NATIONAL INFORMATION BOARD Leadership Summit Health and Care Innovation Expo 2016, Central 5, 6 & 7, Manchester Central Agenda Thursday 8 September 2016 10:00 12:30 plus Public Q&A Session 12:30 13:15 1. Welcome and introductions Chair 2. Minutes of Leadership meeting held on 20 April 2016 and matters arising Paper Ref: NIB 0908-001 Chair 3. Chair s overview Chair 4. Governance arrangements Tamara Finkelstein 5. Minister s keynote address Nicola Blackwood MP BEST PRACTICE 6. Digitisation in health and care benefits in practice for clinicians and patients - Dr Mark Westwood to give overview of benefits of digitalisation to clinical staff - Hugh Huddy to provide his story of the benefits to patients of using Patient Online DELIVERY/ASSURANCE 7. Paperless 2020 reporting Paper Ref: NIB 0908-002a Paper Ref: NIB 0908-002b POLICY/STRATEGY 8. Clinical vision Paper Ref: NIB 0908-003 Dr Mark Westwood, GP and GP IT Lead for North Tyneside CCG Hugh Huddy, patient Andy Williams Martin Severs 1
9. Patient, carers and service users vision Paper Ref: NIB 0908-004 10. NIB Working Group updates Paper Ref: NIB 0908-005 - Learning from Local - Analytical Capacity and Capability - Horizon scanning 11. Microsoft Future technologies for health and care 12. National Data Guardian update - Review of data security, consent and opt-outs - Consultation Neil Tester John Newton John Doyle Leslie Sistla Paul Reid Dame Fiona Caldicott Katie Farrington 13. Professor Keith McNeil, Chief Clinical Information Officer, NHS England and new Chair of the NIB Keith McNeil 14. Concluding remarks Chair 15. Any Other Business Chair Date of next Working Group meeting: 11 October 2016 Date of next Leadership Summit: 6 December 2016 Close meeting and open for public Q&A 12:30 13:15 2
PAPER: NIB 0908-001 AGENDA ITEM 2: Minutes of Leadership meeting held on 20 April 2016 and matters arising PURPOSE: For approval National Information Board Leadership Summit 10:00 12:30, Wednesday 20 April 2016 UK e-health Week, NHS Plenary Room, Olympia, London Notes and Actions Attendees Chair Prof John Newton Chief Knowledge Officer, PHE The Academic Health Science Networks Guy Boersma Managing Director, Kent Surrey Sussex AHSN Care Quality Commission Emma Rourke Director of Intelligence Department of Health Tamara Finkelstein Chief Operating Officer and Informatics Accountable Officer Katie Farrington Director of Digital and Data Policy Peter Knight Deputy Director of Research Information & Intelligence Simone Bayes Deputy Director of Data & Information Strategy Charlotte Buckley Deputy Director of Local Insight & Resilience Health and Social Care Information Centre Andy Williams Chief Executive Kingsley Manning Chair Health Education England Prof Nicki Latham Executive Director of Performance and Development James Freed Chief Information Officer Health Research Authority Stephen Robinson Corporate Secretary Healthwatch England Neil Tester Director of Policy & Communications 3
Human Fertilisation & Embryology Authority Peter Thompson Chief Executive Human Tissue Authority Jamie Munro Head of Business Technology Independent Cancer Taskforce Michael Chapman Head of Cancer Intelligence & Impact, Cancer Research UK Independent NIB Members Alex Kafetz Dr Jo Bibby Dr Justin Whatling Mat Campbell-Hill Sam Smith Local CIO Council Dylan Roberts Chief Digital Officer Local Government Association Mark Golledge Programme Manager Health and Care Informatics Macmillan Cancer Support representing Richmond Group of Charities Lynda Thomas Chief Executive Julie Flynn Strategic Data and Influencing Lead Medicines and Healthcare products Regulatory Agency Dr Janet Valentine Director of Clinical Practice Research Datalink National Data Guardian s Panel Dame Fiona Caldicott National Data Guardian NHS Business Services Authority Nina Monckton Head of Information Services NHS England Beverley Bryant Director of Digital Technology, Patients & Information Dr Paul Rice Head of Technology Strategy NHS Improvement Peter Sinden Chief Information Officer Neil Stutchbury Director of Business Engagement NHS Litigation Authority Helen Vernon Chief Executive Public Health England Prof Peter Bradley Director of Knowledge and Intelligence Strategic Clinical Reference Group Prof Martin Severs Deputy Chair Prof Jonathan Kay Professor of Health Informatics, Farr Institute, University College London and Royal College of Physicians 4
UK Statistics Authority Ed Humpherson Director General for Regulation Additional Attendees Department of Health George Freeman MP Minister for Life Sciences Amanda Gordon Information Legislation Policy Manager Jean King accompanying Minister for Life Sciences Health and Social Care Information Centre Rob Shaw Director of Operations & Assurance Services & SIRO Richard Clay Programme Head, Informatics Portfolio Management Office Tom Denwood National Provider Support and Integration Director Dermot Kehoe Assistant Director, Communications & External Relations NHS England Dr Julia Maier-McAlpine Strategic Programme Manager, Five Year Forward View Deborah El-Sayed Director of Digital and Multi-Channel Development Dr Arvind Madan Director of Primary Care Dr Ossie Rawstorne National Medical Advisor for NHS 111 Dr Robert Varnam Head of General Practice Development Helen Rowntree Head of Digital Services NIB Secretariat Tracy Dibdin Gemma Riley Peter Williams NQB Secretariat Christina Cornwell, CQC Strategic Clinical Reference Group Peter Thomson National Medical Director s Clinical Fellow Apologies The Academic Health Science Networks Mike Burrows Managing Director, Greater Manchester AHSN Association of Directors of Adult Social Services Terry Dafter Associate Director of Adult Social Services, Stockport Cabinet Office Liam Maxwell Chief Technology Officer Anni Hartley-Walder Deputy Director Operations Care Quality Commission David Behan Chief Executive 5
