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Cambridgeshire and Peterborough Clinical Commissioning Group
Cambridgeshire and PeterboroughLocal Digital Roadmap Public Narrative
Cambridgeshire & Peterborough - Local Digital Roadmap
2 3
Cambridgeshire & Peterborough - Local Digital Roadmap
Contents
January 2017
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
2 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
3 Our Footprint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
4 Our Local Digital Roadmap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
4 .1 Roadmap Content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
4 .2 Our Roadmap Development Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
4 .3 Roadmap Approval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
5 Our Digital Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
6 Where are we now? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
6 .1 Digital Maturity Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
6 .2 Sector Progress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
6 .2 .1 Primary Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
6 .2 .2 Secondary Care, Mental Health and Community Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
6 .2 .3 Local Authorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
6 .3 Key Achievements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
6 .3 .1 Primary Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
6 .3 .2 Secondary, Tertiary and Mental Health and Community Care Providers . . . . . . . . . . . . . . . . . . . . . . . . .20
6 .3 .3 Social Care and Local Authority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
6 .3 .4 Independent and Voluntary Sector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
6 .3 .5 Other Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
6 .4 Current Progress Against Our Strategic Themes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
6 .4 .1 Information Sharing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
6 .4 .2 Other Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
7 Delivering Our Digital Ambitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
7 .1 A System Wide View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
7 .2 Delivery of Our Digital Themes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
7 .3 Summary of Projects to Deliver Our Digital Themes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
7 .4 Increasing Our Digital Maturity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
7 .4 .1 Records, Assessments and Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
7 .4 .2 Transfers of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
7 .4 .3 Orders and Results Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
7 .4 .4 Medicines Management and Optimisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
7 .4 .5 Decision Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
7 .4 .6 Remote Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
7 .4 .7 Asset and Resource Optimisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
7 .5 Digital Maturity – Our Future Trajectory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
7 .6 Delivering the Ten Universal Capabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
8 Enabling Our Ambitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
8 .1 Infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
8 .2 Mobile Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
8 .2 .1 Mobile Infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
8 .3 Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
8 .3 .1 NHS Number Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
8 .3 .2 SNOMED-CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
8 .3 .3 Dictionary of Medicines and Devices (DM&D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
8 .3 .4 Other Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
8 .4 Collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
8 .4 .1 Unified communications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
8 .4 .2 Shared Infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
8 .4 .3 Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
8 .5 Digital Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Cambridgeshire & Peterborough - Local Digital Roadmap
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Cambridgeshire & Peterborough - Local Digital Roadmap
9 Our Digital Delivery Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
9 .1 Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
9 .2 Working Together . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
9 .3 System Wide vs Local Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
9 .4 Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
9 .4 .1 Area Executive Boards (AEBs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
9 .4 .2 Delivery Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
9 .4 .3 Cross-cutting Strategy Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
9 .4 .4 Quality Assurance Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
9 .4 .5 The System Delivery Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
9 .4 .6 Digital Delivery Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
9 .5 Transformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
9 .6 Measuring our success . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
9 .6 .1 Monitoring Our Implementation Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
9 .6 .2 Opportunities for Benchmarking and Peer Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
9 .7 Risk Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
9 .7 .1 Our Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
9 .8 Areas of Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
9 .8 .1 Data S ecurity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
9 .8 .2 Clinical Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
9 .8 .3 Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
9 .8 .4 Data Protection and Privacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
9 .8 .5 Accessible Information Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
9 .8 .6 Business Continuity and Disaster recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
9 .8 .7 Technical Approaches to Patient Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
9 .8 .8 System Wide Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
9 .9 Rate Limiting Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
9 .10 Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
9 .11 Resourcing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
9 .12 Sources of Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
9 .12 .1 Local Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
9 .12 .2 National Funding Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
9 .12 .3 Identifying Additional Sources of Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
10 Looking Towards the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
IntroductionThe population of Cambridgeshire and Peterborough is growing rapidly . People are generally living longer, so we have an ageing population, and more people have long term conditions or higher levels of obesity . We have a total budget of more than £1 .7 billion for NHS services, but we spend about £160million each year more than that . If nothing chan ges, by 2021, this overspend is set to grow to about £504million . These are the health and wellbeing, care and quality, and financial challenges we face .
To address these challenges, the local NHS, general practice and local government have come together under a strong, visible and collective leadership in the form of a Health and Care Executive (HCE) . This team, supported by the strong clinical leadership of a Care Advisory Group (CAG) is developing a major new plan to keep Cambridgeshire and Peterborough Fit for the Future . This five-year Sustainability and Transformation Plan (STP) covers hospital services, community healthcare, mental health, social care and GP services . All organisations in the Cambridgeshire and Peterborough area have agreed this plan, and to work together . Our plan aims to:
• improve the quality of the services we provide
• encourage and support people to take action to maintain their own health and wellbeing
• ensure that our health and care services are financially sustainable and that we make best use of the money allocated to us
• align NHS and local authority plans .
To implement this plan successfully, we must use technology to modernise how we deliver healthcare . To achieve this, we will consider digital less a separate entity operating in a supporting role to the main planning process, but more as the way of doing things . This Local Digital Roadmap (LDR) outlines
how best we can meet the challenges of providing healthcare in a digital world and delivers a plan that will improve our population’s health and wellbeing, outcomes, and experiences of care .
BackgroundIn October 2014, NHS England produced the strategy, ‘Five Year Forward View’ (FYFV), as guidance for all sectors of the NHS . It set out a clear view of the challenges ahead, why change is needed, and what change might look like . It outlined a vision to address the challenges facing the NHS, and to drive better patient outcomes . It proposed that the estimated £30billion gap in NHS funding predicted to appear by 2020-21 could be closed completely if the health service develops new, more efficient care models . Digital and information technology is a key enabler to deliver this transformed future for the benefit of every service user, carer, citizen and professional .
NHS England has subsequently published ‘Personalised Care 2020’, which provides the framework for implementing the necessary changes to model care around the patient, using digital technology to transform the patient’s experience, by improving convenience, quality and effectiveness .
This approach resulted in the division of England into 85 footprints . Work is in progress to develop digital roadmaps across all footprints throughout England, enabling CCGs and provider organisations to prioritise investment in, and implementations of, digital solutions for data sharing and paperless working . The ‘National Information Board (NIB) Framework for Action’ calls for CCGs to produce digital roadmaps outlining how its local health and care economies will achieve the ambition of being paper-free at the point of care, by 2020 .
1
2
Shared
Enable multi-disciplinary working
Better access online
Apps
Information
Cambridgeshire & Peterborough - Local Digital Roadmap
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Cambridgeshire & Peterborough - Local Digital Roadmap
Our FootprintCambridgeshire and Peterborough has a committed
and expert health and care workforce . We provide
some excellent services to which people travel from
other parts of the country . We host innovative
research and deliver excellent medical education and
training . We have a resourceful voluntary sector,
strong organisations, active local communities, and
we work alongside research and technology industries
which are world leaders in improving healthcare .
Cambridgeshire and Peterborough CCG is one of
the biggest in the country, with 105 GP practices
as members, that includes three practices in North
Hertfordshire and two in Northamptonshire .
Our CCG serves a patient population of approximately
930,000, which is diverse, ageing, and has significant
inequalities . STP footprints typically map to LDR
footprints, on a one-to-one or one-to-many basis . The
Cambridgeshire and Peterborough STP footprint maps
directly to the Local Digital Roadmap footprint . This
means that we can align our Local Digital Roadmap
vision and ambition with those of the STP . The STP
and LDR boundaries are shown on the map below .
The organisations which make up the Cambridgeshire and Peterborough STP and LDR footprints are shown
below . However, we also recognise that people are supported by a network of formal and informal care;
therefore our roadmap also recognises our partnership work with all organisations involved in the delivery of
care including the voluntary sector .
Our Local Digital RoadmapOur Local Digital Roadmap (LDR) describes our vision for the future, where we are now and our plans to transform the way we deliver care and accelerate change using digital tools and information .
4.1 - Roadmap Content
It includes the following elements:
• Our five-year vision for our digitally-enabled transformation
• A baseline of our current capabilities
• An overview of our ambitions, including a capability deployment schedule and trajectory, outlining how, through driving digital maturity, our staff will increasingly operate ‘paper-free at the point of care’ over the next three years
• Our delivery plan for a set of core capabilities, detailing how progress will be made in fully exploiting the existing national digital assets
• How we will collaborate within our footprint and how digital information is an enabler for this, including our information sharing approach
• How we will deliver our ambitions, including the programme structure and likely sources of funding
As a footprint, our work overlaps with other footprints: For example:
• PSHFT has a ‘catchment’ which provides care split 50:50 between North Cambridgeshire and South
Lincolnshire
• The ambulance trust provides services across the East of England and is driven by a despatching system
rather than a patient-centric system
• Papworth provides the majority of its services to patients from beyond the footprint boundaries
3
4
Nottinghamshire
Lincolnshire
Leicester, Leicestershire and
Rutland
Northamptonshire
Norfolk and Waveney
Bedfordshire, Luton and Milton Keynes
Suffolk
Cambridgeshire and Peterborough
Essex
CCG
NHS Trusts
• Cambridgeshire and Peterborough CCG
• Prime Minister’s GP Access Fund (wave two)
- Primary Care Transformation PeterboroughOther Providers
• Hertfordshire urgent care
Local Authorities
• Cambridgeshire County Council
• Peterborough County Council
Health and Wellbeing Boards
• Cambridgeshire
• Peterborough
Other Partners
• Voluntary organisations
• Patient groups
Other Partners
• Cambridge University Hospitals NHS foundation trust
• Cambridgeshire and Peterborough NHS Foundation Trust (Mental Health, Community and Children’s services)
• Cambridgeshire Community Services NHS Trust (Community and Children’s services)
• Hinchingbrooke Health Care NHS Trust
• Papworth Hospital NHS Foundation Trust
• Peterborough and Stamford Hospitals (Acute)
Cambridgeshire & Peterborough - Local Digital Roadmap
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Cambridgeshire & Peterborough - Local Digital Roadmap
This LDR does not replace the informatics strategies
for the organisations within our footprint, however,
it provides a means to bring together, align and
strengthen these plans in a consolidated view of the
programmes required to become as close as possible
to ‘paper free at the point of care’ and to support the
delivery of integrated health and care services . The
roadmap covers the period 2016-2020, with specific
focus upon the first two years 2016-2018 . The LDR
will be a living document and will be updated on a
regular basis, to reflect the development of the STP .
4.2 - Our Roadmap Development Process
To produce this roadmap, we worked collaboratively
with organisations within our footprint involved in the
commissioning and provision of health and social care .
These organisations and stakeholders included GP
Practices, commissioners and provider organisations
across all care settings including Acute, Community
and Mental Health, and Local Authorities . Specific
input was received from the organisations listed
below:
• Cambridge University Hospitals NHS Foundation
Trust
• Cambridgeshire and Peterborough CCG
• Cambridgeshire and Peterborough NHS
Foundation Trust
• Cambridgeshire Community Services NHS Trust
• Cambridgeshire County Council
• Herts Urgent Care
• Hinchingbrooke Health Care NHS Trust
• Papworth Hospital NHS Foundation Trust
• Peterborough and Stamford Hospitals NHS
Foundation Trust
• Peterborough City Council
We designed our roadmap development process to
ensure that it underpins the delivery of both our STP
transformation priorities and the national ‘paper free
at point of care’ ambitions . This will enable us to
deliver the national vision set out in the 5YFV .
Our roadmap development approach (as shown in the
diagram below) was ratified by our Health and Care
Executive, which comprises the Chief Executives of
member organisations . The CCG was also authorised
to complete, approve and submit the completed
LDR document on behalf of the local community of
organisations . Support for, and review of, the LDR
document has been provided by the collaborating
organisations’ Information Communication
and Technology (ICT) representatives . This was
supplemented by input from the NHSE Regional Office
and feedback from care professionals on the digital
initiatives required to enable our sustainability and
transformation process .
We recognise the importance of Chief Clinical
Information Officers (CCIO) and these roles continue
to be introduced across our footprint . Where
a CCIO is in post within an organisation, these
individuals provided input into the process . Our
support and approval process was conducted via
series of workshops, web conferences and individual
correspondence . Information, Communication and
Technology (ICT) leads were given the authority to
contribute and approve their own organisation’s input
into the LDR .
We began our roadmap development process with a
‘requirements gathering’ phase . This ensured we took
account of all relevant requirements . Areas considered
included national initiatives such as FYFV and the
requirements of the ‘paper free’ agenda . Senior
clinical and managerial staff within collaborating
organisations provided details of the digital
transformation priorities and challenges for their
organisations . As part of the STP process, the digital
agenda and the need for the LDR was discussed in
the STP clinical working groups . Their feedback has
ensured that our entire framework and priorities are
based on input and feedback from care professionals
and patient representatives . In addition, information
was drawn from a number of cross-organisational
groups and initiatives, including Vanguard and Better
Care Fund .
We identified our digital themes via a sequence
of cross community digital maturity sessions, web
conferences and via our STP process work groups .
As part of wider STP discussions, the broad elements
of this LDR have been reviewed with our two Health
and Wellbeing Boards . The LDR has been discussed
with our cross-organisational groups, including the
Better Care Fund Information Sharing Group . The
June 2016 LDR has also been shared with LDR leads
from Norfolk, Suffolk and Essex, as part of an effort
to improve cross-community learning and sharing
of expertise . This approach helped to ensure we
put in place strategic system-wide building blocks
and enablers, whilst supporting different localities
and providers to deliver their local requirements for
improving digital maturity .
We expect our roadmap development to be an
evolving and changing process, reflecting our
agreed ‘plan–do–study–act’ cycle approach to
transformational change . We will continue to review
and refine our LDR as part of the STP process, and
will seek patient and citizen involvement particularly
around the establishment of an acceptable ‘consent
to share’ policy and its implementation . We will also
seek wider involvement from the voluntary sector .
