IM&T 3-Year Strategy - NHS Shetland Vision Statement 10 2.3 Benefits statement 10 2.4 Current...

3-Year Strategy IM & T

of 32 NHS Shetland IM&T 3-Year Strategy v 4.doc

IM&T 3-Year Strategy

Last review date:

October 2012

Next formal review:

October 2015

Implementation date:

October 2012

Original Author:

Head of IM&T

Reviewer: Director of Human resources and Support Services

Version Control Date

Version No: 1 October 2012

Strategy and Redesign October 2012

EQIA Date

Impact Assessment

Approval Record Date

Shetland NHS Board V4 6th November 2012



Contents IM&T 3-Year Strategy 1

Forward 4

Aim 5

Background 5

Summary 5

Recommendation 6

eHealth Prioritisation Principles 7

Background 7

Prioritisation Principles 8

2 Executive Summary 10

2.1 Introduction 10

2.2 Vision Statement 10

2.3 Benefits statement 10

2.4 Current Position 10

2.5 Department Structure 12

2.6 Key Values 12

2.7 National contributions 12

2.8 Local Projects 14

2.9 Delivering the Strategy 20

3. IM&T Vision for NHS Shetland 21

3.1 Strategic Objectives 21

3.2 IM&T Core Values 21

4 Provide a Capable Infrastructure 23



4.3 Benefits Statement 23

5 Support “Better eHealth : Better eCare” 24




6 Govern and Manage Change 26






7 Standards and Policies 27




8 Skills and Training 28




9 Collaboration and Joint Working 30




10 Delivering the Strategy 32

10.1 The Challenge Ahead 32



Forward The way we deliver services to our customers in constantly changing, and we have

to be able to respond to these changes. The extent to which the delivery of our

direct services to patients is increasingly dependent upon fast, seamless IT support.

As part of modern healthcare delivery, technology plays a vital role in ensuring that

information is accessible to assist in faster diagnosis and treatment and to streamline

administrative process. eHealth had become an umbrella term for providing IM&T

services (c0mputers, information and telecommunications) that directly support the

clinician to improve patient care. It does this by combining traditional Information

Technology and Information Management practices with patients and clinical

requirements and experiences as the prime driver.

Over the course of 2012 there has been some major resources and improvements

made with in the IT arena to ensuring the introduction of some critical major systems

have been implemented appropriately such as Egton Medical Information Systems

Ltd (EMIS) the long awaited GPASS replacement for General Practice. Replacement

of the national Picture Archiving Communication System (PACS) is current underway

with a go live date of November 2012, along with a desktop replacement programme

replacing approximately one third of the secondary and primary care desktop estate.

Apart from these headline projects, there is a long list of development, upgrades ad

refreshment work that is on-going across the Board where we are investing

significant sums in both rolling programs and new projects, playing into regional and

national development and procurement processes.

We need to create services that are sustainable and fit for the future and to do so we

need to work with our partners both in NHS and other sector colleagues. This

strategy is about realising this vision.

We are transforming and we will continue to transform our services using the Key

Values set out within this strategy, developing our role in the national projects and

getting us fit for purpose.

The strategy marks the first step of our change.

Lorraine Hall FCIPD

Director of Human Resources and Support Services.



Aim The aim of this paper is to seek approval from NHS Shetland SMT to the following papers „eHealth strategy 2012-15‟, the IT services strategy 2012-15.

Background NHS Shetland SMT approved a local eHealth strategy in May 2006. This strategy reflected the eHealth commitments of „Delivering for Health‟ and local commitment to support improvements in operational systems and infrastructure in preparation for local delivery of the national eHealth strategy. Since then „Better health Better care‟ has been published and more recently a revised national eHealth strategy was published and announced by Nicola Sturgeon in Sept 2011. It is therefore appropriate for NHS Shetland to deliver a refreshed direction for eHealth and this new revised strategy covers the period 2009-12. The eHealth strategy has been streamlined to focus primarily on clinical eHealth strategic components and is supported by an accompanying IT services strategy which outlines in greater details the direction and requirements for the technical infrastructure. This should allow each document to be considered separately or together for those seeking information on eHealth or the IT infrastructure future direction and investments. As the demand has increased for IM&T and eHealth support over the last 4 years since our previous strategy, it has become much more difficult for us to absorb the increased requirements within current resources. It is therefore important that use of resources is prioritised to ensure that IT developments are aligned to the delivery of mandatory and legislative requirements, NHS Shetland Local Delivery Plans and Corporate objectives. The Prioritisation principles accompanying these strategies sets out the start of a process and framework which will ensure that eHealth targets areas considered to be of greatest benefit to clinical services and NHS Shetland strategic objectives and aims.