Dr Paul Bate Executive Director of Strategy & Intelligence Department of Health Dame Una O Brien Permanent Secretary Prof Dame Sally Davies Chief Medical Officer and Chief Scientific Advisor Jon Rouse Director General of Social Care, Local Government & Care Partnerships David Williams Director General of Finance, Commercial & NHS Tim Donohoe Director of Informatics Delivery Management Andrew Baigent Director of Group Financial Management Cameron Robson Deputy Director of Information Policy & Strategy Andy McKinlay Deputy Director of Group Financial Management Government Office for Science Prof Sir Mark Walport Chief Scientific Advisor to HM Government and Head of the Government Office for Science Health and Social Care Information Centre Linda Whalley Director of Strategy & Policy Health Research Authority Dr Janet Wisely Chief Executive Human Fertilisation & Embryology Authority Nick Jones Director of Compliance & Information Human Tissue Authority Allan Marriott-Smith Chief Executive Independent Cancer Taskforce Sir Harpal S Kumar Chair Independent NIB Members Annie Whelan Local Government Association Rob Tinlin Chief Executive, Southend-on-Sea Borough Council Medicines and Healthcare products Regulatory Agency Dr Ian Hudson Chief Executive National Institute for Health & Care Excellence Sir Andrew Dillon Chief Executive Alexia Tonnel Director of Evidence Resources National Maternity Review Baroness Julia Cumberlege Chair NHS Blood and Transplant Ian Trenholm Chief Executive Aaron Powell Chief Digital Officer NHS Business Services Authority Nick Scholte Chief Executive 6
NHS England Simon Stevens Chief Executive Prof Sir Bruce Keogh National Medical Director Karen Wheeler National Director: Transformation & Corporate Operations NHS Improvement Jim Mackey Chief Executive Bob Alexander Executive Director of Resources/Deputy Chief Executive Iain Wallen Director of Information & Analytics NHS Litigation Authority Joanne Evans Director of Finance & Corporate Planning Public Health England Duncan Selbie Chief Executive Julian Flowers Head of Data Science Strategic Clinical Reference Group Clare Marx Chair UK Statistics Authority/Office for National Statistics John Pullinger National Statistician, UKSA Glen Watson Deputy National Statistician, ONS Apologies Additional Attendees Department of Health Dan Markson Finance & Efficiency Board Lead Kate Lillywhite Finance & Efficiency Board Health and Social Care Information Centre Dermot Ryan Director of the Health and Social Care Network (HSCN) programme NHS England Noel Gordon Non-Executive Director Michael Macdonnell Director of Strategy Group Ros Roughton Director of NHS Commissioning NHS Improvement Paul Stroner Head of Business Intelligence NIB Secretariat Jane Pawson NQB Secretariat Lauren Hughes, NHS England 7
Item 1. Welcome and introductions The Chair introduced himself as Chief Knowledge Officer at Public Health England (PHE) and Interim Chair of the National Information Board (NIB), as had been announced at the previous meeting in December. The Chair welcomed members to the meeting, which was being livestreamed with a speech-to-text facility, and attendees of the wider conference. The Chair explained that to be transparent the Board meeting would take place, as usual, with NIB members followed by an open question and answer session with members of the public. The Chair added that all Board papers for the meeting were public and would be available on the NIB GOV.UK website after the meeting: https://www.gov.uk/government/organisations/national-informationboard The Chair welcomed the Chief Operating Officer of the Department of Health (DH), attending the meeting for the first time having taken over the Informatics Assurance Officer (IAO) role, following her predecessor s secondment to the Cabinet Office. The Chair noted the letter he wrote to the Secretary of State (SofS) on the transparency agenda, which included My NHS and its role in transparency, which was shared with members along with the meeting papers. It was a formal duty of the NIB to report to SofS annually on the transparency agenda. 2. Minutes of Leadership meeting held on 8 December 2015 and matters arising Paper Ref: NIB 0420-001 The minutes of the last meeting were agreed. 3. Chair s Overview The Chair thanked the Permanent Secretary for inviting him to take on the role of Interim Chair, which he considered to be a great privilege. The Chair thanked his predecessor, Tim Kelsey, for his leadership of the NIB and all he had achieved during his time as Chair. The Chair recognised that whilst there had been a significant amount of progress since the December Leadership Summit there were still many challenges ahead. The Chair reflected on the significant progress since the publication of the NIB s strategy Personalised Health and Care 2020 (PHC2020) in November 2014. There had been an incredible amount of work carried out by NIB members to develop the proposals set out in the 8
strategy into domains for delivery. The NIB had received a very good outcome from the Spending Review, securing the funding to drive forward the programmes that would deliver the strategy. Particular progress had been around converting the NIB work stream roadmaps into a set of delivery domains. The proposed domains were presented to the NIB membership at a Special Working Session in March, which was an opportunity for NIB members to comment on the emerging plans. Those developing the plans were grateful for the opportunity to get members input to help shape the plans. Work was continuing behind the scenes to integrate the new and existing delivery programmes into the new domains. The Chair thought the NIB had three fundamental roles going forward: Delivery assurance of the domains for delivery and programmes. To continue to make connections between local and national, and across all different organisations and different sectors. To keep a forward look in terms of horizon scanning. The Chair set out some of the work the NIB would look at over the summer. This included: The importance of identifying and capitalising on good processes and practices locally to see how that could support and help to inform the national delivery programmes Working with the Five Year Forward View (FYFV) Patients and Communities Board and Healthwatch England to produce a patient vision paper which would help to articulate the benefits of the delivery portfolio for patients, carers and service users. This would accompany the clinical vision paper that members would hear about later in the agenda. In order to ensure the work of the NIB is well connected with the FYFV, the Chair announced he and the IAO would visit the FYFV Board on 16 May to discuss the NIB s work The Chair thanked everyone for the significant amount of progress that had been made so far and thanked the NIB Secretariat team for their excellent support. The Chair gave special thanks to Jane Pawson, who had been the helmsman of the Secretariat of NIB since the start and had now left to work for the Home Office. 4. Minister s keynote address The Chair welcomed the Minister for Life Sciences, who gave the keynote address. The Minister acknowledged the challenges NIB faced but thought 9