Our LDR is fully integrated in our STP governance and
programme delivery structure, as outlined in section 9 .
4.3 - Roadmap Approval
To help ensure this LDR is in synch with STP plans
and that the ‘golden thread’ of digital runs through
the STP ambitions, we have linked the LDR approval
mechanism with STP processes, wherever possible .
This LDR has been reviewed by the Health and Care
Executive . This full document has been approved
by the CCG on behalf of organisations within
Cambridgeshire and Peterborough, but further
development and approval will see changes that
require further ratification during 2016/17 .
Requirements gathering
Identification of Themes and
Enablers
Review our baseline
Formulate our delivery plan
Cambridgeshire & Peterborough - Local Digital Roadmap
10 11
Cambridgeshire & Peterborough - Local Digital Roadmap
Our Digital VisionTo ensure we harness the power of digital tools and
information to meet the needs of our population, we
agreed the following overarching vision for the Local
Digital Roadmap 2016-2020 .
By 2020:
“Patients and Citizens, Health and Social care staff
will have access to quality, timely and accurate
information regardless of place or time to enable
improved decision making and ultimately better
outcomes for both the individual and the community.”
Digital technology is a key enabler for the delivery of
our sustainability and transformation plans for the
future of health and care within our footprint . The
Cambridgeshire and Peterborough STP footprint maps
directly to the Local Digital Roadmap footprint which
enables us to align our Local Digital Roadmap vision
and ambition with those of the STP .
The sustainability and transformation plans for the
Cambridgeshire and Peterborough footprint are
known as Fit for the Future . These plans focus on
how we operate as a system as a whole, rather
than on individual organisations or services . This
approach is clinically-led and highly collaborative . It
sets out a single overall vision for health and care for
Cambridgeshire and Peterborough, including:
• Supporting people to keep themselves healthy
• Primary care (GP services)
• Urgent and emergency care
• Planned care for adults and children, including
maternity services
• Care and support for people with long term
conditions or specialised needs, including mental
ill health .
Our HCE, through discussions with our staff, patients,
carers, and partners has identified four priorities and
developed a 10-point plan to deliver these changes .
The plan includes six themes for change and four
enablers to help us deliver our vision .
This section of the LDR describes our vision and
ambitions for meeting these themes for change . A
key enabler to achieving this is ‘Using technology to
modernise health’ . The sequence of diagrams below
demonstrates how digital technology is a golden
thread which is essential to supporting our vision for
change . The Local Digital Roadmap guidance provided
by NHS England outlines four digital elements which
will contribute towards delivering these challenges:
• Paper-free at the point of care (PF@POC)
Health and Social Care staff will be able to access
patient and citizen data electronically wherever
they or the patient or citizen are .
• Digitally enabled self-care
Patients and citizens will be able to interact
electronically with health and social care providers
about their own health and care . This can include
patient apps .
• Real time analytics at the point of care
The clinical system used by the clinical staff will
have the ability to provide real time analysis of
the data about the patient and citizens across the
health and social care systems including patient/
citizen provided data .
• Whole systems intelligence to support
population health management and effective
commissioning, clinical surveillance and
research – providing access to pseudonymised
data for analysis across the whole footprint
As part of the LDR development process, we have not
only considered these aspects, but also how other
types of digital tools and information can transform
the way we deliver care to meet our themes for
change . The diagrams below also demonstrate how
our vision for digitally enabled transformation will
help address the three national challenges: a) closing
the health and wellbeing gap, b) closing the care and
quality gap c) closing the finance and efficiency gap .
5
At home is bestPeople powered health and wellbeing Neighbourhood care hubs
Safe and effective hospital care, when needed
Responsive urgent and expert emergency care Systematic and standardised care Continued world-famous research and services
We’re only sustainable together Partnership working
Supported delivery (Our enablers)
A culture of learning as a system Workforce: growing our own Using our land and buildings better Using technology to modernise health
Cambridgeshire & Peterborough - Local Digital Roadmap
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Cambridgeshire & Peterborough - Local Digital Roadmap
Neighbourhood care hubs
Responsive urgent and expert emergency care
People powered health and wellbeing
Systematic and standardised care
More health and care services will be provided closer to people’s homes and we will help people stay at home when they’re unwell.
We will offer a range of easily accessible support for care and treatment, from telephone advice for urgent problems to the very best hospital emergency services when the situation is life threatening.
We will help people to make healthy choices, keep their independence, and shape decisions about their health and care. We will work with community groups and businesses so people of all ages have good health, social and mental wellbeing support.
Doctors, nurses and other health and care professionals will work together across Cambridgeshire and Peterborough to use the best treatments and technology available.
Our Vision Gaps Addressed Digitally enabled by
To coordinate care better, tailored to the needs of the individual, paying close attention to the health and care services necessary to keep people living at home successfully
Health and WellbeingFinance and Efficiency
PF@POCShared recordsDigital self careRisk stratificationShared infrastructureUnified communications
When people become unwell, we will take every opportunity to spot warning signs, for example during regular health checks and visits to urgent care services
Health and Wellbeing PF@POC Shared recordsReal time analyticsWhole systems intelligenceRemote monitoring
Provide local support to help people live with long-term health conditions .
Health and Wellbeing Digital self careTelehealth and remote monitoring
Joint working between local health and social care, with GPs playing a central role, supported by hospital clinical teams .
Care and QualityFinance and Efficiency
InteroperabilityShared recordsReal time analyticsWhole systems intelligenceShared infrastructureUnified communicationsCollaboration tools
Our Vision Gaps Addressed Digitally enabled by
Better coordination, for example referral through NHS 111, close working with the ambulance service
Health and WellbeingFinance and Efficiency
InteroperabilityReal time analyticsShared recordsShared infrastructureUnified communications
To provide clear information to patients about which services are available – and how to reach them – when they have an urgent health need .
Health and Wellbeing Digital self carePatient portal
We have made a commitment that all urgent and emergency care services must meet the recently revised national standards .
Health and Wellbeing Whole system intelligenceReal time analytics
We expect that 24/7 urgent care services will remain on our main three sites .
Care and QualityFinance and Efficiency
Real time analyticsWhole systems intelligence
Our Vision Gaps Addressed Digitally enabled by
To prevent illness and support people to take control of their own health and wellbeing
Health and WellbeingFinance and Efficiency
PF@POCPopulation health managementRisk stratificationDigital self carePatient apps
To develop health services which work alongside patients and carers, social care and housing providers, and help to build strong communities .
Health and Wellbeing Shared recordsPopulation health managementShared infrastructureUnified communicationsCollaboration tools
Patients become equal partners with those caring for them, and with support and advice, make more decisions about their own treatment
Health and Wellbeing Digital self carePatient appsTelehealth & Remote monitoring
Patients become increasingly confident to manage their own conditions, supported by technology .
Care and QualityFinance and Efficiency
Real time analyticsRisk stratificationWhole systems intelligenceDigital self care
Our Vision Gaps Addressed Digitally enabled by
To make better use of research evidence – drawn from Cambridgeshire and Peterborough and beyond – will help us to use care and treatments systematically which are proven to be the most effective .
Health and WellbeingFinance and Efficiency
Whole systems intelligence
Where it is important to provide services from several sites across the area, we believe we can use our skills and expertise collectively to achieve better results through doctors and nurses working across more than one hospital site and sharing their expertise .
Finance and Efficiency Care and Quality
PF@POCInteroperabilityShared recordsReal time analytics Whole systems intelligenceShared infrastructureUnified communicationsCollaboration tools
We expect that maternity services will remain at The Rosie Hospital, Hinchingbrooke Hospital, and Peterborough City Hospital .
Health and Wellbeing PF@POCShared recordsWhole systems intelligence
Cambridgeshire & Peterborough - Local Digital Roadmap
14 15
Cambridgeshire & Peterborough - Local Digital Roadmap
Continued world-famous research and services
We have world-class specialised care, but we are always looking for ways to be better.
Partnership working
Everyone who provides health, social, and mental health care across Cambridgeshire and Peterborough will plan together and work together.
Our Vision Gaps Addressed Digitally enabled by
We will work together with our local research organisations and businesses to deliver world class care .
Health and Wellbeing Finance and Efficiency
PF@POCShared recordsDigital self careRisk stratificationShared infrastructureUnified communications
To achieve consistently better results for people with more serious needs, such as for heart and lung services, or complex surgery, in fewer, specialist units which make best use of the world-class expertise of our specialist consultants .
Health and Wellbeing Finance and Efficiency
PF@POCReal time analyticsWhole systems intelligence
Our Vision Gaps Addressed Digitally enabled by
We will work across boundaries: between NHS and local authority social care; GPs and hospital care; and physical health and mental health .
Health and WellbeingFinance and Efficiency
PF@POCInteroperabilityShared recordsDigital self carePopulation health managementIndustry partnerships
We will support our GPs to collaborate more, and work with them to develop sustainable services
Health and Wellbeing PF@POCInteroperabilityShared recordsWhole systems intelligenceCollaboration toolsUnified communications
We will provide better access to resources through sharing and specialisation and closer working between GPs and their colleagues in hospitals .
Health and Wellbeing PF@POCInteroperabilityWhole systems intelligenceShared infrastructureCollaboration toolsUnified communications
We recognise that people are supported by a network of formal and informal care, and aim to work in partnership with local organisations such as faith groups and the voluntary sector .
Care and QualityFinance and Efficiency
Digital self careInteroperabilityWhole systems intelligence
We consider the enabler ‘Using technology to modernise health’ to be a golden thread, as it will not only allow
us to deliver our vision for our themes, but it is also essential to the development of our other three enablers .
As can be seen from the exploration above, technology
is a fundamental enabler if we are to deliver our
ambitious vision for change, which we set out in our
Fit for the Future Programme . Good information and
advice will help people to take control of their health .
We will use apps and online tools to provide more
immediate and reliable information to patients and
citizens . It is clear that shared information will help
hospital clinicians, GP practices, community teams,
and social care to work together more effectively . This
information sharing must extend to all providers of
care, including third sector and smaller organisations,
such as podiatrists and pharmacies . Effective use of
technology will help us to optimise service design and
improve the patient experience .
To provide a clear focus and ensure our future plans
align with our vision for change, we have identified six
digital themes:
Our enabler The digital factor
Workforce: growing our own
Helps our staff to develop their clinical skills and grow
professionally .
It also helps to grow informatics skills and
professionalise this important area of expertise . This
in turn leads to an increase of clinicians with the
necessary skills to become effective CCIOs
Using our land and buildings better Facilitates remote and mobile working
A culture of learning as a systemPromotes analysis of information to improve care and
enables sharing of knowledge and expertise
Interoperability
Invest in innovative technology to support our vision
Deliver real-time person level information to improve financial
and clinical performance
People powered health and wellbeing
Increase Data and information sharing
Adopt a population based approach to population based analytics
Cambridgeshire & Peterborough - Local Digital Roadmap
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Cambridgeshire & Peterborough - Local Digital Roadmap
We will increase our data and information sharing
capabilities by becoming paper free at point of care, to
provide shared records – i .e . a single view patient health
and care record wherever care is delivered .
We will enable the transformation of services and care
through the use of new technology including telehealth
and remote monitoring .
We will deliver real time analytics to allow the
monitoring of the day to day cost, utilisation and
outcomes of services within the health care system,
as well as system surveillance of financial and clinical
performance .
We will engage patients in their own care, health and
wellbeing via digital self-care, including the use of
healthcare apps, patient portals and online information
sources .
We will deliver IT capability to facilitate data transfer
between organisations including the use of standards
for data capture and messaging .
Where are we now?We have made significant progress across the footprint in raising our digital capability . There is strong digital
leadership, clinical engagement and governance within organisations across Cambridgeshire and Peterborough .
This is evidenced through the recent Digital Maturity Self-Assessment surveys and also within the membership
of the Sustainability and Transformation programme, of which digital development is an integral part .
Below, we set out our current position in relation to our digital maturity which is based on the core capabilities,
which will contribute to our ability to meet the paper-free challenge and the data sharing agenda .
6.1 - Digital Maturity Assessment
The Digital Maturity programme worked with a
number of partners including the Academic Health
Science Networks and healthcare providers and
CCGs to examine effective use of technology, with
particular focus on capabilities such as digital care
records, transfers of care and medicines management .
The result of this work was a framework that can
be used across acute, mental health, community,
ambulance and social care settings . This framework
is called the Digital Maturity Assessment . It builds on
existing evidence about how investing and effectively
using IT can achieve better patient outcomes, reduce
bureaucracy, improve patient safety and deliver
efficiencies .
This section explores our current digital maturity . It
uses the Digital Maturity Assessment information
to measure the extent to which our healthcare
services are supported by the effective use of digital
technology . We used this information to identify key
strengths and gaps in our provision of digital services
at the point of care, and offer an initial view of our
current ‘baseline’ position .
In order to understand our current ability to meet
the paper-free challenge, we analysed our digital
capability scores in the following seven core capability
focus areas:
1. Records, assessments and plans
2. Transfers of care
3. Orders and results management
4. Medicines management and optimisation
5. Decision support
6. Remote care
7. Asset and resource optimisation
For each provider organisation within our footprint
our scores are shown in the table below as %
achievements against the defined areas .
We also recognise that delivering capability in line
with our digital themes is only part of the story . To
achieve our ambitions we must also put in place the
necessary supporting infrastructure . This will include
unified communications, shared infrastructure and
collaboration tools . Furthering partnerships with
suppliers within the industry will also be a key factor
in our success .
We will adopt whole-systems intelligence to enable the
analysis of footprint-wide data to deliver population
health management, risk stratification, effective
commissioning, clinical surveillance and research .
