£3bn Budget 3,000,000 Patients 81,000 Staff 1 Assembly 3 Regions 15 Trusts 22 LHBs 135 Hospitals 15,000 Beds ~2000 GP Practices

Revenue Secondary Care Budget

Legacy

iSoft/ ‘Green screen’ PIMS CWS/ I Soft Pembs PAS WAS Myrddyn PMS I Soft/ PIMS Velindre BSC

Legacy

• In the south, mid and west of Wales the tradition is local development Typically: – PAS – Clinical work station – Departmental systems – Some primary care (GP system) links Usually developed in single Trust, two were later shared with neighbours

Legacy

• North Wales has commercial systems of varying vintages with more limited in house development capacity Almost all Trusts use national systems from the corporate era: – Radiology – Pathology – Pharmacy

Population by System Type

Our Health Informatics People

• Reflect the legacy • Variations in capacity, resource levels and skill sets across Wales • Many Trusts have strong in house teams – Successful implementations – Invaluable knowledge of clinical processes – Excellent relationships with local clinicians • We are know seeking to exploit this resource • Two pieces of strategic work – Deployment and utilisation – Professional development

Staff Deployment and Utilisation Strategy

• Four phase production of strategy • First two phases completed – Best practice model derived – Service wide survey and gap analysis against model completed • CEOs have approved phase 2 report and authorised phases 3 and 4 • Stage 3 - appraisal of options to improve the utilisation of workforce and meet future requirements • Stage 4 - recommended option, strategy and implementation plan (completion October 2006)

Professional Development Strategy

Professional Development Programme Talent Management Standards Education Training CPD Identity & Community

• Recruitment • Retention • Career progression • Workforce planning • Leadership development • A4C/KSF • Succession planning • HI National Occupational Standards • UKCHIP • Other professional standards • Bursary scheme • Vocational schemes • Modular E&T products • CPD initiatives • Community of practice • Body of knowledge • Professional bodies • UK HI professional development bodies • Branding & marketing

Local ‘Readiness’

• Programme inheritance 1% of NHS resources • NHS Wales target 2%, Wanless 4% • Initially emphasis therefore on strengthening generic weaknesses • So in first three years of programme – £41m invested – 65% through local organisations – 15 project managers and 19 support staff employed locally – Networks improved (150 extra sites)

Local ‘Readiness’

• Over 8000 ‘access devices’ deployed • Microsoft enterprise agreement - 35,000 desk tops • Data cleansing and quality – 100 staff deployed locally – Over 780,000 records processed by July 2006 – Duplicates down 4.6% to 1.4% – Missing NHS numbers down 31% to 13% • Foundation skills – European Computer Driving License – 13,000 registered – 25,000 modules passed

Local ‘Readiness’

• Future readiness – Derived from CMiS, IHR and Service Improvement Projects – National work needed e.g. common clinical terminologies / coding • But cannot continue to operate at 65% local allocation • Higher proportion will be national • Local requirements subject to business cases and benefit realisation

Engaging with NHS Wales

• This has been a top priority for the IHC Programme • Stakeholder and communications strategy • Some traditional approaches • But key has been ‘hearts and minds’ through face to face relationships e.g.

– Every organisation visited by Implementation Director at three monthly intervals – Programme funded project managers in every Trust – Residential stakeholder events e.g. National Architecture Event – Stakeholder assurance groups for key projects – Programme Director attendance CEOs meetings – Key strategic thinking explained and tested locally • Position achieved: we are working ‘in common' is the default

Engaging with NHS Wales

• This activity must now ‘ramp up’ further • We must ‘reach down’ further into organisations • Must make use of local internal communication arrangements • Deploy professional communication techniques • Use our health care professionals to engage with professional communities • These activities are resource intensive but a critical success factor in technology supported change

Current Position

• Overall – We have an underinvested and fragmented legacy position (systems and staff) • But … – Programme regarded as moving to new phase and changing pace – Delivery of strategic partner and CMiS foundation phase seen as key – Engagement approach continues to be commended – Trust level and events – Increasing sense of ‘corporateness’, partnership and realism – IHC Programme is increasingly expected to give leadership & direction

Mrs Jones’ Journey

Primary care Home nursing Surgical centre Multidisciplinary team consultation & referral Follow-up Hospice Hospital unit specialist consultation Diagnostic unit Radio/chemotherapy centre investigations pre-operative treatment First case conference Surgery Follow-up Symptomatic care Follow-up second treatment Second case conference Specialist palliative care

Information in silos

Record 1 Record 2 Record 3 Record 4 Record 5 Record 6 Record 7 Record 8 Time

Patient Journey with New Information Services

Primary care Home nursing Surgical centre Multidisciplinary team consultation & referral Follow-up Hospice Hospital unit specialist consultation Diagnostic unit Radio/chemotherapy centre investigations pre-operative treatment First case conference Surgery Follow-up Symptomatic care Follow-up second treatment Second case conference Specialist palliative care

Information in silos

Record 1 Record 2 Record 3 Record 4 Record 5 Record 6 Record 7 Record 8

What have we done so far?

