the governance for the LDR is covered in the section Delivering the Local Digital Roadmap. Neighbouring footprints Figure 3: LDR Governance Structure The importance of working closely with the other London LDRs and the Healthier London Partnership (HLP) was acknowledged early in the development of the LDR and we will continue to work with neighbouring LDRs and the HLP as the LDR develops, particularly around: Engagement with HLP to provide resources and funding to develop and exploit the Health Information Exchange (HIE) to share data within the SEL LDR footprint as well as more widely across London health and care organisations as appropriate for the direct care of citizens Reducing conflict for those organisations that sit across more than one LDR footprint Arrangements for governance, provision of resources will need to be formalised as the LDR progresses to ensure the proposals are aligned. Page 10 of 43

11 Strategic Context National Context The NHS England Five Year Forward View In October 2014 NHS England published the Five Year Forward View (FYFV) setting out a clear direction showing why change was needed and what that change might look like. It provided a vision to address the challenges facing the NHS and drive better outcomes for patients and populations. The fundamental challenges facing the NHS are: Changes in people s health needs and personal preferences; Changes in treatments, technology and care delivery and the need to provide care that is genuinely co-ordinated around what people need and want; and Changes to health service funding growth This leads to three gaps that must be addressed to respond to these challenges: Health and wellbeing a refocus on prevention and reduction in health inequalities; Care and quality reducing the variations in quality and safety of care; and Funding and efficiency a reduction in the projected 30 billion mismatch between population need and resources The FYFV proposes to redefine radically the relationship between citizens, communities and the state, by empowering people to choose the most appropriate interventions and care to meet their needs and to target prevention with systematic use of evidence based intervention strategies. New models of care will be delivered through managing networks that break the barriers between primary care, community services and hospitals; integrating services from multiple providers around peoples needs. Leadership will be devolved, the workforce developed and information technology exploited. Information Technology is a critical enabler to deliver these changes, from providing the electronic glue connecting the health service together, providing fully interoperable electronic health care records, personalisation of care, more effective management of service access, enabling reshaping the workforce; and exploiting widely available consumer technologies. The Spending Review and Autumn Statement 2015 endorsed the proposed approaches. Personalised Health and Care 2020 In November 2014 the National Information Board (NIB) published Personalised Health and Care 2020 outlining how data and technology will be used to facilitate implementation of the FYFV. The document proposed transformation through the use of technology in the following areas: Enable me ( the citizen ) to make the right health and care choices; Give care professionals and carers access to the data, information and knowledge they need; Make the quality of care transparent; Build and sustain public trust; Bring forward life-saving treatments and support innovation; Page 11 of 43

12 Support care professionals to make the best use of data and technology; and Assure best value for taxpayers The NIB has published a series of roadmaps which will be delivered by a combination of national delivery teams and the local digital roadmaps. The Government s Mandate to NHS England for endorsed the proposed approaches with further recommendations made in the Wachter report Making IT Work: Harnessing the Power of Health Information Technology to Improve Care in England. Sustainability and Transformation Plans The NHS planning guidance 2016/ /2021 required every health and care system to develop sustainable transformation plans to implement the FYFV. They will be place based multi-year plans built around the needs of the local populations driving genuine and sustainable transformation in citizen experience and outcomes. The STPs will be the vehicle for making bids for national transformation funding. The SEL LDR will fully support the SEL STP to enable the delivery of its objectives, and will work with the neighbouring LDR footprints to align transformation and delivery where appropriate to enable pan-london transformation and change to occur. South East London s Sustainability and Transformation Plan The delivery of digital solutions and the management of information is a vital component of the SEL STP. The SEL LDR is as much about managing change and delivering new ways of working as it is about introducing new technologies. Traditionally information has been limited by location. For example, a patient registered to a GP practice would have their entire patient record stored at that practice in the form of Lloyd George notes. These paper-based notes pre-date the NHS and whilst in primary care they ve been partially digitised they are not yet accessible by those outside of primary care who need to make decisions on a patient s health and care. This means of working does not lend itself to a population-based approach, where patients are mobile and care pathways often complex and diverse. It also does not allow the heath and care sector to harness the information revolution and increase efficiencies to bring about a more sustainable service for the future. Through better use of new and existing digital technologies we will break down organisational silos and geographical boundaries whilst joining up health and care settings to meet the demands of our growing and ageing population across South East London. The use of technology and improved access to information will facilitate a shift from a treat and discharge model to continuous high quality connected care. This new model will be supported by both self-care and remote-care. The LDR Steering Group, which will become the SEL Digital Board, has seen the SEL STP and will develop plans to enhance existing digital capabilities, deliver new technologies, provide clinical support tools and remote monitoring capability which will allow the transformation of clinical pathways and the way that care is delivered in the community. The following illustration shows the SEL LDR will support the SEL STP and where technology will support the delivery of the STP across primary, community and secondary care, mental health, and social care. Page 12 of 43

13 Figure 4: LDR plan to support the STP The SEL STP has identified five priorities to make the health and care system in SEL sustainable in the near, medium and long term. These priorities are: Developing consistent and high quality community based care (CBC) and prevention Improving quality and reducing variation across both physical and mental health Reducing cost through provider collaboration Developing sustainable specialised services Changing how we work together to deliver the transformation required The LDR is a critical enabler in delivering the change required to achieve the objectives set by each of the STPs five priorities. As such, the LDR has identified five priorities of its own that reflect those of the STP to support the delivery of the SEL STP and deliver the required technological transformation. Local Digital Roadmaps The Guidance for Developing Local Digital Roadmaps states that local digital roadmaps will identify how local health and care systems will deploy and optimise digitally enabled capabilities to improve and transform practice, workflows and pathways across the health and care eco system. They will provide multiple perspectives on plans and priorities for digital technology deployment and optimisation, with a particular focus on paper-free at the point of care. The identification of future aspirations will support local strategic decisions on architecture, prioritisation and investment, and assist in relationships with suppliers. Page 13 of 43

14 LDRs will be the gateway to funding, but are not a replacement for business cases which are still required to support local investment decisions. However, a consideration in any such decision for investment will be the alignment with the SEL LDR. LDRs will not replace individual organisational IM&T strategies although organisations will need to review and reconsider their strategies in line with the SEL LDR. Accountability for many aspects of the digital agenda remains with the Boards of the respective organisations. However, in an attempt to better use experience, knowledge and resources across the LDR footprint the LDR aims to take into account individual organisational IT strategies. Each LDR must specifically articulate their vision for digitally enabled transformation, demonstrate how digital capabilities will be developed, show progress on delivering the universal capabilities, facilitate information sharing whilst minimising the risk arising from technology. These themes are developed below. Stepping up to the place the key to successful integration The strategy report produced by the Local Government Association, NHS Confederation, Association of Directors of Adult Social Services and NHS Clinical Commissioners, offers a shared vision for integration and defines integration benefits at individual, community, system and national level. It describes a fully-integrated system as having the following essential characteristics: a shared commitment, shared leadership and accountability and shared systems (defined as common information and technology), jointly identified and shared long-term payment and commissioning models and integrated workforce planning and development: all of which resonates with activities currently underway in SEL. Outcome based commissioning In response to the challenges outlined above, commissioners are developing new and innovative commissioning partnerships to support integrated care. Commissioners are moving away from legacy models focused on process and activity to outcomes that are important to service users. The King s fund paper, Commissioning and Contracting for Integrated Care identifies some of the common contractual outcomes and it is clear that technology will play a significant part in supporting organisations to achieve Outcome Based Commissioning. Identifying the supporting data elements and technology platforms will also play a key part in contract negotiations and redesign of services. The SEL LDR must consider: Data sharing to support co-ordination of citizen centred care; Pooling population, citizen and service data which is multi-sector, pseudonymised and linked to provide rich data sets to measure activity and outcomes for planning, commissioning and evaluation purposes; Health intelligence platforms to support the detection and early intervention of illness; Technology to support data collection across the continuum of care; Intelligence platforms to support benchmarking, data analysis, reporting and predictive modelling; and Innovative technology to engage and empower Citizens Page 14 of 43

