Greater Manchester Health and Social Care
Strategic Partnership Board
8
Date:
30 June 2017
Subject:
IM&T Strategy and Architecture
Report of:
Stephen Dobson, Chief Digital Officer, GM IM&T Program, GMH&SC
Partnership
SUMMARY OF REPORT:
Following approval by SPB in November 2016 to establish a Digital Collaborative as the
mechanism to coordinate the design and delivery of the GM IM&T Strategy, and the
appointment of a Chief Digital Officer for the GM H&SC Partnership Team, this report
describes the functions of the H&SC Digital Collaborative and sets out the prioritised
implementation plan that will form the basis for the GM IM&T programme
KEY MESSAGES:
Progress has been made to establish the H&SC Digital Collaborative governance as set out
in the paper ‘Implementing GM IM&T Strategy’ agreed by SPB in November 2016.
Extensive engagement has taken place across GM H&SC organisations to identify priorities
and develop the implementation plan.
Work is still required to finalise the formation of the GM Digital Transformation Fund.
PURPOSE OF REPORT:
This report is intended to update GM H&SC Strategic Partnership Board on the development
of the implementation phase of the GM IM&T strategy.
The report also seeks approval to the initial prioritised projects and establishment of the
proposed detailed governance arrangements for their delivery.
RECOMMENDATIONS:
The Strategic Partnership Board is asked to:
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
Note the progress to develop the function of the Digital Collaborative

Approve the approach and prioritisation and implementation

Support the resulting programme of work
CONTACT OFFICERS:
Stephen Dobson, Chief Digital Officer, GM IM&T Program, GMH&SC Partnership
[email protected]
2
1.0
BACKGROUND
1.1.
The delivery of the GM Health and Social Care strategic plan, “Taking Charge”
requires significant system change. IM&T is a key enabler of our ability to change at
the pace and scale GM has set out to achieve. In addition the delivery of each
locality plan is dependent on IM&T transformation. We need to better link our
organisations, improve our capacity to share relevant information safely and
securely across individual localities and the GM footprint. We need to give our
frontline staff the technological tools and skills to improve the way we work and the
care we provide.
1.2.
As a result the IM&T strategy was published in the 30th June 2016 Strategic
Partnership Board paper “Enabling Health and social care reform through
information”. This was followed by the 25th November 2016 strategic partnership
board paper “Implementing GM Information Management and Technology Strategy”
describing the requirements for a Digital Collaborative Board and team.
1.3.
Since February 2017, four members of the Digital Collaborative have been recruited
comprising the Chief Digital Officer, Programme Manager, Project Manager and
Project Support Officer. Together, this team have been working collaboratively with
the wider GM H&SC Partnership to prioritise and develop an implementation plan
with key priorities for 2017/18.
1.4.
The ‘Implementing GM IM&T Strategy’ presented to strategic partnership board in
November 2016 defined the scope of GM IM&T architecture from network through,
software and services to governance and also introduced the five key pillars of the
IM&T strategy as;
Understand:- Ensuring a statistically informed evidence base for practices,
commissioning, patients and beyond.
Empower:- Enabling patient, citizen and professional access and contribution to
information and services and to improve patient, citizen and professional
experience and quality.
Collaborate:- Consolidation of IM&T and related services and applications and
provision of collaborative tools across GM
Integrate:- Ensuring information flows appropriately across the system and
provides the needs of patients and services users at each contact point,
whether for direct care or secondary purposes.
