AGENDA ITEM 2.3
31 May 2017
Health Board Report
DIGITAL HEALTH STRATEGY
Executive Lead: Steve Webster Director of Finance
Author: Karen Winder Head of Clinical Systems, ATOS
Contact Details for further information: [email protected]
01685 724445
Purpose of the Health Board Report
The purpose of this report is to present a five-year Digital Health Strategy
and SOP to the Health Board for approval.
Governance
Link to Health The Board’s overarching role is to ensure its Strategy
Board Strategic outlined within ‘Cwm Taf Cares’ 3 Year Integrated
Objective(s)
Medium Term Plan 2015-2018 and the related
organisational objectives aligned with the Institute of
Healthcare Improvement's (IHI) ‘Triple Aim’ are being
progressed, these in summary are:
• To improve quality, safety and patient
experience.
• To protect and improve population health.
• To ensure that the services provided are
accessible and sustainable into the future.
• To provide strong governance and assurance.
• To ensure good value based care and treatment
for our patients in line with the resources made
available to the Health Board.
The Digital Health Strategy aims to be a key enabler in
the Strategic Objectives.
Supporting
The Digital Health Strategy was informed by a number
evidence
of national and Cwm Taf documents covering both
business and ICT. These include
▶ A Digital Health and Social Care Strategy for
Wales
▶ NWIS Annual review 2016
▶ Cwm Taf University Health Board integrated
medium term plan 2016-2019
▶ Cwm Taf Annual Report 15-16
▶ Cwm Taf ICT Corporate Business Development
plan 2017-2018
Digital Health Strategy
2017-2020
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Engagement – Who has been involved in this work?
Executive directors, UHB departments consulted: Pathology, Radiology,
Pharmacy, Therapies, Community Health and District nursing, Maternity,
Paediatrics, Cardiology, Primary Care, Medical Records, Orthopaedics,
Performance and Information, Finance, Theatres, ICT, Procurement,
Workforce and OD, NWIS
Board development meeting April 2017
Health Board Resolution To:
APPROVE
√
ENDORSE
DISCUSS
NOTE
Recommendation
The Health Board is asked to:
• APPROVE Digital Health Strategy and SOP.
Summarise the Impact of the Health Board Report
Equality and
diversity
Legal implications
Population Health
Quality, Safety &
Patient Experience
Resources
Risks and Assurance
Health & Care
Standards
Digital Health Strategy
2017-2020
Cwm Taf UHB to become a digital exemplar
within NHS Wales, as an innovator and early
adopter of digital technologies and approaches,
to enhance care, quality, better engage with
patients and deliver sustainable services.
None identified
Will support whole population improving
integrated care
Quality, safety and patient experience is a major
theme underpinning the Strategy
There are significant resource requirements to
implement the strategy, but also significant
financial and non-financial benefits. Each project
within the strategy will need individual Business
Cases which define the resources required for
delivery of the project and the associated
benefits.
NHS
Wales
faces
challenges
from
cost
pressures, skill shortages, ageing workforce,
shifting care settings, providing patient centric
services to list a few. To enable the health board
to face the challenge the aim of the Strategy is
that every task, care professionals undertake is
supported digitally, that records are created,
held and accessed electronically and that all such
services work seamlessly and commonly across
organisations and sectors.
The 22 Health & Care Standards for NHS Wales
are mapped into the 7 Quality Themes:
Staying Healthy; Safe Care; Effective Care;
Dignified Care; Timely Care; Individual Care;
Staff & Resources
The work reported in this summary and related
annexes take into account many of the related
quality themes (as applicable)
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Workforce
Freedom of
information status
Digital Health Strategy
2017-2020
The delivery of the Strategy will impact on a
wide range of staff across the organisation.
Change management will be a key element of
the work to support staff through the
programme.
Open
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DIGITAL HEALTH STRATEGY
1.
SITUATION / PURPOSE OF REPORT
The Cwm Taf University Health Board recognises that improving access to
information and introducing new ways of delivering care with digital
technologies must be at the heart of its service plans and its vision for prudent
healthcare.