15 Delivering primary care at scale SEL has developed Local Care Networks (LCNs) to deliver primary care at scale using a Community Based Care model. These LCNs including GP federations, community and metal health providers, and acute trusts to deliver care closer to the citizen s home. Right Care Programme The primary objective for the NHS Right Care programme is to maximise the value that a citizen derives from their care and treatment. This Programme provides universal design principles for an accountable, integrated care system and offers a citizen centred framework. Local Context Local Care Networks A priority area of focus in our STP is around Community Based Care (CBC) and Local Care Networks (LCN). This new care model will transform primary care in SEL by providing an improved service to the citizen at a lower cost, higher value to the system. Digital will be a key enabler in the delivery of this model through the access of information across the LCN s and will enable the channel shift required to move to more community based care. We will join up information, professionals and citizens using a combination of cloud based systems, interoperable applications, citizen facing applications, and shared or common infrastructure. CBC will be further supported through technology to promote out of hospital and self-care. Digital innovations together with easily accessible information via NHS Choices and NHS Online will allow and encourage patients to seek alternative help in the community. Page 15 of 43

16 Our plan on a page below outlines some of the key problem statements we are trying to address, some key technical challenges together with the overarching digital vision for SEL. This plan maps across to the STP equivalent on the following page. We have worked collaboratively to develop our STP for South East London, and will use this approach for delivery where there is a benefit to the system and to our residents though much will continue to be delivered locally. Our STP doesn t capture everything that we are doing as a health and care economy. Instead it focuses on five priority areas and related areas where we believe we can collectively make the greatest impact on our challenges and pressures to address the three gaps of health, quality and finance while increasing value. The delivery of these plans will be supported by new cross- Page 16 of 43

17 organisational governance that will allow us to overcome difficulties and collectively manage the transformation required. Figure 5: STP Plan on a page Page 17 of 43

18 Overview of the Future Digital landscape The Centre Central to the vision are citizen s, members of our care community surrounded by technologies which provide opportunities to self-manage their health and engage with health care providers. These include wearable devices, apps, online communities and citizen portals and the Internet of things (IOT). A shared electronic care record straddles the system reflecting the pivotal role it plays in any digital strategy. The Inner Circle Here we acknowledge the technical solutions required by care professionals working in the CBC setting and emergency care. Examples are decision support, the capacity to access other professionals expertise, tools to prioritise and manage their clinical workload, and tools to identify those citizens at greatest risk. The Outer Circle In this area we place the resource and capability technologies that support organisations in understanding and addressing their challenges. The tools required include business process support, predictive analytics, flow management and e-rostering. Strategy Strategic approach to delivery and resource Through the process of developing the LDR and transition to delivery we have identified three themes in the digital space to focus on: Interoperability How we will join up the relevant information Infrastructure What we will use to transport and deliver the information Data Sharing How we will ensure information is shared responsibly Workshops around each of the key themes have been held continuously since work on the LDR started where stakeholders from clinical backgrounds, patient groups, management and technologists were asked to come together to discuss the challenges presented in the STP, the outcomes required to meet these challenges and the digital capabilities we need to deliver in order to facilitate the outcome s. A workshop held on 5 th Oct 16 and attended by health and care professionals, citizens and IM&T leads identified the needs that have helped to develop the LDR. Weekly Working Groups held during October and November 16 have focused IM&T leads on identifying the outputs that the LDR needs to deliver to meet these needs. Page 18 of 43

19 Whilst considering future change we also recognise that in order to resource the change process itself we need to harness and better use existing funds, capability, and people that we already have in place. We are therefore going through a process of understanding and documenting all current change across South East London to identify any duplication or areas which could be delivered more efficiently to release additional capacity in the system. A register of current projects in delivery and any proposed projects for the future is being created to be managed under the LDR. This will allow us to identify potential aligned projects and what resources we may be able to pool in provider and commissioner organisations to deliver consistent and aligned solutions. Strategic approach to digital solutions We will adopt the design principles below in selecting, upgrading, developing or re-procuring our electronic systems. We will work collectively with the NIB, HLP, other London footprints and our suppliers to embed common data standards which will enable the sharing of information across the system. An Integrated Care Record 5 will be scaled up and connected for greater population coverage and continuity of care. We will take the opportunity of collaborating at a pan-london level in deploying the HLP s London Health and Care Information Exchange platform when it comes online later in The solutions we select to deliver the capabilities will be assessed against the following design principles: Integrated Accessible Proactive Faster Personalised Shared Design Principles for Digital Enablement across London 1. The Health and Care system should remember me. Citizens should be able to express their information sharing preferences (once) and be confident that these will be remembered by the organisations that provide health and care, (provided that they are prepared to confirm their identity and express these preferences in advance). 5 Interoperability between existing solutions, the Local Care Record and Connect Care Page 19 of 43

20 2. Anywhere anytime. Citizens should be confident that data held by organisations providing care and which is relevant to the immediate care needs of the citizen (e.g. to support an e transaction), is available to be shared (in real time) with clinicians who are involved in the delivery of care anywhere in South East London. The continued involvement in pan-london projects such as the HIE would likely open this up to the rest of London. 3. All of the data at my fingertips. Professionals across care settings should expect to be able to locate and access data from multiple sources across London via a single search launched from their usual application and using agreed data content and technology standards. 4. Playing a bigger role. Citizens should be able to connect to health and care systems in London through a reliable information exchange using the application of their choice. Digital Maturity and Core Capabilities Readiness During the initial footprint submission South East London was divided into six boroughs and six LDR footprints. Due to the Strategic Planning Group model, OHSEL programme, emerging STP and the ambition of greater collaboration at scale, partners agreed to form a single strategically aligned LDR footprint for SEL. Southwark & Lambeth and Lewisham & Greenwich have a history of collaboration, examples of this are the two Health Information Exchange platforms which pre-date the LDR. Informatics governance groups were evident, however none spanned the entire SEL geography nor were they as inclusive as they could have been in terms of Local Authority involvement. Although individual organisational informatics strategies existed, due the maturity level of the footprint, there was little cohesion in terms of structured leadership and single vision across the whole STP footprint. Through this process the governance behind the leadership of the STP has now been structured to include Local Authority representation and a better balance of commissioners and providers for the purpose of producing, agreeing and delivering our ambitious five year place-based plans. This structure and balance has been reflected in the informatics work stream and a newly formed IM&T Steering Group was created with greater representation across the SEL region. The composition of the South East London footprint is outlined in the table below. CCG Local Authority NHS Trusts Other Providers NHS Southwark London Borough of Southwark Kings College Hospital NHS FT South London and Maudsley NHS FT 220 General Practices Out of Hours - South East London Doctor's Co- Operative NHS Lewisham London Borough of Lewisham Guy's and St Thomas' NHS FT GSTT community services NHS Greenwich London Borough of Greenwich Lewisham and Greenwich NHS Trust Bexey and Greenwich Hospice Out of Hours - Hurley Group NHS Bexley London Borough of Bexley Dartford and Gravesham NHS Trust Bexley Voluntary Service Council Bexey and Greenwich Hospice Out of Hours - Hurley Group NHS Bromley London Borough of Bromley London Ambulance Service NHS Trust Bromley Healthcare CIC Greenbrook Healthcare Out of Hours - EMDOC Bromley Doctors on Call Capabilities A schema for the measurement of NHS digital maturity has been devised by NHS Digital. Although the indicators differ between Primary and Secondary Care, the capabilities needed to deliver high quality care to patients and to maximise the use of digital technology remain the same. The table below lists Page 20 of 43

