Board meeting 31 January 2007

This paper is being submitted to the Trust Board for amendment and/or approval as appropriate. It should not be regarded, or published, as Trust policy until formally agreed at the Board meeting, which the press and public are entitled to attend. Board meeting 31 January 2007 Title: Information Management and Technology (IM&T) Report Presented by: Phil Hurd, Interim Director of IM&T Number: NPCT/07/13 Purpose/Summary: The purpose of this paper is to update the Trust Board on current IM&T issues. During this time of corporate transformation, the IM&T Directorate views its role as providing information management and technology, systems and solutions to support the modern delivery of healthcare and promotion of health countywide. This report provides an update on activity and implementation of good practice, high quality services and innovative future applications across the range of IM&T activities. It summarises the Directorate s strategy to comply with national expectations for 2007/2008 along with service improvement and healthcare transformation. Relevance to PCT Assurance Framework: Resource Implications Financial/Workforce: Recommendations to Trust Board: The Board are asked to note the large IM&T agenda and the progress towards national targets

Information Management and Technology Report 1 Connecting for Health (CfH) Summary Connecting for Health is the implementation of the National Electronic Care Record. It comprises of national applications delivered by national application service providers (NASPs) and local (regional) applications, delivered by local service providers (LSPs). The NHS CfH LSP that is contracted to provide systems to the East Midlands changed on 8 January 2007 from Accenture to Computer Sciences Corporation (CSC). Examples of national applications are: - Choose and Book Electronic Prescription Service National data network (N3) NHS summary care record Local applications are: - Acute hospital electronic patient record Mental health electronic patient record Community services electronic patient record General Practitioner systems 1.1 NHS Connecting for Health (CfH) NPfIT Local Ownership Programme (NLOP) Following a review of Connecting for Health during the autumn, the Department of Health has implemented a new model of governance for National Programme for Information Technology (NPfIT), called the NPfIT Local Ownership Programme (NLOP). This is part of the new NHS operating framework for 2007-8, and is intended to devolve responsibilities and accountabilities around implementation of NPfIT from NHS Connecting for Health to Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs). It also shows an end date of March 2011 for the final version of the NHS Care Records Service. This will provide a fully integrated Strategic Solution working across all organizational and professional boundaries with full integration to the spine.

SHA Chief Executives are now the Senior Responsible Officers (SROs) for the implementation of NPfIT within the SHA, and PCT Chief Executives are SROs for the local health community. Local health community plans will be required by 31 March 07, showing not only how local but also national priorities will be achieved, including: Deployment and benefits realization for patient administration systems Implementation of GP Systems of Choice (GPSoC) Preparing for the National Summary Care Record Completion of picture archiving and communications rollout (PACS) Implementation and benefits realization for the Electronic Prescriptions Service (EPS) Further exploitation of e-booking As commissioners, the PCT is responsible for ensuring that planned IM&T investment across the local health community (LHC) reflects the IM&T payment by results (PbR) tariff uplift (0.3% in 2006/07 and 0.1% in 2007/08). This should be incorporated into commissioning contracts as appropriate. The PCT will also need to be assured that the IM&T plans of NHS Trusts in the local health community (LHC) meet national objectives. A meeting with Directors of IM&T from in-county provider Trusts is planned for 26th January 2007 to progress these issues. 1.2 Northamptonshire PCT Progress The implementation of the community and primary care clinical system (SystmOne) currently covers the following professional areas: District nursing service Evening nursing service Community Matrons Clinical assessment service Intermediate care teams Prison health service

Number of SystmOne Users in Northamptonshire 500 450 400 Number of Users 350 300 250 200 150 District Nurse Comm Matrons CAS CRT/ICT Evening Nurse Total 100 50 0 JUL AUG SEP OCT NOV DEC 2006 Future areas of deployment to PCT provider services are as follows: Further support to demand management schemes, including deployment to teams that include dieticians, diabetes, and podiatry professionals, the falls team, and implementation of an admission avoidance template. Further guidance and refresher training is planned to support District Nurses in improving levels of clinical recording, plus implementing a Single Assessment Process template. Commencement of deployment to community and day hospitals. In order to be a fully integrated community and primary care record, GP Practices will need to adopt SystmOne. However, at present, general practitioners are allowed a choice of clinical system. Currently four practices in Northamptonshire use SystmOne, and a further four have agreed to deployment over the next three months. Positive contact has been made with approximately another 15 practices, but no commitment has been gained from these yet. Increasing the pace of deployment in 2007-08 will rely upon a number of things: Marketing the benefits of an integrated primary care system to GPs, including the PBC functionality of SystmOne at a locality level Deployment of a GP out of hours co-operatives SystmOne module (currently being tested) The GP IM&T directly enhanced service (DES), which provides financial incentives for general practitioners to move to a Connecting for Health solution. SystmOne will also be deployed to the Cardiac Echo Service, operated by a GP with Special Interest. This will create an integrated record across primary care and secondary care (Northampton General Hospital) for this service.

