Insight Dec15 final

insightThe magazine for HSCIC staffIssue 14 – December 2015

What the Dickens?The ghosts of risk, audit and assurance

Analyse this: How the HSCIC is supporting psychological therapies

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http://www.hscic.gov.uk/

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Editor: Chris Hewitt

Writers: Amy McManus Andrew Glynn

Design & Layout: Ouno Creative

Photography: Simon Dewhurst

Graduate 35 schemeOne year on

contents

Christmas carol 29The ghosts of risk, audit and assurance

Off the wall 33Planning 2016/17

Open houseBuilding bridges with research

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Shining a lightClassification standards for world health

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Casting the netDerm Ryan talks about HSCN

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Spirited awayImproving access to psychological therapies

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The path to a paper-free NHSDigital healthcare challenges

27

Nothing to sneeze atNational Pandemic Flu Service ready to mobilise

24

Exit stage leftThe lasting legacy of the BT LSP programme

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Issue 14December 2015

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At the HSCIC we are in the midst of a profound organisational transformation. You

will all know that in the future the HSCIC will have to achieve more, even though the financial resources made available to us are under pressure.

Organisational change is difficult and uncomfortable, especially in a business such as ours that has a complicated heritage (we are the sum of many parts) and that combines a tremendous diversity of activities and the skills that deliver them. As we travel at pace through the next few months I’m going to be asking you to adapt to new ways of working across the organisation and to prepare for working in the coming Professional Groups structure. During the first quarter of 2016 we are going to be training a 40-strong team of Transformation Ambassadors to run the workshops that will enable everyone at the HSCIC to understand in practice what this will mean for us individually and practically. We are focusing on doing what we can to be creative about the way these workshops will be delivered. In other

words we will be doing our best to make change process engaging, as well as informative.

For my part I know why we are going through this Transformation – so that we can harness the power of information and technology to make health and care better. That is why I do what I do and I suspect that’s why many of you work here at the HSCIC too. I certainly hope so because it is a purpose of which we can and ought to be proud.

As we go through transformation and beyond I want us to become a purpose-led organisation. Of course we are information analysis, technology and project management specialists first. But the work we do is of critical importance if we are to secure a financially sustainable future for the universal system of health and care.

To capture that spirit and provide a reference point for us all we will be launching formally our new Corporate Position Statement early in the New Year. Such Statements are developed and used by almost all effective businesses. Expressed well they articulate the human cause we serve and how we do it. We need to remember too that not everyone is an information and technology expert and that we should be able to describe what we do in direct, accessible and evocative language.

So, our Position Statement will: • articulate the vision of HSCIC and, in

doing so, express its UNIQUE and DIFFERENTIATED capabilities and reason for being

• describe succinctly the HSCIC business proposition – WHAT the

business delivers to those it serves

• identify explicitly those we serve and describes the BENEFITS that our work delivers to them - in our case our users, system suppliers and customers, our Influencer partners in the health and care system and, ultimately patients and the public

• and crucially capture our PURPOSE, WHY we do what do.

In the past the nature of work has meant that we have focused on communicating almost solely from within each programme and project. We need now to develop a reputation that reflects accurately the entirety of our efforts as the HSCIC. The Position Statement will enable us to do that and to ensure that those we serve all know who we are, that we always place them at the forefront of our considerations as we do our work, and that we do what we do in common cause with them.

I very much look forward to sharing it with you in the New Year. Watch this space!

Season’s greetings. Andy Williams Chief Executive

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Our vision is to harness the power of information and technology to make health and care better

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Across London and the South of England patients

and clinicians at some of the country’s biggest and busiest

Trusts are seeing the benefit of electronic patient record (EPR)

systems deployed under the BT Local Service Provider (BT LSP)

programme. With the final Trust exit now having taken place,

Amy McManus takes a look back at some of the

programme’s achievements.

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Alastair Grenfell, Paul Gilliatt, Sue Mifsud and Sarah Jackson


Under the programme, which started in 2003, the Cerner Millennium EPR system was deployed to 16 acute Trusts and

170,000 users; and the Servelec RiO EPR system was deployed to 39 community and mental health Trusts and 150,000 users; resulting in a step change in digital maturity in London and the South.

Over the last two years the HSCIC BT LSP team has supported the go live of over 30 projects with considerable success – from Trusts winning awards for their use of systems through to the biggest deployment of electronic patient records in the last 10 years.

Now the LSP contract with BT has expired, and Trusts have safely exited from the service with new supplier relationships in place. 60% of Trusts have retained their Millennium and RiO systems, with the remainder moving to replacement systems from CSC, IMS Maxims, System C, TPP, EMIS and Advanced Health and Care.

Programme Head Paul Gilliatt says: “The exit programme was a race against time, and has been hugely

successful, but we can’t take all the credit. We have provided support and guidance, but it’s been a collaborative effort, with the Trusts, replacement suppliers and BT working very hard to ensure a smooth transition to new locally managed service arrangements.

“Every one of the 56 Trusts has now exited without any patient safety or security issues, which was our overriding objective.”

It’s been a team effort, as Programme Manager Alastair Grenfell explains:

Exit stage left

“Every one of the 56 Trusts has now exited without any patient safety or security issues, which was our overriding objective.”

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“A large number of teams and individuals from across the HSCIC were hugely supportive in delivering the safe, secure and timely exit required.

“Everyone worked in partnership with supplier and Trust colleagues alike to deliver a fantastic result of which the teams should be rightly proud. Those key teams included provider support, solution assurance, commercial, service, the DIR and others. The testimony from both Lisa Franklin and feedback from Trusts confirms that we delivered all that was expected and more to make it a success.”

HSCIC Service Delivery Manager Rajvinder Jangra joined the team for a year to work on the exit programme. She says: “This has been an enjoyable whirlwind - the speed at which the programme was moving along was challenging and we had very limited timeframes. For service management our job was to oversee migration of data from BT to return it back to the Trusts, and we had to ensure that this process was achieved without interrupting live service.


in helping Trusts move to exit,” she says. “Having the HSCIC supporting all the different Trusts meant that we were all able to successfully exit existing arrangements – something that would have been very difficult to do individually.

“There has been a real collaborative approach and Trusts have felt supported by a team who have tremendous amounts of expertise and

guided us through the process. They couldn’t have done anything more or done anything differently.

“The process has also helped to open up discussions between CIOs and CCIOs. The HSCIC has helped us set up a forum to enable discussions between heads of information, which I hope will unite Trusts to continue this dialogue and sharing of experiences.”

Looking back

Paul says: “The LSP programmes in London and the South have had a long and challenging history, including four major contract resets, termination of the Fujitsu LSP contract, and significant changes in governance and delivery arrangements to keep pace with an ever changing operating environment.

“Since the London and Southern programmes transitioned into HSCIC on 1 April 2013, our focus has been to rationalise delivery structures, deploy new systems and functionality, improve the benefits position, and facilitate a safe and timely contract exit; all of which I am pleased to say we have achieved.”

“For us, communication was key, so we worked directly with Trusts to ensure everyone knew what was going to happen and when. The movement of such huge volumes of data across networks can have an impact on service, so we had to ensure that too much wasn’t moving at once.