21 the capabilities expected from the NHS and provides examples of how they apply in Primary and Secondary Care. Capability Primary Care Secondary Care Asset and Resource Optimisation SMS for direct communication with patients. HCPs use digital systems to manage inpatient beds. Medicines Management and Optimisation 60% of practices transmitting repeat prescriptions by EPS Release 2 by 81% - 100% of inpatient medications prescribed digitally. Orders and Results Management Records, Assessments and Plans Remote Care Transfers of Care Decision Support Integrated Care Records 31/03/2016. Practice routinely places orders electronically for common imaging and diagnostic tests. Data quality accreditation programme in place. GPs have secure remote access to the clinical system. Integrate GP2GP records received within 3 days. 81% - 100% of patients identified using barcode technology when collecting specimens. HCPs can upload digital records from any location. Remote/virtual clinical consultations and advice are available to patients. 81% - 100% of care summaries generated in real time and shared digitally with other care providers as soon as completed. Healthcare professionals receive digital alerts to the existence of patient preferences. Digital access to information has improved dramatically through the collaborative Health Information Exchange platforms Local Care Record (LCR) and Connect Care. These solutions have provided huge boost to capability in terms of health and care professionals having access to records, assessments and plans shared between primary and secondary care. At present 100% of GP registered patients in Greenwich and Lewisham can benefit from the Connect Care solution with 25 of 27 GPs in Bexley due to be registered by 9 th Dec 16. In Southwark and Lambeth the Local Care Record is in use by all GP practices, again offering 100% coverage of the registered population across the two boroughs. The uptake and user satisfaction of both solutions is high with new features and expansion to Adult Social Care planned. Bromley have elected to adopt the Kings Health Partners Local Care Record solution for their collaborative information exchange portal as opposed to procuring their own. This decision was taken based on cost, collaboration and with a view to the pan-london solution on the horizon. Access to the LCR is being offered to their GP s who have already been engaged during recent workshops. Half the Bromley GPs are now linked to the LCR. This is an excellent example of where collaborative discussions have led to convergence rather than divergence of technology. Greenwich, as a national Integrated Care Provider, are acting as an exemplar for the delivery of integrated care are developing and testing new ways of joining health and care services, utilising expertise of the voluntary and community sector. Page 21 of 43

22 myhealthlocker Myhealthlocker allows citizens to have complete control over their health information. Using the application they are able to access their care plan from South East London and Maudsley Hospital NHS Foundation Trust, keep track of how they are feeling, access resources and tips on staying well and manage their health and wellbeing. A web hosted tool, the website works with Microsoft HealthVault, a privacy and security enhanced online service, designed to control individual s health information. HealthVault helps individuals gather and store health information from various sources and share information with those they trust. Urgent and Emergency Care A key area for focus and a big-ticket item for both South East London, and the region is Urgent and Emergency Care. This is signalled in our STP, and was previously included as a focus for a new model of care in the OHSEL strategy. Given that this is a common theme for most or all of the CCG s, the Healthy London Partnership has a programme dedicated to this area and SEL are committed to working with both the U&E Care Programme and the London Digital Programme where the solution and the needs of our footprint align. In SEL and across the region, we recognise there are limited links between U&E Care, Integrated Urgent Care (IUC) and the London Ambulance Service (LAS). We see this being greatly improved by the use of a Patient Relationship Manager solution (PRM), a standards based integrator (such as the London Information Exchange) and the use of an integrated EPR system for the LAS. Going further than this however is a proposal for a Multi-Disciplinary Team (MDT) or Clinical hub, to include several care professions with a variety of knowledge to make a secondary assessment downstream from the IUC call handler. Current position of Urgent and Emergency Care At present the 111 call handlers use Adastra and can perform a Patient Demographic Search (PDS) lookup on the National Spine to auto populate the patient s personal details. Adastra hosts Special Patient Notes (SPNs) which contain information about patients. Both GPs and OOHs providers can create a SPN and enables sharing of the note with 111 and LAS. Once the call handler has entered the patient s personal details (using the Spine) Adastra will flag that there is an SPN for this patient. In addition, the IUC Clinical Advisors have access to Co-ordinate My Care (CMC) End of Life (EoL) records for palliative care patients. The viewing of SPNs and access to CMC is predicated by staff having smartcards to authenticate their access, Not all staff have smartcards and this will need to be addressed. Adastra/NHS Pathways integrate with a web based Directory of Services (DoS) which is hosted by NHS Digital, and populated with service data owned by CCGs and maintained at a local level, by SECSU for South London. This should include and support the Clinical Hub in future on the principle of 'right place, first time'. The Healthy London Partnership (HLP) Urgent and Emergency Care programme is live with a pilot Patient Relationship Manager. Providing real time data exchange from local systems to support improved triage. PRM has been live across London since November 2015 with ongoing development led by HLP Urgent and Emergency Care Team. London PRM is national pilot site with an independent evaluation partner. There is currently some inequality of service across SEL with some OOHs providers (e.g. SELDOC) unable to access taking call directly rather than via 111, sometimes leading to patients having to call 111 if the issue relates to something SELDOC is unable to treat (i.e. a dental issue). SELDOC also Page 22 of 43

23 does not have access to the DoS or PRM. These inequalities need to be addressed as part of the LDRs delivery. Future Position of Urgent and Emergency Care A real-world example of where this works and can be expanded in SEL is in Lambeth where they already book slots directly into their GP hub. Interoperability between EMIS and Adastra is achieved using the Medical Interoperability Gateway. Both EMIS and Adastra are already working with the HLP to offer interoperable capability between systems. This presents an opportunity for introducing this new way of working either via a Medical Interoperability Gateway (MIG)IG, Patient Relationship Management (PRM)RM or the London Health Information Exchange (HIE) solutions. Ideally, the Directory of Service (DoS) will also be integrated with the Clinical Hub, to provide appropriate service information for directing onward referrals and booking primary care appointment slots. The approach SEL are looking to adopt is the HLP IUC model for greater joined up working and collective benefits to the system such as reduced admissions, improved self-care and faster triage. This is similar to a System Integration and Management Model (SIAM) where the 111 and 999 service provide the initial contact, assessment, referral and hand-off. This model has been successfully used in other sectors to commission multiple service towers which work together using contracts and SLA s to deliver a seamless service. It is important in south east London that we ensure the provider organisations are aware of and aligned to the model. Further conversations will need to be progressed to gain this agreement. The features of this model will be: Figure 6: Urgent and Emergency Care model Through enhanced Interoperability Toolkit (ITK) messaging within UEC interoperability between services for clinical content sets outside of NHS Pathways such as community, nursing & Mental Health Services will be enabled. These services will be able to receive referrals electronically from IUC Through the integration of these services we will be able to offer virtual consultations to patients, offer specialist advice over the phone or online and potentially reduce DNAs for GP s. It will develop a full, real time shared care plan (for Integrated Care and end of life patients) that is visible to health and social care professionals. The new IUC service will have specific Information Governance requirements to support the sharing of patient information required, with an appropriate Information Sharing Agreement and new Fair Processing notices to be communicated to the public. It is important that this will include that information may be shared with integrated urgent care services (111). 111 PRM will route callers to appropriate skillsets within 111 providers and be able to share care/crisis plan information with clinicians in 111, GPOOH and LAS999. This will take place through data being retrieved by the cloud and displayed to 111 clinicians in real-time in Adastra SPN format to support clinical decision making. This data can then be sent to GPOOH providers or a precise summary to LAS crews at the scene where referrals are required. There will be an enhanced set of clinical triage algorithms to improve accuracy of triage across 111, 999, front end of A&E and Social Care. Page 23 of 43