there was genuine international excitement around the world about what the NIB were doing. He reported he was leading a piece of work within the EU on data and interoperability to ensure the EU is learning from the UK and how the UK in turn could harness the power of the EU market. The Minister thanked the Interim Chair for his work and leadership of the NIB. He thanked the former Chair, Tim Kelsey, for his previous leadership of the NIB as a forum where organisations across the health and care system had come together to confront the difficult technology and data issues facing the system. He recognised the quality of the work of the NIB and the progress that had been made. He reiterated his continuing support moving forward. The Minister recognised the important role the NIB played in securing the 4.2 billion funding in the public Spending Review round and that the challenge would now be on implementation and delivery. The Minister highlighted three things the NIB did and should continue to do: The oversight role should not be underestimated. The NIB takes responsibility, looks at progress and risk and is honest about delays. It is essential that projects of this scale have a formal and robust oversight role. Showcasing best practice was an important role for the NIB for example, Genomics England (GEL) carried out a particularly successful communications campaign which made a real impact on securing patient support and also winning support for research and the use of data in research. Actively integrating with the FYFV and with the DH Shared Delivery Plan was also key to ensuring the players in the UK health economy were all trying to achieve the same things. The Minister highlighted areas of progress, particularly the following: The NHS e-referral Service: most people were not aware of it as they travelled around the UK, it is an extraordinary achievement. The Electronic Prescribing Service: this drives accuracy, cutting out prescribing mistakes and generating data that feeds back into intelligent treatment regimes. The NHS Spine: the NHS handles more emails than the whole of the Pentagon. This is a phenomenal national infrastructure which needs to be better recognised in communications. The Minister highlighted the important and serious issue of public trust and confidence. The role of the National Data Guardian, Dame Fiona Caldicott and her team, had been established to ensure there was an independent guardian with a statutory role to ensure the security standards put in place were ones in which the public and 10
patients could have confidence in and that ensured the consent model was patient and user-friendly. The Minister confirmed that Secretary of State had asked Professor Robert Wachter to lead a review of the implementation of information technology in the NHS in October 2015, with a particular focus on the introduction of clinical systems, including electronic health records, in the acute sector. The Minister announced that from 1 August 2016 the Health and Social Care Information Centre (HSCIC) would change its name to NHS Digital. Noel Gordon had been appointed as the new Chair. The Minister thanked Kingsley Manning for his leadership and dedication as Chair. The Minister reiterated the importance of clinicians and patients and in ensuring they were at the heart of the NIB agenda. The Strategic Clinical Reference Group (SCRG) played an important role in bringing in clinician voice. Moving forward, there needed to be a better focus on communications and getting key messages across to patients that a 21st Century healthcare model requires patients who are empowered to make choices, take more responsibility and have access to information to enable them to be active healthcare citizens. The Minister highlighted the importance of the Digital Maturity Self- Assessment which allows Clinical Commissioning Groups (CCGs) to track their own digital maturity and their progress across the country. He recognised the progress made by the Director of Digital Technology, Patients & Information and all the team supporting her at NHS England. The target of having 90% of CCGs on the Digital Maturity Self-Assessment by the spring was met. There was now a strong digital benchmark and a map to help drive up transparency of progress, identify best practice and inspire organisations to continue to achieve over the next few years. In June, the digital roadmaps would be published. The Minister recognised the progress made in relation to the 100,000 Genomes Project. The potential was considerable genomic technologies integrated into healthcare could change current thinking about how rare disease and cancer could be treated. Data and informatics were key to delivering the project and realising the benefits. The 2020 vision transitioning from the project to embedding genomics in routine care, was currently being developed. The Minister reported that NHS England and DH had launched several test beds which would harness information to change care pathways. These would accelerate progress towards the FYFV and look at whether smart, digital technologies and remote diagnostics could help particular chronic disease areas to reduce unnecessary hospital admissions. 11