“We acted as a support mechanism to manage the process, so the onus was on the Trusts to ensure data had

migrated correctly – but it was nice to receive their thanks afterwards and to hear that they appreciated what we had done.”

Lisa Franklin is the Chief Information Officer for the Southern Health NHS Foundation Trust. The transition programme for the community and mental health Trusts has been overseen by an exit forum, which she chairs. “The HSCIC team has done a fantastic job

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Exit stage leftproviderinsight

Members of the BT LSP team at Skipton House in London

Programme Manager Sue Mifsud works in acute care settings and has seen first-hand how the programme has changed.

“When I started in 2008 it was a one-size-fits-all configuration approach. This centralised approach meant that if one Trust wanted to change an aspect of configuration, then we had to get agreement from seven or eight other Trusts. This could be extremely difficult,

as they each tended to want different things from their systems.” says Sue.

“A change in thinking really started to happen in 2009 and Trusts started to

be given more flexibility, so they could decide which modules they wanted to take and when they wanted them, so they could choose what fitted their strategies. In the early years the use of the systems was predominantly for patient administration with some order communications, but latterly systems have been much more clinically focused. Building relationships with clinicians means we got clinical input and buy-in from the start.

“As clinical modules, such as clinical documentation and electronic prescribing, are added to the system a fuller electronic patient record is built up - with all of the patient’s

information in one place. This has really turned around the utilisation of the systems and is creating greater patient benefit.

“We’ve seen some great successes under the programme. Croydon Health Services was awarded the UK’s highest ever rating for its use of IT systems to improve patient care by the Health Information and Management Systems Society (HIMSS) in Europe.

“St George’s Healthcare in London designed an electronic prescribing and medicines administration system to meet their complex prescribing requirements. They have greatly improved their digital maturity and have also been accredited to HIMSS Stage 6.

“Anecdotal feedback has also been great. I regularly hear from clinicians that they wouldn’t be without the systems now and that it’s really helping them provide better patient care.”

A lasting legacy

The team has been working hard to embed benefits management into Trust strategy.

Programme Head Sarah Jackson and her team have been leading the work on benefits management.

“Across Trusts there was a lack of identification of the benefits gained from deploying electronic systems. Collecting evidence of benefits is a really crucial element in the process though. It enables a Trust to understand return on investment, how the system has benefited patient care, and also highlights any areas for improvement, so that they get the best from the system,” she says.

Through benefits work and deep dive studies, Sarah and her team have been able to help Trusts establish baselines and put benefits management processes in place. This has helped discover that in Croydon, nurses are saving an average of one hour per shift by having patient and medicines management information all on one electronic system - time that can be spent with patients rather than chasing paperwork.


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At Bart’s NHS Health Trust in East London, patients are seeing the benefit of an electronic record system that enables their hospital, GP, and community nurse to share and update their electronic records, creating a seamless care pathway.

At Oxford University Hospitals NHS Trust staff and patients are benefiting from the elimination of time spent searching for and waiting to access paper notes with immediate access to complete patient records including medications, allergies and risk alerts, which reduces the risk to patients.

Sarah continues: “Through benefits work we have also helped Trusts to make a case to their Boards for investment in systems. For example, proving the clinical and patient benefit of the e-prescribing module at one Trust meant that they were able to use this evidence to secure full roll-out approval to all of their sites.

“We’ve learnt a lot of lessons along the way, primarily around ensuring that benefits management is built in from the start of a project, and continues throughout and beyond the end of the project lifecycle. When Trusts receive central funding for new systems they

now have an obligation to measure and report the benefits of the systems delivered.

“We’re also chipping away at the culture within the NHS to prove that it isn’t just another task to complete – it can be really beneficial to them to capture this information as it actually measures the effectiveness of change and ensures it delivers what they want it to. This can then feed into their future priorities and investment strategy.

“We are now running workshops for Trust staff to talk about benefits management, how to do it and get the best from their investments. We want to build capability within the NHS and transfer skills so that organisations are able to build on their knowledge.

“We hope that one of the lasting legacies of the BT LSP programme will be that the importance of benefits management is acknowledged in the NHS and that it is essential to build in this capability right through a change project and into business as usual.”

So what’s next? Paul says: “HSCIC will continue to be a big part of the post-LSP world. We need to continue to work in partner-ship with Trusts and system suppliers to ensure that local and national services are integrated. And there are a number of exciting opportunities to improve digital maturity and integration that Nic Fox’s provider support team will be taking forward, for example we are talk-ing to NHS England and the NHS Trust Development Authority as they come together to form NHS Improvement on the role that IT can play in supporting clinical transformation.”


“We hope that one of the lasting legacies of the BT LSP programme will be that the importance of benefits management is acknowledged in the NHS and that it is essential to build in this capability right through a change project and into business as usual” Sarah Jackson, Programme Head

Spirited awayIn today’s NHS, everyone with a broken bone gets treated. It’s not the case if you suffer from a broken spirit. But great progress is being made to redress the balance, as the HSCIC reports on access to psychological therapies reveal. Insight investigates...

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Spirited away

Historically, depression and anxiety have not been well understood conditions. The media spotlight on cases of

post-traumatic stress disorder suffered by soldiers serving in Iraq and Afghanistan is changing public opinion, as are high profiles cases of depression suffered by the famous. Actor and writer Stephen Fry is one that springs to mind.

Ten years ago, less than five per cent of people with depression and anxiety were treated using a NICE-recommended psychological or ‘talking’ therapy, as opposed to receiving medication.

In 2008, the Improving Access to Psychological Therapies (IAPT) programme was set up to increase access to NICE-recommended treatment to 15 per cent of patients with anxiety or depression; with 50 per cent moving to recovery. The Government invested significantly, training about 600 new psychological therapists who are now deployed across the 211 Clinical Commissioning Groups (CCG) in England.

For the past three years, the HSCIC has been producing annual reports on IAPT, combining data collected monthly.

David Clark, the National Clinical and Informatics Advisor for IAPT and a Professor of Experimental Psychology

at the University of Oxford, believes the statistics vindicate the investment in the programme, and are driving service improvements.

“We have now reached our 15% target. The last annual report shows that 468,000 finished a course of treatment

with 60 per cent showing reliable improvement and 45 per cent moving to recovery,” says David.

“Given the significant investment in IAPT, the Government needs to know if

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Debs Elliott, James Sykes, Will Adam, Paul Ellingham, Jo Simpson, Navin Bose and Paul Jennings

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it is achieving expected outcomes. We are learning a great deal by collecting the data from clinical services and curating it nationally. It’s a very impressive job that the HSCIC is doing, with data flowing into the HSCIC every month to produce monthly, quarterly and annual reports.

“We get a break down by clinical service and each CCG purchasing the service. We can see comparisons, commissioners can look at the low performers and see what improvements can be made, while encouraging high performing services to share tips on best practice.

“The data is proving that the IAPT programme is achieving what it set out to achieve. We had a target for 50% recovery. It’s at about 45% but the data shows that about a third of services are achieving 50% recovery so we know we are close to achieving it.

“The HSCIC is helping us to achieve fully mature, well-led, properly funded services.”