24 The public will be able to access a self-service clinical triage online via NHS.uk. This will enable a direct link into NHS services if that is what the patient needs. When people are connected to their local integrated urgent care service or clinical hub they will not have to repeat their story as the service will be fully integrated with the digital interface. In time connections with general practice will also be enabled Mental health and community services will have technical information (known as endpoints) on the Directory of Services (DoS) so that they can receive referrals electronically from IUC. My Health London, which includes access to service information from the DoS (via MiDoS), is the preferred public health resource. Community Based Care In South East London one of our key priority areas highlighted in our OHSEL strategy and the STP is to transform Primary Care and Community Based Care through GP Federations and Local Care Networks (LCNs). These new ways of working will allow for extended hours of access to GP services, link together primary, community and social care, and take a proactive and preventative approach to care. The LCN s will bring about a culture shift from medical and paternalistic to more person centred and enabling in order to build personal resilience, self-management and address health and social needs. Citizens will be empowered and supported in their independence. The diagram below from our STP and demonstrates how these LCN s will take shape. Figure 7: Local Care Networks Digitally we aim to support this new care model through: Providing health and care workers with the facility to access any relevant electronic data they need to support care Virtual collaboration via increased use of technology Video Conferencing, VoIP telephony Instant Messaging etc Page 24 of 43

25 Provide the infrastructure and devices to support mobile working in the community 111 access to summary care record including last 3 visits to GP Work with suppliers, AHSN s and the HIN to promote and support clinical apps which will better support self-care and decision support Free Wi-Fi in all NHS buildings to support digital and paperless activity. Linking GP practice sites with Community of Interest Networks (CoIN) An electronic Citizen Account for citizen access to their health and care information Access across the system to crisis care plans including complex patients and end of life. This will initially be achieved though linking the systems between King s, Guys, Lewisham and Greenwich Trusts and GP practices. This will also include developing an electronic link into to IUC Hospices Of those hospices within the SEL LDR footprint, GBCH, SCH and Ellenor use Infoflex (a CIMS product) as their EPR system, Trinity and Demelza use Crosscare. All 5 are IG complaint and have access to NHS mail. The adult hospices routinely input and update Coordinate My Care to ensure patient wishes are recorded and met where possible and they are working towards ensuring that as much information as possible is shared using e-routes to ensure data security, efficiency and to ensure patient safety. The Internet of Things (IOT) The Internet of Things introduces new possibilities for health and care to not only connect the citizen but also their environment. The opportunity to use technologies already in a citizen s home or on their person without huge investment is appealing and makes the use of these technologies innovative and financial viable. With Bluetooth and wireless enabled devices becoming the norm in everyday life The Internet of Things (IOT) seeks to connect these devices giving individuals control of their environment in ways never before envisaged. The ability to switch heating on from your mobile phone whilst travelling home from work; the ability to begin boiling your kettle before entering the house or switch lighting on ready for your arrival; or the ability to use voice activated devices to receive weather reports or travel information are just a few examples of what the IOT allows individuals to do. Now, translate these technological steps into innovative uses for health and care, for example: Page 25 of 43

26 Monitoring a citizen s heating and lighting to identify living conditions that may affect their health and wellbeing would give health and care the ability to recognise changes to environmental factors and proactively respond ahead of a condition worsening or a new condition developing. Monitoring a citizen s use of washing machines, fridges and cooking appliances could lead to proactive identification of a citizen s deteriorating ability to care for themselves or early identification of dementia. The ability to use internet connected televisions in a citizen s home allowing immediate face-to-face support, guidance or re-assurance. Voice activated, intelligent devices that respond to calls for help and immediately dial an appropriate responder, voice prompts to re-order prescriptions or notify individuals involved in a person s care to changes in their circumstances. There are currently trials using the IOT underway 6 and SEL will closely monitor these to see what technology could be used in the medium to long term whilst proactively seeking innovative ideas that could be trialed and subsequently delivered by the SEL LDR. Whilst acknowledging the opportunities that the IOT brings it should also be acknowledged that it would also bring with it unique challenges that would need to be addressed. The way in which support is provided to citizen s using connected devices for health and care would need to be reviewed and would likely lead to investment in developing our staff to provide effective support if required. Delivering the Local Digital Roadmap South East London Digital Alliance (SELDA) The SEL LDR will be delivered under a cross organisational collaboration that will be known as the South East London Digital Alliance (SELDA), The SELDA will be formed to ensure the delivery of the LDR and to continue to review, respond and prioritise the digital needs of the STP and individual organisation s IM&T strategies. The SELDA will be formed as a collaboration of senior health and care IT professionals and clinical representatives from organisations as well as citizens of South East London. The alliance will be broken into two groups, the SEL Digital Board and the LDR Working Group who will be supported by the LDR Shared Delivery Team. We believe our alliance will provide the South East of London with a sustainable and innovative digital foundation that will enable the STP to diversify care over the next five years, shifting care closer to home in the community. Our Local Digital Roadmap aligns to the needs of the STP by providing the platforms and services required to support modern, digital healthcare. Focusing on community care, mental health, supporting 6 Surrey and Borders Partnership NHS Foundation Trust seeking to deliver innovative health services to dementia patients Page 26 of 43