6
TrustAsset and Resource Optimistation
Decision Support
Medicines Management and Optimisation
Orders and Results Management
Records, Assessments and Plans
Remote and Assistive Care
Transfer of Care
Cambridge University Hospital NHSFT 95 88 94 100 69 50 96
Cambridge and Peterborough NHSFT 45 47 32 51 33 59
Cambridgeshire Community Services NHS
Trust17 63 28 59 83 0 68
Hinchingbrooke Health Care NHS Trust 50 55 46 35 48 33 66
Papworth Hospital NHS Foundation Trust 45 19 11 57 28 33 22
Peterborough and Stamford Hospitals NHSFT 70 42 28 70 39 25 48
Cambridge and Peterborough average 54 52 41 59 53 35 60
National Average 43 36 29 54 43 35 50
Interoperability
Invest in innovative technology to support our vision
Deliver real-time person level information to improve financial
and clinical performance
People powered health and wellbeing
Increase Data and information sharing
Adopt a population based approach to population based analytics
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Cambridgeshire & Peterborough - Local Digital Roadmap
The scores for Cambridge University Hospitals NHS
Foundation Trust are very high and the Trust ranks
second against all NHS Trusts for the average score
across these seven areas of functionality . This
reflects the recent investment the Trust has made in
implementation of the Epic EPR .
The other Trusts rank between 64 and 72, out of 240,
with the exception of Cambridge and Peterborough
NHS Foundation Trust, which ranks 125 out of 240 .
As shown below, the footprint is achieving better
than the national average in all areas, except Remote
and Assistive Care, where scores are uniformly low,
but still around the national average . However, it is
important that those organisations at a lower level of
digital maturity progress to a higher level of maturity,
to ensure effective information sharing . This situation
is in common with all other footprints .
In order to continue to improve our levels of digital
maturity, we plan to leverage the knowledge and
expertise within the local and national digital
exemplars, for the benefit of our wider health
economy .
6.2 - Sector Progress
Overall, we are making good progress and have a
firm foundation for the future . We have a number
of organisations who have already implemented an
Electronic Patient Records (EPR): Cambridge University
Hospitals are using Epic and Cambridgeshire and
Peterborough NHS FT is using RiO for Mental Health
and SystmOne for Community Services . Many other
organisations have well defined plans and are making
good progress towards implementing an EPR: with
Papworth due to implement Lorenzo in June 2017,
and Peterborough and Stamford Hospitals with an
approved business case for a new PAS .
6.2.1 - Primary CareCambridgeshire and Peterborough has 105 GP
practices all of which use GP Systems of Choice
(GPSoC) approved systems, and have met the national
contract requirements for digital enabled services,
such as Patient Online, Summary Care Records,
GP2GP transfer, e-Referral System and EPS R2 .
Provision and use of services digitally to patients
within Primary Care tends to be higher than the
national average . For example, approximately 20%
active patients are using Patient Online services .
6.2.2 - Secondary Care, Mental Health and Community ServicesCambridge University Hospitals NHS Foundation
Trust recently achieved recognition for its digital
achievements from the Healthcare Information and
Management Systems Society (HIMSS), reaching
Stage 6 of the international Electronic Medical
Record Adoption Model (EMRAM) . This is a result
of its programme to implement the Epic EPR and
underpinning infrastructure . This programme has
delivered functionality across the core capabilities
which have been widely rolled out across the Trust .
The other Trusts within our footprint have started
the journey to paperless working but will require
investment to complete projects and fully implement
more advanced functionality, such as medications
management, requests and results, and support for
transfers of care and record sharing .
6.2.3 - Local AuthoritiesThe Social Care Digital Maturity Self-Assessment
uses the same structure as the NHS England Digital
Maturity Self-Assessment, but the areas have been
tailored for social care . Its emphasis is on supporting
local work and sharing good practice, and is sector-
led .
The digital maturity self-assessments completed by
Local Authorities across the country show significant
gaps around the capabilities and infrastructure
requirements, and this was reflected in the self-
assessments for both Cambridgeshire County Council
and Peterborough City Council . Officers from the two
local authorities are working with NHS partners to
ensure that these requirements are reflected in Better
Care Fund plans and in the STP . Investment will be
required in order to deliver these requirements .
6.3 - Key Achievements
We have made significant progress in the delivery
of our digital ambitions to date . A summary of key
recent achievements includes the following .
6.3.1 - Primary Care• Meeting or exceeding national contract
requirement for Primary Care IT services . Examples
include:
• GP LSP to GPSOC transition was completed
three months ahead of national contract
requirement
• Patient Online national target 10% for 16/17
local percentage already @ 20%
• Higher than average Electronic Referral Service
(eRS) usage
• All GP practices on GPSOC approved systems
• Significant infrastructure upgrades
• Establishment of new practices within the area
• Prime Ministers Challenge Fund – Greater
Peterborough Network
• 7 day a week IT support provision for GP practices .
• All Cambridgeshire and Peterborough GP practices
submittedw an IG Toolkit self-assessment .
Baseline Digital Maturity Assessment
Cambridge and Peterborough average National average
Asset and Resource Optimisation
Transfer of Care Decision Support
Medicines Management and OptimisationRemote and Assistive Care
Records, Assessments and Plans
Orders and Results Management
60
50
40
60
20
10
0
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Cambridgeshire & Peterborough - Local Digital Roadmap
6.3.2 - Secondary, Tertiary and Mental Health and Community Care Providers• Overall, these organisations have achieved a
higher standard of digital maturity compared to
the national average
• Infrastructure upgrades and significant systems
and organisational change developments have
been delivered
• Increased use of clinical systems across multiple
sites and specialties
• Mobile working initiative for clinical staff .
6.3.3 - Social Care and Local Authority • Creation of Better Care Fund Data Sharing
programme in 2015 (includes representation
for health and care in Cambridgeshire and
Peterborough)
• New procurements for next generation social care
system
• Infrastructure upgrades across the area
• Extensive online services for citizens
• NHS number compliance
• Extensive upgrade to broadband infrastructure
across the area to above national averages,
through the Connecting Cambridgeshire initiative .
More than 100,000 homes and businesses across
the county have been upgraded, taking total
superfast coverage to over 93% completed in
2015 . Peterborough City Council is also running
an ambitious City Fibre project .
• Cambridgeshire County Councils ‘Learn Together’
initiative for schools providing online description
and access to services that the council provides .
Includes the ability to book courses and access
health and social care information
• Peterborough achieved the status of World Smart
City at the Barcelona World Smart City Expo, for
creating smart solutions to city challenges .
6.3.4 - Independent and Voluntary Sector • Increased sharing of information between sectors
• Increased involvement in decision making about
new service provision .
6.3.5 - Other Areas• Cross-organisational working as part of the Better
Care Fund:
• Data Sharing
• 7 Day Services
• Person-Centred Systems
• Information Advice and Guidance
• Healthy Ageing and Prevention .
• Urgent and Emergency Care Vanguard initiative .
6.4 - Current Progress Against Our Strategic ThemesA great deal of cross-organisational work is already
underway or soon to start . These developments
increase the use of digital technology to improve
the efficiency of services, provide services in new
ways, and in some cases provide services that were
not possible until the digital changes had or will be
delivered .
6.4.1 - Information SharingAll providers use email and/or SMS to communicate
with patients . Providers are able (with consent) to
access nearly 900,000 summary care records (SCR) for
patients within Cambridgeshire and Peterborough,
and have access to millions of SCR for visitors,
students etc . The provision of SCR to community
pharmacists is well underway .
As an example of practical information sharing, the
following table describes in summary how individual
health organisations can access GP structured
information (subject to patient consent) . The
organisations involved are committed to increasing
the use of GP information .
TPP SystmOne shared patient record . Note during 2016/17 should also be able to access EMIS Web and vice
versa from within clinical system .
Access to record technically available and used within parts of the respective organisation, increasing access
to GP record (with appropriate consent) .
Trusts do not have full access to GP patient record .
We have also made progress against our ambition to use digital capability to share electronic information with
patients and citizens . The following table shows our progress areas .
Organisation GP Record Clinical view of GP record Summary Care Records
CUH
CPFT
111/OOH (HUC)
Papworth
CCS
PSHFT
HHCT
GP Practices
Organisation Shares electronic information with patients
Type of electronic sharing in place
CUH Choose Well Cambridge – available now gives patients advice re the right level of care to access .
Patient Portal - MyChart - the app available to patients who have signed up to the CUH Epic patient portal . CUH have deployed this in their Obesity service and are just starting deployment in Oncology . This app is written by Epic
CPFT
111/OOH (HUC)
CCS
PSHFT
HHCT
Papworth Pilot re use of Patient Knows Best for some patients within Thoracic medicine . Looking to expand .
GP Practices Patient Online
Cambridgeshire County Council
SMS
Peterborough City Council
Transactional activities
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6.4.2 - Other InitiativesThe following table is a list of key current initiatives;
we have indicated where these projects improve our
core capability related to paper-free at point of care,
and where they contribute to progress against a
digital theme . Some of these initiatives are foundation
projects, which will enable us to deliver our vision . As
our Local Delivery Roadmap continues to evolve, and
the Digital Delivery Group within the STP will continue
to contribute to, and coordinate the range of digital
initiatives in progress .
Delivering Our Digital AmbitionsThis section sets out how we will use digital tools and information to transform the way we provide care and
deliver our digital vision .
7.1 - A System-wide View
To deliver our vision for change we have set in place
a planned programme of work which will support
our digital themes . As an important part of this
work programme we must also increase the digital
maturity of all organisations within our footprint . It is
particularly important that we focus on raising digital
maturity across the Core Capabilities, identified as key
in achieving paper-free working at point of care . This
will ensure organisations within our footprint collect
a broad set of useful data . This is vital, not only to
meet our requirement to share meaningful data about
individual patients, but also to allow us to transform it
into meaningful information, knowledge and wisdom .
It is therefore important that those organisations at
a lower level of digital maturity progress to a higher
level of maturity to ensure effective information
sharing, business intelligence and the opportunity for
footprint-wide analytics .
To help ensure that organisations use existing national
systems and capabilities to share information, 10
universal capabilities have been identified as targets
for health and care organisations, to support the
cross-organisation sharing of information . The
following diagram shows how these 10 universal
capabilities align with the Core Capabilities identified
in the Digital Maturity Assessment framework .
Initiative Description Core Capability Theme
Integrated Urgent
Care service
Provision of integrated 111 and Out of Hours service with the
provision of additional clinical hub, which places additional
expertise within the IUC service to support patients early in
order to direct the patient to correct service .
Decision support Increase data
and information
sharing
Neighbourhood
teams
Provision of information to teams working with patients at
home, to provide improved care delivery .
Records, assessments
and plans
Increase data
and information
sharing
Patient Online Providing patients with the ability to book GP appointments
online, order repeat prescriptions, view results online and view
clinical letters online .
Increase data
and information
sharing
Summary Care
Records, and SCR
to Community
Pharmacies
Providers able (with consent) to access nearly 900,000 SCR for
patients within Cambridgeshire and Peterborough, and have
access to millions of SCR of visitors, students etc . The provision
of SCR to community pharmacists is well underway .
Records, assessments
and plans
Increase data
and information
sharing
Electronic Referral
Service
Nearly 80% of all referrals from GP practices to secondary care
are now done electronically via eRS . The new functionality
within eRS provides opportunities to add value to this process .
Transfers of care Interoperability
Health and Care
Network, network
integration,
provision of Wi-FI
to staff and the
public
Ongoing projects exist to join networks to allow staff to access
systems wherever they are, and to provide free public Wi-Fi
across the health and care estate .
Enabler Enabler
Hospital merger
and moves
IT changes consequent to GP practice mergers, secondary care
potential provider merger (Hinchingbrooke and Peterborough
Trusts), move of Papworth to Cambridge Biomedical site, all of
which provide digital opportunities to deliver services to staff
and patients in new ways .
Enabler Enabler
Support to delivery
of 7 day services
Provision of technical support to GP practices, 7 days per week . Enabler Enabler
Business
intelligence and
system monitoring
The introduction of tools such as SHREWD provides new ways
to view and monitor the delivery of health and care within the
footprint area .
Asset and resource
optimisation
Deliver real-time,
person-level
information to
improve financial
and clinical
performance
Use of health apps The EAHSN has brokered discussions between Trusts and
a number of health app providers, some Trusts are actively
trialling these apps for instance uMotif for Cardiology,
SmartCare CF for Cystic Fibrosis and Helicon Health for Stroke .
Choose Well Cambridge – available now gives patients advice
re the right level of care to access .
Records, assessments
and plans
People powered
health and
wellbeing
7
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Cambridgeshire & Peterborough - Local Digital Roadmap
There are a further two core capabilities -orders
and results management, and asset and resource
optimisation, for which there are no associated
universal capabilities, as these are focused more on an
individual organisation’s internal work processes .
In addition, there are a number of enablers which are
essential to delivering digital change; these include
supporting infrastructure, governance structures and
standards .
Some of the required changes to deliver our
ambitions sit within individual organisations and
others require system-wide changes across our
footprint . In some areas the changes are dependent
on national initiatives, or the actions of other partners/
neighbouring footprints . Our initial focus is on
delivering existing and planned commitments and
optimising previous investment . However, to ensure
a cohesive approach to delivery it is essential that we
consider all current and planned initiatives within the
context of our wider vision for change and digital
themes .
The following sub-sections begin with an overview of
planned initiatives in support of our digital themes .
Then we set out our plan of action to increase the
level of digital maturity within our footprint, and
finish with a summary of our delivery approach and
timelines for the core capabilities . These inputs (plus
our delivery plans for our enablers – covered in the
next section) are all part of our overarching plan to
deliver our digital vision .
7.2 - Delivery of our Digital Themes
Allowing health and care professionals within our
footprint to access and share information across care
settings is key to delivering our priorities for change .
It will help us in our ambition to build services around
our patients and allow us to address the care and
quality gap . A key enabler to this data sharing is
interoperability, that is, developing the technical and
data standards to enable transfer of information
between providers .