In December 2015 Welsh Government (WG) issued the following: 'Informed
Health and Care. A Digital Health and Social Care Strategy for Wales'. This
notes that the Digital Strategy "delivery plans will require a consistent,
incremental approach which accelerates the benefits of having a national 'Once
for Wales' infrastructure whilst supporting local development and
implementation of planned and agreed solutions to allow agile responsive
approached to digitally-enabled service improvement and workforce change".
The Health Board has long identified that it needs to have its own Digital Health
Strategy, which aligns with the national strategy but also takes account of the
local ICT requirements in Cwm Taf, aligns with the Cwm Taf IMTP, and provides
the framework for developing a practical plan of development for the Health
Board.
Following some initial work on the strategy in 2016, ATOS was commissioned to
support the Health Board in developing and finalising the strategy, including
wide engagement across the organisation and with key partners. The
resulting Digital Health Strategy is now put forward for approval
through this report.
Implementation of the strategy requires significant capital and revenue
investment, which in turn enables the delivery of significant financial and non
financial benefits. A Strategic Outline Programme (SOP) has been drawn up to
make the case for the investment required to deliver the strategy. This
Strategic Outline Programme is also now put forward for approval. Once
approved through the relevant Health Board governance processes, via the
Executive Capital Management Group and the Capital Programme Board, this
SOP would then be submitted to the Welsh Government.
2. BACKGROUND / INTRODUCTION
The Digital Health Strategy and the Strategic Outline Programme align with the
Health Board’s IMTP for the period 2017/18 to 2019/20 whilst setting the
overall direction for the next five years. They set out the five year forward plan
for ICT within the UHB.
One of the key aspects of the feedback received during the development of the
strategy and SOP was that there needs to be a clear line of sight between the
themes in the strategy and the specific projects, and then the costs and
resultant anticipated financial and non financial benefits of those projects. This
Digital Health Strategy
2017-2020
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is difficult to present simply in a way that gives clarity and assurance on these
linkages, and so we have sought to address this through the detailed
appendices to the SOP. The content of these is described below.
3.
ASSESSMENT / GOVERNANCE AND RISK ISSUES
The UHB already has a successful track record in terms of deploying its ICT
systems, technology and services. This Strategy sets out how we will build on
those foundations and help move the organisation further forward. Our true
focus, our fundamental objective, is to focus on our services, and the potential
for better outcomes, not on ICT systems in isolation.
The delivery of this strategy will assist the Health Board in responding to
patient issues by giving clinical staff better access to patient information so
they can better involve patients in decisions, and provide more information
about treatments. The technology can also help inform how the Health Board
provides the resources patients need to get help when they need it, and provide
ready (and clinically informed) information.
There is an extensive range of existing ICT systems, technologies and services
currently in use within the Health Board. They exist to support the Health Board
in the achievement of its objectives. In the main the Health Board makes use of
'once for Wales' systems. Increasingly, ICT provides an opportunity to support
service improvement and integration around the patient, by developing a
seamless and shared information base. From the patient perspective, services
will be integrated when health and social care professionals are able to work
with them supported by common information. If we can integrate patient
information then we can help to integrate patient care.
The strategy defines the vision of where we are now and what we want to
achieve. The establishment of the Digital Strategy Group will provide not only
the Governance but the forum to be able to categorise and prioritise the
projects based on the needs of the Health Board. This group is key to delivering
the Strategy and the Strategic Outline Programme.
Documents submitted for approval
The documents submitted for approval are as follows:
1. Digital Health Strategy (Appendix 1)
The purpose of this document is to describe the strategy that the Cwm Taf
University Health Board is taking to using digital informatics services to aid
in achieving its Integrated Medium Term Plan.
It describes the case for change, the future state and the transformation
programme required.
It describes the overall direction for ICT over the next 3-5 years and whilst it
details transformative interventions is not intended to be a detailed
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2017-2020
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transformation programme description. It is important to state that is
intended as a living document which is continually reviewed and revised to
reflect the changing landscape and emerging needs.