27 the emergency pathway, empowering patient and economies of scale, the alliance has agreed to twelve aims for the LDR. These aims will ensure that: 1. By using the most appropriate technology the LDR supports and enables the STP in delivering Community Based Care (CBC) through Local Care Networks (LCNs). 2. Every citizen will have access to their health and care data at any time and from any location in a secure manner. 3. Every health and care professional will have appropriate access to relevant and up to date citizen data at the Point of Care. 4. Our services are available through multi-channel mechanisms, ensuring every citizen can access services electronically as well as through more traditional methods. 5. Every citizen who has an appropriate condition or conditions, will be able to monitor their health and provide appropriate feedback and updates to an integrated care record. 6. Appropriate conditions will be monitored remotely using a variety of applications, telehealth, telecare and other connected devices to feed data back to an appropriate professional to ensure proactive and reactive care to be delivered in a timely manner. 7. We use population health management and risk stratification information to support and enable the delivery of more proactive direct care to our citizens alongside other processes (i.e. care quality reviews) to improve service delivery and quality. 8. Every citizen will be provided with the opportunity to have remote consultations throughout health and care as well as traditional face-to-face appointments and consultations. 9. Health and care professionals will have access to a shared infrastructure and will be able to access required systems at any NHS or Local Authority site in South East London. 10. Citizens will have access to free Wi-Fi at all NHS and Local Authority sites in South East London. 11. An appropriate support model for IM&T will be developed to support users across South East London. 12. The LDR supports the business and organisational change identified by the SEL STP as well as the strategies of health and care organisations within the LDR footprint. Several themes have initially been identified that the SELDA will further develop as the LDR is delivered. These themes are as follows: Clinically Enabling The clinically enabler work streams will focus on the delivery of platforms and services which will be used for direct and indirect care. Services such as a Patient Held Record, the Local Care Record and Connect Care will be used to support modern, innovative ways of working. Through these new platforms we will be able to monitor patients, consult electronically and see a clear view of the patient record from any secure device. Over time additional platforms will be identified to enable remote monitoring, self-monitoring and reporting, and remote consultations. Population Health Management We are fortunate to have world leading healthcare organisations in the South East of London, all of which require access to information for the purposes of research and analytics. Up until now we have not taken advantage of our rich information for the purposes of prevention or direct clinical care. It is our ambition to create a centralised, standardised information repository for the South East to support a near-real-time repository of health information that can be used to prevent ED and outpatient admissions. Page 27 of 43

28 National Objectives The national objectives initiative will ensure that each partner in the alliance are using consistent standards and approaches to deliver nationally required outcomes and objectives. National Alignment is an important factor in our ability to meet the CQUIN and technology requirements needed to support the system over the next five years. Services such as the London Identity Service and the London Integrating the Healthcare Enterprise (IHE) platform that will be provided by NHS England will transform the way we share information and deliver care. Infrastructure and Contracts Each of the partners in the alliance invests in IT hardware infrastructure, management systems and supplier contracts. Most of which the value could be shared through the procurement or agreement of a shared hosting infrastructure across the South East. The infrastructure theme will focus on economies of scale benefits for the South East, looking at the opportunities for shared infrastructure and contract agreements. Resourcing A major challenge for the SEL Digital Alliance will be the recruitment and retention of high quality IT staff. We will therefore look at our ability to create an IT Pay Framework, IT Academy and IT Training Scheme for the SEL. We will also use a shared master vendor agreement for all agency and support staff to drive economies of scale and the associated realisable benefits. This will also work to develop individual organisations digital maturities by ensuring skilled and motivated individuals are employed across SEL. Clinical Issues Through our digital roadmap we will deliver IT services that support a prevention and monitoring model of care. This model will allow us to reduce our outpatient activity and support the big 5 issues across the South East of London. We will deploy technologies to monitor and assist with blood-pressure, smoking, alcohol and drug use to reduce the pressure on our care system. We will support the mentally unwell by providing online tools for them to access and assess their mental well-being, access online therapy, real-time counselling and support services. Resources The delivery of SEL s LDR will require a number of resources to manage and deliver the projects and outputs, both locally and strategically, of the LDR. As part of SELDA a shared delivery team will be established with resources sourced, where possible, from existing staff employed in organisations within the LDR footprint. However, due to the nature of the projects and to enable the uplift in knowledge and expertise within SEL, as well as improve the digital maturity of organisations, there will be a requirement for fixed term and interim positions throughout the LDR s 5-year delivery. To ensure the delivery of the LDR and to continue to develop the relationships with stakeholders and organisations there will be a need to establish two strategic positions that cover the entire LDR footprint. These positions of South East London Chief Clinical Information Officer (SEL CCIO) and South East London Chief Information Officer (SEL CIO) are seen as critical to the delivery of the LDR. It is envisioned that these positions would be filled by existing CCIOs and CIOs from organisations within the LDR footprint, with the post holder s role in their parent organisation backfilled by the LDR. These would be rotational roles with a minimum tenure for each being 12 months. It is expected that these positions will continue to exist beyond the initial 5 years of the LDR. Governance IM&T is an enabling strategy for the SEL STP, supporting the various work streams that will deliver the outcomes in the overall STP. We recognise that, as a document on its own, the Local Digital Roadmap will not support the transformation we need. It is as much about the leadership, collaboration to achieve and change management as it is about delivering technology itself. Page 28 of 43

29 Figure 8: STP Governance IM&T, as an enabler for the aspirations of the STP, has a clear link into this governance structure. In South East London the LDR is also included as a supporting document to the STP to reinforce the correlation, although it stands as a document on its own. The IM&T component of the STP has been developed in conjunction with the development of the LDR whilst also maintaining a cross cutting view of the six clinical priority areas for system redesign. Stakeholders have been engaged via the SEL IM&T Steering Group, the Delivery Team wider IM&T OHSEL group. These groups may flex with the needs of the future digital agenda and requirement to deliver. During delivery of this ambitious vision we will likely require greater collaboration between all commissioners, providers and local authorities and more intelligent use of experience and resources to ensure delivery of the LDR s and its underlying outputs. A governance structure for the LDR has been developed to minimise bureaucracy whilst maintaining visibility of the work being done by organisations locally as well as those pieces of work to be delivered strategically. SEL will establish two new roles, the SEL Chief Information Officer (SEL CIO) and the SEL Chief Clinical Information Officer (SEL CCIO) to oversee the delivery of the LDR and ensure co-operation across the footprint. It is fully expected that the governance structure will develop and change as the LDR progresses but the principals of collaborative working, shared resources and meeting clinical needs and priorities will remain. An outline of the LDR governance that has been proposed is given below. Page 29 of 43

30 SEL Digital Board. Responsible for approval of LDR and directing LDR Working Group on areas of focus, prioritisation of work and agreement on work that spans the LDR footprint. Chair - SEL CIO SRO(s) CIO GSTT and CFO Southwark CCG Board Members: SEL CCIO Local Authority representative Primary Care representative Should include at least one Finance Director 3 x CIOs from across the LDR footprint Citizen representative Professional Assurance Group (Health & Care). Responsible for clinical approval of LDR and LDR outputs as well as providing clinical assurance to the STP Executive Group. Chair - SEL CCIO Members: Local Authority representative To include primary care, secondary care, community care and mental health representatives LDR Working Group. Responsible for scoping, planning, financial estimates and resource estimates for LDR. Provides the detail that makes up the LDR document. Chair LDR Lead/Senior Project Manager Members: IT Leads or other appropriate representatives from all organisations in the LDR footprint Page 30 of 43