Connect:- Resilient, non-redundant supported and
supporting mobility, service re-design and innovation.
1.5.
efficient
infrastructure
In addition they highlighted the establishment of a GM Digital Transformation Fund
which would sit alongside the existing GM Transformation Fund to contribute capital
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and revenue funding for the delivery of IM&T elements of Locality Plans and GM
wide IM&T programmes and priorities.
2.0
WIDER STRATEGIC LINKS
2.1.
Delivery of locality place-based integration and new models of care is closely
aligned to the wider GM Public Service Reform agenda. The GM H&SC Digital
Strategy therefore also needs to be aligned to this work so that we reduce
duplication and increase transformation as a whole public sector.
2.2.
To support this, lead officers from across GM public service partners have fed into
the development of the Digital Strategy, prioritisation of specific programmes of
activity and the development of the draft implementation plan. In particular the
Digital Collaborative team has close links to GM-Connect and with wider public
sector reform both at governance and program levels.
2.3.
In addition the GM H&SC Digital Team are currently supporting cross organisational
locality based conversations to develop an understanding of locality digital maturity
and areas for development. This will help to shape the support given at a locality
level and inform the use of the GM Digital Transformation Fund,
3.0
WHAT NEEDS TO CHANGE
3.1.
The eleven key challenges we are seeking to address are:
3.1.1.
to understand the map of the many systems and applications we employ across
Greater Manchester and to pursue options for standardisation and consolidation,
both for reasons of efficiency and performance
3.1.2.
to address the fragmentation in data capture, storage and use to ensure that our
digital systems properly support our core goal of more integrated care
3.1.3.
to use the ‘one public service’ ethos in GM and the commitment to place-based
integration on a wider scale to identify opportunities to join up data in new ways to
support joint goals, e.g. health and employment, addressing homelessness
3.1.4.
to grasp the opportunity that the devolution deal gives us by developing a worldleading population health informatics platform that gives us the best possible
understanding of people’s needs and also powers our research and innovation
agenda
3.1.5.
to tackle fundamental gaps in digital access across the health and care workforce,
which results in continued heavy use of paper systems in some parts of our health
and care economy
3.1.6.
to use new and improved IT systems to drive higher quality care and better
management of that care
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3.1.7.
to use our collective market power to secure access to the best standard software
and hardware systems at scale and at a good price
3.1.8.
to enable GM to grasp as early as possible the potential role of Cloud technology in
allowing common access to key applications from many locations in a secure way
3.1.9.
to pursue a robust system of information governance that has public and
institutional confidence
3.1.10. to tackle weaknesses in the resilience of our systems across the GM health and
care economy
3.1.11. to use public digital access to empower people to care for themselves access
services and make their own choices (including carers)
4.0
THE FUTURE
4.1.
Translating these challenges into a desired future, we can describe what this
transformation could mean for citizens, professionals and organisations.
4.2.
The Locality Plans, Taking Charge themes and cross cutting programmes are
providing more detailed insight into the direction of travel within local geographies,
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and the programmes of work that will need support and enablement from digital
technologies. These themes include:

