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Evidence in response to Public Accounts Committee inquiry into the Wales Audit Office Report on Informatics systems in NHS Wales:
Steve Ham, Chief Executive, Velindre NHS Trust and Andrew Griffiths, Director of NHS Wales Informatics Services |
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Contact |
Steve Ham, Chief Executive, Velindre NHS Trust Phone: 029 2019 6175 Email: Steve.Ham2@wales.nhs.uk
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Date: |
16th April 2018 |
Wales Audit Office Report on Informatics Systems in NHS Wales
Introduction
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Velindre NHS Trust and NHS Wales Informatics Services |
1. Velindre NHS Trust and NHS Wales Informatics Services (NWIS) welcome the opportunity to contribute to the Public Accounts Committee inquiry into the Wales Audit Office Report on Informatics systems in NHS Wales. We recognise that digital technology and information are essential enablers in the transformation of health and care for the people of Wales. This was set out in Informed Health and Care - A Digital Health and Care Strategy for Wales (2015) and has been further emphasised by the recently published A revolution from within: Transforming health and social care in Wales (the Parliamentary Review of Health and Social Care in Wales, 2018). NHS Wales has made significant progress since the publication of Informed Health and Care and we expect the pace of delivery to accelerate as a result of a number of improvements we have recently made.
2. Velindre NHS Trust and NWIS contributed to the Welsh Government (WG) response to the Wales Audit Office’s report and support the acceptance of each of the 13 recommendations and the actions outlined. We believe that we have made progress on a significant number of the Wales Audit Office recommendations since the field work was completed in 2017 and further improvements are already underway.
3. We recognise that implementing changes enabled by new information systems and technology are not just technical and require changes of culture, behaviours and working practices across organisations. As a result, responsibility does not lie with NWIS or Health Board’s and Trust’s informatics services alone, and are equally dependant on wider organisational leadership and engagement with staff and the public. We continue to work closely with NHS, Local Authority and WG policy colleagues in agreeing and delivering these improvements.
4. WG has committed to publishing a new long- term plan for health and social care in Wales in the spring and there has been extensive engagement by colleagues across health and social care in shaping that response. During this process we have highlighted the potential role for informatics and digital technology to play a central role in delivering the quadruple aim and the priorities set out in the new long-term plan.
Question 1 -The Welsh Government’s leadership role for informatics in NHS Wales, including, for example, ensuring NHS bodes agree what ‘Once for Wales’ means in practice.
5. We will address the issues of wider informatics leadership and ‘Once for Wales’ separately:
Leadership within informatics
6. The delivery of the Informatics strategy across NHS Wales is built on collaboration between WG, Health Boards, Trusts and the NHS Wales Informatics Service (NWIS). We both have key leadership roles within the informatics in NHS Wales.
Steve Ham – Velindre NHS Trust
7. In addition to his role Chief Executive of Velindre NHS Trust, which is the host organisation for NWIS, Steve is also the lead NHS Chief Executive for Informatics (each Chief Executive takes in national leadership and coordination roles for specific areas). Steve is also the joint senior responsible officer for the delivery for Informed Health and Care (with Peter Jones, Deputy Director Digital Health and Care, WG Health and Social Services Group).
Andrew Griffiths - NHS Wales Informatics Services
8. Andrew is Director of NWIS and in addition to his responsibility for managing NWIS he is also the programme director for the delivery of Informed Health and Care. While NWIS is hosted within Velindre NHS Trust, for the delivery of services provided by NWIS the Director is managerially accountable to Frances Duffy in WG (Director of Primary Care and Innovation, Welsh Government Health and Social Services Group).
9. Both Steve and Andrew are members of NHS Wales Informatics Management Board (NIMB), which oversees informatics across NHS Wales. NIMB is a Portfolio Board accountable for the delivery of programmes (and projects) established to support the delivery of the Informed Health and Care Strategy (the programmes) and creates an environment where programmes can succeed in delivering the changes necessary for the benefits to be realised. NIMB provides assurance and advice to WG, and reports directly in to the NHS Wales Executive Board on all aspects of informatics.
10. Both Steve and Andrew have worked together with WG colleagues to develop a wider group of informatics leaders: Executive Director leads for Informatics; Assistant Directors for Informatics; Clinical Informatics leads and NWIS Directors, through NIMB and the introduction of an annual strategy conference, regular strategy workshops and to share good practice and aligning local and national priorities. The Assistant Directors for Informatics peer group has also been developed and is now recognised as an advisory group to NHS Chief Executives.
11. The four work-streams of the informed health and care strategy are now well established. Strategic Leads have been appointed to head up each of the work-streams and ensure that appropriate governance and reporting arrangements to NIMB are in place.
