NHS WALES INFORMATICS SERVICE · NHS WALES INFORMATICS SERVICE Delivering Information and Technology For Better Care Three Year Plan 2014 – 2017 (January 2014) _____

NHS WALES INFORMATICS SERVICE

Delivering Information and Technology

For Better Care

Three Year Plan

2014 – 2017

(January 2014)

___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 2 of 82

CONTENTS

1. EXECUTIVE SUMMARY ..................................................................................... 4

2. STRATEGIC CONTEXT ...................................................................................... 6

3. LOCAL HEALTH NEEDS AND CHALLENGES ................................................... 7

4. CORPORATE VISION AND OBJECTIVES ......................................................... 9

4.1 Vision ................................................................................................................ 9

4.2 Objectives ......................................................................................................... 9

4.3 Health Technology Assessment and Overview of Deliverables ........................ 9

5. SERVICE CHANGE PLANS AND INITIATIVES ................................................ 13

5.1 Service Development and Programme Plans ................................................. 13

5.2 National Services (Applications) ..................................................................... 15

5.3 Infrastructure Services .................................................................................... 19

5.4 National Programmes and Projects ................................................................ 21

5.5 Information Services ....................................................................................... 25

5.6 Service Delivery Risks .................................................................................... 28

6. QUALITY IMPROVEMENT ................................................................................ 30

6.1 Our Planned Quality Commitments ................................................................ 30

7. ORGANISATIONAL DEVELOPMENT ............................................................... 32

7.1 Our Existing and Planned Workforce Profile ................................................... 32

7.2 Our Planned Organisational Development Commitments .............................. 33

8. FINANCE ........................................................................................................... 36

8.1 National Context ............................................................................................. 36

8.2 Organisational Context ................................................................................... 36

8.3 Revenue and Capital Funding Model .............................................................. 37

8.4 Revenue ......................................................................................................... 39

8.5 Savings Plans ................................................................................................. 42

8.6 Capital ............................................................................................................ 43

8.7 Financial Risk ................................................................................................. 45

9. ESTATES AND CORPORATE SERVICES ....................................................... 47

9.1 Estates ............................................................................................................ 47

9.2 Corporate Services ......................................................................................... 48

10. STEWARDSHIP AND GOVERNANCE ............................................................. 49

10.1 Our Board Arrangements .............................................................................. 49


10.2 Working with our Stakeholders ..................................................................... 49

10.3 Internal Management and Governance ........................................................ 51

10.4 Performance Management and Reporting .................................................... 51

10.5 Risk Management and Business Continuity ................................................. 52

APPENDICES .......................................................................................................... 53

Appendix 1 – National Services (Applications) ..................................................... 54

Appendix 2 – Infrastructure Services .................................................................... 69

Appendix 3 – National Projects ............................................................................. 73

Appendix 4 – Quality Improvement ....................................................................... 76

Appendix 5 – Financial Controls, Reporting and Audit Arrangements .................. 80


1. EXECUTIVE SUMMARY

The NHS Wales Informatics Service (NWIS) delivers national information and IT

services to support the provision of integrated care services for citizens across

Wales. The organisation also sets the standard for health informatics professional

leadership and development.

Our strategy is based on the principle that effective and efficient information systems

will give:

Care providers the information they need to deliver better outcomes, more

safely and more efficiently, and

Welsh citizens access to information they need to support their own health

and wellbeing.

Health Boards, NHS Trusts and Local Authorities in Wales had previously planned

and implemented discrete information services for their own local catchment

populations. Now, the National Informatics Programme is coordinated and

implemented by NWIS in partnership with the seven local Health Boards and the

three Trusts. We are also, increasingly, working with Welsh Local Authorities on the

CCIS project.

The over-arching principles we use to plan the way forward are:

Doing things “Once for Wales”

Undertaking clinical and technical design together

Focusing on information services not systems

Making the best use of what we already have

Doing things in common by design or agreement

Ensuring safe migration to new services.