The Minister highlighted future projects such as the NIB s Annual Report which was set to be published over the summer. The report would reflect back work on achieved by the NIB. The Accelerated Access Review would look at device and diagnostics and tangible mechanisms by which digital technologies could be accelerated. The Minister reflected that five years ago he and the Prime Minister set out the life sciences strategy. It was a ten year strategy which went beyond the convenient envelope of one Parliament. GEL was the flagship programme of the first five years. Genomics and informatics should be used to support a new partnership with industry to work on precision medicines and on tackling the real pressure on drugs budgets from increasing expensive drugs. Moving forward there would be a focus on digital engagement and ensuring technologies for patient engagement are harnessed. The voice of patients was crucial for consent over data and insight on care pathway transformation. The key would be to find the right platforms that provide patient voice and consent. In closing, the Minister asked NIB members to think about national interoperability, about how disease-based and place-based leaders could be incentivised, encouraged and supported to harness interoperability. The NIB needs to create the interoperability platform and the common standard, drawing from local early adopters and clinical leads. The challenge for the NIB would be to combine national interoperability with the local and the diseasebased leadership. The Minister thanked NIB members and all those involved in driving forward such an important agenda that was highly valued in Government. The NIB must now ensure it brings patients and the public along in what is increasingly being viewed as a noble endeavour that really drives UK leadership and NHS leadership into 21st century healthcare. 5. National Data Guardian review update The Chair invited the National Data Guardian (NDG) to provide an update on the NDG review. The NDG reported that publication of her report had been delayed. This would allow the NDG Panel more time to progress feedback from the public, healthcare professions and all of the stakeholders on the proposed data security and consent opt-out model. The NDG review originated from SofS s request in September 2015 to for the NDG to work on a single, simple consent opt-out model for the public to consider in regards to choices about the use of their health and care data. She was also asked to work with the Care Quality Commission (CQC) on standards for data security across healthcare. The report would be based on evidence after listening to a wide range of stakeholders including patients, service users and the public. 12
Feedback so far highlighted that in relation to data security there was a lot of good practice across the system with many organisations more concerned about data security than before. However there were still issues around people, processes and technology. The requirement from SofS to develop simple and consistent standards was challenging but it was these standards that would enable organisations and practices to ensure they were doing all they possibly could to safeguard the security of data. In terms of the review of consent and opt-out model there was a clear need to ensure the public had the right information about how the health and care system works. This would help them to understand how their health and care data could be used and that it would be anonymised, secure and they had the opportunity to optout. The better the public understood, the more they would be empowered to make their own choices about their health and social care data. The Director of Digital and Data Policy at DH advised that in terms of next steps there would be further consultation and further testing with key stakeholders including the public and patients and an ongoing continuing conversation about the benefits of sharing data as a way of supporting trust. There was a significant role for the NIB in leading that process and engaging with that dialogue. DH was looking particularly at data security standards and how best to embed them in CQC inspections and in standard NHS England contracts. The DH was working closely with the Chief Executive s team at the Health and Social Care Information Centre (HSCIC), particularly around the Information Governance toolkit, which would need to change in light of the NDG s work. 6. Forward look for the NIB work programme Paper Ref: NIB 0420-002 Paper Ref: NIB 0420-003 The Chair presented the paper Forward look for the NIB work programme: Priorities paper which put forward a proposal on identifying the key new priorities for the NIB and how these should be taken forward. NIB members agreed the approach and approved the paper. The Chair invited the Deputy Chair of the SCRG, who was also Interim Director of Information & Analytics and Lead Clinician (Caldicott Guardian) at HSCIC, to present his paper on the clinical vision. The Deputy Chair introduced his paper Clinical Work 2020: A document in evolution on the clinical vision. He thanked the Chair of the SCRG, who was also President of the Royal College of Surgeons of England, for her vision and leadership in driving this forward, and the National Medical Director s Clinical Fellow for their support. The Chair invited questions from NIB members on both papers. 13
The Chief Executive of Macmillan Cancer Support, representing the Richmond Group of Charities, was pleased with the piece of work because it felt very important to engage clinicians. She wondered what the plan was to link up with the Wachter review as a lot of work had been done in this area. Jo Bibby, NIB Independent Member, thought there was a need to engage the younger section of the workforce in the digital strategy as generally those are already the most digitally aware. Digital technology and communication was already a part of their daily lives with the rise of the smartphone and social media. The Deputy Chair of the SCRG responded, saying that the clinical vision was linking into the Wachter report through the Chair of the SCRG, who was liaising with the team taking the report forward. The team would receive a copy of the clinical vision paper. In terms of younger people, this was a key point. The SCRG, working through their Clinical Fellow, and each of the formal organisations, had been tasked with communicating to all age groups. 