12. Each Health Board and Trust has been strengthening clinical leadership locally in informatics. The recently established a Clinical Chief Information Officer Network, facilitated by the NWIS, will play an important role in the further development of these clinical leaders.
Once for Wales
13. The definition of ‘Once for Wales’ agreed by NIMB was developed through a collaborative process and is owned across health boards, Trusts and NWIS. “Once for Wales” is about “all parties involved in health and care in Wales working collaboratively, to add value and deliver the strategy of a single electronic patient record, ensuring that information is entered once and is made available to all those who need it, at the time and place they need it”.
14. Its combination of commitments common standards; national repositories and services; and applications is powerful and will help us accelerate the pace of change and the delivery of benefits for patients, for clinicians, for service delivery and policy development, across the NHS in Wales.
15. We welcome and support WG’s plans to establish a new Welsh Technical Standards Board (WTSB). This will lead and accelerate work on agreeing the use of common standards, which is critical to delivering the commitments in Informed Health and Care and will enable further integration of data across all health and care systems (and delivering the Once for Wales definition).
Question 2 - The work the Welsh Government is doing to better understand the costs of delivering its vision for informatics and how that could be funded given the downwards trend in spending on ICT and the £484 million estimate of the cost of delivering the vision for informatics on top of current budgets.
16. The development of Strategic Outline Programmes (SOPs) for informatics within each NHS organisation is a major step forward which, along with the increasing focus on informatics within Health Board’s and NHS Trust’s Integrated Medium Term Plans (IMTPs), has supported the development of the National Informatics Plan 2018/19, agreeing the highest national informatics priorities, and will help inform WG allocation of capital resources in 2018/19.
17. It is also important to recognise that while both capital and revenue funding will inevitably be a constraint, our ability to recruit and retain staff with the skills we need for informatics and service change, within NWIS and the wider health and care system, are also a key constraint. Prioritisation of our investment of staff time, and funding, will therefore remain critical. The development of the National Informatics Plan 2018/19 will be a major step forward in this and the publication of health and social care long-term plan in the spring will allow us commence the development of a 3 year National Informatics Plan for 2019/23.
18. We support WG plans to undertake a robust assessment of the investments required; the predicted business benefits; evaluate alternative funding models and savings opportunities; and the engagement of Health Boards, NHS Trusts and NWIS in this work.
Question 3 - The extent of resourcing and investment at a local level.
19. There is increasing evidence of the importance placed in informatics in service improvement in the national delivery plans groups and in each NHS organisation’s IMTP. The development of Strategic Outline Programmes (SOPs) for informatics within each NHS organisation has laid out the scale of the challenge facing the NHS nationally and locally.
20. We recognise that it is important for us to align national and local investment to accelerate progress. NIMB informed the prioritisation of £10M capital investment in national and local informatics, in 2018/19, to improve cyber-security and the acceleration of the roll out of national clinical systems and have committed to develop pan Wales plans for investment in informatics infrastructure and cyber-security in 2018/19.
21. The future publication of the WG health and social care long-term plan will allow us commence the development of a National Informatics Plan for 2019/23, to help further align national and local investment in informatics across health and social care.
Question 4 – The effectiveness of governance and accountability arrangements in light of concerns identified by the Auditor General and the recommendations of the Parliamentary Review to bring bodies such as NWIS within a strengthened central NHS Wales Executive function.
22. We support WG plans to address this through its reviews into infrastructure and system design and governance. This will include an assessment of progress to date and how barriers to progress can be overcome, and will be taken forward as part of NIMB’s forward work plan for the coming year. During 2017/18 we have worked to build collaboration through increased transparency and communication. We believe this is starting to bear fruit and will support WG plans in this area.
23. We are working with WG colleagues to ensure that the reporting to both WG and Health Boards and NHS Trusts, on both the delivery of informatics programmes and projects and their related benefits, is improved and support the proposals to improve this further in 2018/19.
Question 5 - Local leadership, including clinical leadership, and NHS bodies’ perspectives on the factors behind slow progress in delivering the electronic patient record.
24. While there has been significant progress in delivering the electronic patient record and the benefits that arise from it across Wales, both the WAO report and the Parliamentary Review have identified a number of issues that have limited the rate of progress in its delivery. While we have a clear vision, until recently the number of projects and priorities have been growing without explicit consideration of the impact on delivery of other projects. The challenges of securing funding to invest in the recruitment of both specialist informatics staff and staff with skills to lead service change and benefits realisation have limited progress in this area.