As described in our current capabilities section above,
a number of organisations share information with
patient and practice consent every day, through the
use of TPP SystmOne . This provides a patient-centric
record across all organisations using the system, with
access possible from external organisations .
Information is also routinely shared between 111/
OOH, GP practices, and community services . Other
organisations also share information in support of End
of Life Care initiatives . Summary Care Records, GP2GP
solutions, and eReferrals are all actively used across
Cambridgeshire and Peterborough .
Records, assessments and plants
Professionals across care settings made
aware of information on learning disability and
communication preferences
GPs can refer electronically to secondary care
Clinicians in unscheduled care settings can access child protection
information with social care professionals notified accordingly
Patients can book appointments and order repeat presriptions from their GP practice
GPs and community pharmacists can utilise electronic prescriptions
Professionals across care settings made aware of end-of-life
preference information
Clinicians in U&EC settings can access key GP-held
information for patients identified by GPs as most likely to present (in U&EC)
GPs receive timely electronic discharge
summaries from secondary care
Patients can access their GP record
Social care receive timely electronic
admission, discharge and withdrawal
notices from secondary care
Transfers of care
Decision support
Remote care
Medicines
management
and optimisation
Our Delivery Plan
Our Digital Themes
Our Enablers
Raising Digital
Maturity
Ten Universal
Capabilities
Interoperability
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Cambridgeshire & Peterborough - Local Digital Roadmap
We have defined a plan of work which will increase our interoperability over the next 5 years . The following
diagram provides a view of the capabilities which will be enabled by our plan of work .
Some of these changes are enabled by the adoption
of open interfaces as they are released by suppliers .
Examples of technical developments that our local
health and care organisations are working to adopt
are described below:
GP Connect InitiativeThe GP Connect Initiative will standardise the way
INPS, Microtest and TPP integrate . Each principal
clinical system will integrate with a new Digital
Interoperability Platform, a NHS Digital Spine service
which any approved consumer system will also be
able to access .
This will provide access to patient information held in
GP systems, via the Digital Interoperability Platform .
Future developments will also enable all other systems
in other care settings to provide relevant information
through this route .
Nationally, GP clinical suppliers working with NHS
Digital (formerly HSCIC) will deliver this capability by
March 2017 .
Our aspiration is to use this information sharing
functionality to support the delivery of our services .
Transfers of Care - Hospital eDischargeCambridge University Hospitals and Papworth are
currently piloting the use of the AoMRC headings
for eDischarge, with a view to rolling this out across
the hospitals by December 2016 . The Cambridge
University eDischarge approach uses the national
Clinical Data Architecture (CDA) Standards, which
will provide the capability for the recipients to use
the discrete data contained within the eDischarge
notification within their own systems . Other acute
Trusts are adopting eDischarge standards and are
planning to deliver in line with national targets .
Acute CareOur priorities in this area include expanding access
to a patient portal, giving patients full access to their
records, as well as the opportunity to transact with
the hospital (for example, arrange appointments) .
Community CareWe also have plans to deliver web-based portals for
community clinicians to access records and consult
with clinicians regarding the care of patients .
Social Care RecordsBoth our Local Authorities are planning to replace or
upgrade their care records systems during the next
two years . These modern systems will allow for service
user accessibility and better interfacing with health
records . In addition, the ability to work remotely will
support a move to closer to real time information
capture and exchange .
Other Interoperability InitiativesOther interoperability initiative which will allow health
and care professionals within our footprint to access
and share information across care settings include:
• Care networks: Supporting the information
exchange required to allow staff access to
shared knowledge about patients across the care
network .
• Ambulance: Supporting EEAST develop its digital
transformation programme which includes
increased use of Summary Care Records (SCR) by
Ambulance staff, including access to enhanced
SCR, improvements in technical integration with
Emergency Departments and deployment of new
devices to allow ambulance staff improved access
to information . Supporting the development of
the EEAST clinical care hub and hear and treat
services .
• Integrated urgent care and clinical hub: An
integrated 111 and Out of Hours service with the
provision of access to additional clinical advice via
a clinical hub went live on October 2016 . This was
dependant on new telephony and clinical system
changes .
• Minor injuries units: Continue the process of
improving the mechanism to share (with patient
consent) clinical information .
• Embedded mental health: Supporting the
information requirements of clinical staff who are
working within police control rooms .
• Discharge: Improving discharge from hospitals
supported by improved access to information and
data .
• Ageing Well: Supporting the ‘eyes and ears’
approach where all NHS and council staff have
the means, information, authority and skills to
offer access or referral to additional services for
individuals they may encounter who are becoming
vulnerable .
• 24/7 standards: Continue to provide technical
support to service delivery 24/7 and where
necessary work to improve the support service
arrangements .
• Patient choice hub: Continue to support patient
choice through the use of the increasing
functionality being released via the Electronic
Referral System programme of work .
• Patient access to Maternity Records: Provided by
K2 Midwifery System in Peterborough .
Current State
Future State
End 17/18
Cap
abilities en
abled
by in
form
ation
sharin
g
End 18/19 End 20/21
Digital approach
Community Pharmacists can view
patients Summary Care Record
Patients are able to be transferred
electronically from secondary to primary
care
Social Care recieve data electronically
from health providers
Patients are able to book into other providers using
Electronic Referral Service/NHS UK
Patients able to access GP
records online
Patients able to access GP
records online
Health and Social Care using NHS
Number as patient /citizen identifier
Acute Pharmacy Teams able to check patients
medications online
GP records available to view in Unscheduled Care Settings
GP receive structured discharge
summaries from secondary care
Near real-time cross organisational
monitoring of system pressures
EoL Care Plans shared cross
health
Information Sharing
Agreement in Place
Integrated Urgent Care
Hub
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Cambridgeshire & Peterborough - Local Digital Roadmap
As described in the overview of our interoperability
ambitions we are currently working to ensure
information sharing is routinely undertaken where this
is legally and technically possible across organisations
of all types . However, effective information sharing
also underpins our ambitions for digital change and
therefore further capability is planned . As described
earlier, our overarching vision for digital change is that
by 2020:
“Patients and Citizens, Health and Social care staff
will have access to quality, timely and accurate
information regardless of place or time to enable
improved decision making and ultimately better
outcomes for both the individual and the community.”
Our strategic approach to improve and simplify
data and information sharing is to implement an IT
platform which will allow (where appropriate and with
appropriate consent obtained) access to a number
of provider’s patient information systems . This single
view of the patient record will integrate primary
care, mental health, community care and social care
patient information via the NHS number . Initially we
will develop this for our urgent and emergency care
teams (NHS 111/Clinical Hub) and Joint Emergency
Team (JET) through hand-held devices, as well as in
Emergency Departments, where we will allow access
to core patient data about diagnoses, medication,
prior health encounters and resuscitation status to
help minimise inappropriate non-elective admissions .
Our ambitions in this area are to progress from
viewing information through to using structured
information, and onto using this structured
information to provide advanced decision support .
However, to ensure we share a complete set of useful
information, we must continue to make progress
in increasing the digital maturity of organisations
within our footprint . Where possible, this data must
be structured and use appropriate data standards . To
improve the quality and safety of the care we deliver,
and to support the decision making of our staff, this
shared information must be available in real time and
include care plans and patient preferences .
To help improve the health of the citizens within our
footprint, it is essential to engage people in their
own health and wellbeing . To facilitate this, we will
introduction a number of patient-focused initiatives,
including the use of health apps . Primary areas of
focus will be apps suitable for our ageing population
and those with long term conditions . These apps
will give advice about symptom significance and
management, and in some circumstances will foster
introductions to wider disease-specific patient self-
help circles . This project will be closely allied to the
STP’s Prevention Strategy and with that of public
health, local and district councils . Specific areas where
we have plans to introduce apps include:
• Prevention: Provision of health advice through a
variety of digital means will be supported locally,
including both national and local health and care
mobile apps .
• As described in our current progress section,
the EAHSN has brokered discussions between
Trusts and a number of health app providers . We
will continue to actively trialling these apps for
instance uMotif for Cardiology, SmartCare CF
for Cystic Fibrosis and Helicon Health for Stroke .
We will also continue to explore areas where
health and care apps can contribute to the health
and wellbeing of our patients and the wider
community .
• Psychological wellbeing . The Cambridgeshire
and Peterborough community of organisations
will continue to provide information about
services digitally . A local initiative undertaken
between the Integrated Urgent Care service and
Cambridgeshire and Peterborough Foundation
Trust to allow access to additional mental
health support via 111, is an example of this
commitment .
• Self-Care: Providing information and services to
support patients better manage their own long
term condition is already underway through a
variety of national and local digital means . These
technological aids are very likely to improve in
usefulness over the lifetime of the STP and LDR .
• ICU patient communication app: this app allows
ventilated patients to indicate how they are feeling
and what is concerning them . This is now being
developed to get it to a place where it could be
shared with other hospitals .
• NCCU patient diary: this app will collate
information into a patient diary for critical care
patients . This will give them some reference to
what happened to them whilst they were in
ICU . This approach has been shown to help with
reducing post-traumatic stress .
• Chronic pain diary: providing a secure, flexible
SMS-based chronic pain diary for use in routine
pain service clinics .
• Extend the roll out of MyChart to CUH patients:
this app is available to patients who have signed
up to the CUH Epic patient portal . It is currently
deployed in the Obesity service and is being rolled
out to Oncology . This app is written by Epic .
We will use innovative technology to transform the
way we deliver care . In partnership with providers of
tele-health and monitoring equipment we will develop
virtual outpatient wards in certain disease specific
groups . A range of wireless enabled devices will be
used to give both active patient monitoring during
exacerbation (e .g . COPD), and patient reassurance
and security when they are isolated . We outline some
of our ongoing initiatives below .
• Housing and Business . Community plans to work
with partner organisations and housing developers
to deploy smart technology that promotes
independence for older people as well as wider
benefits of active lifestyle .
We will also explore the possibilities of working
with other partners to facilitate innovation . In this
area we can engage The Eastern Academic Health
Science Network (EAHSN) to provide a brokerage
service between our organisations and innovators .
This approach may identify additional innovative
solutions . A small element of non-recurrent funding
is also available to support initial adaption and
implementation of innovations . Alongside this, the
Eastern AHSN can provide enabler support in the form
of service improvement methodology and networking
to support the implementation phase .
In addition, as part of feasibility studies for new
technology, the associated service changes can be
modelled using a Scenario Generator provided by
SIMUL8 Healthcare, in conjunction with EAHSN . This
will enable areas for improvement to be identified,
new ideas tested out and, most importantly, allow
us to understand the impact of a change without
taking any significant unnecessary risks . The Scenario
Generator is a simulation tool which works by
generating a virtual population with the demographics
of an actual population, and with conditions which
are randomly allocated, in line with known prevalence
data .
People powered health and wellbeing
Increase Data and information sharing
Invest in innovative technology to support our vision
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We will create a platform to analyse data on capacity
within the system, and person-level operational
data on utilisation, cost and potentially even
outcomes, which will be used in real time to help
providers manage their resources . This will allow
both monitoring of the day to day status of services
within the health and care system, but also system
surveillance of financial and clinical performance .
We will adopt a population-based approach to health
analytics, which will enable us to track patients across
the system, particularly those with poor outcomes and
incurring high costs, with the aim of understanding
what we could change to improve the way we provide
care . This will also allow us to predict who to target
with intensive proactive case management . It will be
imperative to turn population data into information
that allows for intelligent patient insight and effective
decision making . This data will also enable the
tracking of progress of new care initiatives, and
monitoring of their impact .
Our ambition is to create a data source which can be
used to proactively identify issues in service delivery
or clinical outcomes . We are currently scoping a
partnership with Datalytics on the development
of an information platform development for
activity modelling, risk stratification, prediction and
simulation .
There is also an opportunity to work with partners
such as the Academic Health Science Centre and
Cambridge University Health Partners to develop
a technology platform to connect real world data
for research, subject to appropriate information
governance and consent .
This approach gives an opportunity for example:
• to support improved pharmacology vigilance as
follow up to drug trials
• identification of multiple uses for drugs
• improved understanding of patient disease
progress based on machine learning
• analysis of pathways to improve primary and
secondary care prevention
7.3 - Summary of Projects to Deliver Our Digital Themes
The following table summarises the projects which are proposed to be managed through the LDR lifecycle with
input from all participating organisations .
Improvement Area Project Due Date Theme or enabler
Direct cross
community Care
Paper Free at Point of Care 31 .03 .20 Enabler
Shared multi agency patient / citizen record 31 .03 .18Provide a shared health and
care record
Patient and citizen held records (including
summary care records, end of life records,
special patient notes, mental health crisis plans,
and pharmacy access to care records)
31 .03 .18Provide a shared health and
care record
Organisational change opportunities (Merger,
relocations etc .) 30 .03 .21 Enabler
Information Quality improvement . NHS number
use 31 .03 .18 Enabler
Secondary Use
Health analytics, real time system monitoring 31 .03 .18
Invest in health analytics
to support whole systems
intelligence
Pseudonymisation at source 31 .03 .18
Invest in health analytics
to support whole systems
intelligence
Business Intelligence use of data 31 .03 .18
Invest in health analytics
to support whole systems
intelligence
Investing in People
Digital skills for professionals 31 .03 .20 Enabler
Digital skills for citizens and patients 31 .03 .20Engage, educate and
empower our patients
Patient Online including remote patient access
to health and care services31 .03 .20
Engage, educate and
empower our patients
Technology and
Infrastructure
Shared Wi-Fi, infrastructure for professional and
citizen – all health and care locations *31 .03 .18 Enabler
Telecommunication sharing 31 .03 .18 Enabler
Health and Social Care Network development 31 .03 .18 Enabler
Mobile and remote working for professionals * 31 .03 .18 Enabler
Digital opportunities ( tele medicine, tele
monitoring, GS1, remote monitoring, internet
of things)
31 .03 .18
Invest in innovative
technology to support our
vision
Standardisation of shared investments 31 .03 .18 Enabler
Develop Cyber Security 31 .03 .18 Enabler
* Initial accepted bids for the Estates Technology and Transformation Funding (supporting Primary Care)
Deliver real-time person level information to improve financial
and clinical performance
Adopt a population based approach to population based analytics
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7.4 - Increasing our Digital MaturityTo deliver our ambitions we need to ensure that all
information relating to a patient’s care is recorded
online . This means we must increase our digital
maturity and achieve the paper-free at point of care
targets outlined in the Five Year Forward View .
