Value-Adding Approach to Lot 3 Service Delivery

Through providing IT and information services to CCGs, primary care (more than 1,000 GP practices across the south of England), community providers and STPs, SCW is experienced in ensuring digital initiatives and IT service infrastructure add measurable business value. This can be evidenced by the Local Digital Roadmaps (LDRs) that SCW has developed for 10 health and care systems, the ‘de-risking’ of essential IT infrastructure across the south of England to deliver better standardisation, resilience, efficiency and security, and our ‘single-domain’ approach for integrated clinical working. 

Our capability and experience is embedded in our core IT operating model and covers asset management, service desk, client device management, disaster recovery, telephony and mobile devices, information and system security, remote access services, network services and storage and server management – delivered by a team of more than 200 highly qualified technicians. Systems gain value from our ability to provide an end-to-end ICT infrastructure support service: 

  • We believe that the purpose of a digital strategy is to support and facilitate service transformation and support improvements to the quality and safety of patient care.
  • We have supported health and care systems to identify key priorities and service development initiatives, and then explore how the digital strategy could support delivery of their objectives. 
  • As an early adopter of CareCERT Assure, SCW can reassure customers that our processes and policies can operate across organisational boundaries, be applied at scale, and comply with cyber security standards. 
  • Through ‘single domain’ IT support, we can join-up health and care system to facilitate clinical integrated working, single sign on, access to records from any location, and solutions like ‘pop-up practices’.
  • We support the ‘seven-day NHS’ through a focus on improving system reliability and ‘de-risking’ the technical infrastructure.
  • Where support is required to source, test and procure IT equipment, SCW has the infrastructure and expertise to provide this.
  • Our IG specialists will also be able to ensure that solutions comply with current and incoming legislation at every stage.

The case study that follows this response describes a major IT mobilisation programme in the Surrey health and care system. We completed this major transition programme on time with no interruption to the provision of critical primary care services. As well as a strong record of successful mobilisation, our ongoing support maximises value by delivering the same service at a lower cost or better service at the same cost. 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 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: Mobilising IT Services for Surrey Heartlands STP and East Surrey CCG

SCW migrated four Surrey CCGs onto a new IT infrastructure in just five weeks, including the mobilisation of 637 user accounts and re-imaging 668 devices. We completed this major transition programme on time with no interruption to the provision of critical primary care services. 

In June 2017, SCW was awarded an LPF call-off contract to deliver IT Services to the Surrey Collaborative comprising East Surrey, Guildford and Waverley, North West Surrey and Surrey Downs CCGs, and their 111 member practices. Following the development of a detailed Project Initiation Document (PID) for mobilisation, we initiated the background infrastructure work almost immediately. However, external factors linked to the customer’s previous contract meant that the go-live date was not finally agreed until October. This gave us a five-week window in which to transition services away from the incumbent supplier and into our own organisation. To deliver in such a short timescale required excellent partnership working with the CCGs’ and dedication and commitment from SCW staff based across the geography.

For Surrey, our proposal was for SCW to deliver the overarching IT contract, while sub-contracting the GP IT technical service team to our strategic partner, Healthcare Computing (HCC). Across the south of England, SCW uses either in-house technicians or third-party services like HCC depending on what is the ‘best fit’ for the system concerned. In Surrey, one CCG has already received support from HCC and were very pleased with this service, so we decided to extend that service to the other CCGs in the system.

HCC is an ISO 9001:2008 accredited LPF supply chain partner. They specialise in delivering at scale NHS IT Infrastructure and Support services to CCG and GP customers to improve digital maturity and patient care in the NHS. SCW has a long-standing working partnership with HCC (over 12 years) and has a proven record of delivering GP IT support services in partnership across 500 GP Practices in the south of England.

“As a long established partner of SCW, Healthcare Computing are delighted to support their bid for this framework opportunity and look forward to continuing to work with them successfully in the future within the Primary Care IT arena.”  Matthew Trudgill, Director of Business Development, HCC.

SCW provided IT Support, overall system management, digital strategy, IT projects and programmes, and IT training. HCC provided the on-site technical support at GP practices. Working with SCW’s expert HR team, we jointly facilitated the TUPE transfer of existing NHS employed technicians directly from the legacy GPIT provider to HCC.