Data collected includes information that patients themselves provide through questionnaires that help to assess their condition and their recovery. Before

the IAPT programme, only a minority of patients with anxiety or depression treated were objectively measured on the severity of their condition at the beginning and end of treatment.

“Now it’s 97% which is very impressive,” says David. ”No-one else in the world is achieving this.”

The statistics are also unearthing new discoveries.

“We always assumed that older people wouldn’t respond as well to psychological therapies but they have one of the highest recovery rates,” says David.

“We also had concerns about ex-armed services personnel and wanted to ensure they were receiving effective mental health care. It’s reassuring to know that armed service personnel recover just as well as anybody else.”

Jo Simpson, from the HSCIC Community and Mental Health Team, who has led on the development of analysis and reporting from IAPT, says: “I smile now when I’m at events and hear IAPT reports referred to as the ‘gold standard’ for measuring access,

“We always assumed that older people wouldn’t respond as well to psychological therapies but they have one of the highest recovery rates”

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David Clark, National Clinical and

Informatics Advisor

waits and recovery. This is not how our analysis was described two years ago.”

There have been plenty of challenges on the way to producing the 3rd annual report.

“The people who developed the IAPT programme were relying on data to demonstrate its effectiveness – and so there was a lot depending on our reports, and significant political interest. It takes time to establish a reliable flow of data about pathways and people were impatient for results,” says Jo.

“For us, it’s fascinating but highly complex, patient level data that is constantly changing. Providers submit updates every month – so for us, developing methods for a consistent, reliable set of national reports that could be used to measure local progress presented lots of challenges. Added to this we had to work out how to calculate recovery using outcome tools used in clinical practice. “However, I would say the main challenge was around building confidence. We had to build confidence with data suppliers so they


trust our processing and analysis of the data and understand how we are producing key measures.

“We also had to build confidence with national stakeholders – that any data quality issues are accessible to improvement, that there are no quick fixes, and that we progress by paying attention to detail and following sound statistical practice.

“The support of Statistical Governance function has been particularly useful because of the political pressure we have felt. Although I’m not a government badged statistician I think the UK Statistical Authority Code of Practice is a wonderful framework for us. It’s also been really helpful to develop a good working relationship with the National Clinical Director who has taken the time to help us with our analysis methods and with technical guidance on presenting clinical aspects of the data.”

The loading and validation team is also heavily involved with monthly data flows, handling data quality and supporting local services to understand the analysis.

Senior Information Analyst Paul Ellingham says: “We are handling 1.5 million rows of data from around 170 providers across the country in each month’s submission. We produce data quality reports and send them back to the providers.

“We spend a large amount of time going through the data with outliers, whose performance is lower than others and working with new providers to help them understand and interpret the reports. We have regular events and webinars to help suppliers across the NHS. This is all helping to build up high levels of confidence in our methodology and analysis.

“We also share intelligence with NHS England’s Intensive Support team on a

monthly basis, which helps to identify where targeted guidance can be provided.”

The team has certainly been through the mill and a tough learning curve but the results are now being rewarded.

Jo adds: “I am so proud of what the team has achieved. I really admire their can-do attitude and hard work. We have produced 13 publications in the last year, managed a change in dataset, undertaken a full consultation, developed official waiting time measures and hosted many events.”

Mental Health Programme Manager Netta Hollings is also pleased. “In all, this work represents very good value for money for the tax payer. The annual

cost for the whole of IAPT statistics is £450,000 which covers our costs and also the processing costs. For this, all providers submit at least one primary and at least one refresh file every month. We then produce 117 activity and 127 data quality measures monthly, 11 additional quarterly activity measures plus an annual publication. The monthly and quarterly measures are broken down by provider, CCG and provider/CCG combination.”

The last word must go to the National Clinical Director.

“The Spending Review has just announced an extra £600m for further evidence-based psychological therapies and the programme will continue to expand. The Government has the confidence to do this because of the very helpful reports that HSCIC produces. The reports are excellent and I thank all the team involved for their hard work.”

Read our statistical reports on Improving Access to Psychological Therapies: Click here

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http://www.hscic.gov.uk/searchcatalogue?productid=19398&returnid=1741


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Opening the shuttersA new approach and closer working with the research community is beginning to bear fruit.

Following the review of data releases last year, researchers described the HSCIC going into virtual meltdown.

“It simply put up the shutters,” said one leading research academic.

Now we’re opening the shutters and winning back the trust and understanding of researchers who depend on us for health information.

Andrew Glynn reports

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The reputation of the HSCIC in the research community was not very high in the months following the publication of the Partridge Review in June last year.

The report into the data releases ushered in a low point in the history of the organisation and did little to enhance customer relationships facing long delays in data applications.

At this time many research organisations began to worry about their own futures. They faced long waits for data and stories began to circulate about delays of up to a year or more. One of the criticisms the HSCIC had to deal with was the accusation it was not reaching out to researchers and didn’t understand their needs.

A new approach

Relationships have now started to change for the better as efforts to understand our customer’s needs and concerns have started to filter through.

Head of Data Access Garry Coleman, along with members of the Data Access Request Service (DARS) team, has been building relationships with customers over several months through a Customer Focus Working Group made up of a wide range of people from universities and research organisations.

Garry says: “We’ve tried to capture all the things people were concerned about and list their questions to enable us to pre-empt their concerns. We’re slowly getting the right reputation – it’s coming across that

we’re a more principled organisation.”

The growth of this trust and confidence has taken time to develop and taking HSCIC out to the home of the researchers themselves -with trial runs at three universities - has enabled the DARS team to showcase what we are doing to improve our service.

Recent roadshows in Leeds and London have added to our profile and put HSCIC people in front of customers to answer questions, deal with concerns and gather feedback face-to-face.

A positive step

From the research organisation’s point of view this head on approach to tackling problems and communicating what we do is very welcome.

The Centre for Health Economics at the University of York is a long-term user of Hospital Episode Statistics (HES) data. It forms the core resource for their research.

Professor of Health Economics Andrew Street has some sympathy for the HSCIC and an appreciation of the efforts being made.

He says: “We understand the hard work that has been going on to improve the management of the data application process after the organisation virtually went in to meltdown – it simply put up the shutters. What happened in 2014 was not a good year - not a good example of how to respond to a crisis on all fronts. The HSCIC put the tin hat on and hid away and this has generated a lot of criticism. Thankfully, the situation today is very different as relationships are a lot more open and we can see the hard work being put in to improve the management of data application process.”

The Yorkshire Centre for Health Informatics at Leeds University has worked closely with the HSCIC for the past three years and its input during this time has helped to put the new approach in place.

The Centre’s Director, Dr Susan Clamp, describes the past 18 months as being a very difficult time. She says: “We got to a situation a year ago where people were going to lose their grants. Things were very ad-hoc and there was no uniform approach with little transparency.”

Thankfully, according to Dr Clamp, the HSCIC workshops and one-to-one sessions are resolving a range of issues and the future now looks promising.

datainsight Opening the shutters

“Things were very ad-hoc and there was no uniform approach with little transparency” Dr Susan Clamp


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“Both sides have learned a lot as a result of these conversations and each now has a better understanding of the other. We’re now past the difficult time and it would be a great waste if we couldn’t build on what we’ve learned to create quicker and better research.”