The Digital Health Strategy has identified 8 Key Themes which reflect the
business needs of the Health Board, and sets out what the Health Board
requires, in overall terms, from ICT. These key themes are:
• Digital Health board
• Insights-driven healthcare
• Single patient view
• Intelligently integrated healthcare
• Digital workforce
• Adoption and exploitation
• Managing innovation
• Digital enablers
2. Digital Health Strategic Outline Programme (SOP) (Appendix 2)
The Strategic Outline Programme document sets out a programme of
strategic investment in information and ICT to enable the provision of high
quality care and support service change and modernisation across all care
settings within the Cwm Taf University Health Board. The preferred option in
the SOP would deliver the future state envisaged in the strategy.
This SOP details the technical infrastructure and information required to
deliver the Digital Health Strategy across the next five years and is therefore
integral to the success of the Health Board’s strategic plan. Furthermore, the
SOP outlines the parameters set for the programme, the key projects split
by the strategic themes that constitute the programme and their critical path
for delivery.
Annexes to the Strategic Outline Programme
Financial Model:
The costs and benefits are at a relatively high level. More detailed
assessments of costs and benefits will be undertaken as individual business
cases are developed.
High level financial summary by theme (Appendix 2a)
Financial summary by theme and financial year (Appendix 2b)
Financial summary by project and financial year, sub totalled by theme
(Appendix 2c)
Financial and efficiency benefits assessed by project & financial year
(Appendix 2d)
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It is important to note that these benefits combine cash releasing and
potentially non cash releasing benefits.
Phase 1 and 2 Strategy projects by Financial costs of individual projects by
year (Appendix 2e+2f)
Non Financial Model:
Projects Catalogue (Appendix 2g)
Catalogue of projects detailing themes, activity and benefits
Roadmap (Appendix 2h)
This lists the projects of work identified by the strategy/SOP. Against each
project there is detailed:
• initial ranking of cost, benefits and difficulty in delivery based on the
McKinsey model
• project timescales
• Capital, revenue and non recurring revenue spend
The purpose of the spreadsheet is to enable a single view on where a project
is in its delivery and to give a basic indication of value for money and what
projects would deliver maximum benefit relative to cost and difficulty
Qualitative benefits by project (Appendix 2i)
This appendix details the qualitative benefits found in the SOP, delivered by
each project. It focuses on non financial clinical and non clinical benefits to
patients and staff.
Net opportunity verses ease of implementation (Appendix 2j)
Using the McKinsey model the projects have been ranked as ease of
implementation against net opportunity. Providing a guide as to the projects
which will provide quick wins against those who may be more difficult to
implement but will deliver maximum benefits.
Financial and value impact of the strategy and SOP
The detail of the financial impact is provided in the detailed SOP appendices
referred to above, re-stating again that this is at a relatively high level at SOP
stage in most areas, and further detailed assessment of costs and financial
benefits needs to be developed in BJC’s and business cases. In addition, as
stated above, the financial benefit figures combine cash releasing and
potentially non cash releasing benefits. With these provisos, the overall
summary is as follows:
Digital Health Strategy
2017-2020
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Overall financial impact
Year 1
2017/18
£m
Year 2
2018/19
£m
Year 3
2019/20
£m
Year 4
2020/21
£m
Year 5
2021/22
£m
Total
Capital cost
5.1
6.0
3.6
1.3
1.1
17.1
Non-recurring revenue
Recurring Revenue
Savings and time released
0.3
0.7
0.6
1.0
1.3
5.8
1.0
1.9
8.4
0.1
2.2
9.8
0.1
2.3
12.2
2.4
8.4
36.8
Net revenue impact (if all cash releasing)
Net revenue impact (if 50% cash releasing)
0.3
0.7
-3.5
-0.6
-5.6
-1.4
-7.5
-2.6
-9.8
-3.7
-26.1
-7.7
£m
In submitting the SOP to the Welsh Government, the Health Board is asking for
its financial support for the programme, but if it is supported by the Welsh
Government, this would be subject to consideration of individual business
cases. It will be some while before the Welsh Government considers and
responds to the SOP, much less receives and responds to subsequent business
cases. And Welsh Government is only likely to support capital, not revenue
expenditure.