Summary These two strategies set out an overall direction of travel for IM&T and eHealth over the next 3 years. They are underpinned by a commitment to a transparent prioritisation and investment framework which will ensure that technology is directed at the areas of greatest benefits to NHS Shetland and the patients it serves .



Recommendation SMT is asked to approve the IM&T strategy and the associated prioritisation principles. Policy / Strategy Implications This strategy is consistent with the national

eHealth strategy and „Better health Better care‟. It compliments these national strategies and is consistent with NHS Shetland local delivery plan and corporate objectives.

Consultation eHealth Steering Group, IM&T

Consultation with Professional Committees

-

Risk Assessment Risks of non-delivery and financial impact will be assessed within individual programmes

Compliance with Board Policy requirements on Equality and Diversity

Will be progressed through Equality Impact Assessment of Programmes

Resource / Staffing Implications As set out in the Strategies attached

Approved By Name Designation Name Designation

Author (s) Name Designation Name Designation

Drew B Berry Interim Head of IM&T



eHealth Prioritisation Principles Author: Drew B Berry Date: October 2012 Ver: 0.1

Background Over the last 3 years a number of new clinical and business systems have been deployed in NHS Shetland. IM&T have provided services to implement and support these at no additional cost to services, except very occasionally, where capacity constraints have meant the use of external contract resources to complete work in the timescale. On-going support has been absorbed as part of the overall IM&T support services. Additional capacity can only be created by bidding for funds through the local health plan cost pressures process. Essentially, IM&T services have been provided „free at point of use‟ to departments using the service. The core business of IM&T is to support and provide an infrastructure which is robust and secure. While there is some flexibility, there is very limited capacity to deliver new developments or support new initiatives. Demand for refreshed or new deployments to support both business functions and clinical care far outstrips the capacity available. It is therefore important that use of resources is prioritised to ensure that IT developments are aligned to the delivery of mandatory and legislative requirements, NHS Shetland Local Delivery Plans and Corporate objectives. IM&T workload can be generated by SG initiatives, legislative or regulatory compliance, requests from service departments, or internally within IM&T. The Capital Planning Group, and IM&T prepare a capital investment plan and make recommendations of priority for the Capital rolling replacement program. The investment plan is agreed and prioritised by the eHealth Steering Group, the Capital Planning Group and where applicable, SMT and NHS Shetland Board. Other departmental capital investments not covered by the rolling program are prioritised and agreed by the same groups. To date this has dictated a significant proportion of the discretionary work undertaken by IM&T resources and the process works relatively well. There are also numerous requests for non-capital schemes of varying scale. Some of these come from departments who have funds for a purchase and implementation



of a system, others are simply requests where a need has been identified but there is no purchase from a 3rd party. There is an expectation that where IM&T deliver the service within existing resources, it will be at no cost to the requesting department. Even where these schemes can be delivered, there is no mechanism other than the LVP (Local Vacancy Process) to increase capacity within IM&T to provide on-going support. This means that the risk associated with supporting new developments is heavily biased to IM&T and can impact support for core services. These requests are not subject to any formal prioritisation and are accommodated where there is opportunistic capacity. This frequently leads to delays or disappointments for departments and difficulties for IM&T staff in resource planning and managing expectations. It also means that effort is not necessarily targeted at the most important areas for NHS Shetland overall aims. This position is no longer sustainable. Demand far outstrips the capacity within IM&T to both deliver new systems and provide on-going support. We now require a new approach to delivering and supporting business, clinical and eHealth projects which will ensure that NHS Shetland gets the most from the resources available. It is proposed that a set of principles are developed within an IM&T prioritisation, funding and resources framework. The proposed principles are described here.

