PROGRAMMES
COMMISSIONING STRATEGY
F3025787 2.1
Table of Contents
1.
PURPOSE ...................................................................................................................2
2.
KEY PRINCIPLES .......................................................................................................2
3.
APPLICATION OF THE KEY PRINCIPLES................................................................4
3.1
3.2
3.3
3.4
3.5
3.6
3.7
4.
COMMISSION ..........................................................................................................4
INITIAL AGREEMENT (IA) – STRATEGIC OUTLINE CASE................................................4
AGREEMENT/PROCUREMENT DEVELOPMENT (OBC) ..................................................4
CONTRACTUAL SIGNING/IMPLEMENTATION FBC ........................................................5
IMPLEMENT – DESIGN, BUILD AND TEST (DBT) ..........................................................5
IMPLEMENT - ROLLOUT ............................................................................................6
BENEFITS REALISATION ...........................................................................................6
NSS ROLE AND RELATIONSHIP ..............................................................................6
DOCUMENT CONTROL ........................................................................................................8
DOCUMENT HISTORY .........................................................................................................8
DISTRIBUTION ....................................................................................................................8
F3025787 2.1
eHealth
1.
Commissioning Strategy
Purpose
The purpose of this paper is to outline the key principles in relation to commissioning for
the National eHealth Programme. The document has been circulated to eHealth Leads
and NSS and feedback obtained to date has been incorporated where considered
appropriate. Strategy Board is asked to agree the key principles (section 2) and
note the points in relation to application (section 3), NSS relationship (section 4)
and the examples covered in the appendix.
2.
Key Principles
1. The eHealth Strategy Board will approve and own the Commissioning Strategy.
2. The eHealth PET will approve the commissioning approach in relation to each
project/work, and in some cases this may be referred to the eHealth Programme
Board
Reasons for referring a commission for a project/piece of work to the eHealth
Programme Board are as follows:

Procurement incurring total boards costs in excess of £2m and/or > £0.5m
to an individual NHS Board

Complexity and/or sensitivity in one or more of the following
 impact of NHS Boards LDPs
 challenges/impacts the strategic eHealth applications and/ or
services
 demands on NHS Boards to fulfil other eHealth commitments
 requires significant backing from NHS Boards to deliver
 political implications and/or directive
N.B. All at the discretion of eHealth PET
3. The most appropriate commissioning approach should be determined based on
the:
 merits of each project/work in question;
 stage in the national lifecycle; and
 particular circumstances
The key questions in relation to each commission are as follows:
 possession and availability of appropriate skills;
 capacity to deliver;
 value for money;
 size and complexity (including political, public, legislative and financial);
 contracting capability (if a procurement);
 degree of risk involved;
 strategic importance / fit; and
 potential conflicts of interest.
4. Commissions can take on a number of different forms, for
example:
 conducting a market intelligence exercise;
 creating a scoping report;
 developing a business case;
 developing user training material for new processes and systems;
 implementing a solution;
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

procuring an application and associated services; or
undertaking an investigation or audit.
5. Commissions could be awarded to any of the following:
- a special board e.g. NSS;
- NHS Board (either singly or as a consortium);
- private sector (including AOA, Consultancy, other) - although note that an
NHSScotland organisation would still have to take the lead in this case;
- other public sector body (NES, Telehealth Centre, etc); or
- academic sector.
6. The initial commission remit will be developed and the appropriate organisation(s)
requested to submit a proposal against this. This will be undertaken primarily
through the Head of Programmes working with an appropriate National project
board, although the terms of reference and/or or business case development, as
appropriate, will be led by the Head of Strategy.
7. eHealth Programme determines the ‘eHealth Commissions’ and agrees the scope,
parameters, approach, budget, financial tolerances and any other relevant matters
with the commissioned organisation. The details will include the individuals who
will undertake the work, to ensure both the capacity of the commissioned
organisation to deliver and the capability of the team.
8. The commissioned project manager must be suitably skilled and experienced
irrespective of the lead organisation. An external project manager should be
enlisted using the AOA contract or another consultancy when appropriate. The
external project manager may be supported by an internal ‘assistant project
manager’ to provide skills transfer on large projects.
9. There will always be appropriate representation on the national project board (and
national programme board if required) from SGHD and the NHS health boards.
SGHD will decide the project board membership to cover all stages of the project
(this will include benefits realisation for the programme board).
10. In terms of the standard procurement project lifecycle, the typical approach to
leading (L - L either one in italics will apply) on each commission is summarised in
the table below. ‘S’ indicates a possible supporting role.
Stage
SGHD
NSS
Boards
Third
Party
Commission
L
S
S
S
Business Case Stage
Initial Agreement (Strategic
Outline Case)
L
S
S
S
Business Case Stage
Outline Case (OBC)
L
S
S
S
Business Case Stage Full
Case (FBC)
S
L
L
S
Design build test
S
L
S
S
Rollout
S
L
L
S
Benefits realisation
S
S
L
S
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Notes
Commission The norm is SGHD is the lead. However there can be projects for
which it is appropriate for NSS, an NHS Board or consortium of NHS Boards. to
be the lead.
Initial agreement and agreement development The lead is determined by
SGHD based on the project complexity, cost etc. For some projects SGHD will
commission NSS, an NHS Board or consortium of NHS Boards to lead on this
work.
Design build test and rollout The norm is NSS is the lead. However there can
be projects for which it is appropriate for the health board(s) or SGHD to be the
lead. Example - a health board solution and approach that is appropriate could
be adopted nationally.
The next section gives more detail on how these principles would be applied with
respect to the typical commissioning approach outlined in the table above.
3.
Application of the Key Principles
3.1 Commission