A need for shared record solutions;

Ensuring digital inclusion for citizens and all care providers across GM Health
and Social Care;

Empowering patients and carers to interact using technology;

Supporting new modes of interaction using telehealth, telecare, telemonitoring
and e-health;

Population health informatics to enable early intervention, prevention and
targeting of services;

Ability to view professional contact information in one place;

Guided digital pathways;

Better understanding of community assets and how to utilise them;

Development and support for new models of contracting;

Development of care co-ordination models;
5.0
ROLE OF THE GM H&SC DIGITAL COLLABORATIVE
5.1.
The GM Health and Social Care system is complex, with 34 different partner
organisations, each with different strategic priorities and statutory responsibilities.
Yet there has been no single way in which organisations implementing IM&T
solutions can come together and work towards a single direction of travel.
5.2.
However, as stated in the Wachter review “The NHS should learn, but not overlearn the lessons of NPfIT”. NPfIT was overly centralised and top down, stifling
innovation and slowing digitisation. The H&SC Digital Collaborative does not intend
to dictate a single technology system across GM. A single GM wide Electronic
Patient Record for instance would be extremely disruptive, extremely costly and not
guaranteed to succeed. The H&SC Digital Collaborative would however encourage
organisations to consolidate systems and move to a smaller number of
interoperable systems across Greater Manchester.
5.3.
We expect the H&SC Digital Collaborative to have five main functions. Each of
these is designed to reduce duplication, and to enable organisations to build upon
each other’s capabilities, so innovations can be rapidly shared and scaled, effective
systems re-used and organisational and information silos broken down.
5.4.
Firstly the H&SC Digital Collaborative will establish and mandate a GM IM&T
Framework to support innovation, localities and the anticipated GM Digital
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Transformation Fund. This framework is made up of a set of capabilities that any
new solution should aim to comply with and a set of strategic solutions that localities
should consider prior to introducing alternatives. Localities must also consider
whether they can re-use existing solutions and expertise across GM prior to
introducing their own.
5.5.
We would stress that the formation of the GM Digital Transformation Fund is still not
fully over the line. We have agreed phasing of revenue and capital with the national
organisations but are still to secure sign-off that would allow for the release of
resources. This delay is frustrating and we have escalated within NHS England and
the Department of Health. We understand that this is not a GM issue per se, but
rather that our requirements are part of a much larger amount of capital funding for
digital strategy that is not yet been approved by HM Treasury.
5.6.
Once formed, we would expect all applications to the GM Digital Transformation
Fund to be assessed against this framework. A separate paper describing this
framework in more detail and the mechanism for applying for GM IM&T funding is
being prepared.
5.7.
The GM IM&T Framework is summarised below. Compliance with this framework
should ensure that organisations minimise the number of new applications that are
implemented and that successful programs can be easily rolled out across GM at
scale where it makes sense to do so.
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5.8.
Secondly, the H&SC Digital Collaborative will monitor all projects supported by the
GM Digital Transformation Fund to ensure they are delivering expected capabilities
and benefits against an agreed set of delivery milestone dates.
5.9.
Thirdly, the H&SC Digital Collaborative will create a GM IM&T Framework
Compliant Platform. This is likely to be a GM Cloud based environment
synchronised with the active directories of each organisation. Applications within
this platform will therefore be scalable, and can be made accessible to
professionals in any organisation, potentially on any device simply by granting
permission.
5.10.
Cloud solutions are already emerging within GM. As well as supporting
collaboration, creating a GM Cloud platform will help prevent a proliferation of
unconnected, disjointed and silo cloud environments and applications from
emerging.
5.11.
As organisational systems become Cloud capable we expect use of this platform
will provide a mechanism for consolidation allowing organisations within and across
localities to share applications from anywhere without the need for multiple
passwords.
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5.12.
Such a platform would facilitate unconstrained care pathway re-design, operational
consolidation and help reduce information silos and support requirements.
5.13.
Fourthly the H&SC Digital Collaborative will prioritise and implement projects that
directly or indirectly support localities themes or cross cutting programmes.
5.14.
Considerations as to whether projects will be implemented by the H&SC Digital
Collaborative or at the locality include;

Will the solution promote integration between services and organisations in
pursuit of better care

Is there a scale advantage for implementing across the whole of GM, from a
simple collaborative procurement all the way through to a single GM wide
supported system.

Does it provide a GM wide view of patients/citizens beyond that obtained within
a locality.

Can the solution be implemented by a locality, but in such a way that scaling to
the rest of GM is relatively simple (this is one of the purposes of the GM IM&T
Framework)?
5.15.
Finally the H&SC Digital Collaborative will challenge embedded culture and
encourage change. It will also engage organisations and encourage sharing of
knowledge, experience and innovation.
5.16.
In September 2016 Salford Royal Foundation Trust (SRFT) was chosen as one of
the 12 National Global Digital Exemplars, created to have a unique role to advance
new ways of using technology to drive radical improvements in the care of patients
and tasked with spreading learning and best practice across the NHS. The H&SC
Digital Collaborative will work with SRFT to support development and dissemination
of these technologies across GM in line with the national expectations of all Global
Digital Exemplars.
5.17.
The GM H&SC Digital Collaborative will also provide GM with the mechanism to
agree our position in response to national issues and to speak with a clear voice,
informed by GM-wide debate. This will include developing an engagement plan for
patients, public and workforce to ensure their involvement and perspective in the
design and delivery of our programmes.
6.0
DIGITAL COLLABORATIVE PROJECT PRIORITISATION
6.1.
A set of potential projects have been identified by considering the following;

GM Strategic Plan, thematic and cross cutting programmes

Greater Manchester Health and Social Care Digital Road Map, including the
key challenges summarized in section two.
9

Requirements for locality integrated working / LCO development

NHSE 10 Universal Capabilities (as part of 2020 ambition of Paper-free at the
point of care)

Five Year Forward View requirements (2014 and 2017)

Clinical Digital Maturity Index and system review analysis

The Wachter Report - Making IT work: harnessing the power of health
information technology to improve care in England