7.4.1 - Records, Assessments and Plans Programmes to replace patient record systems
for Hinchingbrooke and Papworth Hospitals are
underway; this will enable increased data coverage
and capability for patient access to records and data
sharing .
National initiatives for access to the child protection
register at point of care, and access to the summary
care record at point of care are part of the work plan
to improve maturity in this capability .
All acute hospitals will implement access for their A&E
clinicians to see local GP records and care plans by
2017/18 .
New social care systems for both Adult and Children’s’
services are planned by 2018/19, and these will enable
integration through use of the NHS number, and
interoperability to receive hospital discharge notices .
7.4.2 - Transfers of Care Organisations will work to meet targets for use of the
national e-Referrals system, provision of standardised
electronic discharge summaries and use of the
Summary Care Record .
Additional infrastructure such as integration engines
will be implemented, where necessary . Appropriate
national and local data sharing agreements will be
required to deliver the transfer of care agenda .
7.4.3 - Orders and Results Management The organisations which are upgrading their patient
record systems will improve their digital maturity in
this area once the requests and results functionality
is rolled out, together with integration with their
laboratory services providers .
The community provider will also benefit from access
to existing electronic orders and results systems in
2016/17, ahead of a shared record platform .
Replacement of the local PACS imaging solution
at Papworth Hospital, with the regional PACS
in 2016/17, will improve capability for image
interchange .
7.4.4 - Medicines Management and Optimisation All Acute Trusts have plans to implement electronic
prescribing and medicines administration, in line with
their current EPR programme schedules through to
2018/19 .
In 2017/18, the Out of Hours service is planning to
implement SystmOne electronic prescribing, which is
already implemented for GP users .
Community pharmacies will be given access to the
national shared care record in 2016/17 .
7.4.5 - Decision Support Peterborough and Stamford Hospitals and
Hinchingbrooke Hospital will implement Nervecentre
in 2016/17, which will provide access to clinical
observations and real time alerting .
The child protection information sharing system will
become available to social care providers in 2017/18 .
The use of data from across the footprint for whole-
system business intelligence will be facilitated by the
delivery of the national technical solution for de-
identified patient level data sets in 2017/18 .
7.4.6 - Remote Care Mobile working across community and social care is
planned through 2016/17 and 2017/18 .
The Connecting Cambridgeshire programme will
provide 95% coverage of super-fast broadband
by 2017/18, which will facilitate the use of mobile
devices, particularly in community and social care .
Out of hours services will implement a new mobile
working solution in 2019/20 .
Telemedicine services will be developed and extended
through 2017/18 and 2018/19 .
7.4.7 - Asset and Resource OptimisationUse of asset management and GS1 for real time asset
location is planned for all acute organisations .
Real time analytics from a shared record platform
will be able to be used for near real time cross
organisational monitoring of system pressures .
7.5 - Digital Maturity – Our Future TrajectoryWe have estimated the effect of planned progress against the core capabilities for the Digital Maturity
Assessment, and expect to move forward across the Cambridgeshire and Peterborough footprint, as shown
below . NB . Includes Herts Urgent Care
Average scores across providers
Capability groupBaseline score (Feb 16)
Target (end 16/117)
Target (end 17/18)
Target (end 18/19)
Records, assessments and plans 56 .3 62 .3 71 .6 77 .5
Transfers of care 65 .6 70 .3 76 .1 82 .5
Orders and results management 58 .3 63 .2 71 .5 78 .7
Medicines management and optimisation 37 .3 40 .2 59 .2 83 .6
Decision report 57 .4 62 .6 75 .4 84 .9
Remote care 24 .9 41 .5 51 .7 77 .5
Asset and resource optimisation 59 .1 70 .0 73 .8 82 .8
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Ave
rage
sco
res
acro
ss p
rovi
ders
Baseline score Feb 2016
Target end 2016/17
Target end 2017/18
Target 2018/19
Records, assessments and plans
Transfers of care
Orders and results management
Medicines management and optimisation
Decision support
Remote care
Asset and resource optimisation
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7.6 - Delivering the 10 Universal Capabilities
The following summary describes some of the
initiatives in progress and planned to meet the 10
nationally required universal capabilities . We have
made good progress in many areas, for example:
• Patients can access their GP record
• GPs can refer electronically to secondary care
• GPs receive timely electronic discharge summaries
from secondary care
• GPs and community pharmacists can utilise
electronic prescriptions
Additional work is required to deliver the following
by 2018, but plans are in place and the partner
organisations have committed to the delivery of the
universal capabilities by the end of March 2018 .
• Social care organisations receive timely electronic
assessment, discharge and withdrawal (ADW)
messages from secondary care . (Implementation
of ADW messages does require action by both
acute trusts and social care . There will be the need
for social care systems to be able to receive and
action these ADW messages . The expectation is
that in upgrading and or replacing current social
care systems this provide this functionality, subject
to investment in APIs and change management
activities)
• Clinicians in unscheduled care settings can access
child protection information
• Children’s services professionals are notified of
unscheduled care attendance
• Clinicians in U&EC settings can access key GP-held
information for patients identified by GPs as most
likely to present (in U&EC)
• Professionals across care settings made aware of
end-of-life preference information
• Professionals across care settings made aware
of information on learning disability and
communication preferences .
A detailed summary of our progress against each universal capability is shown in the table below .
Ref Key requirement Initiative programme Implementation Date Status
A
Professionals across care settings can access GP-held information on GP-prescribed medications, patient allergies and adverse reactions
Summary Care Records
2016-2018
Locally already achieved - 111/ OOH, MIU, Ambulance, Emergency Departments and Acute Pharmacies can access this information from SCR .
Community pharmacy access to SCR is part of the national project
There is a need to build upon ability to view already in place, to encourage active use . Also to interface this information within key systems in use across the LDR area to present information in the users primary system
B
Clinicians in U&EC settings can access key GP-held information for patients identified by GPs as most likely to present (in U&EC)
111/OOH Procurement – Integrated Urgent Care
ED access to GP held information (SystmOne / EMIS)
GP information within ED system
Emergency department can access all GP information . The new Integrated Urgent Care system will enable access to GP held records, no plans to restrict to cohort of patients most likely to attend
NHS Digital to confirm roadmap for suppliers to complete GPSOC
Pairing Integration Assurance Process .
Active
Some access available .
Subject to system providers completing GPSOC
CPatients can access their GP record
105 practices (SystmOne and EMIS Web)
Complete
From April 2016 all GP practices can offer access to coded data to patients
Active . As outlined in GP contract requirements
DGPs can refer electronically to secondary care
Electronic Referral System
Technically complete
Further activities to promote use of eRS will continue .
Active
Currently 70% bookings from GP to secondary care via eRS
Aim to increase use of eRS during 2016 to 80%
E
GPs receive timely electronic discharge summaries from secondary care
Secondary care send discharge summaries electronically
Use of coded discharge summaries (EMIS Web and TPP SystmOne can technically receive coded discharge summaries)
Any electronic format Completed - 1 October 2015
Format using AoMRC Headings
Completed - December 2016
CDA document messaging standard target Q4 2018
Active
CDA structured messages dependent upon secondary care ICT supplier compliance, e .g .CUH CDA capability will be delivered in 17/18
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Ref Key requirement Initiative programme Implementation Date Status
F
Social care receive timely electronic assessment discharge and withdrawal notices from secondary care
Social care services currently receive information electronically
Transfer of information electronically is in place at most Trusts . Details not routinely collected .
Active
Baseline information being gathered
G
Clinicians in unscheduled care settings can access child protection information with social care professionals notified accordingly
Implementation of Child Protection Information System
2017/18
NHS organisations committed to use CPIS . Implementation scheduled for Cambridgeshire and Peterborough Q1 17/19
Active . PCC and CCC leading
Dependent on resource availability
TPP SystmOne due to be compliant end of 2016
H
Professionals across care settings made aware of end-of-life preference information
Variety of methods in place to share end of life preference information .
End of Life Dashboard in place . Used by over 60 practices .
End of life information is a special note in GP systems available for access from ED, Urgent care and Acutes .
Active
Continue to support roll out to GP practices
I
GPs and community pharmacists can utilise electronic prescriptions
EPS R2EPS R2 roll out due to complete 2017/18
Active
100% GP practices EPS R2 compliant
60 plus community pharmacies receive EPS R2 data
Possible EPS Phase 4 early adopter
JPatients can transact electronically with their GP practice
Booking appointments
Repeat prescriptions
Access to summary record
Technically completed
Active
Work to communicate and encourage increased usage
Ref Key requirement Current resource Future resource
A
Professionals across care settings can access GP-held information on GP-prescribed medications, patient allergies and adverse reactions
SCR use will continue to be supported by individual organisations
As part of sharing initiative use of enhanced SCR may be subject of funding proposal .
B
Clinicians in U&EC settings can access key GP-held information for patients identified by GPs as most likely to present (in U&EC)
Integrated Urgent Care Implementation Team (dedicated funded project team, funded clinical lead etc .)
Trusts have access to view of GP record .
Once initial IUC implementation completed programme of work up to April 2017 .
C Patients can access their GP record
CCG has allocated staff resource both to the technical enablement of GP practice systems (completed) and also supporting GP practice staff offer and enable online access to patients
CCG to continue to provide support resource to enable GP practices help patients access their GP record
DGPs can refer electronically to secondary care
All GP can electronically refer to secondary care .
CCG has a dedicated eRS resource to support patients, practices and Trusts use eRS more effectively .
GP Practices and Trust are committed to achieving 80% of all referrals via eRS
CCG continues to fund eRS resource
EGPs receive timely electronic discharge summaries from secondary care
All Trusts currently send some or all of their discharge summaries electronically
Work to understand the timeliness of this is underway
Trusts continue to improve timeliness of electronic discharge summaries .
The following table gives a further insight into the continued resource commitment required to deliver the
Universal Capabilities .
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Ref Key requirement Current resource Future resource
F
Social care receive timely electronic assessment, discharge and withdrawal notices from secondary care
Trust send a proportion of ADW messages electronically
Trusts committed to the continued improvement in the percentage of ADW message sent electronically .
G
Clinicians in unscheduled care settings can access child protection information with social care professionals notified accordingly
Trust have sent formal notification to national CPIS team intent to implement CPIS
CCG is working with national CPIS representatives to understand implementation issues and support measures to introduce CPIS locally
Potential funding sources to support local authorities implement CPIS are being identified
Once confirmation of CPIS availability, implementation and training resources will be identified for participating organisations .
HProfessionals across care settings made aware of end-of-life preference information
Trusts providing data electronically to support dashboard
CCG has staff resource working with GP practices to use EoL dashboard
CCG continues to support EoL dashboard
IGPs and community pharmacists can utilise electronic prescriptions
CCG has dedicated resource supporting EPS R2 implementation
Continue to support EPS R2 roll out
JPatients can transact electronically with their GP practice
CCG has provided support to practices to enable patients to transact with GP practices (Patient Online)
Enabling Our AmbitionsWe recognise that delivering capability in line with our
digital themes and increasing our digital maturity is
only part of the story . We must also have in place the
necessary infrastructure, governance and standards .
In addition, we need to ensure our workforce, patient
and carers have the necessary skills to use our digital
information and tools .
8.1 - InfrastructureTo build the digital future we outlined in our
ambitions, we require firm foundations . Below we
outline the infrastructure required to underpin these
changes .
• General practice at scale: The technological
changes, information exchange, new digital
services are already being deployed to support
the delivery of General Practice work at scale .
A number of partnerships, federations, mergers
have been supported technically, and these
developments will continue to be supported . The
ease of implementing these changes is facilitated
by technical decisions made over several years,
which anticipated this requirement .
• Acute consolidation: The merger of
Hinchingbrooke and Peterborough Trusts and the
move of Papworth Hospital provide opportunities
for digital transformation, which the respective
organisation and wider community are working
to achieve . Work continues to support the greater
integration and merger of Peterborough and
Stamford Hospitals NHS Foundation Trust with
Hinchingbrooke Health Care NHS Trust by April
2017, and the move of Papworth Hospital NHS
Trust to the Cambridge University Hospitals (CUH)
site .
• Back office: A number of systems have already
been deployed to allow organisations to work
collaboratively and reduce some back office costs .
As the ongoing work to examine opportunities for
back office teams to work collaboratively identifies
further opportunities, the technical changes and
system changes required will be delivered
• Other partnership development will also be
supported with technological and digital
developments, including provision of systems and
services to aid voluntary sector delivery of services .
For example, access to secure email exchange
services, community connectivity etc .
• Neighbourhood teams: We will continue to
support and increase the provision of equipment
and access to information for these community
based teams .
• Community experts: We will deploy the technical
changes to allow the neighbourhood teams to
access advice from community experts .
• Sharing knowledge: We will continue the roll out
of secure access of their care records to patients as
well as providing staff access to online information
resources .
• Embedded mental health: Supporting mental
health staff work within primary care . For example
the PRISM scheme is supporting mental health
professional’s work with GPs and within GP
practices with the mental health staff being able
to access mental health clinical systems from
within the practice .