SGHD will lead on this stage, with input from the relevant groups/organisations
that have an interest in recommending the project.

This will be undertaken under the Strategy work stream, to assess the idea
against the Programme strategy, blueprint and portfolio.
N.B. This will be undertaken under the Strategy workstream, to assess the idea
against the Programme strategy, blueprint and portfolio. The Design Authority would
have input to check alignment to the architecture roadmap and the Change &
Benefits workstream to ensure alignment with the benefits framework
3.2 Initial agreement (IA) – Strategic Outline Case

SGHD will lead on all IAs that are strategically important, politically complex or
likely to result in a significant national implementation.

NSS or NHS Board(s) will lead on all other IAs.

In all cases the Strategy workstream will assess the idea against the
Programme strategy, blueprint and portfolio. The Design Authority would have
input to check alignment to the architecture roadmap and the Commissioning
Quality Services to ensure the appropriateness of and agreement with the
outcomes and outputs

There may be some initial third parties engagement, depending on the project.

Substantial representative input from appropriate stakeholder groups to the
project team and /or project board will be mandatory.
3.3 Agreement/Procurement Development (OBC)

SGHD will lead on all OBCs that are strategically important, politically complex
or likely to result in a significant national implementation.

NSS or NHS Board(s) will lead on the procurement and all other OBCs.
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N.B. SGHD may lead on the procurement if there are particular circumstances
surrounding the project which make it more appropriate to provide this lead (for
example, if NSS does not possess the capacity).

Third parties may be engaged at any stage in the lifecycle, depending on the
project.

Substantial representative input from appropriate stakeholder groups to the
project team and/or project board will be mandatory.
3.4 Contractual Signing/Implementation FBC

NSS will normally be the lead organisation for sign up to National contracts.
However, the role could also be undertaken by an NHS Board or consortium of
NHS Boards.

Where health board resource is involved, this would normally be funded to
ensure the resource is secured.

In all complex national procurements, representative health boards will be
involved. This will take place in two ways:
1. Lead NHS Board(s) - one or more NHS Boards will be engaged as part
of the project team, in order to support requirements definition,
evaluation and discussions around services and implementation
approach.
2. There will be further representation on the user reference group and the
project board from representative NHS Boards.
At the project initiation stage, nominations will be sought from NHS Boards
that would like to be involved in both 1 and 2 above. The recommendation will
be openly discussed with the eHealth Leads group, NSS and the National
Clinical Reference Group. The decision will be taken by the appropriate body
as determined by the project (cost, complexity, political sensitivity etc). This
will be based on need, experience, resources available and capacity to
support.
3.5 Implement – Design, Build and Test (DBT)

NSS will be the lead organisation for DBT, however the role could be
undertaken by a lead NHS Board or consortium of NHS Boards.

The concept of lead NHS Board is continued through implementation, with the
intent that one or two of the lead Boards from the procurement stage continues
to be the lead Board for implementation. This will provide further focus on the
solution being fit for purpose, clinical buy-in and end to end service delivery.
Maintaining the NHS Board input will be critical to the success of the rollout
stage.

Decisions made during design need to be universally acceptable to NHS
Boards. This will require processes to ensure that all Boards sign-off on the
design and test stages – ideally through involvement of the lead Boards with
any potential issues highlighted to all Boards. It may require further
discussion/input to achieve this sign-off for contentious points.