The recovery position

The HSCIC started its recovery by creating the DARS service making amendments to processes, policies and procedures. An account manager was then appointed to build working relationships with key customers.

One of the new features is the introduction of HSCIC roadshows which tell people about who we are, what we do and what we intend to do in future. DARS On-line - an online data application system – is being introduced to simplify and speed up the application process. And we have seen the introduction of customer forums which showcase new products, gather feedback and ask customers how we can improve the way we work with them.

HSCIC’s Data Dissemination Director Terry Hill has sympathy with the situation researchers found themselves in previously and is determined to consign the episode to the history books with the development of greater customer focus.

He says: “For a while after the Partridge Review and the Health Select Committee hearing last year, we were almost a closed door and customers had the experience that they were putting their applications into a closed box. Now what we are looking to do is engage with them at the start of the process and have a constructive conversation about what the application is, why they need the data and how we can help them to put a good application into the system and receive the service they deserve.”

The past year has seen significant changes in the way HSCIC works with its customers. The customer is now seen as part of the solution in helping to create proposals for how we might engage with them better. Ultimately, this helps us provide the data to enable them to deliver the research to improve patient care.

Terry says there’s a significant difference to what has gone on in the past: “We have moved to and need to keep moving to having a customer-centric focus in what we do. We are here to service the data needs of the health community to improve care for patients in England and Wales.”

Easier applications

The online application process – DARS On-line - is still being developed but is not far away from the finished article.

One of the ways customers have been involved is in helping to craft the final look of the service, the way it operates and the features it contains. The digital

datainsight Opening the shutters

“Now what we are looking to do is engage with them at the start of the process and have a constructive conversation about what the application is” Terry Hill

Dr Susan Clamp

system will provide more efficient applications and make the process quicker than the current paper route.

DARS Applications Manager Louise Dunn says: “My team are interacting with customers in a more direct way and on a one-to-one level. Better relationships are being built as a result. We’re much more upfront with customers about asking them what we need and why we need it. They now know what’s expected of them and this has the benefit of reducing the number of repeat visits.”

News of these developments is being welcomed by the research community. Neurology Registrar Graham Powell, who is on a Clinical Fellowship with the University of Liverpool, had started to worry about the stories of long delays and so was delighted to hear about the new application process.

He says: “I’ve just been to a conference in Glasgow and heard a number of horror stories about delays over HES data, framework contracts and IG Toolkit scores. I was very concerned about the prospect of a long wait for data even though my fellowship doesn’t come to an end until September 2017. Having heard Louise talk about the website I feel very encouraged about the new application process and timescales. This has been a pleasing trip to Leeds.”

What do the improvements look like?When an application is received it enters a triage system which checks all the information is there and

correct. Within a few days the customer will know if there is a problem and we will give a clear estimate of how long their application will take to process.

All of the things we are doing – including the DARS On-line system - have been developed in alignment with customer feedback and suggestion. The HSCIC now knows where its systems have been failing

and the enhanced relationships it has built with its customers have enabled a more flexible approach to be introduced to the benefit of the organisation and customer alike.

Estelle Spence, the HSCIC’s Strategic Account Manager for Research and Life Sciences, says: “We know the research community has many different personas – not just between universities but among different types of researchers too. I think it has really helped us to get out and meet people and bring back their key questions for us to then go and work out the answers. As a team effort things are working very well and what we are now putting in place has been designed by the customers themselves.”

At a recent DARS Roadshow in Leeds one of the researchers suggested there was a “light at the end of the tunnel” in terms of the HSCIC’s recent progress. The research community are clearly warming to the new approach but Garry Coleman says this is just the beginning: “The online applications system is the start of a journey, a new website, new IT system, then the review of patient objections from Dame Fiona Caldicott and a change to the data sharing agreement - there will always be things evolving. It makes you feel good to hear people are noticing what we are doing but there’s still a lot of work to do and there will be for many years to come.”

Further DARS roadshows are planned for Liverpool, York, Sheffield, Leeds, Birmingham, Warwick and Oxford.


Opening the shuttersdatainsight

Terry Hill and Estelle Spence

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Earlier this year 295 subject matter experts in health classifications and coding from across the world gathered in Manchester to discuss classifications and debate the global challenges of interoperability – the meaningful exchange of health information. It’s one of the biggest tasks in health informatics.

Amy McManus investigates.

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Shining a light on world health

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Clinical classifications are designed to help accurately classify and count health conditions, treatments and surgical

procedures. They make it possible to monitor specific diseases, interventions and health trends for national and international purposes. In October, the world’s experts converged on Manchester to attend the HSCIC-hosted WHO-Family of International Classifications (WHO-FIC) Network Annual Meeting. At the official opening, HSCIC Chief Executive Andy Williams emphasised that work on health classifications is pivotal to the future of healthcare. “It is impossible to overstate the importance of high quality, standardised health and care data for tackling the world’s most intractable health challenges,” he said. This data is used for the compilation of statistics for the World Health Organization, which informs global health statistics, helping to shine a light on world health and support surveillance of epidemic or pandemic outbreaks.

The work WHO-FIC is doing aims to help raise the global profile of the importance of classifications. In West Africa, where the Ebola outbreak first reported in March 2014 has rapidly become the deadliest occurrence of the disease since its discovery in 1976, the WHO have difficulty collecting data – leaving Africa’s health information in the dark.

Lynn Bracewell, the HSCIC’s Head of Terminology and Classifications Development, says: “Classifications provide logical groupings of diseases or procedures that enable easy storage and retrieval of information. This is important because it allows the creation of reliable statistics to underpin the delivery and monitoring of health care.

“The HSCIC clinical classifications service team is a national resource responsible for developing and maintaining the clinical classifications and associated products on behalf of health and social care.”

Dr T Bedirhan Üstün, Coordinator of Classifications, Terminologies and Standards at the World Health Organization says: “We are extremely pleased that the UK now has a Collaborating Centre, and feel that it is very important for the WHO network. HSCIC’s experience and expertise in technology and digitisation of healthcare will be invaluable to us.”

The HSCIC hosts the UK centre of expertise and Lynn’s team is a point of contact for international coding classifications work.

“We work in partnership with our stakeholders to deliver up to date clinical terminologies, classifications and guidance to create high quality coded information,” she says. “This information is used routinely across the health and care system to deliver improvements and innovations that serve patients, populations and future generations.”

How does it work?

The classification systems used in NHS hospitals are ICD-10 (International Classification of Diseases) for diagnoses

peopleinsightstandardsinsight Shining a light on world health

“The meaningful exchange of information (made possible by consistent coding) enables researchers, health professionals, policy makers and technologists to work together regardless of geographical, linguistic, political and other boundaries.” Andy Williams

Back from left to right: Hazel Brear, Genevieve Cogman, Malgorzata Bartkowska. Front from left to right: Lisa Swain, Lynn Bracewell, Phil Saville, Andrew Brooke

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produced by the World Health Organization and OPCS-4 (Office of Population Censuses and Surveys) for procedures.