Prioritisation Principles IM&T will create a draft capital and eHealth plan for the rolling program. This will continue to be prioritised and investments authorised using the current process. Other departmental capital and non-capital schemes will be collated and be subject to a prioritisation process. The eHealth Steering Group will be used as nominal groupings for collation of requests and prioritisation. Further work is required to determine how Support Services and organisation wide programs are considered and prioritised. Each grouping will be issued with a list of related IM&T programmes in January of each year. This will include „in flight‟ Programmes and outstanding or new work requests from services under their area. If the list does not reflect all the envisaged priority work areas a new work request form must be submitted for inclusion in the list.



Each department will be asked to validate items as being necessary to the delivery of its HEAT targets, corporate or board level objectives and note the objectives the development would help to meet. Each department will prioritise the items in order of importance by undertaking a risk / impact assessment of non-completion. Each item will be assigned an importance score, from the following weightings;

Criteria

Points Importance Total Score

Importance to Customer

20 1 – 5 Points x Importance

Cost/Benefit

15 1 – 5 Points x Importance

Revenue Savings 15 1 – 5 Points x Importance

Leverage 10 1 – 5 Points x Importance

Statutory / Obligation 20 1 – 5 Points x Importance

Clinical Risk 20 1 – 5 Points x Importance

All lists will then be collated into a single NHS Shetland list. The eHealth Steering Group will review, prioritise and agree the list. Once items have been prioritised they will be subject to a further assessment against available resources – both financial and capacity. IM&T will assess the likely cost and effort. Finance will be asked to undertake an affordability assessment against available funds. Once this assessment has been undertaken a further validation by the eHealth Steering Group will take place prior to an agreed work plan being created. This will be an annual process and will form the basis of the eHealth delivery Plan required by the Scottish Government eHealth directorate.



2 Executive Summary

2.1 Introduction

NHS Shetland Information Management & Technology (IM&T) has developed its Strategy to provide clarity on the measures and goals the service have set and importantly how these are intended to be achieved over the next three years. This sets out the direction of the IN&T service underpinning the eHealth strategy to support the overall objectives of NHS Shetland. Fundamentally this strategy details the key principles the service will adopt and adhere to over the period to ensure tactical changes in priorities are governed against this strategy. Whilst this Strategy has been set for a three year period there is recognition that prioritisation going forward will reflect the national Healthcare Quality Strategy, the Board‟s Clinical Strategy and the Boards Property Strategy to ensure that the infrastructure supplorts the direction that is required to deliver sustainable quality services. An Equality Impact Assessment has been completed to support this strategy.

2.2 Vision Statement “NHS Shetland will deliver patient care to the highest level and improve the health and wellbeing of the local population within the resources available directly and through partnerships with organisations and individuals.

2.3 Benefits statement The specific benefits identified within the strategy are:

Stable and available Information and Communications Technologies (ICT) infrastructure.

Measurable and reportable change management.

Managing effectiveness through standard process and polices.

Improved productivity and satisfaction levels.

Partnerships aligned to the strategy.

2.4 Current Position Throughout 2011/12, significant inroads were made in addressing the underlying technology which through this strategy can be built upon to further improve; service management, service availability and service continuity, all of which are becoming increasingly critical in the delivery of frontline services.



As the dependency on core infrastructure increases at the user end, there has been recognition of service based issues that have resulted in investment for a number of core systems. For example the Helix Patient Administration Systems (PAS) is fundamental to medical record tracking, patient booking system and patient administration system for medical records staff and clinical staff, or (Egton Medical Information Systems Ltd) EMIS which was successfully deployed to all Health Centres, throughout Shetland as the replacement for GPASS We have seen improvement to our network infrastructure, however this still requires further update and upgrade work in order to shift the current perception of services and become a true enabler of health services at the front-end. This will be carried out in consultation with staff, service users and partnership and is part of out action plan. We have also seen significant improvement within our desktop and server estate, providing enhances and more efficient access to electronic data in a more secure and stable environment. Desktop devices and server estate continue to provide a high quality support in the face of increasing demand for information and our growing dependency on highly available systems for clinical services. To sustain the on-going development of IT we need to ensure that the core skillset of the IM&T team keeps pace with technology developments. We will achieve this by ensuring that staff‟s learning and education is up to date via the eKSF process. Governance arrangements for projects and improvements have been partially adopted and fresh arrangements need to be across IN&T to ensure appropriate levels of business and cross-party arrangements are included.