7. National Information Board Annual Report Paper Ref: NIB 0420-004 The Chair introduced the Deputy Director of Data & Information Strategy at DH to present the latest draft of the NIB Annual Report to seek members input, noting that members had already seen the review in an earlier draft. The Deputy Director of Data & Information Strategy took the group through the report. She thanked those that had contributed and reiterated that the aim of the report was to report on work achieved to date, describe next steps and to encourage engagement with the digital agenda going forward. The Chair invited members to ask any questions or make any observations; however there were none at this stage. 8. Personalised Health and Care 2020 portfolio The Chair introduced the Chief Executive of HSCIC and the Director of Digital Technology, Patients & Information at NHS England, who would present the work carried out so far on the planning of the portfolio and the development of the new domains plus the output of the workshops. He acknowledged the enormous amount of work that had been undertaken and congratulated them both for driving this forward. The Chief Executive commented on the change of name from HSCIC to NHS Digital and its new subtitle NHS Digital: Information and technology for better health and care, which, particularly in the context of the work it would be doing, was a much better description of its remit as an organisation. He reported that the HSCIC had tested the new name, particularly with the younger age group, and found the name communicated the purpose, remit and future vision well. 14
The Chief Executive took NIB members through the first part of the presentation which introduced each of the domains for delivery, and then handed over to the Director, who took NIB members through more detail at programme level. The Chair invited questions to the Director or the Chief Executive. Jo Bibby, NIB Independent Member, in reference to the Self-care and Prevention domain, said self-care wasn t always understood to be self-management they were distinct things. The word selfcare didn t quite reflect the full range in which people could take responsibility for managing their own care. Additionally, the description of the rationale being to reduce pressure on frontline services didn t come across as a particularly compelling reason for doing so from somebody as a service user, which reinforces the need to have some of this articulated from the perspective of people using the services. The Chair responded that each of the domains was a start in terms of identifying the requirement which was at that point built around the current programmes. There was not an assumption that the programmes under each domain were necessarily fulfilling everything that people wanted in that domain. The Chair noted there was no attempt to make these a comprehensive list, and the challenge was for those who were leading those domains to engage with NIB members as well people outside the NIB with a legitimate view on this. This was a beginning, it was not the definitive view and that was why the ongoing involvement with the domains was useful. 9. Widening digital participation: recommendations for action (update) Paper Ref: NIB 0420-005 The Chair introduced the National Provider Support and Integration Director at HSCIC to provide an update on progress of the Widening Digital Support programme which included a video from Baroness Martha Lane Fox. The Director took NIB members through the presentation and then introduced Baroness Lane Fox s video about her visit to South London and Maudsley NHS Foundation Trust. The Director handed over to the Head of Digital Services at NHS England who talked NIB members through the remainder of the presentation around the reaching the furthest first recommendation. Mat Campbell-Hill, NIB Independent Member, felt it was not clear whether there was any clinical research supporting the claim that free WiFi in hospitals enabled patients to return home earlier good WiFi and internet connectivity at home would enable patients to go home earlier. Clinicians were able to contact them and they could have face-to-face consultations from home. He noted that by 2019, it was expected there would be a 5G network available, so it was a concern that a vast amount of money could be spent on putting in a system that would not be needed in the near future. 15
Director of Knowledge and Intelligence, PHE thought the point being made was around equality of access to digital technology across society and the people who were most likely not to have access were the most likely to use the services. The National Provider Support and Integration Director, HSCIC responded saying it was possible that 5G might be appropriate very quickly for a number of hospitals but this may not be the case for more remote GP practices who may be able to benefit. He said it would be interesting to see the peer reviewed academic research if it existed. In terms of cost, it would be an incremental cost, building on existing infrastructure. The case which Baroness Lane Fox put forward was compelling and should be progressed. He invited NIB members to join the Programme Board and provide challenge to them at every step along the journey. 10. How will our plans for information and technology (or PHC2020) support and enable the Five Year Forward View The Chair handed over to the Director of Digital Technology, Patients & Information at NHS England to introduce the next item about how the delivery programmes were supporting the FYFV. The Director presented the FYFV slide pack to the NIB members. The Director handed over to the Head of General Practice Development at NHS England, who took the group through the slides relating to the specifics of Transforming General Practice. The Head of General Practice Development handed over to the National Medical Advisor for NHS 111 who took the group through the FYFV Urgent Care presentation. 11. Digital Maturity selfassessment Paper Ref: NIB 0420-006 The Chair noted that, due to lack of time, the Head of Technology Strategy at NHS England had agreed not to present his paper on the Digital Maturity self-assessment. The Chair apologised to the Head of Technology Strategy for dropping this item from the agenda but noted that he had provided an excellent paper, which members of the public could access. 12. Informatics Accountable Officer summary/overview response The Chair invited the IAO to give a summary. The IAO thanked the Chair and expressed her pleasure to have taken on the role of the IAO from her predecessor, Will Cavendish. The IAO noted that previously, the DH Permanent Secretary, Dame Una O Brien, joined these meetings but since her departure from the DH there was a gap before her successor, Chris Wormald, took up his post. The IAO understood that the new Permanent Secretary was aware of the NIB and was keen to join these Summits and learn more about the work of the NIB in future. The IAO said it had been a real privilege to sit through the 16
