Value-Adding Approach to Lot 2A Service Delivery

The combination of strategic and technical expertise and programme management capability means SCW is a natural partner to support health and care systems to develop integrated care records. Using our experience of developing and deploying five major integrated care record and interoperability programmes across the south of England, we are well positioned to provide expert advice and implementation support to systems across the full range of the programme cycle.

The support we provide includes the following:

  • Strategic advice for solution design
  • Effective implementation support
  • Identifying and overcoming challenges
  • Risk management
  • Compliance with current and future governance requirements

Specifically within this lot, our offer benefits from our established partnerships with leading technology suppliers (including Cerner, Graphnet/System C and Orion) who will provide input into the strategy and technical design of local health and care records. These and other partners such as PA Consulting and Unipart bring extensive experience of collaborative programme development and process reengineering. This allows us to provide end-to-end support for developing local health and care records that covers engagement, strategy, infrastructure, implementation and continuous improvement.

The case study that follows this response describes how SCW is engaging with partners in Bristol, North Somerset and South Gloucestershire STP to develop a digital strategy to meet the evolving needs of the health and care system. It shows how we are working at multiple levels in the system, supporting leaders to plan, manage and evaluate change, developing person-centred care models, driving digital integration, and piloting innovative approaches to system-wide ways of working.

While we have the ability to produce credible and thought-provoking reports and plans, we invest most energy in actually delivering and embedding change in the fabric of a local health and care system. We are passionate about creating beneficial change at the front line. We take accountability for delivering transformation outcomes, and we optimise sustainability by ensuring that local care teams are fully engaged in the process. We have an appetite for sharing the pain and pressure of change, which helps build commitment, motivation and resilience in the individuals delivering it. This is our definition of partnership working.

Extended Case Study: Digital Strategy Development for Bristol, North Somerset, South Gloucestershire (BNSSG) STP

Following completion of the Local Digital Roadmap for BNSSG in 2016, SCW reported that delivery of the ambitions set out in the Roadmap would be reliant on revisions to the leadership, governance and delivery model of the STP Digital work stream. As a result, the BNSSG STP Executive commissioned further work to support the development of the BNSSG Digital Transformation Strategy. They were keen to build on their previous digital successes, such as the Connecting Care LHACR programme also managed by SCW. This BNSSG them to name the resulting Digital Transformation strategy that ‘Building on Success’.

Through extensive engagement and co-creation with partners across the system, SCW produced a coherent and achievable digital transformation strategy and roadmap that would improve joint working and sustainability and deliver 19% savings on digital spend – bringing the STP back in line with its planned operating budget.

While previous digital transformation and interoperability initiatives in the region had improved performance and value, there was a need to develop a single, coherent strategy to facilitate closer working between all system partners, to align and de-duplicate digital initiatives in train, and to drive out the short and long-term efficiencies required by the STP plan. The required outputs included a baseline of digital and technical architecture capabilities, a strategic plan, and a framework for transforming digital services across BNSSG for the next ten years.

 

SCW worked collaboratively with partners across the whole system, building close working relationships and acting as a ‘broker’ to ensure that local stakeholders were able to achieve their digital ambitions within the context of the overarching transformation strategy. To improve this engagement process, we developed a shared vision and goal for digital development and established a common language so that health and non-health partners could communicate effectively. This enabled us precisely to map all existing systems, architecture, suppliers and programmes within the system, as the basis for evaluation and planning. 

Providing a flexible, multi-disciplinary support team for the eight-month project (including Digital Transformation, IT, Finance, Communications and Marketing skills) ensured that STP leaders had cost-efficient access to the expertise they required at every stage and brought pace to each of the core activities – stakeholder engagement, research and analysis, data collection, financial analysis, budget management, and report production. As well as driving performance and on-time delivery, our experienced leadership team linked seamlessly into the STP governance structure to provide strategic advice and guidance where needed and to maximise visibility and control of the programme for the STP Executive.