31 Citizens x 3 LDR Delivery Team. A shared resource pool responsible for delivering the outputs of the LDR. Although there may be some permanent roles in the team, the majority will be made up from individuals from across organisations. Ensures maximum use of resources and sharing of knowledge and experience whilst transferring knowledge across the LDR footprint. The LDR Delivery Team flexes as appropriate based upon the projects it is required to deliver. Programme Manager/Senior Project Manager x 1 - reports to the SEL CIO Remainder tbc Supporting Workstreams. Provide specialist support to the LDR Working Group and, where required, the LDR Delivery team. STP Workstreams. Responsible for feeding STP requirements to the IM&T Working Group for assessment, prioritisation and delivery The governance structure for the LDR takes into account the need for appropriate levels of control around the delivery of technology and transformation within CCGs, and seeks to support these local deliveries, sharing experience from across the footprint where appropriate. SEL LDR Principles As a group organisations have agreed to a number of principles by which everyone will work to ensure the delivery of the LDR. These principles are: Implementing the SEL Local Digital Roadmap Transform first. Transformation comes from new ways of working not the technology itself. A transformation programme supported by technology underpins everything else. Culture change is crucial. Most issues we will face in delivering the digital roadmap will be people problems not technology problems. We will invest at least as much into the programmes of organisational change and transformation as in the technology. Leaders will reimagine how work is done and know how technology could best support it. User-centred design. Transformation requires a deep understanding of the work to be done and the users. There is a balance between using off-the-shelf solutions, solution developed by organisations in SEL and integrating existing clinical systems. Invest in analytics. Transformational change requires extensive redesign of work processes. We must build in data capture and analytical tools to enable us to proactively learn, adapt and continuously improve. Multiple iterations, continuous learning. We will not get everything right first time, implementing the Local Digital Roadmap will be an on-going programme of change where we will build capability in small manageable phases proving the benefit of each phase. Support interoperability. Inability to share and combine data between different providers is a major inhibitor to realising the full benefit of technology. We will empower all providers to develop their capabilities to enable data sharing using national standards. Page 31 of 43

32 Strong and informed information governance. Data sharing requires strong data governance, security and compliance that does not obstruct useful sharing for the purposes of safe Citizen care. Robust information sharing agreements and consent models will enable citizens to own and share information as they wish. Approach to interoperability A single unique identifier. All systems will use the NHS number as the unique identifier for the citizen record; where this cannot be supported local mapping tables will be required. Bi-directional sharing of information. We recognise that each organisation will have their own strategic clinical system in the near term that may either pull a view of Citizen data from other care settings or push alerts and revisions to systems supporting the provision of care. Single Sign-On (SSO). Wherever possible we will limit the number of logons and passwords users are required to use to access the various health and care systems. Users should not be forced to log into differing systems to find the information they need. Relevant information should be made available in the most comprehensible format with least possible user effort. Appropriate system suppliers. We will choose suppliers and implement systems that: Can interact with one another (Open APIs), preferably using interfaces (APIs) that are endorsed by NHS England. Standards will include HL7 and CDA to make data readily available to others involved in the citizen s care; Adopt NHS England standards for records and fields including Academy of Medical Royal Colleges (AMoRC) (clinical documentation), SNOMED (clinical coding) and dm+d (Dictionary of Medicines and Devices). Data extracts as required. Where systems will not allow access through direct interrogation via an Open API interface, we will make key data available by taking regular downloads of relevant data to data warehouse. Scalable IT solutions. Chosen IT solutions must be able to grow and change to meet the changing geography and demands they have to meet Consent to share information. We will apply agreed consent rules where data is transferred between Providers and give the ability to citizen s to view and update their consent. Approach to Information sharing A SEL wide data and information work stream will form part of the LDR to focus on developing the foundations of good practice to support a SEL approach to information governance. Key areas will include: The voice of citizens. Establishing a citizen focussed group to give voice to the needs and fears of SEL s citizens A common commitment from care providers: A health and care commitment statement to share data and information that will be ratified by all the Chief Executives of SEL health and social care provider organisations, including Boroughs Page 32 of 43

33 A suite of IG products: To include principles around supporting the integration of care and taking a whole system view on digital transformation work wherever possible. A series of IG products will be required including: A SEL information sharing framework for direct care purposes; A joint consent to share model; and Common communication plans. Change management Currently OHSEL has a shared Programme Team to deliver change across the SEL footprint. Whilst historically this has been focused on change for the six clinical areas it is intended to expand this capability to include a digital element for transformation over the coming years. Resources have been identified to help facilitate change at the local level and strategically and the financial estimate includes estimated costs for these additional resources. Whilst it is intended to use management methodologies such as PRINCE2 or AGILE, each project will be reviewed and the most appropriate management process used to ensure its delivery is successful. Benefits management Each project will build a business case with the end user which will identify benefits and articulate how benefits will be measured and realisation monitored. The measure will be based on successful delivery of clinical outcomes aligned to the SEL STP work stream outcomes and other strategic initiatives. This will require transparent data sharing across all stakeholders delivering the projects and those involved in running the resulting processes. Universal Capabilities NHS England has identified ten Universal Capabilities that are mandatory for inclusion in LDR footprint planning. Initial delivery plans have been developed locally by commissioners and are being further refined as part of strategic plans for delivering the Universal Capabilities as part of wider LDR plans. The Universal Capabilities are A. Professionals across care settings can access GP-held information on GP-prescribed medications, patient allergies and adverse reactions. B. Clinicians in U&EC settings can access key GP-held information for those patients previously identified by GPs as most likely to present (in U&EC) C. Patients can access their GP record. D. GPs can refer electronically to secondary care. E. GPs receive timely electronic discharge summaries from secondary care. F. Social care receives timely electronic Assessment, Discharge and Withdrawal Notices from acute care. G. Clinicians in unscheduled care settings can access child protection information with social care professionals notified accordingly. H. Professionals across care settings made aware of end-of-life preference information I. GPs and community pharmacists can utilise electronic prescriptions. J. Patients can book appointments and order repeat prescriptions from their GP practice. Page 33 of 43

34 LDR Objectives Over the course of developing the SEL LDR a continuous assessment of what would be needed to deliver the LDR has been carried out. Current capabilities of providers and barriers to information sharing have been reviewed and will continue to be reviewed. Based on this assessment the following objectives focus on building the foundations and functionality which will enable the SEL Digital Alliance to succeed in achieving the required health outcomes, care quality and integration goals over the next five years. Objective 1: Establish a sustainable capability to deliver the roadmap Objective 2: Enable delivery of health and care improvements: Objective 2.1: Deliver enhanced data sharing across health and care in SEL Objective 2.2: Continue developing and embedding the ten Universal Capabilities identified by NHS England Objective 2.3: Promote wellbeing and self-management Objective 2.4: Exploit Population Health Management to target preventative interventions and manage continuous improvement Objective 3: Enable delivery of health and care objectives: Objective 3.1: Primary care enablers: Optimise, Standardise and Integrate primary care systems Objective 3.2: Secondary care enablers: Optimise, Standardise and Integrate secondary care systems Objective 3.3: Further enablers: Optimise, Standardise and Integrate other provider systems Objective 3.4: Improve workforce productivity and satisfaction Objective 3.5: Provide a robust shared infrastructure across SEL Objective 1 Establish a sustainable capability to deliver the roadmap Fundamental to the digital roadmap is the need to provide services that are adaptable and responsive to the changing needs of care professionals and citizens. Change should reduce not raise cost and risks to organisations, therefore the most appropriate resources must be used to deliver the aims of the LDR. It is crucial that a structure be agreed to create the foundations to lead, coordinate and drive forward the digital agenda while effectively managing delivery, costs, risks and benefits. We will adopt a flexible approach to delivery using a blend of traditional and Agile methodologies as appropriate. Action Establish a cross provider delivery team Establish an enterprise architecture and design authority Develop the roadmap in line with evolving care needs to enable delivery of benefits Deliverable A structure to plan, manage and monitor delivery of the digital agenda and identified benefits Agreed terms of reference, scope and governance structure Reporting to the LDR Working Group chaired by the SEL CIO Agreed architecture and long term vision of the rationalised infrastructure and application portfolio Agreed standards and how to deploy them aligned with neighbouring footprints Detailed roadmap and projects to deliver the architecture South East London Local Digital Roadmap periodically reviewed and amended to reflect changing situation and needs Revised programme/project portfolio to deliver evolving needs Develop business cases and benefit profiles Monitor and manage benefits realisation Page 34 of 43