presentations and discussions given today. The work the NIB had done on delivering the strategy set out in PHC2020 had been significant, as well as underpinning the Spending Review. The vision the NIB had created built a strong connection as to what technology could do to transform health and care. It was that connection that would help to deliver the vision in the FYFV, the vision that the DH had set out in the shared delivery plan for the system and the transformation plans that were being developed in the different local footprints across the country. The domains and programmes for delivery would help take this forward. The NIB had highlighted how information and technology would help to drive the transformational changes needed. It also set out the type of environment in which it could be successful, particularly around public trust and the work the NDG and her team are doing on data security and consent, and the work being carried out around widening digital participation. Leadership is another key part of the environment, particularly clinical leadership and it was reassuring to hear about the work around the clinical vision. The forward-looking role of the NIB and its intention to bring wisdom and experience into implementation and delivery is essential. Looking at the widest definition of health and care, beyond the NHS, beyond institutions into public health, personal health and social care is essential work which the NIB is currently doing and will continue to do on behalf of DH and its arm s length bodies. The IAO thanked the Interim Chair for his leadership. 13. Concluding remarks The Chair thanked the IAO for her response. The Chair thanked all the speakers and presenters, in particular all the members for their contributions to the meeting. 14. Any Other Business No other business was discussed. The Chair ended the Board meeting and handed over to Jo Bibby to chair the public question and answer session. 15. Dates of next meetings Date of next Working Group meeting: 17 May 2016 Date of next Leadership Summit: 8 September 2016 17
PAPER REF: NIB 0908-002a AGENDA ITEM 7: Paperless 2020 reporting PURPOSE: This paper provides the National Information Board (NIB) with an update on the Paperless 2020 portfolio of programmes, which were announced at the Leadership Summit in April 2016. ISSUES FOR INFORMATION The paper provides an update on: the background and evolution of Paperless 2020 ; the structure of the portfolio; the governance arrangements; the progress made since April 2016 including the outcome of a series of reviews held in July 2016; the key dependencies across the programmes; and the forward delivery plan. NEXT STEPS: The paper is for information and is intended to fulfil NIB s oversight role. It is anticipated that delivery progress updates will be provided to future meetings of the NIB. 18
Paper Ref: NIB 0908-002b Paperless 2020 Delivery Update September 2016 Copyright 2016 Health and Social Care Information Centre. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital.
Paperless 2020 Contents Purpose 21 Background 21 Portfolio Structure 21 Governance 22 Tracking Delivery Progress: Deep Dive Checkpoint Reviews 22 Progress Since April 2016 23 Portfolio Scope and Composition 23 Financial Re-baselining 23 Interdependencies/Scope 24 Delivery Plans 24 Controls and Reporting 25 Annex 26 20 Copyright 2016 Health and Social Care Information Centre.
Paperless 2020 Purpose This paper provides the National Information Board (NIB) with an update on the Paperless 2020 portfolio of programmes, which were announced at the NIB Leadership Summit in April 2016. This paper outlines the progress made since then and provides further details on the programmes comprising the portfolio, an overview on how they will be delivered and measures being taken to assure delivery. This paper is intended to help fulfil NIB s oversight role. Background Personalised Health and Care: A Framework for Action was published in November 2014 and was elaborated into a set of requirements by the eight NIB workstreams, which culminated in the publication of the workstream roadmaps (in June and September 2015). This set of requirements was translated into a proposed delivery portfolio during the Summer of 2015 and that was used to inform the health and care submission to the Spending Review that Autumn. The subsequent financial settlement from the Spending Review required a review of our plans and priorities for transforming health and care through technology and a further period of intensive planning took place during February and March 2016. This involved representatives from NHS Digital, NHS England, the Department of Health and other Arms Length Bodies including CQC and Monitor. In April 2016 we announced the 33 programmes, organised into 10 business domains, which we have collectively termed Paperless 2020. This portfolio translates our ambition and objectives into a set of business led delivery programmes. The overall composition of Paperless 2020 was presented to the Secretary of State on the 4 th April 2016 and announced at the NIB Leadership Summit on 20 th April 2016. Portfolio Structure We have organised the programmes into a series of ten domains, related to the Five Year Forward View, in order to link technology and information to the transformation of the way care is delivered. We have appointed a Domain Business Sponsor to ensure the planned outcomes remain relevant to the needs of the health and care system, especially during periods of change. The Domain Business Sponsor is a key leadership role and will work with the Senior Responsible Owners (SRO) and delivery teams to represent the needs of the health and care system and ensure that the programme outcomes remain relevant. 21 Copyright 2016 Health and Social Care Information Centre.