To strengthen the strategic plans we developed and ensure the STP benefitted from wider learning, we supplemented our own technical and sector expertise with a deep analysis of digital transformation and interoperability solutions successfully delivered in other national and international health economies and other non-health sectors.

SCW produced a series of reports and recommendations as part of the ‘Building on Success’ strategy, which were based on the research and analysis we conducted. These reports indicated that the digital and IT infrastructure across BNSSG was sub-optimal and at risk of remaining that way because of a lack of system-wide strategic planning, limited interoperability, and divergent development programmes with duplicated activity and misalignment between outcomes.

As well as the baseline position, the report identified six themes for transformation across BNSSG including a proposed governance structure to oversee delivery of the plan and ensure that digital transformation was a core component of the STP: a full financial plan, recommendations for a unified interoperability programme and a convergence programme, and how to build commitment to further co-operation across BNSSG to deliver this digital strategy. Within the financial plan, we identified that savings of £7.8m to £9.7m per year would result from the STP adopting the approach outlined in the report, representing 19% of their current spend and bringing them back in line with their planned operating budget.

This extensive engagement has given SCW an excellent understanding of the goals, priorities and working preferences of partners across the system – insight that we are now using to drive delivery of the digital strategy and other services we provide in the region. Particularly relevant is the learning we gained regarding viable governance frameworks for co-design, delivery and management of technological change. We continue to support these organisations to de-duplicate their development plans and converge their digital priorities and plans.

This truly is a superb piece of work.

Sir Ron Kerr, BNSSG STP Chair

This really is a fantastic piece of work, I mean really fantastic. For the first time ever we have a picture of the whole BNSSG system. Digital is leading the way – we need this for every other area.

Andrea Young, CEO, North Bristol NHS Trust

Andy’s team led by Paul Arrigoni have done a stunning job of pulling this together, I am very grateful for their work.

Robert Woolley, CEO University Hospitals Bristol NHS Foundation Trust, STP Lead, Digital SRO

How We Work with Partners in Lot 2A

Specifically within this Lot, our offer benefits from our established partnerships with leading technology suppliers (including Cerner, Graphnet/System C, and Orion) who we have worked with to deliver several major integrated care record and interoperability programmes across the south of England. These organisations will provide input into the strategy and technical design of local health and care records. PA Consulting brings extensive expertise in strategies and solutions for digitising healthcare, for example providing essential support on the development of the system-wide architecture model for Hampshire and the Isle of Wight. Other partners such as Cerner and Unipart bring extensive experience of collaborative digital programme development, system deployment, and process reengineering. SCW is therefore able to provide end-to-end support for developing local health and care records that covers engagement, strategy, infrastructure, implementation and continuous improvement.

Case Studies

When supporting a health and care system to design and establish a Local Health and Care Record (LHACR) solution, SCW offers deep strategic and technical expertise, combined with a rigorous programme management methodology, that we have used to develop integrated care records for several major health and care systems. Our teams have been central to the development and deployment of five major integrated care record and interoperability programmes - Connected Care (Berkshire/Frimley), the Hampshire Health Record, Joining up Your Information (Gloucestershire), the Oxfordshire Care Summary, and Connecting Care (Bristol, North Somerset and South Gloucestershire). This covers a total population of more than 5 million. 

“The support which SCW provides has been critical to the development of our Integrated Care System. An example is SCW’s support to the development and delivery of the Connected Care shared care record programme. The development of a shared care record is a central building block to the overall development of our ICS – and to the realisation of our transformation plans for the system – and SCW’s support to us on this programme has been excellent.” Nigel Foster, Director of Finance and IM&T, Frimley Health NHS Foundation Trust

Our approach has been refined based on the extensive learning these programmes have generated. It enables us to provide expert advice and implementation support across the full programme life cycle; from strategy definition and setting the digital vision, stakeholder mapping and engagement, technology design, business case approval, procurement, contract management, information governance, change management and benefits realisation. To provide effective and broad ranging strategic advice, we continually enhance our expertise and insight into the national ‘direction of travel’ by supporting and advising NHS England programmes relating to interoperability, target architecture, personal health records, cancer digital programmes, and local health and care records. This has included preparing the business case analysis for the national LHACR programme. 