Over the past 18 months a restructure of IM&T has taken place, to ensure long term sustainability of services within our existing budget, with the appropriate personnel now in place to support and maintain the current infrastructure, desktop, mobile devices and server estate, thus providing an effective and sustainable service.



2.5 Department Structure

2.6 Key Values The Key Values are the guiding principles which will oversee the strategy for the next three years. Whilst individual priorities and projects will undoubtedly vary the Key Value will remain the cornerstones of the IM&T vision and ultimately determine the rationale and viability of initiatives that fall within this strategic period.

1. Positively impacts patient care. (Clinical Risk) 2. Improves accessibility and availability of services 3. Is financially, service and environmentally sustainable. (Revenue Savings) 4. Statutory / Obligation 5. Leverage 6. Provides added value. (Cost Benefit)

These Key Values will be used to access the suitability of projects by IM&T during the period the strategy is in effect and as such will support the basis for the governance and business case criteria.

2.7 National contributions NHS Shetland is involved in a number of national projects. Egton Medical Information Systems Ltd (EMIS) was successfully deployed to all Health Centres in Shetland. Digital Dictation (DD) was successfully deployed with Mental health services. Picture Archiving Communications Systems (PACS) is currently on track with a go live date early November 2012.



2.7.1 Other National Projects currently being undertaken by IM&T. eESS (a single national HR System) The Key Benefits associated with

implementing eESS are as follows. Effective management of staff,

resources and service delivery.

Improved patient safety due to more robust regulatory and mandatory checks.

Better Governance, including equality compliance.

Improved quality and management of workforce related data.

More robust control and audit of access to workforce information.

Business processes‟ increased effectiveness and efficiency, standardisation and consistency

Better delivery of service change through budget management and control.

More effective sickness absence monitoring and management.

Reduced risks of legal challenge, potentially arising from organisational failure to need equalities requirements.

Abdominal Aortic Aneurysm Screening (AAA Screening)

Key Facts:

Men aged 65 and over are eligible for AAA Screening.

The NHS Invites men for AAA Screening during the year they turn 65.

Men over 65 who have not been screened previously can arrange a screening appointment by contacting their local programme directly.

Screening involves a ultra sound scan that takes around 10 mins.

The NHS AAA Screening Programme aims to reduce death from ruptured AAA amongst men aged 65 and over by up to 50%.

TrakCare Patient Management System (PMS)

TrakCare Patient Management System (PMS) will help to speed and improve the effectiveness of patient care in NHS Shetland by ensuring patient information will only need to be entered once to make it



immediately accessible by authorized staff in other care settings. The TrakCare patient management system includes hospital and mental health patient administration, order communications, results reporting and clinical support tools. A number of optional modules are available for: accident and emergency; hospital electronic prescribing and medicines administration; pharmacy management; maternity; neonatal; and theatres.

2.8 Local Projects There will continue to be a number of local projects rolling and the Key Values will be used to prioritise there over a period of this strategy. Currently there are approximately twenty local projects of varying magnitude and these, need to be aligned and prioritised in terms of funding and implementation dates to maximise investments and resource constraints. Business cases will require to be provided for all new local projects going forward to enable us to measure key values.



Backups and Disaster Recovery Progress to date

Due to significant failings with the existing backup system, throughout August IM&T have been deploying a completely new backup infrastructure. The system is designed to backup all servers overnight to disk, and then duplicate the backups sets to tape during the day. The backup system components – backup server, disk storage and tape storage are all linked via dedicated optic fibre providing the fastest possible throughput and minimal network load. The system also utilises the virtualisation technology in place, meaning entire servers are backed up in a matter of minutes each. Restores from the backups have been tested, and a scheduled testing procedure is being put in place. Recording of backup success/failure is recording each morning with helpdesk jobs being generated for any failure for escalation through the technical team. Since implementation one operational server (Dental R4 system) has been restored from the backups due to a real server failure. Next Steps

In terms of Disaster Recover (DR) provision, NHS Shetland has a server rack in the SIC data centre. This rack has a bladecentre and disk storage that, in the event of a failure of the GBH data centre, could be used to restore the live servers from the backups. The next phase in DR provision is to implement real-time replication of the live servers to the DR site, so that in the event of a failure, service could be restored quickly (in the order of 2-3 hours) with minimal data loss.