Lynn says: “The information is taken from the patient’s medical records and coded. The coding process is completed by qualified health informatics technicians who translate the medical diagnoses, interventions or surgical procedures written by the clinician into classification codes using ICD-10 or OPCS-4.

“The assignment of the codes is dependent on the patient’s medical condition, treatment provided and the complexity of the episode of care as well as the rules, standards and conventions of the classifications. Accuracy and consistency are vital for the production of reliable coded data.

“All hospitals have a mandatory requirement to provide classification data on admitted patient care for inclusion in the national datasets.”

How is the information used?The information created not only helps at an international level, but at an

organisational level. Hospitals can use the data to make informed decisions about their patient services, identify cohorts of patients for operational purposes such as theatre lists, receive correct reimbursement for the services they have provided to patients, and better understand the health problems in a geographical area to support the future design of patient services.

The ICD and OPCS-4 classifications are also a key component of national datasets such as Hospital Episodes Statistics (HES) in England, Patient Episode Data for Wales (PEDW) and Scottish Morbidity Records (SMR). The databases are used for statistical and epidemiological analyses and publications.

In England: • Annually over 18 million patient

hospital episodes are given ICD-10 diagnosis codes to monitor diseases

• Over 11 million patient hospital episodes are given OPCS-4 procedure codes to support hospitals manage their services and secure funding for patient care.

Lynn says: “The information is used

by clinicians, researchers, health information managers, analysts and health information technology workers, policy-makers and patient organisations to name but a few.

“Nationally, analysis of the coded data helps to monitor and evaluate health care at hospital, regional and national levels and produce meaningful statistics which are accurate, consistent, complete and comparable across time and between sources.

“It also helps to monitor the incidence and prevalence of diseases and other health problems, proving a picture of the general health situation of the population and can support surveillance of epidemic or pandemic outbreaks.

“The classification systems allow information to be compared and shared in a consistent and standard way, whether it is between hospitals, regions, countries or continents.”

peopleinsightstandardsinsight Shining a light on world health

Left to right: Christian Hyde, Emma Bruce, Lorraine Battle, Gavin McIntosh, Maureen Atkinson, Sarah McDonagh, Naheeda Aslam


Casting the netprogrammeinsight

With a background as Director of Provider Support and Integration for the London and South regions, Dermot Ryan is no stranger to leading large-scale programmes. However, he describes his new role as Programme Director for the Health and Social Care Network (HSCN) as the biggest challenge of his career. Insight’s Amy McManus finds out more about the challenges that lie ahead. Continues >


HSCN has been dubbed a fundamental enabler to achieving the vision for health IT set out in NHS England’s Five Year Forward View and the National Information Board’s Personalised Health

and Care 2020. As the successor service to the N3 network, it will provide the connectivity to join health and social care and the data flows required by new models of care.

Dermot joins the HSCN programme at a pivotal stage, with the outline programme business case in the latter stages of approval and a busy procurement schedule on the horizon.

Dermot, you’ve been in role for about a month now, what are your initial observations? My initial impressions are that we have the foundations of a really strong team, with a lot of knowledge and experience. There’s been a high level of cooperation from both within the HSCN programme team and others from across the HSCIC to get things going and get to the point where we have outline business case approval. The speed at which the team is working is very impressive which is handy as the timeline for the programme is incredibly challenging.

What is your personal driver as Programme Director? The opportunity to work on what it essentially the vascular system of health and social care IT was a big draw, as it’s important to me personally to feel like I am making a difference, but I’d be fooling myself if

I didn’t also admit that the size of the challenge and the early stage of the programme were factors. I’m from a major programmes background, so I’m not moving into unknown territory, but to be honest it was not also without some trepidation on my part – it will definitely be the biggest challenge I’ve faced in my career.

Ultimately though, HSCN is an enabler to much of what we’re trying to do in our organisation and within health and care in general – it’s the glue between a number of evolving and existing services and systems, and so it’s a fantastic opportunity to be leading on.

Why is HSCN seen as so key to the future of health and social care? Access to reliable information at the point of care is, as we all know, essential to the efficient function of the health and social care system and the network clearly has a big part to play in enabling this.

If we look at the network from the perspective of what HSCIC does both on the data and the systems side you can begin to get a sense of how so much of what we do as an organisation could simply not happen without data networks. Looking forward, when you think about the vision for health and social care in the Five Year Forward View, and the new models of care suggested, you can see that there will be an increasing reliance on the network to ensure the right information is available at the point of care in an increasing variety of settings.

Is this just a replacement for N3, or something more ambitious? We are careful to point out that HSCN is a successor to N3 but is so much more than a simple replacement. The most exciting thing about HSCN is that it will be inclusive of both health and social care and will therefore enable a whole heap of improved information flows and working practices. Currently the N3 network is predominantly used in health settings and it is often both impractical and costly for social care organisations to get access.

The new network will also enable users to easily access the network from anywhere (with a 3g mobile signal) and on a much greater variety of mobile devices. This should help organisations to make better use of mobile working technologies and the efficiencies and work-force benefits that mobile working allows.

What major milestones are coming up? The first calendar quarter of next year will be a busy period as we will see the start of procurement activity in earnest. As with any procurement activity it’s incredibly important that the execution of this is spot-on so that what we end up with is right and delivered in the timeframes required. The procurement will be a mammoth effort that will continue for much of 2016.

Are things still on track for April 2017? They are, but the amount of work to do and the challenging timescales are at the forefront of our minds. We can’t forget the scale of the programme we

Casting the net

Continues >

programmeinsight


aim to design and deliver a whole new network solution depended on by the health and social care system by 2017 – it’s no mean feat.

What are your priorities? Maintaining a live network service for our customers is absolutely key to all this activity. N3 is deemed to be critical national infrastructure (by MI5) and is depended on day in, day out, by the vast majority of the health system across the country. Paramount in my mind during all this activity will be that the existing exemplary standards of service are maintained. What will the new network mean for HSCIC? The current N3 network is managed by a single supplier, BT, and we will be moving to an environment where the network is disaggregated; where core network provision is separated from network management and the buying and selling frameworks that health and social care providers will use. It is likely that there will be a number of different suppliers involved so, it will be a big change, particularly for our service management organisation to embrace. Added to that there will be new skills and capabilities required as we start to take on a more involved role in the network management and network security space.

And the future? We plan to have a staged exit from N3, and I am fortunate that colleagues on the team have worked on the recent exit of Spine and LSP exits, so we will be able to exploit their learnings. We’re also working

closely with the other HSCIC programmes that have recently completed large scale procurements to get their advice and lessons learnt.

As the programme evolves I envisage a great deal of cross-team working to utilise the fantastic knowledge and expertise we have in-house. HSCN is one of the most significant programmes in our organisation’s portfolio and providing an innovative network solution that supports the future of health and social care will be a great achievement for our organisation as a whole.

“Maintaining a live network service for our customers is absolutely key to all this activity.”

programmeinsight Casting the net

EPS2015

242,720,984GPs Live with EPS

Total of

EPS items claimed from December 2014 to October 2015

The Electronic Prescrption Service (EPS) has seen considerable success this year. The pace of deployment has increased, with 210 GP surgeries going live every month, the number of EPS repeat prescriptions dispensed has more than doubled, and even the Queen’s doctor is on the act- EPS went live at the Royal Mews Surgery at Buckingham Palace last month.