35 Action Establish a centre of excellence Deliverable Pooled resources: architect, design authority, project delivery, change management, strategic and transactional procurement, contract management Funding and resources for the delivery team should be sourced from stakeholders in the footprint and will begin to be established in the next three to six months with the start of the delivery of NHS England approved projects funded via the ETTF. It is clear that the digital roadmap team will need a breadth of change management experience as well as a technology capability to successfully deliver the proposed digital roadmap. The governance structure and its relationship with the STP s is important to the successful delivery of the outputs of the LDR and as such the SEL Digital Board will report directly to the STP Quartet Executive Group. A risk management, benefits management, and change management processes will be developed over the next 6 months to support the LDR delivery. Objective 2 Enable delivery of health and care improvements Objective 2.1 Deliver enhanced data sharing across health and care in South East London A citizen centred approach to sharing information is crucial to delivering safe, efficient, co-ordinated care. To deliver this the LDR Delivery Team will assess and agree the set of interoperability principles outlined earlier in this document. A working group comprised of Provider and Commissioner Information Governance leads, Caldicott Guardians and citizen representatives, will be established to develop an Information Sharing Agreement Framework for SEL that can also dovetail into current work underway by the HLP in developing London-wide Information Sharing protocols. Action Identify data sets to be shared Engage with care professionals to identify their needs, concerns and barriers to data sharing Integration/Interoperability between Local Care Record and Connect.Care Integrate social and health care data Deliver common assessment tools Integrate neighbouring health systems Deliverable Create a catalogue of data sets detailing which data will be shared by whom and when data sharing is required building upon work already done as part of the Local Care Record and Connect.Care Agreed Information Governance (IG) framework for sharing data which can be applied to each shared data set Communication widely to SEL citizens and care professionals IG rules implemented into the data sharing infrastructure Initial workshop already held in early October ETTF submission made in June 2016 Project Initiation Document to be completed Ensure Citizen only need to tell their story once, that all professionals supporting an individual know what other members of the multi-disciplinary team have done System wide information governance compliance of the shared care record Fully interoperable health and social care citizen data sharing Assessment completed in different care settings with common thread Different agencies sharing non-specialist areas assessment Agree data and protocol standards and data sets to transfer in both directions Objective 2.2 Continue developing and embedding the 10 Universal Capabilities identified by NHS England NHS England has identified ten Universal Capabilities that are expected to be incorporated into the LDR. Tools were provided by NHS England to measure the current digital maturity of Providers and CCGs to deliver these capabilities. The LDR will support organisations in improving their digital maturity Objective 2.3 Promote wellbeing and self-management Self-care and prevention of illness is crucial to improvements in population based health outcomes. Citizens require access to information, their care records, and decision support tools to self-manage their health. Intelligent data is required to understand and profile who is ill, or at risk of ill health, and target with appropriate interventions. Page 35 of 43

36 A countywide initiative, the TECS programme, is now underway. Its vision is to Harness technologies to transform citizen outcomes and experiences of prevention and care, and empower people to manage their lives in a way that is right for them. TECS currently refers to 7 themes: tele-health, tele-care, tele-medicine/tele-consultations, telecoaching, self-care apps, citizen-controlled data access and peer to peer support. Action Understand wants and needs of citizens Understand wants and needs of care professionals Evaluate current best practice Alignment to STP priorities Establish knowledge and understanding Establish pilot projects to integrate health and care Deliver a Digital marketplace Deliverable Workshops with citizen advisory groups Run user engagement and experience sessions to develop needs during 17/18 Run user engagement and experience sessions to develop requirements during 17/18 Public Health to provide evidence-based appraisal of the current models and best practice Looking at the care pathways that have been prioritised in the STP, undertake deeper research to evaluate specific products Evidence to inform commissioning cycles from 17/18 onwards. Identify priorities and enablers Rich content to signpost citizen to care services and sources of help and advice offered by all care providers in the eco system Subscription services to alert citizens of changes they have registered an interest in Objective 2.4 Exploit Population Health Management to target preventative interventions and manage continuous improvement Intelligence is critical for managing quality standards and benchmarking, risk stratification and understanding the health needs of the population, monitoring quality and outcomes of service provision, managing contracts; and providing clinical and executive decision support tools. Exploiting citizen level, pseudonymised multi-sector linked datasets will allow joined up commissioning and evaluation of care programmes. Broad datasets which include linked data from primary, secondary, out of hours, mental health, ambulance and hospice health care, as well as social care enable the following: Analysis of combined needs across health and care, especially for aging population; Analyse changing patterns of multiple morbidity & frailty; Characterise different population segments for targeted programmes of preventative care; Develop approaches to care costing including development of capitated budgets to reward providers to adopt a more preventative approach and identification of cross-sector costs and savings Model possible system changes before implementation Continued innovation, evaluation of performance, improving quality and fully understanding the cost of interventions The SEL STP and the SEL LDR will place increased demand on informatics teams for enhanced data sets both nationally and locally, with a need for greater breadth and depth; and improved analytical tools. There will likely be a need for shared informatics across SEL and this will need to be addressed as the LDR develops. Action Identify enhanced data sets required to support the ambition Review quality of current data sets used Deliverable Agreed enhanced data sets to be developed taking into account the needs of health and care organisations Phased plan to deliver remediation activities to improve the quality of data where it is not currently acceptable Page 36 of 43

37 Action Identify barriers to accessing centralised primary care data for purposes of population need, risk stratification and cohort identification Prioritise data sets to be delivered Educate staff Deliverable Meetings/workshops with GP network to get their buy-in and engagement Structuring of role based user access to data sets aligned to an SEL IG framework Plan to capture these additional data items and the analytics required to be applied to the data sets Phased delivery of additional data sets Phase delivery of additional analytical capabilities Improved understanding of BI, analytics and self-service tools available Objective 3 Enable delivery of health and care objectives Objective 3.1 Primary care enablers: optimise, standardise and integrate primary care systems General Practice software is key to improving quality of primary care, clinical decision support, variance and medication optimisation, and for achieving the vision of paperless working. There are a number of tools, both national and local that have been invested in and that are not being used to their full potential (i.e. Summary Care Record, Enhanced Summary Care Record, Docman, and e-rs. For example, some practices have strong usage of Docman, while others report low usage. One reason for variation across practices is the use of different Primary Care Systems. This is a barrier to standardising data, improving quality, and reducing costs. Standardised data, workflow and architecture will provide considerable benefits to achieving the data sharing goals that underpin the digital roadmap. Action Standardise clinical system portfolio Scale up to deliver Locality Care Networks Engage with practice managers and GPs to identify why tools are not being used optimally Multi-Channel consultation Develop a Target Operating Model for General Practice Deploy mobile working Identify and recommend citizen apps for self-management of conditions Deliverable Agreed set of clinical systems across all GP practices and then accelerate deployment of this standard set of systems (systems that could be standardised include EMIS web, SystmOne, Vision, Docman 10, Docman Vault, EMIS Enterprise Reporting, EMIS AnyWhere) Locality Care Networks using federated clinical applications Federation level reporting Understanding of why tools are not being used successfully Change programme to address the concerns and barriers identified Exploiting suppliers such as EMIS, SystmOne and Vision to provide resources and tools to improve user experience and utilisation of their software Ability to enable citizens and clinicians to interact via multiple channels: face-to-face, teleconferencing, videoconferencing, virtual consultations, or website Standardised workflows Optimised utilisation and access to standard set of systems. Mobile devices deployed to all practices able to access home systems in real-time in all care settings Secure bi-directional data transfer between mobile device and home system Locally approved citizen apps for managing conditions such as obesity, diabetes, blood pressure, COPD Objective 3.2 Secondary care enablers: Optimise, standardise and integrated secondary care systems There is a need to identify enablers to support the integration of acute clinical systems. These enablers will deliver improved health outcomes for both the citizen and the Trusts involved, both within the LDR footprint and more widely across London. Integration of these systems will enable the Trusts to improve citizen safety and experience, enhance the digital support offered to frontline staff; and reduce duplication thus realising key health priorities and progress the financial sustainability of each organisation. Action Develop standard workflow system Deliverable System wide alerting Agreed clinical pathways supported by workflow Page 37 of 43