Restoration from backup would take 1-2 days and would revert to the previous nights backup. However the current infrastructure does not provide the ability to replicate from GBH to SIC in real time due to two limitations: there is insufficient fibre capacity between the two sites to run replication; and there is insufficient fibre-attached disk storage to host all the servers simultaneously at the DR site In order to complete the Disaster recovery element of this project, two pieces of work need to be completed: Increase fibre between GBH data centre and SIC data centre. This work is being undertaken as a Capital Project and discussions with SIC Shetland Telecom are underway to provide a solution. Upgrade of the DR Storage Area Network (SAN) and implementation of replication software to provide real-time DR provision. This will be part-funded by a capital project and part funded by the eHealth Backups and DR project.

Imprivata Single Sign On Progress to Date

Imprivata were onsite 5th – 7th September to provide training and re-energise the implementation in Shetland. The server infrastructure was reviewed and reconfigured so that we now have one Physical server and one Virtual server to provide resilience. The system configuration is also backed up every night. Profiles were configured for 14 applications. Client roll-outs have begun and users who have been set-up are reporting positively. The Imprivata on-site consultancy was extremely productive and has got us back on track.



Next Steps IM&T will continue to deploy clients as resources allow. Consideration will be given to having a concentrated deployment over the Christmas period to try to reach a critical mass of deployments (around 80%)

Foula Telehealth Progress to date

SIC and NHS agreement was reached to jointly implement network connectivity for the Foula clinic via the council Pathfinder link. SIC will provide the wireless bridge and access point required (NHS to pay). NHS has provided brackets for aerial mounting to the SIC for their end (Foula School). Electrical and structural works on the clinic have been completed by Estates prior to the relocation of the portakabin. IT and Estates/BSU staff will travel to Foula together to complete the installation. This was initially agreed for 12th October, but the timescale for the relocation of the Clinic to Foula has been delayed and now not scheduled until the end of October. The network connection will therefore be scheduled for early November and Dan Medical will be scheduled to install their equipment in mid-November. This has been agreed by all parties. Next Steps Network installation in early November, depending on final commissioning of the clinic by contractor FLJ. Telehealth equipment installation and training by Dan Medical in mid-November. Note. There is a risk to this project that deteriorating weather closes the window of opportunity to get the clinic into Foula. If this does occur, the Project Board will give



consider recommending that the pilot of Dan Medical Telehealth equipment is undertaken at an alternative non-doctor island.

Wireless Infrastructure (Capital Project)

Progress to date Twenty Wireless Access Points (WAPs) have been deployed throughout Brevik House and Lerwick Health Centre. Currently at Brevik there is a single network being broadcast that is password protected. At LHC a separate wireless network has been configured that is linked to the domain, meaning users will need to use their domain username and password to access the wireless. The final wireless network service will consist of two available networks (SSIDs). One will provide staff access to the NHS Shetland domain and will be linked to the current web filtering system to apply appropriate filtering. A second SSID will be implemented in due course that is for public/visitor use. This access will not require a password, and will provide internet access only. It is proposed that, at least to start with, public access is also filtered to ensure no inappropriate use, and also protect the limited bandwidth we have from large numbers of users streaming video and using social media. Next Steps IM&T will procure and install WAPs throughout GBH, Breiwick and Montfield between now and the end of the calendar year. Implementation of wireless at Health Centres will be implemented once final configuration has been developed.

Wireless – Mobile Device Provision and Management.

Progress to date This project comprises two streams of work 1. Mobile Device Provision –



Departments will be invited to „bid‟ for eHealth funded mobile devices (iPads, Tablets etc.) An eHealth sub-group met to discuss the information that we would want to capture in order to evaluate departmental business cases. This has been worked up into a draft pro-forma for review. The group also recommended that a drop-in session is arranged for staff to try out devices and share good practice with colleagues.