Paperless 2020 Governance We intend to appoint Senior Responsible Owners at the domain level for each of the Domains, to lead and drive the work in the domains. The SROs will be accountable for delivery progress across the domain and will play a lead role in shaping and leading the necessary business change. This allows the SRO to consider the transformation of health and care for the domain resulting from the collective delivery of the multiple programmes within that domain. NHS Digital has assigned delivery ownership of each Domain to a member of the NHS Digital Executive Management Team and appointed Programme Directors/Programme Heads to lead the programmes. The NHS Digital Executives will work closely with the Domain Business Sponsors and Senior Responsible Owners to define our delivery approach and ensure delivery is on track. NHS Digital is mobilising resources to deliver the new programmes. We have examined our existing initiatives and delivery plans and are in the process of assigning appropriately skilled resources to the new programme teams, as our delivery plans are being developed and transitioning from the old to the new portfolio. We understand the critical importance of clinical input throughout the lifecycle of a change and transformation programme but this is vital during the design and initiation stages. NHS Digital is aligning clinical resources to the Domains and Programmes within Paperless 2020 at this early stage of delivery to make sure clinicians are not just represented but have an active voice to shape both the outcomes which will support the transformation of care and the way the programme will be delivered. We are working closely with the Strategic Clinical Reference Group as they develop the clinical priorities and requirements which will allow us to achieve the maximum clinical benefit from Paperless 2020. As the clinical requirements evolve we will map the delivery of these to the relevant Domains and Programmes. We will continue to work with the Strategic Clinical Reference Group to track delivery progress. Tracking Delivery Progress: Deep Dive Checkpoint Reviews Having identified and announced the key leadership roles responsible for delivery (including the Domain Business Sponsors, Senior Responsible Owners and Programme Directors/Programme Heads), we held a series of Deep Dive reviews; one per domain in July 2016. The purpose of the sessions was to ensure complete alignment between the Domain Business Owners, Senior Responsible Owners and Programme Directors/Heads during the crucial start-up period. Each Domain was asked to present their long term vision, outline the scope of the programmes within their domain and provide an update on delivery. The reviews were conducted by a core team which included representatives from across the system including Andy Williams, Beverley Bryant and Rob Shaw (from NHS Digital), Tim Donohoe (from the Department of Health), Keith McNeil, Juliet 22 Copyright 2016 Health and Social Care Information Centre.
Paperless 2020 Bauer and Ronan O Connor (from NHS England) along with representatives from the Infrastructure and Projects Authority. These sessions acted as a checkpoint on progress and enabled us to understand the cross-cutting issues facing the programmes. It also consolidated an understanding and agreement of scope between the Domain Business Sponsor, Senior Responsible Owner and the Programme Directors/ Programme Heads. Progress Since April 2016 Portfolio Scope and Composition During the Deep Dives sessions a number of proposals were made to amend the composition of the domains and the component programmes which they comprise. For example we believe the Personal Health Record programme better aligns to Domain A (Self Care and Prevention) than where it currently resides (within Domain D- Integrated Care). We are currently assessing the impacts of all these changes and we will progress this through a change control mechanism which we will agree between NHS Digital, NHS England and the DH to ensure any changes from the baseline are appropriately tracked with appropriate governance. We expect to be able to communicate these agreed changes in late September 2016. Financial Re-baselining The individual programmes are separate entities which will need separate financial justification and approvals before any major investment decisions are made. The overall portfolio finances are therefore inherently integrated and tightly coupled. In our planning work earlier this year we had to balance the priorities for delivery with the need to ensure overall affordability based on the Spending Review settlement. Affordability considerations required the portfolio finances to balance within each financial year and separately by both revenue and capital spend, over the next five years. Since April 2016 further work has been undertaken on the cost profile of delivering the portfolio. This has identified some changes to the original position. Some programmes are seeking additional funding (for example to allow earlier delivery of benefits, such as in the case of electronic referrals) whereas others have reflected on the profile of spend over the five years and the revenue-capital split. We have considered the changes identified by the programme teams and have investigated areas of forecast change in a series of financial Star Chamber reviews. These reviews tested the validity of the proposals and any resulting anomalies. We also had some areas of underspend from existing activity to balance against these proposed changes. As a result we have achieved a balanced portfolio. We will track delivery progress against this revised position and if we need to revisit this due to future changes this may require some decisions about sequencing and priority to be taken. 23 Copyright 2016 Health and Social Care Information Centre.