This early wave Integrated Care System (ICS) asked SCW to support development of its LDR. We rapidly engaged and explored the context and needs of the STP through close engagement with stakeholders. We developed the LDR in close liaison with the parallel creation of the STP plan so that the digital programme aligned to support STP priorities. Following this, we supported the creation of a Digital Programme for the STP, focussing on work stream definition and governance. 

Through a competitive tender in mid-2017, we were appointed to develop an Options Appraisal for how the STP and emergent ICS would create the target architecture to meet multiple goals for use of information. We are now leading work on the Outline Business Case to enable the progression to investment and delivery of the programme. This has entailed close links with the three Global Digital Exemplar (GDE) programmes in the area to create a preferred option that aligns and converges the focus of STP-wide requirements with key elements of GDE programmes, such as records-sharing and intelligence. The favoured option is based on applying open platform architecture, looking to deliver the significant benefits of a vendor-neutral platform. 

“BLMK STP has established a very successful relationship with SCW on the basis of their in-depth knowledge of technical architecture and the role digital capabilities can play in system transformation. With excellent partnership working, they have worked across our system on a range of strategic projects such as delivery of a single digital roadmap with delivery plans, a clearly defined options appraisal for architecture to support shared care records, and population analytics. They have demonstrated good engagement with partners in developing solutions which are then clearly articulated. They have managed to work flexibly with the relevant people as they were needed, to ensure each project’s timely progress.” Pam Garraway, BLMK STP Programme Director, Luton Borough Council.

Having been central to their digital programmes for many years, SCW recently led the design and delivery of a major review of systems, connectivity and data flows across this large footprint (extending to include Swindon).  This work is proving highly valuable as the combination of STPs and early wave ICSs in the area look to collaborate on digital strategy and potentially on the Local Health and Care Record programme (LHACR). 

We supported the system to identify key priorities and service transformation initiatives, before connecting with the leaders of those programmes to explore the clinical and business requirements that digital strategy could enable. We also brought insights from our horizon scanning, market intelligence, and knowledge of the evidence relating to technology interventions in health (e.g. our liaison with Microsoft and the ‘wearables pilot’ in Frimley as outlined below) to help shape the prime opportunities and candidates for the content of the digital programme which target the system’s priorities.  We are currently supporting a number of areas to explore the benefits and opportunities of adopting an open platform model for system-wide technology architecture.

Through our work on integrated care records and interoperability, SCW has developed strong relationships with leading technology suppliers who are expert in providing the digital infrastructure services specified in Lot 2B. These partners (including Cerner, Graphnet/SystemC, and Orion) can input to key elements of LHACR strategy and technical design and we introduce them to ICS/STP customers and programmes where they increase value. The Graphnet/SystemC Alliance is a material sub-contractor for LHACR strategy and implementation support, bringing extensive experience of collaborative programme development and delivery with SCW in programmes across the UK, including Hampshire and Berkshire, as well as other UK health and care systems and across related technologies such as child health records systems and acute EPRs. .  PA  Consulting are a further material sub-contractor, bringing extensive expertise in strategies and solutions for digitising healthcare, for example providing essential support on the development of the system-wide architecture model for Hampshire and the Isle of Wight STP.

As well as material co-delivery partners, SCW gives ICS/STP customers rapid access to a broad range of pre-vetted technology suppliers through our dynamic purchasing system. This is convenient for suppliers, SCW and our customers, as it gives us ready access to hundreds of companies who have already been through a qualification process, reducing the time it takes to award contracts. This means we can easily engage co-delivery partners to provide extra capacity and/or specialist skills relating to the requirements of each programme.