2. Mobile Device Management – IM&T have procured and installed a device management system called „Airwatch‟. Once configuration is complete existing iPad users will be required to register with the system, and new users will automatically be registered. The system will allow IM&T to remotely manage, secure and protect devices. It will also provide the means for the Board to centrally deploy Apps and content (such as committee papers) to devices. Next Steps Once the „Application for mobile device funding‟ form is approved by eHealth Steering, bids will be invited via Heads of Service Bids will then be evaluated and a procurement and installation plan will be managed by IM&T. When Airwatch has been fully tested, users will be asked to either register their device themselves, or come to IM&T for assistance with the process.

ensure password policies are enforced;

configure NHS Shetland wireless access for users

provide the ability to remotely locate and/or wipe lost or stolen devices.



2.9 Delivering the Strategy This strategy sets out the guidance and tools to deliver the projects. The re-definition of governance and prioritisation of projects will support the delivery of the strategy.



3. IM&T Vision for NHS Shetland

3.1 Strategic Objectives The IM&T strategy is to build on current successes, improve our effectiveness and performance supporting NHS Shetland business objectives and strategic goals. An important component in achieving greater synergy is the implementation of the ITIL service management framework within the organisation. The current technology objectives for NHS Shetland IM&T is consolidation, centralisation, and service continuity inclusive of disaster recovery; enabling access to systems and patient information at the point of need by the appropriate person. However IT success is not only derived from hardware or software investments. Additionally; NHS Shetland IM&T success will result from: • Hiring, retaining, and developing high performance IT staff. • Making effective use of management processes, tools, and systems. • Collecting, analysing, reporting, and tracking key metrics. • Defining and implementing inclusive governance practices. • Utilising Technology to bring revenue cost savings to NHS Shetland. In combination, these critical factors will improve business/IT alignment overall and enhance the value of IT to the business. The IM&T will support the delivery of both by continuing to:

Provide an infrastructure capable of delivering the vision;

Support the delivery of “Better eHealth: Better Care”;

Govern and manage change;

Review Standards and Policies;

Ensure all appropriate resources have relevant skills;

Ensure our staff, suppliers, patients and third parties are regularly kept up to date on IM&T changes taking place;

Deliver this strategy in accordance with our Equality and Diversity strategy;

Collaborate and drive joint working initiatives.

3.2 IM&T Core Values By adopting the following set of core values IT Services will ensure a definitive set of goals that are better aligned to the organisations goals and ultimately improving patient care and safety.



IT management and staff improve and do a good job of managing relationships with both senior managers and end users

IM&T goals are aligned with the overall goals of the organisation

ROI (Return on Investment) is used effectively to both justify IT investments and measure the business value after investments have been made.

IT projects meet expectations in terms of being on time, on budget, and delivering what was promised.

Established Key performance metrics are used to measure the value of IT to the enterprise

Well-defined and managed work processes are used to facilitate IM&T success.



4 Provide a Capable Infrastructure

4.1 Current Position Significant inroads have been made to addressing the issues with backups and virtualization of the server estate, with 80% of applications now virtualized. Update to back-up software has meant we are now in a more stable for backing up our virtualized network. By addressing virtualization we have reduced on-going maintenance costs and downtime with our physical servers. By replacing some of our core switches has also given further stability across the Local Area Network (LAN)

4.2 Strategic Objectives Significant investment has taken place over the past 2 years to the IM&T budget which has been prioritised to enable the implementation of a number of improvements to the base infrastructure as an enabler for the future business applications and business improvements. Over the next three years we will develop the infrastructure by:

Implementing and securing a stable and more robust Wide Area Network (WAN) environment.

Work with Shetland Island Council (SIC) in upgrading our links between the Gilbert Bain Hospital and the Disaster Recovery Site, Gilbert Bain Hospital and Montfield using Fibre technology.

Improve network management and reporting.

Improve Service Desk Management reporting between Shetland Island Council (SIC) and NHS Shetland.

Standardise hardware, software and processes.

Improve and enable secure remote and mobile working practices.

Manage change and implementation

More effectively manage our IM&T assets.

More effectively manage our licence compliance.

4.3 Benefits Statement Achieving this baseline infrastructure foundation is critical to achieving our wider aspirations as a service. These changes will improve the on-going availability and stability of our systems and allow front-facing colleagues to concentrate on delivering patient care whilst being confident in their support services.