Note should the procurement stage identify prerequisites that the lead Boards
cannot meet then there would be a change in lead board for implementation.
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3.6 Implement - Rollout
This will vary by project, depending on rollout approach. The normal case would
be:
 Rollout would be led by the joint team from the DBT lead organisation, lead
Board(s) and supplier.

The national project team (commonly resources from all of the above) would
deploy across all sites, working with the local project team in each case (the
size of which would depend on the scale of the project).

Each NHS Board will have its own ‘local case’ for the project - based on the
national business case and focusing on planning, resourcing and benefits
realisation. This will be used to engage the local management board and
signed up to by each NHS Board.

Rollout considerations will be addressed during the DBT stage. Engaging
NHS Boards in this to ensure that practical issues are thought through as early
as possible will be critical to successful rollout.

On acceptance of a solution in the lead site, it will be rolled on to the next NHS
Board/site with the national reference files and national reporting requirements
fully pre-built. The aim is to minimise ‘local configuration’ differences.

The delivery capacity of the Board will be determined by the level of funding
agreed by the NHS Board Chief Executive. Each NHS Board would be
accountable to SGHD through their local eHealth delivery plan, as part of the
Board’s local delivery plan. This will be agreed with each NHS Board on an
annual basis in terms of which solutions and to how many sites they intend to
roll out.

Overall accountability for delivery will sit with the NHS Board Chief Executive,
as part of the local delivery plan, and delegated to the Board’s Director of
eHealth. The reporting line (professional relationship) between the NHS Board
Director of eHealth and the SGHD eHealth Programme Director will provide a
line of accountability for roll out and for delivering benefits.
3.7 Benefits Realisation
4.

NHS Boards will take the lead in benefits realisation, although this will be
supported by SGHD and NSS as appropriate.

Each NHS Board will be accountable to SGHD through their local eHealth
delivery plan for delivering benefits.

Additional resources are required in order to ensure benefits are realised, this
will be built into the business case and supported by SGHD.
NSS Role and Relationship

The Head of Programmes working with an appropriate National Project Board,
will determine ‘eHealth Commissions’ and agree the scope, parameters,
approach, budget and any other relevant matters with NSS based on the
eHealth programme.
eHealth - Commissioning Strategy
Objective: F3025787 2.1
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eHealth

Commissioning Strategy
NSS ( supplier and statutory body) has the right to reject commissions if it is
unable undertake the work for any of the following reasons:
 insufficient capacity and or expertise
 it exposes NSS to unreasonable risk as an organisation
 to raise major project issues that arise during the course of the work.

‘eHealth Commissions’ should have underlying business cases which commit
SGHD, and NHS Boards where relevant, to the financial and operational
consequences of the investment.

The Commission will be formally passed to the commissioned organisation
together with appropriate delegated budget from the eHealth Programme
Director.

The Head of Programmes and project board will continue to work with the
commissioned board to receive reports on progress, provide ongoing
monitoring and guidance, resolve issues, agree any changes to the original
commission, and report progress to the Programme.

The Head of Programmes and project board will continue to work with the
commissioned board to ensure programme quality standards and
management processes are applied.

The NHS Board is normally the lead delivery agency for eHealth Projects.
However the commissioned board may procure and manage a third party
(commercial supplier) to deliver the solution, instead of undertaking it
themselves.

The commissioned board will be responsible for effective delivery against the
agreed commission and achieving VFM within the delegated budget.

PET, the Strategy and Programme Boards will be responsible for the content
of the commission and its strategic relevance. Albeit ultimate responsibility
rests with the Director of eHealth. The commissioned board will input to the
strategy only as part of the wider NHS Scotland set of organisations.

The commissioned board will receive regular and timely reports from the
project manager in order to discharge the governance responsibilities.

The Project boards will have responsibility for considering issues that arise
The commissioned board will also need to satisfy itself that these
recommendations and actions are compatible with their governance and
accountability responsibilities.

The Project boards will have responsibility for making recommendations to
the appropriate eHealth Board (through the eHealth PET).
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eHealth
Commissioning Strategy
Configuration Management
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Title:
Programmes - Commissioning Strategy
Document ID:
Reason for last change
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Author:
Owner:
Commissioning Strategy
Standard
Interim eHealth Commissioning Manager - Ian Hamilton
eHealth Head of Programmes - Lesly Donovan
Scottish Government eHealth Board Approval
Approved by: eHealth PET
Name
Title
Signature
Date
Approved by: eHealth Programme Board
Approved by: eHealth Strategy Board
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eHealth - Commissioning Strategy
Objective: F3025787 2.1
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Capacity
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