Repeat dispensing EPS items claimed in England

of pharmacies are now live with EPS98%

72%

42%

146GP GO LIVES INOCTOBER

2014

OVER200GP GO LIVES INOCTOBER2015

December2015

December 201

4

72%

42%

146GP GO LIVES INOCTOBER

2014

OVER200GP GO LIVES INOCTOBER2015

December2015

December 201

4


digitalinsight

< 24 >

Nothing to sneeze at

operationsinsight

An online application created by the HSCIC is now on standby and ready to mobilise if there’s a pandemic flu outbreak. The threat is number one on the Government National Risk Register.

Andrew Glynn reports.

Continues >

< Back to contents

Toni says: “Following a short Discovery phase, HSCIC were asked to build a prototype of the citizen portal as part of a six week Alpha development. Every two weeks, at the Show and Tell session, Ruth Allanson, as the product owner, would be able to see progress. Development continued and progress of the remaining portals was presented to show how they worked and this continued throughout the build process.”

There are four portals connected to the system - a citizen portal, call centre portal, healthcare professional portal and an antiviral issuance and collection point finder which will only be available during a pandemic.

If the online system indicates a person is in need of viral medication they would be provided with a unique


After almost 10 months’ work by teams from the HSCIC’s Operations and Assurance Services (OAS), the National Pandemic Flu Service (NFPS) was declared as ready to support a pandemic from 1 December.

The NPFS has been devised to help the health system cope with increased demand on its services in the face of a potential flu pandemic.

It will help to keep infectious people away from health providers by providing on-line access to the services, ensuring the spread of flu is controlled.

The National Pandemic Flu System, which supplements the response from Primary Care, has been developed by the HSCIC on behalf of Public Health England.

Operations Director for the Command and Control Response for the National Pandemic Flu Service, Ruth Allanson, says: “You don’t want infectious people sitting in busy GP surgery waiting rooms. The idea is to get people to do a self-assessment online to determine whether they need a viral medication or not and to advise where to go to pick

up the medicine if they have the right symptoms.”

The clinical algorithm created by HSCIC (NHS Choices) is based on a series of medical questions which are designed to assess the patient’s condition and recommend the right course of treatment. The outcome may be to offer appropriate medication or suggest a visit to A&E or a GP depending on the answers given.

A highly flexible system

Programme Manager Toni Scott-Baxter says: “User research and engagement has been very important in support of the development of the application. Feedback from potential users, including the public, call centre operators, GPs and healthcare workers who would be involved in the service was obtained to ensure the system is fit for purpose”. ”

The basis of the application is built around a clinical algorithm which alters in the event of a pandemic in response to the type of flu. The system has been created using ‘agile’ principles and in line with the Government Digital Services (GDS) Service Manual.


Continues >

operationsinsight

Left to right: Ed Hiley, Sean Robinson, Janet Lewis, Stuart McNeill, Jamil Yunis, Annette Shaw, Chris Squibb, Sam Wortley, Ruth Allanson, Toni Scott-Baxter, Richard Hall, Neil Gibbs, Sharon Fitzgerald, David Pool and John Rhodes


reference number and directed to a collection point, where a friend or family member, known as a “flu friend” should collect the medication to avoid the risk of spreading infection.

In the previous pandemic, which began in July 2009 and continued until February 2010, churches and school buildings were used as distribution centres.

The HSCIC as supplier and partnerThe NPFS belongs to Public Health England and the HSCIC is providing a service to them, acting as a supplier.

Ruth Allanson says it’s a very complex project shared between a number of parties: “There’s an agreement about who’s delivering what, when and where which involves a multiple stakeholder family who all have a share in this product being developed and includes NHS England, the Department of Health and the HSCIC.”

HSCIC Programme Director Ian Lowry says this is a tremendous achievement: “What the HSCIC has shown in creating the online citizen pandemic

flu application is that it is capable of taking on and managing complex projects and working very effectively with partner organisations. The importance of this work is highlighted by the fact it is the number one risk on the Government National Risk Register and is another example of our ability to take on and deliver work of the highest quality.”

Ready and waiting

In addition to building the system the OAS directorate has also provided assurance, the support model and

undertaken relevant testing to deploy the application on to an external cloud hosting environment which has the ability to manage upwards of 75,000 users simultaneously.

The importance of the work and the smooth running of the system is illustrated by the potential scale of an outbreak.

Ruth says excellent planning is essential: “We’re working on a figure of 50 per cent of the population coming down with flu and this is what we are preparing for. Normally a pandemic cycle lasts about 16 weeks from start to finish”.

In a situation like this the HSCIC’s responsibility is to make sure the application is available 24 hours a day.

We would normally expect a six-week notification of a pandemic being declared to enable the mobilisation plan to be invoked and the live environments to be made available and tested.

Toni says: “We are officially in dormancy from 1 December and the HSCIC is responsible for the

monitoring of the training environment. We may be monitoring a dormant system but the HSCIC is continuing to provide ongoing services to further develop non Minimal Viable Product functionality, and of course we’re on standby waiting for something we hope will never happen.”

Technology

The National Pandemic Flu Service is made up of six different web applications built using modern open source technology such as NodeJS, React, Docker and Riak. The service needs to meet high peaks in demand from the public and supporting call centre and healthcare professional use. Up to 130,000 concurrent users could be expected in a worst case pandemic scenario. To meet demand, the service has a small footprint and is horizontally scalable. As the service is expected to be dormant most of the time it has been built to run on cloud infrastructure with automated deployments for short and predictable deployment times to allow Public Health England to respond quickly in the event of a pandemic. Unlike most projects, NPFS is an emergency-use only system, with a 3% risk each year of being required.


“We’re working on a figure of 50 per cent of the population coming down with flu and this is what we are preparing for” Ruth Allanson

operationsinsight


clinicalinsight

The path to a paper-free NHSJunior doctor Peter Thomson has joined our clinical leadership team for a year. His experience of digital healthcare in hospitals to date suggests there are significant challenges ahead - but he’s starting to see the real potential.

Continues >


I arrived at the HSCIC in October to start a 1 year secondment from my normal role as a junior hospital doctor. My interests lie in patient safety and quality improvement,

and I was keen to learn how health informatics can influence the efficient delivery of quality healthcare.

I set about exploring “what the HSCIC does”, partly so I could attempt to provide a good answer when people asked how the new job was going. Most clinicians I know are not familiar with the HSCIC’s output, despite the important role it plays in the health and care sector.

A summary I’ve arrived at is “an arm’s length body of the Department of Health which acts as the national trusted data source and operator of health and social care systems”. It’s impossible to condense the function of a 2,500 strong, complex organisation into one sentence, but that is the best I’ve done so far.