• Other service changes supported by access to
information will also be undertaken to support the
development of care hubs .
• Infrastructure investment will be required to
support the new or continued implementation
of systems within health and social care
organisations, including EPIC at CUH, CCC and
PCC (local authorities) replacement of adult and
children’s systems, ePrescribing implementations
etc . PCC is considering closer alignment of adult
social care system with CCC .
• Meeting ICT requirements, as set out in national
contracts, e .g . electronic standard format
discharge summaries by December 2016 .
8
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8.3.1 - NHS Number ComplianceAll statutory health and social care organisations within Cambridgeshire and Peterborough use NHS Number
as one of their patient or citizen identifiers . For NHS organisations, this is the primary patient identifier for
correspondence .
All statutory organisations are committed to the use of NHS Number as primary identifier and to include it
within all correspondence etc . by 2017/18 where this has not yet been achieved .
Take up of and use of NHS Number is a measure within the Digital Maturity self-assessment . The reported
compliance across the footprint is shown below .
Other providers of patient and citizen services are
contractually required to use NHS Number in all
correspondence etc . However, gaps may exist within
the third sector where small organisations provide
specialist support to patients and citizens . At present
a record of use of NHS Number by all the small
providers of services is not centrally recorded .
To improve the use of NHS Number, and meet the
2017/18 target, partner organisations are committed
to improve their ability to verify the NHS number
automatically, and to include this in all electronic
correspondence . To that end, CCC is replacing current
social care systems (Cambridgeshire County Council
Adult Social Care Implementation – Mosaic 2017/18),
and one area of anticipated improvement is the
automatic validation of NHS Number . Peterborough
City Council also has plans to replace its current adult
social care record system within similar timelines . A
project is underway to create a children and families
multi-agency portal within the Children’s Social Care
record, which will also support improved coverage of
NHS Number .
Use of the NHS number is part of contracts with
smaller providers, and the improvement path in NHS
Number uses will be monitored as part of this process .
The above steps will improve and reduce the
gaps where they exist in NHS number use, with
organisations committed to meet the 2017/18 target .
Further initiatives are in progress or required to meet
the needs of the following drivers:
• Primary Care GP IT . Implementation of IT elements
of GP Five Year Forward View, GPSOC changes,
GP IT Operating Model, GP contract requirements .
2016 onwards
• Supporting ICT elements of the multiple GP
practice mergers, federations, extensions, moves
and creation of brand new practices . Planned for
2016/17 onwards .
• Better Care Fund Data Sharing programme
2016/17 priority schemes:
• Neighbourhood team fast track pilots .
• Sharing access to existing systems .
• Eyes and ears / Indicators of vulnerability
• Information governance .
8.2 - Mobile Working
An effective mobile working infrastructure is required
to fully exploit the Paper-free at the Point of Care
capabilities . The organisations within the footprint
have identified a number of projects required to
improve mobile working capability, particularly for
community-based staff .
Our approach is to ensure our staff have access to
appropriate devices and user interfaces are tailored to
the device in use . We also take account of potential
connectivity issues and put in place processes for
mobile device management . We recognise that mobile
working is not just about providing working devices, it
is also about the transformation of working practices .
Our approach to mobile working will not only mobilise
professionals within their normal place of work, but it
will also provide them with the ability to work in other
care settings . These include patient homes, residential
homes and other potential touch-down points across
the community .
8.2.1 - Mobile InfrastructureThe current status of the mobile working
infrastructure is varied across Cambridgeshire and
Peterborough . In part, the current use of mobile
technology outside of health and care sites is limited
by the commercial infrastructure (Wi-Fi and mobile
mast provision) . While the respective broadband
initiatives undertaken by partner local authorities are
increasing access, there remain gaps in provision .
• A number of providers have confirmed that they
have plans to further develop their mobile working
infrastructure and these are described in the
capabilities deployment schedule .
• Current system-wide initiatives to develop the
mobile working infrastructure are being led
by the respective local authorities . Further roll
out of the Connecting Cambridgeshire and
Peterborough City Fibre initiatives will deliver
high-speed broadband across Cambridgeshire and
Peterborough .
8.3 - Standards
The use of data standards is essential for effective
information sharing . This section reviews the current
level of compliance with relevant standards across the
footprint .
Organisation90% plus NHS Number usage
on correspondence
Plan to Achieve 90% plus NHS
usage by 2017/2018
CUH Complete Complete
Papworth Complete Complete
GP practices
PSFHT
CPFT
HHCT
Cambridgeshire County Council
Peterborough City Council
Independent Providers
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8.4.2 - Shared InfrastructureWhere practical we will share infrastructure across the
local health and care system . This has the potential
to not only provide benefits in terms of cost savings,
but may also enhance the opportunity for data and
information sharing .
A number of NHS organisations and elements of
independent providers and local government already
share physical sites and infrastructure . Shared estate
work, under the maximising public estates work,
has also necessitated the sharing of networks and
telephony infrastructure . The sharing of this type of
infrastructure is almost routine .
Cambridgeshire County Council provide access to
social care systems to people in other organisations
(with appropriate safeguards in place), to ensure that
they can see relevant data, in order to make the best
possible decisions .
Papworth plan to implement a hybrid cloud solution
in 2018 . This will integrate its local IT infrastructure
with cloud services .
The development of shared data centres, or joint call
centres is currently under investigation .
8.4.3 - Governance Our ambition is to share more efficiently and
effectively . With appropriate consent and security
arrangements in place, collaboration and sharing of
information can take place regardless of organisation
or place . Cambridgeshire and Peterborough
have a well-established multi-agency Information
Sharing Framework, maintained by Cambridgeshire
County Council on behalf of organisations within
Cambridgeshire and Peterborough . All key local
health and social care organisations have signed
this agreement . However, although the majority of
major statutory organisations are signatories to this
agreement, not all providers are . In general, the
providers yet to sign the agreement tend to either be
very small organisations or provide limited services
to Cambridgeshire and Peterborough patients and
citizens .
Smaller organisations are being encouraged to
complete reduced Information Governance toolkit
assessments . Some smaller organisations have
also been sponsored and supported by larger local
organisations, so that they can operate within the
technical and governance arrangement of the larger
sponsor organisation . This approach is likely to
continue until simplified compliance measure are
developed and approved at a national level .
A consent model is being developed under the Better
Care Fund arrangements to cover information sharing
between health and social care systems, both at a
personally-identifiable level for the purpose of direct
care delivery, and at a pseudonymised or aggregated
level for the purpose of risk stratification and demand
profiling .
8.5 - Digital Skills
We recognise that digital literacy and digital inclusion
are key enablers of our digital vision . To address these
areas, we have launched the following initiatives:
• Digital skills for professionals
• Digital skills for citizens and patients
These initiatives will also take account of our equalities
obligations, both in terms of the Equality Act 2010
and section 14 of the NHS Act 2006 .
8.3.2 - SNOMED-CT Cambridgeshire and Peterborough organisations will
rely on system supplier roadmaps for the adoption
of SNOMED-CT to support the direct management
of care . CUH is already SNOMED-CT compliant .
Papworth will be compliant in June 2017 . SystmOne
is targeted to support SNOMED from 2018, however
there are indications this may be delayed .
8.3.3 - Dictionary of Medicines and Devices (DM&D)Systems will provide DM&D compliance as part of the
roll-out of e-Prescribing functionality . CUH already use
the DM&D, Papworth will use DM&D from June 2017 .
SystmOne and Emis both use DM&D .
8.3.4 - Other StandardsWe anticipate the publication of national Information
Governance Alliance documents in 2016, which will
include new standards in relation to pseudonymisation
and anonymisation . We will include compliance with
these standards in a future version of the LDR plans .
We will continue to take forward the requirements
from the Health and Social Care (Safety and Quality)
Act 2015 .
8.4 - Collaboration
In line with our focus on partnership described in
our vision, we believe it is essential that health and
care professionals from different organisations are
able to collaborate . We have a blended approach to
collaboration, which takes account of infrastructure,
governance and transformation . This system-wide
view will allow more effective prioritisation, the
targeting of resources, increased opportunities
for joint initiatives, common solutions and shared
expertise . It will also allow more effective decisions on
where in the system benefits should be realised . We
explore how we will achieve collaboration below .
8.4.1 - Unified communications It is essential that health and care professionals from
different organisations are able to collaborate, and
this requires a unified approach to communications .
To enable this communication we must improve our
current infrastructure, including telephony and email .
During the lifetime of the LDR local NHS organisations
will all be using NHS Mail 2, as either their only email
system or as a principal clinical communication tool .
At present it is unknown if NHS Mail 2 will be
extended further into social care, the third sector
etc . If this was allowed nationally this would provide
significant opportunities for collaboration . A request
for clarification of NHS Mail plans for this has been
raised, and we await a response .
There is already a small measure of telephony
collaboration between some partner organisations .
The opportunities provided by the new range of
telephony solutions, including hosted telephony, are
starting to provide options for greater cooperation .
Papworth and CUH have a planned telephony
collaboration with the intention of putting in place
a unified telephony service by April 2018 . CPFT
has introduced a Single Point of Access call centre
which provides a one contact route for patients to
all its services . It is expected that during the latter
part of 16/17 greater examination of the options for
telephony collaboration will be undertaken .
We also have ambitions to harness the power of
digitally enabled communications, including instant
messaging, video and web-conferencing, presence
solutions, and enterprise collaboration tools . The Health
and Social Care Network will be an enabler of this in
the future . It is expected that organisations will utilise
the new functionality that NHS Mail 2 provides to
support instant messaging, presence information etc .
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The eight commitments made in the MoU include:
1 . One ambition: to return Cambridgeshire and
Peterborough to financial, clinical and operational
sustainability by developing an Accountable Care
Organisation (ACO), acting as a single leadership
team, with mutual understanding, aligned
incentives and coordinated action with external
parties (e .g . regulators)
2 . One set of behaviours: all Partners agree explicitly
to exhibit the beneficial behaviours of an
accountable care system
3 . One long-run plan: collectively responsible for
delivering the STP and capturing the saving
opportunities identified . We believe in the plan we
have submitted
4 . One programme of work: all system projects will
be aligned to the HCE, and under supervision of a
delivery or design group
5 . One budget: within NHS contracting, a number
of financial incentive design options will be
considered
6 . One set of governance arrangements: the HCE
and the groups reporting to it (AEB, the CAG (and
strategic sub-committees), the FD Forum and the
eight Delivery Groups), will be the vehicle through
which system business is conducted
7 . One delivery team: resources are in place to deliver
the STP
8 . One assurance and risk management framework:
Crucial to strengthening trust and creating a sense
of shared accountability, will be evolving the HCE
from a forum for making strategic decisions, to
one where Partners can be assured of the delivery
of System-wide improvements
9.3 - System Wide vs Local Approach
We have set the following processes in place to
balance the requirements of local organisation
projects and system wide projects . The proposed split
of work between system and organisational business
will be agreed by the HCE, with new work not
starting without HCE ratification . The proposed split
of system work between what is undertaken once
across Cambridgeshire and Peterborough, and what is
undertaken on an area-basis will be according to:
• Phase of project life cycle: design projects must be
done once across C&P
• Locus of relationships: delivery projects should be
local where vertical relationships dominate, and
C&P-wide where horizontal (for example across
acute trusts) relationships dominate
• Subsidiarity: change happens bottom-up, and
neighbourhoods across C&P differ significantly
Each System project will have a CEO Sponsor and a
named Senior Responsible Officer (SRO), at executive
level . Each system project will have a delivery objective
– a savings, activity shift or quality improvement target
(or a combination), and delivery date . Some system
projects will have an agreed investment plan . The
collective impact of system projects will be measured
against an agreed definition of success .
Our Digital Delivery ApproachThis section describes our approach to delivering
our plan . It includes an assessment of our leadership
capabilities, an overview or our governance structures,
and highlights the importance of the transformation
aspects of delivering our digital vision .
9.1 - Leadership
There are significant and high levels of digital
leadership, clinical engagement and governance
within the organisations across Cambridgeshire and
Peterborough . This is evidenced by the assessment of
these factors through the recent Digital Maturity Self-
Assessment surveys and by the membership of the
Sustainability and Transformation Programme .
We also have several cross-organisational groups
and initiatives that provide significant high level
organisational input and leadership . These include,
but are not limited to, the Better Care Fund
arrangements, the Vanguard initiative (now part
of the wider STP process), Integrated Urgent Care
programme and implementation project . Most, if not
all, cross-organisational changes have senior staff in
digital leadership and direction roles .
We recognise the crucial part that chief information
officers, chief clinical information officers and others
play at board and senior levels in local organisations in
leading the delivery of this agenda . This is reflected in
the setup of our Health and Care Executive, and the
governance structure of our delivery group, which is
described in the section below .
9.2 - Working Together
As described in this Local Digital Roadmap, the
local health economy within Cambridgeshire and
Peterborough CCG has agreed a single Sustainability
and Transformation Plan (STP) for 2016 – 2021, which
was submitted to NHS England and NHS Improvement
in October 2016 . In order to deliver this plan we
must manage risk (financial, operational, quality and
reputational) through a number of jointly agreed
commitments (outlined below), to which our partner
organisations have agreed . The most important of
these commitments relate to a new set of behaviours
intended to build long-standing, trusting relationships
that replicate those of an accountable care system .
These behaviours are outlined in the newly agreed
Cambridgeshire and Peterborough STP Memorandum
of Understanding (MoU) between organisations .
9
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9.4.3 - Cross-cutting Strategy GroupsThere will initially be three cross-cutting Strategy
groups: Sustainable General Practice, Parity of Esteem/
Mental Health, Ageing/ BCF .
These groups will be responsible for steering/quality
assuring projects that span multiple delivery groups
and, in particular, implementing the GPFV, MH
Taskforce and BCF . They may develop business plans
for future savings and investments that pertain to
more than one project group, across multiple delivery
groups .