5 Support “Better eHealth : Better eCare”

5.1 Current Position Hands-on involvement in the national projects is limited largely due to resourcing constraints. Mandated projects such as EMIS have been delivered, PACS is on course for a go live date 6th November 2012. Other national initiatives which are cost effective are being considered and in some cases implemented. The eHealth Programme is a national programme designed to change the way in which information and related technology are used with NHS Scotland in order to improve the quality of patient care. The eHealth programme has objectives around the use of clinical portal, primary and community care development, management of patient journeys and the good governance and assurance around these projects. NHS Shetland considers these projects to be critical to the on-going improvement of patient care and contributes regularly to the national forums. eCare is the name given to the Scottish Government‟s multi-agency information sharing framework which covers, amongst other aspects, consent, standards, security, procurement, organisational development and technical issues relating to the electronic sharing of personal data. NHS Shetland is currently working in close collaboration with Shetland‟s Island Council around a number of key information gathering / sharing projects which will have significant benefit on patient care pathways. Some national deployments are prohibitive due to the national agreements that have been agreed largely due to the relatively small user and patient population of NHS Shetland. On this basis, NHS Shetland is exploring consortia bids with larger health boards to ensure continuity of improvement of care to NHS Shetland patients in line with expectations across the rest of Scotland.

5.2 Strategic Objectives NHS Shetland will continue to review and express interests in utilising national initiatives however we recognise that we are constrained by location and size in terms of influence. Over the next three years we will:

Understand and develop opportunities to act as a “pilot” Board for national initiatives.

Formulise joint working relationships to improve cost justification.

Increase awareness at a national level for tiered national agreements which offer comparable benefits to all Boards.



5.3 Benefits Statement We understand our local constraints and by increasing awareness and formalising joint working arrangements we can ensure out patients receive the best possible care.



6 Govern and Manage Change

6.1 Current Position Whilst the IM&T department operates to known working procedures, we need to document these appropriately; there are a range of policies that IM&T will be working on updating this lifespan of this strategy. The introduction of ITI service management (a best practice standard within IM&T) is also recognised as being significantly beneficial to the entire organisation and introductions to this work have now been completed. The majority of the IM&T team have completed ITIL registration by completing ITIL V3 Foundation Level. Change management process within the department is emergent and requires to be documented more fully to enable more rigorous management and control management processes.

6.2 Strategic Objectives The management and alignment of change is critical to IM&T‟s success and delivery and ensuring there is significant change it is important to have sufficient and robust governance arrangements in place. A significant focus of this will be the impact and transition of projects in to delivery and ensuring there is sufficient management of change during this period and throughout to measure benefits realisation. This will be achieved over the next three years by:

Reviewing existing arrangements;

Standardising processes and documentation;

Defining approvals and measurement criteria;

Aligning to the Key Values;

6.3 Benefits Statement Measuring and reporting on initiatives is critical to demonstrating the business case has been met and the benefits realised. These arrangements will ensure there is a system to capture changes at all levels and measure their success against the guiding principles of the strategy.



7 Standards and Policies

7.1 Current Position Operational standards need to be reviewed to ensure their appropriateness in today‟s delivery environment. Appreciation of ITIL and Prince2 as industry standards for service management and project management respectively, and its relevance within the organisation need to be determined. Security standards are the recognition of data sensitivity and data distribution need to be more fully understood as it is the risk to data loss from whatever means. The IT Lead of IM&T has been appointed as the Boards IT Security Officer and an overhaul of the existing IM&T Security Policy is due to be reviewed and updated. A number of proactive steps have been taken within IM&T to improve network / account security, with the setting up of a Security Group which meet every two weeks, although there is recognition that further work is required within this area. Users receive essential training in systems, although there is significant opportunity for more expansive training, and this coincides with operational standards and policies such as Usage for Internet and Email, Joiners, Leavers and Movers, IT Security, and Passwords as some examples.

7.2 Strategic Objectives The scope of this is extensive and will touch everyone within the organisation at some point. NHS Shetland will become an organisation that is more confident and can demonstrate a robust approach to the delivery of systems and technology in support of excellent patient care. These objectives to be achieved over three years by:

Confirming the standards and policies it strives to achieve.