38 Action Further develop transfers of care Optimise medicines management Develop and deploy clinical decision support Enhance enabling infrastructure Enhance enabling devices Enhance citizen experience Deliverable Safety system Exploit capabilities of LCR and Connect.Care for sharing of citizen data Implement/embed electronic prescribing and medicines management Exploit electronic prescribing and medicines management Introduce intelligent systems to enhance workflow by providing clinicians with cohesive and comprehensive information on alerts and risks Introduce initiatives such as universal access to WiFi Investigate moving data centres off site, disaster recovery and business continuity Develop and improve mobile working, Microsoft licences, NHS Mail Introduce online booking, self-check-in kiosks, virtual consultations, self-assessment and reporting Objective 3.3 Further enablers: optimise, standardise and integrate other provider systems Improving how services in the community work around citizens is critical to making the NHS more effective and efficient. There is currently poor co-ordination of community services with other agencies that provide care within the community, although each individual provider provides quality care. The FYFV envisions new models of care that break down traditional divides between primary care, community services and hospitals with the aim that citizens receive personalised and coordinated care from different services and clinicians working together. Action Move to new ways of working or new models of care that are digitally enabled and interoperable Connect all providers to a CoIN Deliverable Deliver enablers to support the development of Locality Care Networks (LCNs) Shared WiFI across NHS and Local Authority sites Enhancing the availability of data through the LCR and Connect.Care, and creating a single view of information in both systems Interoperability with primary care, secondary care, social care and mental health systems Mobile working capturing and delivering data at the point of care delivery Enhanced data collection to improve Population Health management enabling better performance management and preventative interventions. Digital support for locality based teams SEL plan for the implementation of the Health and Social Care Network (HSCN) Objective 3.4 Improve workforce productivity and satisfaction Technology, information and flexible working arrangements can create a motivated and satisfied workforce, improving productivity, and staffing levels. Efficiencies can also be gained through use of business technologies to improve communication and knowledge sharing. Action Migrate all Providers to a modern secure system e.g. NHSMail2 Assess and deploy mobile solutions for care professionals Assess and deploy remote and home working for all professional staff not designated as office bound Deliverable Enhanced capabilities and Instant messaging Secure file transfer File sharing capabilities Options recommendation for most appropriate mobile solution Care workers able to work in care homes and citizens own homes with access to the patients care records as needed Detailed analysis of roles and role requirements for IT equipment Options recommendation (e.g. Virtual Device Infrastructure (VDI) technology and moving to cloud based options (with perpetual licenses)) and Business case Objective 3.5 Provide a robust shared infrastructure across SEL Networking is a fundamental requirement to enable interoperability. All NHS stakeholder organisations already share a common networking infrastructure (N3), but the current N3 contract expires at the end of March 2017 although an extension of 18 months has been put in place by NHS Digital whilst a replacement network is negotiated. National contracts for CoIN also comes to an end during To ensure ongoing collaborative working capability a robust common network must be maintained in SEL that can to connect seamlessly with future national networks. This is also an opportunity to consolidate Page 38 of 43

39 and to move to current technologies with enhanced capabilities which can be delivered more economically and at scale. Action Procure an upgraded network, a COIN Virtual COIN (VCOIN) Exploit capabilities of VCOIN Deploy compatible WiFi across all stakeholder sites Develop a security model Adopt GS1 asset management for all medical devices Provision connectivity to other health care providers Develop model GP practice standards Deliverable COIN or VCOIN implemented across SEL Transition funding request for change to HSCN All active primary and secondary care sites and CCGs directly connected to CoIN Direct connection to Local Authority networks All stakeholders moved to a common domain reducing complexity in the current provider communication channels Unified communications using VoIP telephony Enabled teleconferencing and video conferencing. NHS Local constraints removed but maintaining IG compliant security Ability for professionals to access their home systems from any NHS or LA sites Full support for mobile working allowing users to access their home systems Common security architecture to be deployed across the health and care in SEL Incremental deployment of security architecture across the CoIN and progressively into each stakeholder organisation Agree solution for GS1 barcoding and associated call-off contract Current and maintained asset register Preventative maintenance schedule Connected pharmacists, dentist and opticians as a building block for future integration and interoperability Templates for the optimum IT infrastructure and equipment to support Model practices developed as exemplars Page 39 of 43

40 LDR Risks and Mitigation The barriers and challenges to delivering the LDR include: Risk Too many competing priorities Insufficient funding Insufficient resources or capacity in organisations Data security concerns Insufficient technical skills Lack of understanding Lack of collaborative sharing culture Lack of Open APIs from system suppliers Lack of Digital Maturity Table 1: SEL LDR Risks Mitigation Agree with the IM&T Steering Group the priorities for IM&T across the health and care economy Agree funding and effort to spend on delivering the LDR vs maintaining current services Identify funding needs and make appropriate bids Identify potential partners co-fund innovation Explore opportunities with industry to partner in delivering elements of the LDR Pool resources to optimise current spend Identify resource requirements Identify individuals with experience and skills in organisations and agree willingness to pool resource(s) Agree and implement data sharing agreements that safeguard Citizen, social care and healthcare data Develop procedures for obtaining appropriate Citizen consent for the primary and secondary uses of their data Providing transparent assurance that only those care professionals with the need to access Citizen data can do so with a full audit trail of access made Identify specific skills required to deliver the roadmap and build costs into bids; this may be through increasing resource capacity and/or by up-skilling existing resources Pool technical resources across all providers Identify and work with specialist 3 rd parties to access a larger skill base and resource pool The workforce need further education and guidance on how to exploit the IT currently available to improve productivity As projects are delivered by the digital team there needs to be good communication to inform the public, carers and staff of what the benefits of the technology are and how to make best use of that technology. Establish a footprint-wide co-ordination and delivery team to work across the health and care economy Share resources and budgets to deliver shared objectives Continuous communications which reinforces collaboration and shares successes Escalate Open API issues to national team responsible for commissioning system suppliers Where possible identify local work-arounds - this will be both sub-optimal and costly. Agree baseline for organisations Improving Digital Maturity and LDR priority A full risk management strategy for the LDR will be developed as part of the initial workstream to establish the SELDA. Page 40 of 43

41 ANNEX A TO SEL LDR DATED 30 NOV 2016 SEL LDR - Expanded Vision Page 41 of 43