25. NHS Chief Executives agreed improvements in the development of and NHS assurance of informatics business case at their February 2018 meeting. This will ensure earlier and wider engagement, and common assurance processes to accelerate the development of cases and support “start; stop; accelerate” decisions.
26. NIMB has supported the development of an improved prioritisation process during 2017/18 to help increase the focus on the highest national priorities. Alignment of local and national priorities through the collaborative development of the National Informatics Plan will help address this.
27. We expect the first National Informatics Plan to be agreed at the April 2018 NIMB Meeting. While this will be short term (i.e. 1 year in the first instance), this will help us be clear on the highest national priorities, to accelerate their delivery, and also importantly be clear on the role of NIMB in agreeing the additional or removal of national informatics priorities. We support the WG plans to utilise NIMB to continue the prioritisation work, taking into account the Parliamentary Review’s recommendation to “start; stop; accelerate”” and to commence the development of a 3 -year National Informatics Plan, once the health and social care long-term plan has been published.
Question 6 - Workforce challenges, including recruitment and retention of ICT specialists.
28. We recognise that there are major challenges to recruiting and retaining all areas of informatics staff, not just ICT specialists, within Agenda for Change. The impact of Brexit on this recruitment and retention of scarce skills in this area is also difficult to quantify.
29. NWIS has a comprehensive workforce strategy and function with a particular focus on recruitment, retention, staff and organisational development. Evidence of the success of this is that turnover is below industry average and at NHS average with the workforce headcount increased by 20% to 550 Whole Time Equivalent (WTE) over the last two financial years.
30. NWIS works collaboratively with NHS organisations on professional development of the informatics workforce and has undertaken ground breaking work with the Welsh University sector through partnership arrangements to bring academic and work based training together. The most advanced element of this is co-location of NWIS Offices with University of Wales Trinity Saint David’s and the establishment of the jointly Welsh Institute of Digital Innovation.
31. We support the WG proposals to develop partnerships across the public sector; with academia and with private sector businesses to support economic development in Wales. This is not an issue for NWIS alone but for the wider informatics community across health and care in Wales.
Question 7 - Getting greater clarity about whether the intended benefits of investment are being achieved.
32. NIMB, through the Planned Future work stream of the Strategy Delivery Programme, has developed a common framework for describing and quantifying benefits. Further work is planned to improve this further and to find ways to quantify and measure benefits more consistently.
33. Recent reporting to NIMB have increased the focus on system utilisation as a proxy for benefit realisations. Work is also already underway on implementing agreed changes to improve the Business Case process, which will also increase the focus on benefits, including that resources are identified to support benefits identification and business change; and ensuring effective benefit ownership, to improve their quantification and realisation.
The Parliamentary Review
34. A number of the issues and challenges within the Auditor General for Wales Report were also considered by the Parliamentary Review into Health and Social Care report, “A revolution from within: Transforming health and social care in Wales”, published in January 2018.
35. The Parliamentary Review report makes a major contribution to the debate on how to create a sustainable health and care system in Wales in the future. We agree that a different system of care is needed – one that is seamless across health and social care, physical and mental health, and secondary and primary community care.
36. The Report recommended “Putting the people in control”, through advances in the availability and use of information in treatment and care to recast the relationship between users and professionals. This will mean Wales actively providing information about care; seeking assessing and scaling technologies that enhance access to advice and information, and supporting users and care professionals to adapt. In addition, the report recommended harnessing innovation and accelerate technology and infrastructure developments.
37. The Parliamentary Review report recognises that we have been moving towards a more integrated system for a number of years and there are many good examples of new models of care that are already working in Wales. The challenge is how we can be more radical and ambitious, to accelerate the pace in moving to a genuinely seamless system. Following the Parliamentary Review report, we are working with the WG and other organisations in the health and social care sector to develop a plan of action that will deliver the best services to the people of Wales.
Summary and conclusion
38. As stated earlier, we recognise that digital technology and information are essential enablers in the transformation of health and care for the people of Wales. NHS Wales has made significant progress since the publication of Informed Health and Care in 2015 and we expect the pace of delivery to accelerate as a result of a number of improvements we have recently actioned.
39. We expect that, the new long -term plan for health and social care in Wales will build on the priorities set out in the Informed Health and Care strategy and the first National Informatics Plan (which we expect to finalise at the April NIMB meeting) will set out a central role for information and digital technology in delivering the quadruple aim and the new priorities for NHS Wales. The plans for improving governance; clarifying accountabilities and structures are likely to impact on NWIS roles and wider informatics planning and delivery.
40. We remain committed to working closely with NHS, Local Authority and WG policy colleagues in accelerating the pace of improvement in informatics across Wales to support delivery of the quadruple aim.