Emerging NHSE definitions of expected locality digital capabilities

Health Innovation Manchester business plan
6.2.
Of the potential projects a set of eight have been selected due to their urgent need
to support localities and achieve wider objectives at the GM level.
6.3.
This plan is a live document and will be reviewed and updated iteratively, so that as
a system we can collectively understand what has been delivered to date and agree
our next set of priorities. It is also important where there are anticipated challenges
to delivery, we can work together to resolve them.
6.4.
We expect many of the projects we have identified, but not yet prioritised, will be
implemented by the H&SC Digital Collaborative at a later stage or may be
implemented by specific localities, prior to scaling across GM.
6.5.
The table below outlines how the eight prioritised projects support all the pillars of
the IM&T strategy and each of the themes of “Taking Charge”, each of these
projects are outlined in the following sections.
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7.0
GM POPULATION HEALTH
7.1.
GM needs the ability to understand people’s needs using information across the
entire system and the ability to implement controlled interventions that produce
measurable improvements in care quality, efficiency or experience.
7.2.
Combining appropriate clinical, operational, statistical and academic skills together
with whole system data, including wider economic determinants of health, GM has
the opportunity to create a world-leading population health platform that can power
care improvements and our research and innovation agenda.
8.0
GM WIFI (STAFF AND PATIENT)
8.1.
GM has the opportunity to rapidly take advantage of emerging WiFi standards that
would allow the entire public sector to rapidly adopt and publish a common WiFi
standard. If adopted this would allow any enabled WiFi device to connect to the
internet from every public sector building.
8.2.
Our goal would be to go beyond this and allow staff to seamlessly access their own
applications and file structure as though working from their host organisations. This
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capability supports service redesign with staff able to work anywhere in GM and
may be a relatively low cost quick win.
8.3.
Similar technology could also be adapted to allow low cost standard patient/citizen
WiFi access to the internet from any public sector building, improving experience
and digital engagement.
9.0
GM HEALTH AND SOCIAL CARE INFORMATION EXCHANGE
9.1.
To support our ambitions around new integrated care models all localities need a
standards based health record exchange and associated information governance.
The existing GM DataWell program will provide this functionality and link to existing
locality solutions.
9.2.
The DataWell program is split into 2 main components:
9.2.1.
The Exchange is the core infrastructure; the “motorway” that will enable information
to be shared.
9.2.2.
Accelerators support GM health and care organisations to use the system to
support new ways of working within localities. Examples in development include the
Shared Pathology Viewer, a GM wide standard minimum dataset and Patient
Consent
9.3.
GM-Connect are working with the DataWell program and H&SC Digital
Collaborative to ensure a robust GM information governance framework to support
the GM H&SC information exchange and wider programs.
10.0
GM ELECTRONIC DOCUMENT EXCHANGE
10.1.
GM sends approximately 500K documents from 13 provider organisations to GP’s
every month using Docman.
10.2.
Docman is also used for GP workflow.
10.3.
The H&SC Digital Collaborative has already been instrumental in acting as a single
voice for GM, by representing providers and GP’s to create a new GM wide
Docman contract.
10.4.
This new contract has resulted in greater than £200K of cost avoidance and has
allowed GM to move from a restrictive contract (limited by providers and number of
documents) to a GM wide contract allowing any GM H&SC organisation to send
unlimited documents in any direction.
10.5.
The H&SC Digital Collaborative now has a role in monitoring implementation and
benefits enabled by this solution.
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11.0
GM ASSET ANALYSIS AND CONSOLIDATION
11.1.
The number of IM&T assets (servers / applications / systems) in use across GM is
unknown, but likely to be greater than 1000 per locality. The Digital Collaborative is
proposing a GM wide review to create an asset register of all organisations and to
determine which of these assets could be consolidated within a GM Cloud
environment.
11.2.
This would result in:

An up-to-date per organisation asset register improving organisational
information governance compliance

A roadmap for future organisational architecture design

A roadmap for organisational application consolidation

A roadmap for GM wide system procurement to drive down costs

A roadmap for system retirement to remove duplicate capabilities and costs

A potential roadmap for GM datacentre consolidation and potentially a roadmap
for organisations to move into more efficient commercial datacentres with
higher availability.
12.0
GM CLOUD PLATFORM
12.1.
As existing cloud platforms are starting to emerge in GM, the Digital Collaborative is
investigating the potential creation of a collaborative GM cloud platform
12.2.
This would be synchronised with each organisation’s directory of users and would
allow them to have their own cloud or promote applications into a GM cloud
accessible by organisations. This would enable:

Access to applications from anywhere (potentially on any device)

Sharing/scaling of applications across organisations, simply by granting
permission.