Junior hospital doctors have a varied experience of clinical IT systems. Over my four years as a doctor, I have worked in six different hospitals and used five different electronic patient records and a mixture of electronic and

paper imaging requests, discharge letters, referral systems, observation charts and only one e-prescribing service. Clinicians value systems which improve efficiency and quality of care. My overall experience of healthcare IT systems is that they tend to be

cumbersome and difficult to use, and although I am not an advocate of using paper, I sympathise with the view that electronic systems can add to, rather than reduce, the workload. I have no doubt that electronic systems are the future, but at present they are far from perfect.

Over the past two months I have been exposed to a variety of work that the HSCIC does. The Summary Care Record and enhanced SCR have vast potential to improve quality of care through a variety of professionals; from hospital pharmacists and emergency doctors to district nurses. Oxygen, a mobile app which securely accesses Spine data, takes SCR further still. The e-Referral Service will improve patient choice, and the Transfer of Care initiative will improve the sharing of information and safe transfer of patient care.

As we move towards a paperless system, with increased citizen and patient access to records, it strikes me that HSCIC will have an even greater role to play.

Information governance standards will need to be maintained, and trusted by citizens to maximise the potential of initiatives, such as care.data. There is enormous potential for the HSCIC to improve the quality of care that we deliver to patients.

Hopefully, by the end of the year more clinicians will be familiar with the work of the HSCIC and the potential of electronic health.

Image caption

“As we move towards a paperless system, with increased citizen and patient access to records, it strikes me that HSCIC will have an even greater role to play. “ Peter Thomson

clinicalinsight

< Back to contents < 29 >

Christmas carolOur tale begins on a ‘cold, bleak, biting’ Christmas Eve in Leeds and Ebenezer Scrooge is sitting in his office at Trevelyan Square.

Continues >

corporateinsight


Marley warns Scrooge that he is about to be visited by three powerful spiritual beings representing risk, assurance and audit from the past, present and future. He tells him to listen to them or be forever cursed to carry chains that are much longer than the ones carried by Marley himself.

Scrooge is visited by three Ghosts:

The Ghost of Risk, Assurance and Audit Past

Later that night, Scrooge is woken by the Ghost of Risk, Assurance and Audit Past, a strange childlike phantom with a glowing head. The spirit takes him on a journey into the past to learn the lessons from previous HSCIC projects, programmes and operational incidents.

He is taken to visit happy times earlier in his career when he followed the rules and he had yet to discover the shortcuts which had now come to haunt him. Back to a time of his life when risk management and the assurance and audit of these risks were seen as something instinctive and positive rather than a hindrance.

Scrooge was shown the best of these times and the changes which led him to move from a path of appreciation and consideration of risk to the self-serving view he had developed which had tainted his career and relationships.

The Ghost showed Scrooge scenes from the past of him disregarding warnings, ignoring risks, missing deadlines and not caring about performance targets.

Visits to the scenes of Health Select Committees, Public Accounts Committee appearances and the Partridge Review into data releases by the NHS Information Centre passed before him to highlight the importance of managing risk, assurance and audit.

“Spirit!” said Scrooge in a broken voice, “remove me from this place.”

“I told you these were shadows of the things that have been,” said the Ghost. “That they are what they are, do not blame me!”

“Remove me!” Scrooge exclaimed. “I cannot bear it!”

Several years have passed since Scrooge’s former colleague and business manager Jacob Marley left the organisation to go and

work elsewhere. They have not seen or spoken to each other since - even though they worked very closely on a number of projects and shared the same approach to getting the job done.

There are only a few hours to go before the office closes for Christmas and as usual Scrooge is thinking of the holiday with dread, describing the season and its festivities as ‘humbug’. Finally, 5 o’clock arrives and as Scrooge walks home from the office, he growls at carol singers and frowns at all the festive frolicking around the pubs and clubs of Leeds City Centre.

At home later the same evening, he is sitting by his meagre electric fire with only one bar when he is suddenly visited by the Ghost of Marley who appears shackled by a large and heavy chain.

Marley says: “I wear the chain I forged in life. I made it link by link and yard by

yard; I girded it of my own free will. Is its pattern strange to you?”

“Or would you know,” pursued the Ghost, “the weight and length of the strong coil you bear yourself? It was full as heavy and as long as this, seven Christmas Eves ago. You have laboured on it since. It is a ponderous chain!”

During those seven years, our Scrooge has created a complicated and tangled plan to deliver his business objectives and commitments, ignoring risks and control points, continuously missing deadlines and failing to achieve performance targets.

Christmas carol

Continues >

“I wear the chain I forged in life. I made it link by link and yard by yard; I girded it of my own free will.”

corporateinsight


The Ghost of Risk, Assurance and Audit Present

The next sprit to visit Scrooge is the Ghost of Risk, Assurance and Audit Present, a giant clad in a green fur robe. He appears in his room and offers to take Scrooge on a tour of the organisation to reveal what is happening today at the HSCIC.

“Spirit,” said Scrooge submissively, “conduct me where you will. I went forth last night on compulsion, and I learnt a lesson which is working now. Tonight, if you have ought to teach me, let me profit by it.”

The Ghost reveals the HSCIC to be an organisation on the verge of transformation with many examples of good practice.

Scrooge witnesses the benefits of effective risk management and the long term effects of assurance and audit on development and growth. He is shown the importance of focusing on key control systems to address significant areas of risk.

The Ghost introduces him to an important area which is seen as a

Continues >

Christmas carol

“Spirit, conduct me where you will. I went forth last night on compulsion, and I learnt a lesson which is working now. Tonight, if you have ought to teach me, let me profit by it.”

corporateinsight

Scrooge was changing but his biggest test was yet to come with the appearance of the final Ghost.

The Ghost of Risk, Assurance and Audit Future

The Ghost of Risk, Assurance and Audit Future - who bears a terrifying resemblance to the Grim Reaper – arrives in Scrooge’s bedroom later that same night.

He leads the terrified business manager through a sequence of scenes relating to the future of the HSCIC and the introduction of an Integrated Risk and Assurance Framework, which he fears he will not be a part of.

The structure, explains the Ghost, supports the organisational change delivered by the transformation programme and enhances the controls already in place. The introduction of a

barrier to the success of assurance and audit activity – Ignorance.

Ignorance about risk, assurance and audit is not acceptable in an organisation which prides itself on its expertise, professionalism, values and transparency, says the Ghost. Ignorance is no longer an excuse – it never has been.

The Ghost continues to introduce Scrooge to the ways the HSCIC is building on its reputation and the lessons it has learned during a testing 18 months following the Partridge Review.

Scrooge pleads with the spirit to let him stay at the organisation - especially when he sees for himself the workings and benefits of the Risk Management Framework and a range of assurance activities, including quarterly statements on internal control; the assurance map (which defines and assesses assurance activities); and the internal audit programme.

“The Ghost was greatly pleased to find him in this mood and looked on him with such favour that he begged like a boy to be allowed to stay…but this the spirit said could not be done.”

Stephen Treece and David O’Brien


Christmas carol

risk and evidence-based assurance programme focuses on the operation and effectiveness of key control systems to address significant areas.

Scrooge sees the organisation providing a more streamlined and co-ordinated assurance regime which addresses risks proportionately and effectively, whilst providing better value and removing duplication.

Risk, control and assurance are now a part of everyday life at the HSCIC and are part of the fabric and culture of the organisation.