Note that the IM&T Directorate is currently defining the processes for validation of various components of the IM&T directly enhanced service (DES). 1.3 Electronic Prescriptions Service (EPS) Release one of EPS requires GP practices to print a barcode containing prescription information on the FP10 prescription. Pharmacies should have a barcode reader and the associated technology to interpret this. Currently 22 practices and 46 (from 111) pharmacies are technically live. Pharmacies are currently being sent a test EPS bar-coded script to verify business live, which will trigger payments to pharmacies. Completion of Phase 1 of EPS in Northamptonshire is due September 2007 but this is dependant upon GP system suppliers modifying their application software in time. 1.4 Choose and Book The IM&T Directorate is working with practices to increase usage of Choose and Book, by resolving technical issues (such as hardware and network issues) and by providing additional demonstrations and training to users. Currently 47 (out of 78) practices make at least 50% of referrals via choose and book. 2 Service Desk (Helpdesk) The Service Desk currently supports some 6000 service users across the County. The Service Desk (ITIL compliant) application software, deals with up to 135 requests for assistance per day and the current number of hardware items listed on the system is in excess of 14,000. It provides a single point of access to wider services provided by NHI such as Information Technology and Clinical Systems Support and is the gatekeeper to comprehensive support for clinicians and IT users. Service Desk monitoring of call trends, volumes and user requirements such as requests for training enables NHI to anticipate emerging requirements and areas for growth and improvement and hence plan accordingly. 2.1 Developments As a key area in a growth industry the responsibilities and workload of IM&T has expanded along with the national initiatives. The Directorate will develop the systems knowledge base which is key to the benefits realization checklist; and with continuing work on trend analysis and performance indicators will ensure that the Service Desk is in line with nationally recognized industry standards.

Currently the Service Desk is preparing for achieving national accreditation for Northamptonshire, thus ensuring a centre of excellence. Accreditation should be achievable by the end of March 2007. 3 Information Management 3.1 Practice Based Commissioning A series of new Executive Viewer (EV) reports was released on 5 January. These reports cover the following areas: Activity and spend compared to the Practice plan and compared to previous years levels: for admitted patient discharges and outpatient attendances activity, showing a year to date summary, forecast outturn, a month by month and quarter by quarter comparison. (Note that practice plans are only available for practices in the old Heartlands PCT area since plans are not available at a practice level for other areas.) Data Validation: these reports are designed to assist Practices in data validation, particularly in checking admission and discharge dates, and the effect of these on excess bed days and the short stay tariff. Practices are supported with additional guidance on how to use EV and onsite training is available if required. 3.2 Business Analysis The new PCT structure includes a Business Intelligence function within the Finance Directorate (subject to consultation). To support this in the interim, two Senior Information Analysts have transferred to the Finance Directorate. They are undertaking a number of projects including Capacity Planning and Demand Management reporting. 3.3 Support for Demand Management Schemes Excess Bed Days application supporting PCT staff in identifying inpatients who could be discharged this is being re-created to allow a stricter security model, so that it can be rolled out to the North of the county Normed Admissions Avoidance application Information Services continue to support this application and are currently undertaking further development of reporting functionality. Independent Packages of Care this application has been re-developed, and is currently with users for sign off; the development of a reporting module has commenced.

4 Information Governance 4.1 Records Management Policy A draft records management policy is out for consultation providing the PCT with a framework for the systematic management of all its records (both health care records and corporate and business records). Early implementation work is currently focusing on internal and external information sharing policies and initiatives to ensure compliance with the Care Record Guarantee as per the NHS in England: Operating Framework for 2007/08. 4.2 Confidentiality and the National Data Spine: Guardian Coupons The Guardian newspaper published an article on 1 November 2006 that encourages readers to write to their General Practitioners asking them to ensure that their records are not put onto the NHS Care Records Service (also known as the Spine). The article included a number of misleading statements, for example that the Police and other agencies can gain access and that the Department of Health threatens to withhold appropriate medical care to objectors. It is understand that nationally, copies of these letters and an associated cut-out coupon are being received in GP Practices. The Department of Health (DoH) has now issued a response to this letter that addresses each of the points raised. This should be used when such letters are received. The legal position (supported by the Information Commissioner) is that although Patients have a right to 'opt-out' of their records being held and shared electronically, PCT's do not have an obligation to accede to that request, particularly where this may be detrimental to the standard of clinical care provided. The IM&T Directorate will be producing guidance for clinicians and advice leaflets for patients over the coming months. 5 Patient Services 5.1 Patient Registrations During the financial year 2005/06 65,147 new patient registrations were entered onto the patient administration system, averaging 16,286 each quarter, but the quarters do fluctuate due to seasonal changes, such as variance in the housing markets etc. The number of patients added to the system during the period 2 July to 1 October 2006 being 18,849 (this quarter is always one of the highest, due to the university and college students registering with a GP during late September). The number of persons registering with a GP arriving from abroad is increasing (2,313 during the period 2 July to 1 October 2006, against 7,369 for the whole financial year 2005/06.