9.4.4 - Quality Assurance GroupsWe have two quality assurance groups . The Care
Advisory Group (CAG) is responsible for reviewing
care model design proposals from the delivery groups,
horizon scanning for innovations and reconciling any
differences . The Financial Performance & Planning
Group, will develop a framework for contracting and
incentives, aligning planning assumptions, quality
assuring savings and investment proposals, and
tracking savings progress .
9.4.5 - The System Delivery UnitTo ensure pace and a system-wide focus, the HCE has
agreed to establish a new small central team, called
the System Delivery Unit (SDU), which will:
• maintain a long term strategy for developing
the beneficial behaviours of an accountable
care system, updating the work programme as
required, and updating national bodies as required
• ensure partner behaviours put the system above
organisational interest, where the system gains
would exceed individual losses
• manage interdependencies across a wide range of
improvement areas
• support individual organisations to ensure that
local investments in digital capability are aligned to
the LDR and the STP
• provide the necessary support and challenge to
diagnose new problems, design suitable solutions,
demonstrate what changes work in practice and
to spread solutions so they become engrained in
day to day practice
• track performance, quality and financial metrics
using a balanced scorecard, and monitor
implementation of the delivery plan
• promote a common set of approaches to
improvement and widespread adoption of
improvement techniques, as part of developing a
shared culture of learning
• link closely to new care models described in the
Five Year Forward View, and consider how the
application of the new care models form part of
the medium term solution for this local health
economy
• engage with staff, patients, service users and the
public to develop solutions .
The Unit will have teams, of mixed background and
seniority, working on the following:
• Developing and maintaining the system’s long
term plans
• ostering system leadership and a quality
improvement culture (including the use of tools
like Right Care)
• System-wide financial modelling and population
health analytics to support delivery planning,
tracking benefits realisation and evaluation
• Programme delivery and oversight, including
ensuring other aspects of the STP are on track
and, in particular, ensuring the strategies for key
enablers (digital, workforce, culture/ organisational
development, and estates) are supporting of the
STP’s vision for Cambridgeshire and Peterborough .
9.4 - Governance
As part of our approach to sustainability and transformation we have rationalised the governance structures
within our footprint . Our new governance structure has been designed to address the need for balance
between local and system-wide requirements, and is shown in the diagram below .
9.4.1 - Area Executive Boards (AEBs)
There are three Area Executive Partnerships / A&E
Delivery Groups):
• Greater Peterborough
• Hunts & Fens
• Cambridge & Ely
Each AEB is responsible for ensuring implementation
(including savings realisation), where a common
design can be tailored locally . Supervised projects
will be a mix of proactive care (e .g . integrated
neighbourhoods), and reactive care (e .g . in-hospital
flow, attendance avoidance) . The AEB also fulfils the
nationally defined responsibilities of A&E Delivery
Groups, with a Part A/Part B structure and two
chairs . The Terms of Reference of the AEBs are being
developed by the COOs . AEBs are responsible for:
• monitoring local implementation
• collating feedback from each locality on adequacy
of implementation of C&P wide improvement
projects
• identifying new local issues for HCE consideration
9.4.2 - Delivery GroupsThere are eight delivery groups:
• Care pathways: UEC, Elective, Primary Care &
Integrated Neighbourhoods, Women & Children
• Enablers: Workforce & OD, Digital
• Shared Services
• System Delivery
Each delivery group is responsible for ensuring
implementation (including savings realisation)
of design projects and delivery projects, where
implementation needs to happen consistently
across the patch . Each project will require a savings
and investment plan, which will also identify the
anticipated benefits associated with the project,
including those which are cash-releasing . Some
projects will be associated with The Carter Review
or the Better Care Fund, and progress will also be
reported to national bodies . Delivery groups will
horizon-scan – identifying future opportunities
consistent with the objectives of the STP . Further detail
regarding the role of the Digital Delivery group is
included later in this section .
HWBs x 2
Care advisory group
Shared Services Delivery GroupPrimary Care & Integrated
Neighbourhoods Delivery Group
Digital Delivery GroupUrgent and Emergency Care
(UEC) Delivery Group
Workforce & OD Partnership Board
Elective Delivery Group
System Delivery Unit (SDU)Women & Children’s
Delivery Group
Mental Health Strategy Group
Ageing Well Strategy Group
Sustainable General Practice Strategy Group
Financial Performance & Planning
Group
Regional bi-partieIndividual Boards x 7 Council Committees
Area Executive Board (AEB)/ A&E Delivery
Boards
HCE (Independent Chair, CAG Chair as deputy
49
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48
9.6 - Measuring our success
9.6.1 - Monitoring Our Implementation PlanThe System Delivery Unit is responsible for monitoring
implementation of the STP plan and giving assurance
to the HCE about delivery of the plan . The SDU will
provide timely, and regular reporting to the Delivery
Groups, Area Executive Boards, the CAG, the FD
Forum and the HCE to give mutual assurance that the
Delivery plan is on track .
A set of new monitoring dashboards will be
developed by the SDU for this purpose and agreed
by the HCE and/or relevant CEO sponsor . To minimise
the burden on our staff, where possible, existing data
items will be used as metrics to monitor progress,
even if these are not normally shared . In exceptional
circumstances new data items may be collected .
We have set out our core capability milestones by
year, and we will use local metrics to monitor and
manage our progress towards them . The national
digital maturity assessment initiatives are expected to
be repeated on an annual basis .
We have set out our universal capability delivery plan
activities by quarter . This will allow us to monitor and
manage the activities required to meet the required
targets . We will use local metrics to review actual
versus planned progress at quarter-end . We recognise
that work is underway to develop national metrics to
cover the full set of universal capabilities .
In addition, we will measure our success against the
new CCG Improvement and Assessment Framework .
This framework incorporates two indicators relevant
to paper-free at the Point of Care . The first is
confirmation that the CCG is represented within a
‘signed-off’ Local Digital Roadmap . The second is
a composite indicator covering digital interactions
between primary and secondary care . It consists of
four components that can be mapped directly to the
universal capabilities .
9.6.2 - Opportunities for Benchmarking and Peer ReviewOur ambition is to improve our services, therefore
we need to understand variations in how care is
delivered within our region and across England .
One way we can achieve this is by engaging the
Eastern Academic Health Science Network (EAHSN)
to deliver a benchmarking service which would track
provider and commissioner data across a series of key
indicators . This approach will help to identify clinical
variation (process, workforce, medicines optimisation
etc .) and administrative variation as opportunities for
productivity improvements . The EAHSN can also help
to broker links with peers as an additional opportunity
for sharing experiences about what works .
9.4.6 - Digital Delivery GroupAs described above, the Digital Delivery Group is an enabler work group . It not only has responsibility for the
delivery of the projects it owns (as shown in Summary of Projects to Deliver Our Digital Themes) it also has
responsibility to input into the other projects for which digital is an enabler . This activity will be coordinated by
the System Delivery Unit which has a responsibility to ensure that areas for digital enablement are flagged up to
the Digital Delivery Group . The STP priorities, as starred in the list of current projects below, can only progress
through ICT enablement .
The Digital Delivery Group will also play a role in the development and refresh of local IM&T strategies, to
ensure that local investments are consistent and in support of the system-wide LDR .
9.5 - Transformation
We recognise that focusing on the deployment
of technology alone without a credible change
management approach will not realise the potential
of digital transformation and deliver our ambitions .
We will focus not only on achieving optimisation
but also on achieving maximum take-up of digital
tools and information . We will ensure changes to
clinical workflows and pathways are driven by clinical
engagement and our staff and patients are supported
and trained .
Under the newly agreed Cambridgeshire and
Peterborough STP Memorandum of Understanding
(MoU) between organisations, there is an agreed
approach to the delivery of change . This will provide
the basis for change management across the
community . It is expected that the SDU will play a
vital part in coordination of change between delivery
groups and between organisations .
We will look for opportunities to share learning
across organisations within our footprint . We will
also explore options for sharing learning with
organisations within other footprints . For example,
the EASHSN offers support in convening professional
or geographic networks to work on specific areas .
Our Delivery Plan
Imp
rove
men
t sc
hem
esD
eliv
ery
g
rou
p Area executive board/a&e
delivery boards (x3)
Area based integrated urgent care
Time to care test beds and
roll out
In hospital now
Shared services
Clinical support services
Back office
Productive health
workforce
Market forces factor
Estates
Procurement
UEC
Out of hospital integrated
Acute frailty & ageing recovery
pathway
Ambulance efficiencies
Stroke pathway
Psychiatric liaison
New care models
Women & children
Parental mental health
Establishing a maternity
network
Community & acute
paediatrics
Children & family health & wellbeing
Elective
Improved removal
pathways
Cardiology
Orthopaedics
Ophthalmology
Other specialities
Patient choice hub
ENT
Outpatients
Primary care & integrated
neighbourhoods
Long term conditions:
diabetes
Long term conditions: respiratory
Long term conditions: CVD/stroke
Proactive & prevention care model
Mental health
Self care
Healthy ageing
Digital delivery
Direct cross community care
Secondary use
Local digital roadmap
Investing in people
Technology & infrastructure
Workforce & organisational development
Training and wider
development
Workforce planning
Primary care woekforce
development
Leadership and OO
Strategic delivery unit
Impact tracking
& evaluation
System analytics
Aligned incentives
System planning
Spreading a QI culture
Consistent messaging
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9.8.6 - Business Continuity and Disaster recoveryThe Digital Delivery Group will assure that new
systems implemented across the STP are procured
with an appropriate level of resilience to provide
workable business continuity arrangements . We will
specify the disaster recovery approach for central
systems .
9.8.7 - Technical Approaches to Patient SafetyGS1 standards incorporated within barcodes and RFID
are increasingly used to provide improved patient
safety, deliver greater regulatory compliance and drive
operational efficiencies . We are moving forward with
the adoption of these standards . The following table
describes local compliance within organisations .
9.7 - Risk Management
9.7.1 - Our ApproachEffective management of risk is crucial to the
successful delivery of our ambitions . Inevitably, not
everything will go as planned, and we have already
identified some areas where there is a risk that
planned benefits may not be realised . Some of these
risks will be best managed individually, but most
can only be effectively managed with a joint focus .
Across our partner organisations we have committed
to a transparent approach and joint mitigations .
This approach applies to a broad definition of
risk including reputational, clinical, governance,
performance against targets and financial risks . This
will minimise risks to patient safety and organisational
reputation associated with the use of technology . We
have agreed the following approach:
• A HCE Risk Register maintains emerging risks
to both the agreed delivery plan and agreed
mitigations .
• System Delivery Groups, Area Executive Boards,
the CAG and the FD Forum may raise with the
Programme Director an emerging risk and a
written Requirement for Risk Mitigation by the
HCE . This requirement will reflect a perceived risk
that the Sponsor CEO considers he/she is unable
to mitigate within the Group .
• Project SROs are expected to deliver all actions to
the pre-agreed timetable of milestones – repeated
risks and issues regarding process delays due to
poor project management and oversight, which
are within the control of the SRO, will be escalated
by the Programme Director to the employing CEO .
• For the purposes of this agreement, risk is not
narrowly defined; examples include reputational,
clinical, governance, performance against targets
and financial risks .
• Select risks will be reviewed by Boards each
month, as determined by the Programme Director
and Independent Chair .
9.8 - Areas of Risk
When managing risk we will take account of all
relevant aspects of risk including human factors,
technology factors and procedures and process
factors . How we handle specific types of risk is
outlined below:
9.8.1 - Data Security The National Data Guardian review of data security
is underway . This is expected to produce a set
of leadership responsibilities and data security
standards – for example, that a strategy is in place
for protecting systems from cyber-threats based on a
proven framework such as Cyber Essentials, and that
unsupported operating systems, software or internet
browsers are not being used within the IT estate .
9.8.2 - Clinical Safety The Digital Delivery Group will assure that existing
national regulations for clinical safety are met, both
that suppliers provide clinical safety assurance for their
software products, and that a clinical safety review is
included in all implementation projects .
9.8.3 - Data Quality As systems are integrated into a shared record or
analytics platform, key data quality measures will be
applied to the data sources, and targets will be set
which should be achieved before data will flow into
the shared platforms . We have prioritised the project
for implementation of the NHS number across the
STP footprint as one of the headline Direct Cross
Community Care projects .
9.8.4 - Data Protection and Privacy Each contributing organisation will be responsible
for ensuring compliance with data protection and
privacy regulations within their estate . Where there
is a common platform, the hosting organisation will
assume the data protection responsibility as the data
processor .
9.8.5 - Accessible Information Standards Suppliers will be required to conform to national
standards for data structure and messaging . Wherever
possible, central systems will provide open APIs to
enable integration with clinicians’ frontline systems .
Provider Current Position (baseline) Future Plans for Adoption
Cambridge University Hospitals
NHS Foundation TrustTBC TBC
Cambridgeshire and Peterborough
NHS Foundation TrustTBC TBC
Cambridgeshire Community
Services NHS TrustTBC TBC
Hinchingbrooke Health Care NHS
TrustTBC TBC
Papworth Hospital NHS Foundation
Trust
GS1 used within Theatres
RFID not currently used
GS1 to be expanded post
relocation to New Papworth
Hospital Site
Peterborough and Stamford
Hospitals NHS Foundation TrustNot currently used
RFID to be introduced as part of
New Papworth Hospital relocation
At present plans to take forward
still to be confirmed
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9.8.8 - System-wide RisksWe have identified the following system wide strategic, operational and implementation risks arising from the
LDR .
Category Description Potential Impact Mitigation Measures
Strategic
All partner organisations have operational and therefore technical links with organisations outside of the Cambridgeshire and Peterborough Footprint.
Cambridgeshire and Peterborough patients and citizens are not constrained by geographical boundaries.