• Network improvements • Improving access to technology • IT skills • Electronic library • Reducing duplicate records • Service Improvement Projects – My Health On-Line – Diabetes Monitoring – Individual Health Record – ‘Out of Hours’ – Transfer of Care Communication

Organising to Deliver

Programme Informing Healthcare Sub-programme Project

NHS business change resources, benefits management National architecture Service improvement projects Individual Health Record Corporate programme resources Projects Projects Projects

IHC Strategic Partner

• Why do we need one? – NHS Wales does not yet have the required collective internal capacity & capability to deliver the programme – There is a need for significant flexibility in constructing teams (skill share, scarce resources) – To scale up and deploy existing services and support new developments – Create momentum as quickly as possible.

The success of this relationship and a combined ability to craft change is of equal importance to the more formal, contractual obligations

IHC Strategic Partner

• Some of the things the partner will do for us … – Joint working with NHS Wales and other countries – Capability and capacity – Hosting services – Management of the catalogue – a restricted choice of common services only – Technical development expertise – Continuity support – legacy

IHC Strategic Partner

• Some of the things they will not do for us … – Overall design – Final choice of systems – Stakeholder engagement – Implementation plan

Supplier Engagement

• To date, open dialogue prior to procurement – Do suppliers fully understand IHC’s approach? – How do suppliers view working with IHC?

– How will suppliers approach securing the market capability and capacity to support the Programme?

– Do suppliers actually have the capability to support the IHC design principles?

– Is the scope of the programme commercially attractive to suppliers?

Approach

• Supplier Day: March 2006 • Phase 1 workshops: May - July 2006 • Phase 2 workshops: July - September 2006 • Intellect UK Briefing: May 2006 • Concept Viability: September 2006 • Issue OJEU Notice: Jan - march • 7 months of constant dialogue with the market place • 20 workshops within supplier community • 50 hours of open dialogue outside workshops • 50+ responses to Prior Information Notice (PIN)

Findings

• Incremental approach of IHC is much welcomed • Catalogue approach best approach to meeting service requirements • Strict governance around management of the catalogue is required, but flexible enough to meet service requirements • Broad support for service orientated architecture approach – helping to leverage existing and new capabilities • Delivery using service orientated architecture approach is relatively untried in healthcare • Strong governance will be needed to balance IHC & the partnership

Investment Decisions

IHC AIMS

Shared view of care World class infra structure Enabling change

Sustained investment ahead of service change Individual Health Record Core foundation services Sustained investment determined by service change priorities Catalogue of information services required to deliver safe, effective and efficient healthcare Regional plans, clinical futures, Delivering integrated services, care close to home

Implementation Strategy and Benefits Realisation

IHC AIMS 0 Timescale for Designed for Life (Yrs) 3 6 Sustained investment ahead of service change

Shared view of care

Individual Health Record Core foundation services

World class infra structure

Sustained investment determined by service change priorities Catalogue of information services required to deliver safe, effective and efficient healthcare

Enabling change

Regional plans, clinical futures, Delivering integrated services, care close to home 9

Implementation Strategy and Benefits Realisation

IHC AIMS

Shared view of care

0 Timescale for Designed for Life (Yrs) 3 6 Sustained investment ahead of service change IHR in emergency care IHR for long term conditions Clinical correspondence via portal MHOL patient access Patient Record Service Sustained investment determined by service change priorities 9

Implementation Strategy and Benefits Realisation

IHC AIMS

World class infra structure

0 Timescale for Designed for Life (Yrs) 3 6 Sustained investment ahead of service change Pt & Carer Emp.

Portal services Data storage & Processing facilities Registration & Audit Authority Patient ID Service (PMI) - home countries & RoI Local and National Messaging Services Legacy Integration Services Patient Authentication for internet access to summary record Mobile and fixed network connectivity for all clinicians Sustained investment determined by service change priorities Scheduling Ordering & Results Rep.

Referrals/Discharge Imaging Pathology National email service Medicines Management Video conferencing, Access to IT, Knowledge & Learning – All Existing Services Cancer Information – Existing Service (CANISC) Readiness – Data Quality, Info Gov. – Existing Services 9

Implementation Strategy and Benefits Realisation

IHC AIMS 0 Timescale for Designed for Life (Yrs) 3 6 Sustained investment ahead of service change 9

Enabling change

Sustained investment determined by service change priorities Regional Plans Clinical Futures Bro Morgannwg Care close to home – (e.g. National Tele-Dermatology & National Minor Injuries Service) Project 2009 Patient Safety Integrated Care Pathways Decision Support