Paperless 2020 Interdependencies/Scope We have already identified the key technical interdependencies across the portfolio and we are ensuring our plans align to the timely delivery of these. The critical, cross portfolio areas of dependency across the Paperless 2020 portfolio include: Developing and applying a mature and standards-based interoperability architecture, allowing information to flow in a meaningful way between across the system; The delivery of the National Data Services Development Programme including the Data Services Platform as this is a crucial element of the supporting infrastructure to enhance our future capability for the efficient processing and storage of datasets from across health and care; Building enhancements to the National Spine, which is the key national infrastructure upon which we will develop components to enable the safe and secure transfer of information between organisations (for example through the Message Exchange Service for Health) and develop the National Record Locator Service; Providing a solution for Citizen Identity, enabling citizens to asset their identity and benefit from the provision of digital health and care services. This will enable patients and citizens to transact online, for example in managing their own referrals, prescriptions and appointments; Acting on the outcomes of the Review of Data Security, Consent and Opt- Outs undertaken by the National Data Guardian for Health and Care to ensure that we safeguard information about patient s health and care and enable the public to make informed choices about how their data is used; and, Ensuring we have an ability to uniquely identify patients to ensure that the right information about a person is always presented to clinicians and care staff. Delivery Plans Annex A shows the Domains and the Programmes which comprise them. More detail on the individual programme plans has been developed and this will be combined into a single, overarching plan to be presented to the Secretary of State in September 2016. A small number of programmes in the portfolio remain with an Incubation stage where the scope of our ambition has not yet fully crystallised into a clear set of deliverables or clarified this scope with their business stakeholders and sponsors. In order to ensure that during this critical initiation phase we are providing extensive support to these programmes and the delivery teams are working closely with key stakeholders to define a clearly agreed scope which balances the priorities for transforming health and care whilst ensuring the scope of our ambition remains affordable. The programmes which are currently in this incubation state are: Health Apps Assessment and Uptake (including Wearables); Personal Health Record; Digital Diagnostics; and, 24 Copyright 2016 Health and Social Care Information Centre.
Paperless 2020 Out of Hospital Care. We have reviewed our existing initiatives to ensure clear strategic alignment between any existing activities and our new programmes. All our existing initiatives have been mapped to the domains to ensure optimum use of the NHS Digital delivery resources and provide delivery clarity. This has identified some initiatives which are closing, having successfully delivered the outcomes required and also a series of existing initiatives which are no longer change programmes but a critical live service (such as the Electronic Prescription Service) which we will continue to deliver but as a live service. Controls and Reporting Portfolio delivery performance is governed and held to account through the Informatics Portfolio Management Board. The Board meets monthly and receives reports on delivery performance and financial performance and future forecasts. This Board is comprised of representatives from across the health and care system. In future portfolio delivery progress reporting will be the responsibility of the Digital Delivery Board which is currently being established and will be chaired by Keith McNeil as Chief Clinical Information Officer for NHS England. NHS Digital will provide the Digital Delivery Board with reports on delivery, financial forecasts and benefit achievement. 25 Copyright 2016 Health and Social Care Information Centre.
Annex A: Paperless 2020 Domains Programme Delivery Confidence Overview 26 Copyright 2016 Health and Social Care Information Centre
PAPER REF: NIB 0908-003 AGENDA ITEM 8: Clinical vision paper PURPOSE: The Strategic Clinical Reference Group (SCRG) has been working with colleagues within the National Information Board (NIB) over the last six months to ensure meaningful outcomes for clinicians from Paperless 2020. The driving force for this work is to create a clinical pull for digital transformation to improve care including at the point of consultation and to avoid errors of the past when clinicians and their needs from digital transformation were not supported or even encouraged. The output of the work undertaken has 5 major components, which act as a cohesive whole and must be seen in that context: 1. A commitment to engagement by the clinical bodies via SCRG with NIB constituent bodies with regard to Paperless 2020 [see appendix 1]; 2. An agreed focus on clinical benefit and in particular clinician benefit for the portfolio of programmes and each individual programme; 3. A mechanism by which the clinical ask [see appendix 2] can be converted into an agreed deliverable in terms of clinical benefit by November 2016; 4. An operational mechanism whereby each business domain [or group of related programmes] has a clinician leader responsible for delivering their contribution to the portfolio clinical benefit statement and describing the individual programme clinical benefit and delivering it; 5. Regular dialogue with SCRG every 15 months by each business domain to give assurance that the clinical focus is on track for delivery and that any unresolved national clinical challenges are raised with the aim of resolution. The initial definitions of clinical benefit and clinician benefit are: Clinical benefit is a described and/or measurable improvement in the outcome or process of care from a clinical team, resulting from a Paperless 2020 instigated change, assessed to be a good thing by at least one clinical stakeholder group. Clinician benefit is the extent to which clinician functions are enhanced by the digital transformation or not. Clinician benefit should be described in a way which is reliable, understandable, measureable, behavioural and appropriate to clinicians. Recommendation: SCRG seeks support from NIB on process and content of its deliberations and forward plan 27