We installed the same WiFi in all four HQ sites, removing the need for staff to re-log onto the network when they attended meetings or visited their colleagues and fully supporting current mobile working requirements. This was particularly helpful subsequently when three of the four CCGs announced they were merging. All re-imaged PCs and laptops were upgraded to Windows 10 and all devices were configured to maximise the benefits of NHSMail2 by introducing Skype for Business Instant Messaging and Presence Detection. Successful transition away from unsupported, easily corruptible traditional email storage systems to a bespoke mail archiving tool reassured the CCGs that archived mails were now backed up and fully recoverable, and gave them options to manage mailbox sizes.  

As part of the mobilisation, we also mobilised primary care enabling services for General Practices across Surrey providing effective and efficient services in role-based access, Information Governance, local administrator of NHSMail support service, and clinical safety assurance.

The transition was executed smoothly within the given tight timescales illustrating the dedication and commitment from SCW staff based across the geography and excellent partnership working with the CCGs. The feedback from the customers was extremely positive in relation to SCWs provision of large support teams on the ground during the mobilisation and the team’s ability to deal quickly with any issues that arose.

The transition was executed smoothly within the given tight timescales illustrating the dedication and commitment from SCW staff based across the geography and excellent partnership working with the CCGs. The feedback from the customers was extremely positive in relation to SCWs provision of large support teams on the ground during the mobilisation and the team’s ability to deal quickly with any issues that arose.

Lisa Topper, Performance Analyst, Business Intelligence, Guilford and Waverley CCG

Wi-Fi is splendid, and I’ve had lots of positive feedback from the staff.

Elaine Stevens, Head of Corporate Services and Risk, Guilford and Waverley CCG

The rollout of the IT transition for Guildford and Waverley was in my opinion, one of the smoothest transitions that I have ever observed! Clearly, there was significant upfront time and investment from all parties in understanding the localisms of the CCG and how these might be affected during the transition. In particular, for the Business Intelligence arm of the CCG, this is highly dependent upon the IT infrastructure, and there was a seamless continuity of service from day one of the transition for myself and all my team. I can already see the benefits that this new contract and partners will bring and I want to thank everyone involved in making this happen so effortlessly.

David Howell, Head of Performance and Information, Guilford and Waverley CCG

How We Work with Partners in Lot 3

We will continue working with organisations such as Healthcare Computing Services (HCC), Dacoll or ABS Computing Services to deliver local IT engineering services. To deliver an integrated service for a health and care system we also work with NHS Acute Provider IT departments such as those at Oxford and Gloucester. Our partnering approach to engineering support is flexible to suit the requirements of each system. We currently provide in-house GPIT engineering support and for some systems while elsewhere we sub-contract.

Case Studies

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.

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 previously ‘de-risked the infrastructure’ in the Bristol locality, SCW identified a programme of work to consolidate and standardise multiple data centres and data centre technologies across the STPs of Bristol, Somerset, Hampshire, Gloucestershire, Wiltshire and Thames Valley. In order to remove operational risks and increase service availability and flexibility, our programme objectives were to consolidate from 12 data suites to a maximum of four fit-for-purpose data centres across three legacy health areas, as well as improving capabilities around performance, future-proofing and flexibility.

We undertook an exercise to identify all the legacy shared infrastructure from across the regions and developed a transition approach to achieve a common dynamically resilient scalable single architecture. We have engineered a single approach architecture with dynamic failover routing technologies triangulated between all data centres enabling fast and efficient failover Disaster recovery (DR) and Business Continuity (BC) capabilities across all supported service user areas.

Working with numerous Wide Area Network (WAN) service providers, a resilient WAN architecture was re-engineered through upgrading and relocation and redundant services were ceased to realise ongoing operational savings. Services have been transitioned from proof of concept to production without impacting service users, utilising where possible the redistribution of existing core infrastructure to maximise the return on investment.

Using PRINCE2 and MSP methodologies with Agile approaches to deliverables, the programme has delivered real benefits in terms of improved service availability and capabilities. Early engagement with key stakeholders was delivered through a series of workshops and a simple to understand short video that could be shared and understood at all levels. Further benefits have been seen in technical staff coming together sharing knowledge and working closely across previously separate geographical and organisational areas delivering a common solution.

Outcomes: The entire Southampton and Portsmouth Primary Data Centre was relocated from its location at St James Hospital, Southsea and consolidated into to the SCW Data Centre located within University Hospitals Bristol Foundation Trust Tier 3 Data Centre. In addition, a single common architecture has now been adopted across the four remaining legacy area data centres reducing risks, and increasing service availability and performance, while enabling capabilities of providing Infrastructure as a service to customers efficiently agnostic of location. We further implemented a fit for purpose domain, highly available, scalable and future-proof infrastructure for the consolidation of all legacy BI applications, enabling improved service user access from numerous customer domains. The programme has delivered cashable savings through consolidation and increased service availability times – £10k for Phase 1 in 2018/19 with Phase 2 forecast to deliver £100k in 2019/20.