The development of at-scale LHACR presents significant challenges around ensuring and demonstrating compliance with Information Governance (IG) standards and developing confidence over the handling of data with patients, service users, the wider public, and care-professionals. We have developed an implementation methodology that promotes extensive early engagement with all partners in the system, using our pool of experienced professionals in digital transformation and related technical disciplines such as IG to give each ICS/STP has access to the capacity and capabilities they require to succeed. 

SCW brings a wealth of experience into the system relating to overcoming IG issues during the delivery of several major integrated care records programmes, including Connected Care (Berkshire/Frimley), the Hampshire Health Record, Joining up Your Information (Gloucestershire), the Oxfordshire Care Summary, and Connecting Care Bristol, North Somerset and South Gloucestershire (BNSSG). A number of these programmes go beyond a strict focus on sharing data to support direct or individual care, and into areas such as risk-alerts and clinical analytics (for example providing frailty index scoring). Our IG support service adds rigour and insight as systems seek to address the use of information for multiple purposes, along with their strong connections into national policy development through continual liaison with NHS Digital, the Information Commissioner’s Office (ICO), and the office of the National Data Guardian.

SCW conducted a comprehensive IG compliance review for the Symphony PACS Vanguard data set in South Somerset. Because of our scale, we were able to use an independent IG team that had not been involved in the initial development project, and whose role was to critically review and confirm legal compliance for the project. They were also tasked to provide clarity on information ownership, access, safeguards and privacy impact assessment processes. The ultimate aim of the review was to establish the legal basis on which GPs would share patient data for use in the Symphony database; how SCW would link GP data with SUS and Social Care data; and whether underlying data flows, information sharing agreements and privacy impact assessments were appropriate. The final report confirmed compliance and recommended additional work and a regular review programme to ensure the system remained compliant as the project continued and extended in scope. 

Subsequently, working in conjunction with the national New Models of Care (NMOC) IG lead, we supported Somerset as an IG test site for NHS Digital’s DARS process. In December 2016, Dr Geraint Lewis from NHS Digital visited Somerset to run a workshop with key stakeholders. In January 2017, we supported Somerset to complete an NHS Digital IG Audit where Symphony data was a key area of scrutiny. As part of that process, we facilitated a full-day workshop in Leeds between NHS Digital, NHS England’s NMOC team, and representatives from Somerset and SCW to validate the application and associated IG plans. 

Our Symphony data analysts and in-house data management leads have worked with NHS Digital to develop a DARS-compliant framework for integrated data. These proposals went for NHS Digital IGUARD approval in March 2017 and SCW was the first integrated data proposal in the country to receive approval. NHS Digital has subsequently shared our IG solution widely.

“I've just been at the Vanguard PACS IG event where NHS Digital used our diagram as an example of good practice!” Jeremy Martin, Symphony Programme Director, Yeovil District Hospital NHS Foundation Trust.

An example of good practice in this area is the user adoption of local health and care records within the health and care systems we support. SCW has demonstrated how the adoption and use of this information is dependent on the following elements, which are now designed into our standard approach: 

  • The information that is available; making sure the content in the record is relevant and valuable to users. 
  • The ability to launch the record securely from a user’s source system, without the need to log into another system and remember another user ID and password.
  • The facility to directly access the patient record without the need to search for a patient.
  • User interfaces and work-flow within the shared care record being aligned with and based on user needs.  
  • A sound basis for governance and partnership working across the programme, as user-adoption involves input and engagement with multiple parties. 

In many cases, the integration is so seamless that users are not aware that they are now operating in an external system rather than a module of their line-of-business system (for example a Trust EPR). An example of this in operation is the integration between the community and mental health system in Hampshire and the Isle of Wight (HIOW) and the Hampshire Health Record (HHR), which holds GP, acute hospital, social care and other information about patients. The community provider for Hampshire is Southern Health Foundation Trust (SHFT). Following the success of similar work for other systems, we began integration work with SHFT in December 2016. The work was to introduce a direct link into the main case record in use across the Trust, as can be seen in the screenshot in Figure 21.1. 