It is possible that the STP/LDR plans and priorities of these other communities are different to that of Cambridgeshire and Peterborough.
It is also possible that they are developing technical solutions that have poor technical and operational fit with the Cambridgeshire and Peterborough LDR.
Good communication with other neighbouring STP / LDR programmes. The potential establishment of regional STP/LDR footprint to ensure specialist providers e.g. EEAST, Papworth to address items of risk cross community.
Use of national standards and systems
Technical initiatives to consider not only data and information flows within Cambridgeshire and Peterborough but also external to the area.
As our patients are often “out of area” information sharing at a patient level rather than an organisational level will be a key mitigation measure.
Strategic
The Digital Delivery Programme as described within this LDR needs to be flexible enough to respond to clinical and organisational change.
If the digital programme is not agile enough there is a danger that technical changes required may not be available.
There is a tension as digital and technical changes need to be measured and in some cases undertake formal clinical safety review processes.
Inclusion of digital / technical representation in each of wider STP improvement area groups.
Use of common systems and infrastructure wherever possible to reduce interoperability and technical information sharing issues
Operational
The digital delivery programme does not reflect the patients, citizens clinical, managerial and wider health and care professional day to day operational needs for quality, accurate and timely information
If clinical, care and managerial information is not consistent, inaccurate, unavailable etc . this will have a material impact on the efficiency of the delivery of health and care services
Organisation clinical, social care and managerial leads together with patient representatives involved in each of the developmental areas
STP / LDR linkage to individual organisations IM&T / digital transformation groups.
Category Description Potential Impact Mitigation Measures
Implementation
The scale of technical change involved within the wider STP as well as the LDR is significant. There is a risk that scale and pace of technical change will not keep pace with STP / LDR needs.
Should the technical developments not be able to be delivered in time or to the quality standard required it is possible that the organisational change required will not be delivered.
It is also likely to negatively impact the wider benefits achieved as part of the change .
Each project and programme to identify technical resources required interdependencies etc. to ensure resource is identified prior to project start.
Implementation
Systems supplier’s capacity to meet our and other STP/LDR technical developments requirements and challenges
Should providers of systems not be able to meet STP / LDR development timescales this will potentially delay service changes
Involve current suppliers and support organisations with development of STP/LDR technical implementation plans.
Cooperate with neighbouring STP / LDR communities to coordinate developments. The additional benefit is that this may result in shared savings in implementation costs and also promote cross organisation issue.
Implementation
Individual organisational pressures and key drivers may have a negative impact cross community technical developments
There is the possibility that technical changes made to meet internal organisational requirements may not support wider cross organisational information sharing / interoperability work .
Engage organisations to consider how individual technical developments will impact cross community developments.
Implementation
Individual organisations data quality may not support the wider use of that data for business intelligence and health analytics
Data quality issues within an organisation can be worked around but when data is shared the context may be lost and data becomes misleading or invalid
The interoperability work-streams for each organisation should include a focus on developing data collection and data quality management.
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Issues with National Systems / Solutions
Rate Limiting FactorsCambridgeshire and Peterborough area patient and
citizen population is growing by several thousand
people a year . This makes it more difficult to target
training for all patients and citizens on the health and
social care systems available for use . As there is an
ongoing need to identify new patients and citizens .
Training of health and social care staff in the technical
use of technology plus the opportunities information
provides .
The scale of change which can be delivered within
challenging timescales is impacted by the level of
resource available . This work must be balanced with
the need to deliver services on a daily basis .
MitigationsPatient and Citizen training programme
Professional training programme
Inclusion of digital technology requirements within
service change and business case development as a
standard part of the change process .
Issues with National Systems / Solutions
Rate Limiting FactorsFinancial challenges resulting in less funding being
available locally for ICT developments .
Lack of knowledge about how to access the central
funding promised to local communities to progress
and then maintain the LDR is a current limiting factor .
Many developments will progress only if central
funding is made available and then sustained funding
is made available .
Mitigations Organisations continue to bid for funds against
national and other schemes for additional funds to
support technical development within and across the
community of organisations
9.9 - Rate Limiting Factors
As part of the Local Roadmap Development process, we have identified a number of rate limiting factors . This
process is essential to ensure that where possible we can address or mitigate these issues .
Issues with National Systems / Solutions
Rate Limiting FactorsGPSOC GP clinical systems providers are required to
follow national development path rather than local
requirements . The national development path does
not fully reflect local priorities .
Multiple national delays in releasing software
developments across a suite of national system
developments, these often do not meet published
timetable resulting in a lack of confidence in the
availability of system e .g . NHS Mail 2 implementation
much delayed . This inhibits local organisations ability
to proceed with national solutions .
MitigationActively working with and supporting suppliers
to implement collaborative technical changes .
Supporting progress through NHS Digital (previously
HSCIC) GPSOC supplier development process .
Through working with GP clinical suppliers we have
secured understanding of their development roadmap
for 2016 onwards .
Providing advice and guidance for potential suppliers
around technical requirements . Introducing potential
suppliers into national supplier forums etc .
We will continue to contribute to national forums
around technical developments that will support local
progress .
Infrastructure Issues
Rate Limiting FactorsPhysical network and communications infrastructure
within Cambridgeshire and Peterborough does limit
the ability to use mobile technology and in some cases
the physical networking is also poor . Cambridgeshire
County Council and Peterborough City Council
are very active in working to improve connectivity
and have achieved much more than the national
average but there are areas where infrastructure does
limit what can be done . In addition, the national
decision not to provide equitable N3 provision to
GP Practice locations means that some practices are
disadvantaged compared to others as they cannot
access network connections with the required
performance levels to support the use of some of the
newer technologies .
Not all of the current health and social care systems
allow disconnected working, which limits use of
systems external to buildings .
A large number of staff work in community
settings . The funds required to support these staff is
considerable and needs to be provided on a recurrent
basis . This level of funding is not available within the
local community . Provision of external funding on a
recurrent basis would provide significant benefit in
advancing use of technology at the point of care .
MitigationThe CCG has approached the Health and Social Care
Network (HSCN) team to seek assurance around
equity of provision for the new HSCN service from
2017 .
Together with developers we are supporting the
provision of additional GP Primary Care capacity
including the technical aspects to deliver new services .
Major area of work currently and over the lifetime of
the LDR .
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the next five years as a means of delivering savings,
efficiencies and improved quality . We expect new
investments to come from multiple sources over the
life of this digital roadmap .
This LDR is a ‘gateway’ to funding . We will align
our future request for digital funding, including
our progress towards paper-free at the Point of
Care, to our digital ambitions outlined in this Local
Digital Roadmap . We have the necessary board level
engagement and clinical leadership that is essential to
successfully deliver this agenda . Our progress to date
and our plans outlined in this Local Digital Roadmap,
including the requirement for further investment in
infrastructure, demonstrate our understanding of how
we can use digital capability as the golden thread to
help us transform the way we deliver care .
We are ready to invest effectively in the digital
agenda . We have introduced local governance which
we will leverage to oversee and assure the creation of
robust ‘fit for purpose’ business cases which follow
NHS standards to support local investment requests .
We recognise that a consideration of granting the
funding requested in business cases will be alignment
with the LDR .
9.12.1 - Local FundingLocally organisations continue to invest funding
in digital developments with business cases and
change initiatives including a number of important
developments .
Each organisation is currently using its own resources
to maintain and develop digital services for use by
its own staff, to provide services electronically to
patients and citizens, and to facilitate information
sharing between organisations . The investments
involved are set out in individual organisational plans .
To deliver this LDR, local committed/prioritised capital
investment in local IM&T initiatives must continue . We
will ensure that any investment is strategically aligned
with out LDR .
9.12.2 - National Funding InitiativesThe amount of national funding will directly impact
the speed of implementation of a number of the LDR
developments . At present it is uncertain how much
funding will be made available each year for each LDR
area .
If full national funding required is not received locally
this will reduce the elements of the LDR that can
be delivered . A number of the projects to fulfil our
ambitions as laid out in the Local Digital Roadmap are
funding dependent . These are:
• Interoperability mechanisms and our shared record
ambitions
• Self-care mechanism including apps
• Shared infrastructure including unified
communications and telephony
Potential targets for investments include the £900
million Estates and Technological Transformation
Fund, the £1 .8 billion Driving Digital Maturity
Investment Fund and Vanguard funding .
The Estates and Technology Transformation Fund
(ETTF) is a multi-million pound programme to
accelerate the development of infrastructure to enable
the improvement and expansion of joined-up out of
hospital care for patients . Additional capital will also
be invested in general practice beyond the ETTF which
means that the overall total investment in capital
assets up to 2020/21 will be £900 million .
The Driving Digital Maturity Investment Fund is made
up of both capital and revenue . The process for
accessing and criteria for allocating this funding is
currently being agreed .
It is also anticipated national funding will be made
available to continue central GPSOC funding post
2018 for GP clinical systems . Should no funding be
available centrally this will be a significant limiting
factor as developmental funding would need to be
directed to maintain current provision . NHS England
has not allocated any protected funding to the CCG
to support the implementation of the ‘Securing
Excellence in GP IT Services 2016-2018 Operating
Model’ or the wider Primary Care IT aspects of the
LDR .
9.10 - Benefits
Our governance structure and transformation
approach will ensure we optimise workflows and
pathways across our footprint . We expect this to lead
to quality benefits, for example, shared information
will help to ensure better informed clinical decisions
are made at the point of care . This will also lead
to direct economic benefits, such as time saved by
avoiding unnecessary home visits and a reduction in
duplicate diagnostic tests . In addition, the patient
experience will improve as care givers will have access
to previous information, so patients won’t have to
repeat their answers to the same questions . We
have embedded the identification, realisation and
tracking of benefits into our governance structure .
As the Cambridgeshire and Peterborough STP moves
into active implementation, the shared benefits
management and measurement approach for all
digital developments across all organisations will
develop further .
We will make use of national benefit management
and measurement tools where these are made
available .
In addition, we have identified the following areas of
potential savings from collaboration:
• Cross-organisational utilisation and access to
systems and infrastructure that already in place
that have been purchased by other partner
organisations . This already takes place on a regular
basis .
• Continue to share use of hardware and networks
within joint buildings and locations including
telecommunications
• Removal of paper transfer between organisations
• Joint training resource provision
• Sharing of specialist or expensive technical
resource specialist
• Use of national frameworks for procurement of
technology
• Use of national systems in preference to locally
procured systems e .g . for Health use of NHS .net
9.11 - Resourcing We recognise the scale of change required in
delivering our ambitions, and all the partner
organisations have committed to aligning their staff
and, by prior HCE agreement, funds to deliver these
changes . This may include prioritising the availability
of staff for planning activities and implementation,
the voluntary secondment/loan of staff and other
such pragmatic arrangements . This approach
recognises that delivering the STP is essential to each
organisation’s individual sustainability strategy .
Through the delivery planning process, each prioritised
project will be allocated staff, from across partners’
organisations . These, ‘aligned’ staff will be expected
to dedicate the bulk of their time to the system work
– with up front negotiations about what may need
to be stopped as a result . SROs and if necessary CEO
sponsors, will be expected to escalate to the employer
if they feel staff are not being released as agreed .
The employing Partner will be expected to rectify
the situation within two weeks . The SDU will make
transparent the relevant WTE contributions (clinical
and managerial) from each organisation, to ensure the
burden of effort is fairly shared .
In addition, there are other assets which can help us
to deliver our ambitions, including local communities
and Health and Wellbeing Boards . We will explore
how existing relationships with the Universities,
Charitable trusts, local business, informal carers and
other public services (like the Fire Service) can be
leveraged . All Partners will highlight opportunities for
using these assets .
Where our staff don’t have the required skills and
expertise to deliver the scale and nature of the change
required, we will recognise and address this . It’s
important that our people are in the right roles .
9.12 - Sources of FundingOur Sustainability and Transformation Plans describe
the underlying financial position and plan for our
footprint plus the need for significant recurrent
savings to be delivered . However, it also recognises
the role of digital tools and information in enabling
efficient care and service transformation . There will
therefore need to be further investment in digital over
Cambridgeshire & Peterborough - Local Digital Roadmap
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9.12.3 - Identifying Additional Sources of FundingWe intend to explore additional avenues for securing
funds . For example, the Eastern Academic Health
Science Network (EAHSN) can provide support in
providing information about organisations that might
be able to assist with funding a commercial product
or service, as well as sources of national, regional
NHS, government or third sector funding, outside of
the committed transformation fund . In addition to
supporting the identification of alternative funding
sources, EAHSN offers an independent bid review
service to maximise the chance of successful bids
which would secure additional funding .
The EASN is also offering support to providers to
implement new solutions to address productivity
challenges . A small element of non-recurrent
funding is available to support initial adaption and
implementation of innovations .
Looking Towards the FutureWe will develop and improve our Local Delivery
Roadmap on a rolling basis . Future versions will
address gaps that exist in initial versions – for
example, extending coverage to encompass partners
who are not part of the mainstream health and care
system, but play a significant role in our patients’
pathways . We will also update our LDR in response to
evolving local priorities as new models of care emerge
and current clinical processes are reviewed – for
example, identifying a new capability for deployment
in or re-phasing the deployment of one already
on the schedule . We will need to flex our plans in
response to the funding and business case decision
making processes, and take into account the latest
assessments of digital maturity .
We will also review and respond to new strategies,
policies and reviews . For example, we understand a
children’s digital health strategy, a new strategy for
nursing, midwifery and care staff, and an updated GP
IT operating model are all under development . We
will continue to horizon scan the digital technology
landscape and marketplace to ensure we continue to
take account of new innovations .
We will also take opportunities to learn from other
footprints identifying best practice, lessons learnt,
both positive and negative . This will improve our
understanding of how successful digitally enabled
transformation takes place and allow us to review
and refresh our LDR to provide an increasingly
comprehensive view over time .
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