5.2 Screening (Breast and Cervical Cancers) Cervical Screening Coverage (last reported year 05/06) was 85.3% Daventry and South Northants PCT and 80.4% Northampton and Northamptonshire Heartlands PCTs. 70,370 invitation letters and 40,888 reminder letters were sent to eligible women during this same period. In the quarter 2 July 2006 to 1 October 2006, 16,947 invitation letters and 10,614 reminders were produced and sent. This team also commenced a demand management scheme where 490 households were sent letters requesting the householders to list the patients living at the house. This has resulted in 1180 patients being immediately removed from GPs lists. A further 2119 patients have been identified for possible removal, if the GP Practice cannot provide a new address for the patient by 30 June 2007. 6 Knowledge Management 6.1 Web Services A new public web site for the PCT was released on the 1 st October. The site Northants Health Gateway is designed to the highest accessibility standards, (W3C AAA) making it available to the majority regardless of their physical ability. Content includes news, and documents about the PCT including all Trust Board papers available in advance of the meetings. Alongside this the redesign of Health Network Northants Intranet site allows the new PCT organizational content to grow whilst maintaining the content of the old PCT s until such a time as it is decommissioned. The new Staff Notice board facility designed to reduce email traffic across the network provides additional communications methods for NHS staff. Other new content and functionality on the web sites includes: - Prescribing traffic light system System status alerts Countering fraud documentation All new PCT policies 6.2 Library services Library services have gained a Stage 2 accreditation in the national HeLICON library accreditation framework. This stage of accreditation reflects an excellent service and acknowledges areas of outstanding provision. Additionally Knowledge Management drop-in clinics are now held at Towcester Health Centre, Grange Park Surgery and at Welland Centre, St. Mary s Hospital, Kettering. A new Finding the Evidence workshop is now delivered by Library Services as part of the academic programme for GP Registrars across the LNR Deanery.

A stand at the NHS Healthy Schools Conference on Personal and Sexual Health Education provided an opportunity to display resources and multimedia aids to service users across the county. Leaflets and information packs have been sent out in response to: - Flu immunisation campaign. Sourced and collated packs were sent out to pharmacies, (104 in the county) with additional foreign language leaflets & audiotapes selected from stock distributed to local organisations (Bangladeshi Association, Maple access Centre, Northampton College). Exercise and Nutrition Pharmacy Campaign packs were sourced and collated and sent to all pharmacies in the county. 4500 Choose and Book leaflets were sent out to GP Practices in the south of county. Additionally Library Services are developing a financial recovery plan brought about by the reduction in funding of over 10% of budget this year from educational funding streams. As part of this fines are being introduced on the late return of all items from January 2007. 7 Information Technology The merger of PCT s has had a significant impact on the workload of IT systems and infrastructure but has also in some cases given an opportunity to streamline processes and increase effectiveness. For example: - Over 5,000 staff mailboxes across 24 servers have had to be transferred to new email addresses, including some manual processes to realign these accurately. New servers have been built, configured and commissioned with file access permissions to facilitate data and information usage and sharing for the new PCT. A standard desktop configuration has now been deployed across all of the PCT. This provides a greater level of remote support to users thus ensuring quicker response times, reductions in travel time and cost for IT technicians and enables a greater level of throughput for call resolution. The next phase of this project deployment will be across the GP community. Anti-virus software upgrades and patches are now delivered online directly from our supplier providing immediate protection against network viruses. The next phase of this project deployment will be across the GP community. Reductions in the costs of software for GP practices as already been negotiated with the supplier.

GLOSSARY CAB CSC DES EPS FP10 GP GPSoC GpwSI IM&T ITIL LHC NASP NCRS NLOP NPfIT PACS PbR SHA Spine SRO W3C AAA Choose And Book Computer Sciences Corporation Directly Enhanced Service Electronic Prescription Service Family Practitioner form 10 (paper based prescription) General Practitioner/General Practice GP Systems of Choice General Practitioner with Special Interest IT Infrastructure Library (international standard for helpdesk software) Local Health Community (Northamptonshire) National Application service provider NHS Care Record Service (also known as the 'Spine') NPfIT Local Ownership Programme National Programme for Information Technology Picture Archiving and Communications System Payment by Results Strategic Health Authority National data spine holding summary care records & demographic information Senior Responsible Officer World Wide Web Consortium - Triple A compliance