The self-serving attitude which Scrooge has held for many years now feels out of date and no longer in the interest of the organisation - or his own views.

He hears people discussing the HSCIC in glowing and positive tones and pleads with the Ghost to allow him to be part of the organisation’s future:

“Spirit!” he cries, tight clutching at its robe, “hear me! I am not the man I was.

I will not be the man I must have been but for this intercourse. Why show me this if I am past all Hope? “Assure me that I yet may change these shadows you have shown me, by an altered life!”

Holding up his hands in one last prayer to have his fate reversed, he sees an alteration in the Phantom’s hood and dress. It shrinks, collapses, and dwindles down into a bedpost.

Scrooge realises – with the collapse of the Spirit, that the time before him “is his own, to make amends in!”

He is indeed a changed man and vows from that day on that risk management, assurance and audit will become an essential part of his relationship with the HSCIC.

Scrooge goes out onto the streets with an enormous smile on his face and cheerfully joins in the Christmas celebrations.

“God Bless Us, Every One!” A Merry Christmas to all at HSCIC.

This is of course a seasonal fantasy. We are implementing a refreshed Integrated Risk Assurance Framework, so that you can avoid Scrooge’s experiences.

The objectives of this framework are: • Effective and proportionate

assurance of the mitigation of the major risks to our business objectives and obligations, whilst

• Minimising the assurance ‘burden’ and impact on delivery.

The approach we are taking will: • Provide an integrated risk and

assurance policy, framework and processes

• Deliver evidenced-based assurance on key risks and control systems

corporateinsight

• Embed collaborative working with the internal audit team and ensure that we close off audit actions promptly

• Minimise duplication of effort

• Be consistent with Transformation

• Provide the opportunity for the business to help us re-engineer the risk, control and assurance framework

To find out more contact:

Steve Treece, Head of Corporate Risk and Assurance: [email protected]

David O’Brien, Head of Business Intelligence: david.o’[email protected]

Integrated Risk Assurance Framework

mailto:[email protected]

mailto:david.o%E2%80%[email protected]

< 33 >

Businessinsight

Off the wall Gone are the days of sketching out plans on the back of an envelope. Today, the Health Digital Services portfolio team is writing its business plan on the wall.

Continues >

< Back to contents

Dean McGarr does not hold any truck with the concept that you ‘can’t teach an old dog new tricks’.

For many years, Dean has been heavily involved in writing business plans. This year he’s attempted a novel, KanBan-style approach – and it’s been more engaging and rewarding than ever before. Kanban is Japanese for ‘visual signal’.

“We were looking for a creative way of doing the business planning for next year with real engagement and buy-in from across the Health Digital Services (HDS) portfolio,” says Dean, Programme Head for HDS Transformation and Project Management.

“We have an agile coach who has working with many of our teams to develop new project management techniques. KanBan boards are typically set up to breakdown project scheduling into highly visual core components. This way makes it easier to communicate on what work needs to be done. So we did this by breaking down the HSCIC business plan template and placing these on a wall visible to everyone in Bridgewater Place.”

The elements constituted: • Projects - a time-bound piece of

work to create, amend or close a managed service that already has confirmed funding.

• Minimum Viable Service – the ongoing service that the HSCIC continues to provide to health and social care that delivers benefits.

• Opportunities - an opportunity or idea that has been proposed but not yet fully funded and resourced, including discovery.

The HDS Transformation Forum and Champions for Change have been directly involved in providing input and there is an open invitation issued to all staff to visit the BP Wall which was emphasised by the HDS Director James Hawkins at one of his weekly stand-ups.

“Our aim was to make the business plan accessible and understandable to all out staff, and ensure that our PDR objectives are aligned. Our Senior Management Team has subsequently taken into account all suggestions that have been made to inform our initial draft business plan,” says Dean.

“In summary it has been incredibly rewarding and interesting to do business planning this way, really encouraging buy in and engagement from different areas of HDS.

“Moving forward the business plan needs to be a fundamental framework in which to determine whether new work is progressed: does it align with our strategic objectives, aspirations and priorities?

“HDS also has a lead role to play in the delivery of National Information Board programmes. Our planning will

be taking account of the spending review announcement, particularly as details for how that funding will be allocated become clearer in the next few months.”


Businessinsight

Rekha Prasad and Dean McGarr in Health Digital Services

“In summary it has been incredibly rewarding and interesting to do business planning this way.”

Off the wall

The graduates

< Back to contents

graduateinsight

The HSCIC’s Graduate Scheme is almost a year old and the first people to take part in the two-year programme are beginning to realise there is more to a career in IT than first meets the eye.

Andrew Glynn has been out to meet these eager new trainees and find out how their ambitions have moved on since they first arrived.

Continues >

< 35 >

Pictured left to right:Daniel Johnston; Alistair Webster; James HepworthAdam Brown; Phil Gee;Matthew Puzey;Emma Holmes; Paul Adegbemisoye; Zubiar Patel.


T he nine graduate trainees who are working in IT in various different roles at HSCIC were selected from a field of more than 100 applicants.

A year ago they each faced a series of tests to evaluate their technical and personal attributes to become one of the chosen few.

This is the first time HSCIC has run such a scheme and we’ve just come to the end of the graduates’ first year .

The two-year programme includes four six-month placements in rotation with each graduate being given a mentor and a work ‘buddy’ to oversee their development.

Spine Programme Director Ian Lowry is one of the driving forces behind the ‘grow our own talent’ approach.

“Any organisation needs to have a balance between experience, mid-career and young people coming in,” he says. “There has to be a constant change otherwise you are left with a big void. It’s an opportunity for us to contribute to the knowledge pool, not only for the HSCIC but for the UK and I feel we have a duty to do so.”

Ian is keen to emphasise the graduates are responsible for their own careers but the HSCIC is offering a positive experience with access to senior management and highly talented individuals working on exciting projects.

He says the graduates have responded positively. “One thing I’ve noticed is how they’ve grown, how they’ve matured in the workplace. I see it every day.”

The graduates all agree the past year has made a big impression. It’s been challenging but has introduced them to areas of work they never knew existed.

“Any organisation needs to have a balance between experience, mid-career and young people coming in”

The graduatesgraduateinsight

Learning from each otherFor the HSCIC what has been noticeable is the blossoming of confidence among the graduates. HR Manager Charlotte Goulding quotes the example of Emma and Alistair at the Leeds Graduate Recruitment Fair and seeing the impressive way they spoke to undergraduates as evidence of how they have developed.

Charlotte says the graduates have all changed in different ways: “They all had ideas about what they wanted to do when they arrived but quite quickly through their placements they’ve found what they now see as being their preferred career path. Seeing this level

of development in such a short time makes it all worthwhile and rewarding. Feedback from line managers about the way they have contributed to the HSCIC has been impressive and they have contributed new ideas and different ways of thinking.”

They are a generation who have grown up with technology in a different way and both sides have benefitted from learning from each other.

The current scheme has another year to run and the next group of graduates is expected to begin work in September 2016.

Watch a video about our graduates here

http://connect/internal-services/human-resources/graduates

Insight Dec15 final

Documents

Transcript of Insight Dec15 final