Reviewing existing and creating new policies where appropriate.

Identifying systems requirements for current and future needs.

7.3 Benefits Statement Standardising and managing effectiveness drive performance and culture and during times of change this is critical. Realigning existing processes and increasing awareness of individuals and groups roles towards the vision improves the effectiveness of the approach as does ensuring there is clarity across the organisation.



8 Skills and Training

8.1 Current Position There remains a significant development opportunity in increasing end users expectations of their IM&T service. Following significant investment, 2011/12 saw considerable improvements in the estate architecture, however, historical trend coupled with a lack of expansive training has left users with low expectations of the service. This at times has resulted in duplication of activities and reduced productivity as users continue to work around systems rather than fully utilise their functionality. Recent recruitment within IM&T has come a long way in reducing the gap in the skills required to carry out some important tasks, and maintaining the current infrastructure and server estate. As part of the work undertaken with partners around a sustainable future service provision, the skills required to deliver this strategy and organisation objectives will be developed in line with eKSF and Performance Reviews.

8.2 Strategic Objectives Users should be capable of utilising their business systems to improve and support their daily activities. They need to have the opportunity to understand the systems and the functionality in order to apply this to their work and improve the overall operation of the business. Support skills should be aligned to the systems and activities of the business with core skills capability in the chosen delivery method and formalised. Non-core activities can be sourced on an ad-hoc basis but there should be frameworks for accessing this in a means relative to the situation. These objectives will be met by:

Baseline current position.

Confirming core and non-core services.

Identifying training plans as part of the appraisal and eKSF process, as aligned with our HEAT target.

Capturing training mechanisms (on-line, one-to-one, classroom, peer).

Training needs and plan core to business case justification.

Re-baseline the strategy annually to ensure that it still meets the requirements of our Business.



8.3 Benefits Statement Productivity and satisfaction levels will be increased across users and will be measured by user feedback.



9 Collaboration and Joint Working

9.1 Current Position Collaboration with NHS Shetland is delivered within the standard means of engagement, such as face-to-face, telephone and email. This format extends to other Boards and agencies as required. The video-conference suites across the estate have led to improved remote access arrangements for patients. Joint working arrangements are usually engaged to deliver specific services, for example visiting consulting services, or for national initiatives as described in section 5 above. Collaborative working with the Shetland Islands Council (SIC) has been in place for the past 2 years. Basic firewall changes have been made within each organisation to enable collaborative working between NHS and Social Work for single shared assessment. Further collaborations with SIC are expected in the future to drive joint efficiency and ensure sustainability.

9.2 Strategic Objectives Due to the physical and geographical constraints of NHS Shetland it is important to make use of collaboration tools. These can drive changes in culture to improve team performance, communication and outcomes. Collaboration should be achieved through a variety of means at a time that suits the users and not subject to transport or conditions. Collaboration tools are being increasingly exploited by organisations with remote workers and disparate teams to improve productivity and responsiveness. NHS Shetland will achieve this by:

Defining the business case for collaboration tools.

Assessing suitability and effectiveness.

Deploying and reviewing success in pilot areas before review. Joint working extends across departments, organisations and locations and NHS Shetland strives to be an organisation that seen to adopt shared and joint working initiatives. This will be achieved by:

Clearly defining strategic projects and potential strategic partners.



Understanding and communicating our benefits to partners.

9.3 Benefits Statement NHS Shetland will improve productivity and responsiveness across services whilst positioning strategic partners and projects to build improved capability for the future.



10 Delivering the Strategy Delivery against this strategy is the responsibility of the Head if IN&T and progress will be reviewed quarterly at information Support Group (ISG)

10.1 The Challenge Ahead The challenge ahead is by no means an exhaustive list, but due consideration needs to be applied to achieve a fundamental baseline in the following areas;

Patch management.

Backup and DR

Service and business continuity.

Support resource capacity and capability.

Users training – systems and policies.

Network capacity impacting productivity and capabilities.

Data and network security.

Asset management

Licence compliance

Suitability of the equipment hosting facilities.

Standardisation

Policy review and update

Account and user management.

Governance – management and control.

IM&T 3-Year Strategy - NHS Shetland Vision Statement 10 2.3 Benefits statement 10 2.4 Current...

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