Therefore, it is important for the Health Board to consider how far it is willing
and able to use its own resources towards delivering prioritised elements of the
programme, particularly in 2017/18. It is important to note that funding has
already been committed and included in the 2017/18 budget in some key
areas.
The section below provides an outline of the position and approach to delivering
the prioritised elements of the 2017/18 programme in the likely absence of
substantial Welsh Government funding in year for investments where we have
not yet submitted a business case.
Capital
Of the £5.1m planned expenditure:
• £2.2m relates to electronic health records, and it completely subject to
WG funding. The business case is already in and being reviewed by WG,
and the procurement process which will provide greater clarity on costs
and options is well underway
• £0.6m relates to CCIS, and this is already included in the discretionary
capital budget for 2017/18
• £0.75m relates to CCIS, and this is already included in the discretionary
capital budget for 2017/18
• The balance of circa £1.5m relates to a number of individual projects. The
principal potential funding sources for these projects are:
a) Local discretionary capital for service development - total £600k in
total
b) Cwm Taf share of £10m national ICT capital
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The role of the Digital Health Steering Group and then ECMG will be key.
Of the £0.7m recurring revenue:
• £0.4m is already budgeted as an unavoidable cost pressure for Microsoft
licenses and Citrix licences, and initial WCCIS costs
• The balance relates to a number of projects such as digital medical
records(£100k) which is subject to business case, data centre
consolidation (£106k) which is an invest to save case, and other items.
None of the £0.3m relating to non-recurring revenue is currently budgeted.
Further work on prioritisation and business cases will be key for the currently
unfunded recurrent and non-recurrent revenue costs. It may be possible to
secure external funding for some aspects of these.
In all cases, the financial and non financial benefit of the relevant projects
needs to be taken into account.
Further work which is critical to get the full value from the strategy
The strategy and the SOP set out at a high level the key investment and
enablers to significantly develop the extent and maturity of digital working
within Cwm Taf services, and an outline assessment of what the financial and
non financial benefits of that would be.
It is important to understand that while this is an important stage to get to,
there is a critical next stage to enable the realisation of the benefits projected.
That key next stage is to work with clinical services and clinicians (in particular
but not entirely) to:
• map out the current patient care (and administration of care) processes,
and the extent to which the current and planned ICT functionality enables
them to become fully digital.
• thus identify the gaps and blockages to digital working
• develop plans for the potential new processes that could be operated
once these gaps are addressed, and what the financial and non-financial
benefits of the change would be
• use this to development business cases and prioritisation plans for the
investments in the SOP, refining the costs and benefits.
• Thus ensure that we are not developing ICT solutions in a vaccum; we
are very clearly identifying bottom up, with clinical teams, the future
state which will be implemented once the ICT functionality is in place
It needs to be borne in mind that in many cases the investment has already
been made, and the “gap” is to reconfigure a process or a pathway, or how we
use the software we have, to make the change. Examples here could include:
• Moving to fully electronic outpatient referrals from primary care, and
fully electronic management of those referrals in secondary care
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2017-2020
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•
•
Moving to full electronic requesting of pathology tests from primary
care
Realising the full benefits of EDaL to reduce length of stay,, through
discharge earlier in the day avoiding midday peaks in bed demand, and
avoiding some discharges dropping through to the next day.
Next Steps:
• Establish the Digital Health Steering Group. This will provide both
Governance and the forum for decision making on the projects, in terms
of considering business cases and determining their relative priorities and
sequencing.
• Engage with clinical services and clinicians to map out the beneficial
changes that can and will be made to clinical and administrative
processes with the enablement of the projects within the Strategy and
SOP
• Through the Digital Health Steering Group, prioritise unfunded
investments, and through business cases, seek sources of funding both
internally and externally, with clear associated financial and non financial
benefits.
• Identify major investments and feed back to ECMG and Executive Board
as necessary via the Digital Health Steering Group recommendations on
priorities, investments and associated benefits.
4.
RECOMMENDATION
The Health Board is asked to:
•
•
APPROVE The Digital Health Strategy;
APPROVE The Strategic Outline Programme.
Freedom of
information status
Digital Health Strategy
2017-2020
Open
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