Consolidation of existing applications.

Ability to pilot and then terminate applications without large infrastructure
resource costs, supporting rapid innovation.

Reduction of
consolidation

Prevention of multiple silo’d GM Cloud platforms.
physical
datacentre
pressure
and
potential
datacentre
13

Potential collaboration suite (presence, video, file sharing)
13.0
GM HIGH AVAILABILITY NETWORK
13.1.
With the end of the NHS national N3 network (which currently provides links
between organisations), GM has a short time window of opportunity to design a GM
wide high availability, high performance network that supports service redesign
across GM and new innovative systems that may have large network capacity
requirements (e.g. Digital pathology / radiology).
13.2.
This network should reduce unnecessary and costly connections within and
between organisations, to the national health and social care network infrastructure
and to a GM Cloud. It should also enable individuals to connect back to their own
infrastructure from any other organisation.
14.0
BENEFITS
14.1.
An overall benefits plan will be developed for each of the programmes of work
highlighted within this document and aligned to the desired future state in section
4.1. In many cases these benefits will be indirect due to the programme supporting
wider locality plan benefits or will provide qualitative benefits for user or
patient/citizen experience. For instance the WiFi and information exchange projects
will allow access from anywhere to host services, will allow some service redesign
and increases in efficiency. Also the clinical pathway re-design enabled by a cloud
strategy could result in greater capacity across GM for theme 3 and reduced
information silos for theme 2.
14.2.
We expect many of the benefits to result in cost avoidance. For instance the GM
Cloud platform will result in reduced future data costs and increased resistance to
malware (preventing unnecessary down time and loss of capacity). The asset
review could result in simplification of architecture and reduced support
requirements and the enabling of greater 24/7 support. All of these will have
indirect benefits for service continuity.
14.3.
However some of the programmes may have significant cost savings associated
with them. If the population health programme, enabled by a single GM population
health Business Intelligence hub, is to more effectively target resources, prevent
health deterioration and reduce demand then savings in the region of £10 – 100
million could be realised.
14.4.
The asset review should identify procurement opportunities across GM and allow
the development of a GM supplier management function. It is also an important
precursor for service consolidation. Combining procurement across providers and
primary care for just one contract (Docman) has already resulted in approximately
200k of cost avoidance. This programme could indirectly result in savings in the
several millions for GM.
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15.0
STRUCTURE AND GOVERNANCE
15.1.
The structure for the H&SC Digital Collaborative is shown in the diagram below.
GM HSC Digital Collaborative - Programme Governance
GM Health & Social Care
Transformation
Portfolio Board
GM Health & Social Care
Digital Collaborative Board
GM HSC
Informatics
Engagement
Group
GM HSC
Technical Design
Authority
GM HSC
Business Advisory
Group (as required)
GM HSC
Clinical / Practitioner
Reference Group
Project / Technical teams as required
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The Digital Collaborative Board will oversee and drive delivery of the GM IM&T
strategy with senior level representation from across the whole health and social
system. It will also be responsible for management of the GM Digital Transformation
fund.
15.2.
The GM H&SC Informatics Engagement Group will provide operational oversight
and coordination of the GM IM&T strategy. It will also support engagement and
adoption of systems back into the respective organisations.
15.3.
The GM H&SC Technical Design Authority will define the technical standards and
processes to ensure a common IM&T strategy and approach. It will also confirm
compliance to standards.
15.4.
The GM H&SC Business Advisory Group will meet on an ad hoc basis in order to
support discrete pieces of work or projects that require the expertise in a specific
business or functional context
15
15.5.
The GM H&SC Clinical / Practitioner Reference Group will ensure that clinician
input and expertise is effectively harnessed in the design, development and
implementation of the GM IM&T strategy and provide assurance that the direction of
the strategy is clinically safe.
15.6.
Using this structure we are seeing an energetic grass roots engagement of
technical architects across GM H&SC, bringing together technology opportunities
into standards that can be quickly ratified with clinical and senior colleagues prior to
passing through appropriate governance and implementation across GM. [Insert
Text]
16.0
RECOMMENDATIONS
16.1.
The Strategic Partnership Board is asked to:

Note the progress to develop the function of the Digital Collaborative

Approve the approach and prioritisation and implementation

Support the resulting programme of work
16