SHFT began a pilot in one of their localities in April 2017 and, following an evaluation period, the remaining Trust users went live in September 2107. Access to the HHR gives community and mental health staff immediate access to their patients’ full medical history, enabling clinicians to deliver more holistic, integrated care. 

For example, if a patient presents in the emergency department with shortness of breath and confusion at 3am, clinicians are able to view their GP records to see what their social situation is, whether the patient has recently visited their GP, whether their medication was changed, and which medicines are prescribed for the patient. This enables better care to be provided and can reduce duplication and waste.

Feedback from community staff was very positive. Having a system that is accessible and easy to navigate results in more people using it, and this, in turn results in patients receiving better care. This can be seen in Figure 21.2, which shows the uptake of access to the HHR over the course of 2017. The average use during the period increased by a factor of 10 from around 2,000 documents accessed per month to more than 20,000.

In Bristol, North Somerset and South Gloucestershire (BNSSG) SCW has worked with Orion, the main system-supplier for the Connecting Care Programme. The integrated digital care record unifies citizen information from across 18 systems into a single view. Connecting Care can now be accessed by 3,628 authorised professionals from a wide range of groups from GPs, nurses, occupational therapists, pharmacists, social workers, care of the elderly and out of hours to pathologists, anaesthetists, homeless health service, community discharge and emergency care staff. The number of records viewed per month is steadily growing, hitting 17,596 in January 2018. The programme is constantly adding new functionality and data sets. Initiatives currently underway include consolidated medication history and a Patient Demographic Service Spine cohorts interface to allow demographic changes to be updated in the Enterprise Master Patient Index more quickly.

“It was amazing having this resource over the long weekend. I was able to access information about a patient’s usual insulin regime when she was severely unwell and not able to communicate with us”. Joanna Latimer, Pharmacist, North Bristol Trust

To encourage wider and continued use of the LHACR, we monitor and share usage information with key programme stakeholders. Together, we can then identify areas of poor uptake and plan how this should be addressed. 

We can also monitor trends, which alert us to areas where, for example, usage was high, but is reducing. This would require a different type of intervention to explore the underlying causes and agree how these obstacles can be overcome. Figure 21.3 is an example of the kind of usage information that we share with the Connecting Care programme board in BNSSG on a monthly basis to highlight usage and uptake across partner organisations.

SCW has worked with a range of technology suppliers on a number of major local care records programmes to integrate data from multiple health and care providers and deliver benefits for patients, care professionals and commissioners. Connected Care in Berkshire / Frimley was built using Graphnet's CareCentric solution, and is now providing integrated data for 18 health and social care partners across Berkshire. The programme oversaw the design of an interoperability solution that provides unique opportunities for health and social care providers to access whole-system data analytics. The Connected Care solution went live in February 2017. It is currently a read-only shared care record with more than 700 active users, accessing 3,000 to 5,000 records a month. This increases each month as new data feeds go live. The clinical data repository is the basis for a range of capabilities: 

  • Integrated care record for use by health and social care professionals accessing under role-based access control 
  • Patient and carer portal / Personal Health Record (PHR) 
  • Data for clinical analytics and risk-modelling to support direct patient care, with plans to apply machine learning methods.

“The support which SCW provides has been critical to the development of our Integrated Care System. An example is SCW’s support to the development and delivery of the Connected Care shared care record programme. The development of a shared care record is a central building block to the overall development of our ICS – and to the realisation of our transformation plans for the system - and SCW’s support to us on this programme has been excellent.” Nigel Foster, Director of Finance and IM&T, Frimley Health NHS Foundation Trust.

Want to see more

Why not browse the entire SCW case study library ?

SCW Case Studies