SCW identified that the physical IT estate providing systems to the wider health care community in Bristol, North Somerset, Somerset and South Gloucestershire was in need of substantial investment and a new focussed approach to meet the changing needs of the primary care environment. We partnered with University Hospitals Bristol Foundation Trust to leverage their tier 3 data centre and embarked on an IT roadmap to consolidate and optimise IT service delivery arrangements.

During 2015, we undertook a large-scale re-location exercise to move the IT infrastructure services from a number of disparate locations and devices into two consolidated data centre-based solutions. We delivered this without any unexpected impact on users, which included: installing nine server racks, 160 mains power sockets, more than 3,000 metres of fibre optic cables and 1,800 metres of Ethernet cables; connecting more than 700 network ports and physically moving 14 high-power servers and disk storage totalling more than 300 terabytes; moving 192 virtual servers and 682 databases totalling around 14 terabytes of storage.  Simultaneously, we undertook replacement of infrastructure at our second data centre with new state-of-the-art high-performance servers, new high-speed and high-capacity storage, an upgraded virtual server environment, upgraded high-speed communication infrastructure, and new backup technology enabling much faster back-up and restore times and real-time replication at our DR site.  

The effect of this investment has been a 50% reduction in major incidents with CCG IT services and the delivery of a platform to consolidate GP IT infrastructure to reduce ongoing costs in the future. We are progressing with further work to further improve DR capabilities and responsiveness by replicating these two high-level data centre solutions. We are also embarking on a programme of work to all remaining CCGs supported by SCW so that they benefit from this state-of-the-art and highly resilient solution.

SCW was heavily involved in protecting health and care systems from the May 2017 Wannacry cyber-attack. We currently provide IT services for more than 1,000 GP Practices (10% of the national total), 27 CCGs, four community social enterprises, two private community providers, an NHS hospital trust, an NHS mental health provider and a local authority. Our rigorous security patching policy resulted in minimal exposure and a more limited impact for these customers than for many other NHS organisations. 

Within 30 minutes of initial detection in Spain, SCW’s cyber security service detected infections in local GP practices. Initially treated as a Priority 1 incident according, we soon escalated as it became clear this was a major cyber-attack. We implemented our full Business Continuity plan and deployed Bronze, Silver and Gold response teams. Our fully documented and tested IT Service Continuity Plan worked as designed. The command and control centre in our Taunton IT engineering and storage facility was available 24/7 and fully networked. Our engineering teams were able to work remotely and communicate using WebEx to share screens, voice and video, which were invaluable and all available on a single platform.

Recovery actions were rolled out immediately and over the next three days. These included contacting customers and keeping them informed, isolating IT services from the N3 network, applying software patches, and effecting ‘roll-back’ in 18 of the 878 practices we support – where infections had been detected. This lead to successful recovery of data at each site. There were no incidents reported across any of the datacentres that SCW supports. Somerset CCG rated our performance 5 out of 5 and recognised the benefits of recent IT infrastructure upgrades, a sentiment echoed by other organisations we support: 

“I am glad we have been unaffected. I suspect Single Domain has enabled all of our Windows PCs to remain up-to-date with the latest patches.” Rishi Mannan, CCIO, Windsor, Ascot and Maidenhead CCG

“Many thanks for your efforts in what must have been a difficult weekend for your department.  We appreciate your hard work in keeping us going.” The Partners and Staff of Close Farm Surgery

NHS England praised SCW’s response, particularly around how decision-making and regional control of status updates was coordinated centrally, and how local teams were kept suitably informed to enable them to take the necessary mitigating actions. Following the Wannacry incident, we developed a report for system stakeholders that identified further actions and recommendations to improve future responses, which have now been implemented by SCW as follows: 

  • Shortening the software patch acceptance testing cycle taking into account the increase in risk that this creates 
  • Removing the ability for staff to indefinitely postpone the application of updates 
  • Standardising management tools across the estate so engineers need only contend with one platform in an emergency
  • Reviewing investments in vulnerability and patch management software to assist operational teams
  • Increasing checks on customer contact details – given challenges in contacting ‘on call’ customer staff
  • Bringing all third party suppliers of IT services to SCW under one set of contractual terms to ensure response and access in the event of a business continuity incident, which was completed by the end of October 2017.

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