Our priorities are:

The development of common infrastructure, including data centres, data

networks (e.g. PSBA), mobile platform, data storage facilities including

private cloud capabilities extending across the NHS in Wales

Continue roll-out of systems to accurately identify patients and staff across

Wales

Further development of systems that share essential information and

messages between services, such as the Individual Health Record (IHR) and

Welsh Clinical Communications Gateway (WCCG)

Progress adoption of systems that give better access to patient with systems

such as My Health On-line (MHOL)

Further implementation of the Welsh Clinical Portal’s core clinical processes

such as pathology and radiology requesting and reporting, medicines

management and viewing of clinical information collected by other systems

Further roll-out of common systems, such as new GP Clinical Systems, the

new LIMS for Pathology and Blood Services, and RadIS2 and PACS for

Radiology and imaging services

Developing requirements and procuring a new system to improve document

management and provision and sharing of the patient record, such as the

Welsh Care Records Service

Progress national adoption of a Community Clinical Information System

(CCIS) that bridges the information gap between Health and Social Care for

Health Boards and Local Authorities.

We will continue to develop our three year business plan by working with Local

Health Boards and Trusts to make sure that National and Local IT Plans are

aligned.


2. STRATEGIC CONTEXT

NWIS responds to a range of national strategies and plans for health and social

care. The current principle drivers in this respect are:

Together for Health (2011) 1 is the five year vision for the NHS, based around

primary and community services, placing prevention, quality and transparency

in healthcare.

Digidol yn Gyntaf – Delivering Welsh Public Services Online (2012) 2 is

reviewing the Welsh public sector digital on-line services with the aim of increasing

the range and quality and uptake by Welsh citizens.

Framework for Delivering Integrated Health and Social Care (2013)3. Welsh

Government has recently ended a consultation on its proposals to develop

closer relationships between health and social care providers to support a

transformation in the quality and effectiveness of care for older people in

Wales.

The Commission on Public Service Governance and Delivery (2013) 4 has been

formed by Welsh Government to review the way that public services are delivered

and run.

1 See http://wales.gov.uk/topics/health/publications/health/reports/together/?lang=en

2 See http://wales.gov.uk/docs/det/publications/130304digitalfirsten.pdf

3 See http://wales.gov.uk/docs/dhss/consultation/130823consultationen.pdf

4 See http://wales.gov.uk/topics/improvingservices/public-service-governance-and-delivery/?lang=en

http://wales.gov.uk/topics/health/publications/health/reports/together/?lang=en

http://wales.gov.uk/docs/det/publications/130304digitalfirsten.pdf

http://wales.gov.uk/docs/dhss/consultation/130823consultationen.pdf

http://wales.gov.uk/topics/improvingservices/public-service-governance-and-delivery/?lang=en


3. LOCAL HEALTH NEEDS AND CHALLENGES

Across Wales, Health Boards have been developing plans for the future safe delivery

of services to patients. The following plans have been developed and are at various

stages of engagement and consultation:

South Wales Programme - Involves all Health Boards in South Wales

(Abertawe Bro Morgannwg, Aneurin Bevan, Cardiff & Vale, Cwm Taf, Hywel

Dda, Powys) but proposals only relate to main hospitals in the Cwm Taf,

Cardiff & Vale, Aneurin Bevan and Abertawe Bro Morgannwg areas. Ideas

have been proposed by clinicians about the future of a range of specialist

hospital services: consultant-led inpatient paediatrics, neonatal care,

obstetrics and A&E care. The ideas put forward include concentrating this

expertise on fewer hospital sites - four or five - across South Wales.

Healthcare in North Wales is changing - Betsi Cadwaladr Health Board.

Proposals are based around the following principles: staying at home when it

is safe and appropriate; more care closer to home

Getting the best results from specialised services; better services on fewer

sites; and improved acute hospital services

Your Health: Your Future - Hywel Dda Health Board are running their own

consultation exercise on proposals for change in the West Wales region.

There are strong links between these plans and the South Wales Programme

to make sure specialist services elsewhere in South Wales which are used by

Hywel Dda residents continue to be available.

We will continue to work with Welsh Government, NHS organisations and all other

partners to ensure that their requirements, in the light of changing services, are met

and aligned with national informatics policy.


In response to these needs and challenges, Informatics strategies have been

developed by NWIS in support of delivering and improving technology services, in

particular:

National Infrastructure Strategy for NHS Wales (2009)

National Security Strategy for NHS Wales (2009)

National Application Strategy for Wales (2010)

GP Clinical Systems Strategy – Delivering next generation systems for

General Practices within Wales (2010)

The continued investment in the implementation of our Informatics strategies

supports the delivery of these seven strategic benefits:

Health system

costs

decreased

Heath System

efficiency

increased

Increased

positive

health

outcomes

Patient safety

is increased

Legal/policy

compliance

increased

Patient

confidence

Increased

Convenience

of care

increased


4. CORPORATE VISION AND OBJECTIVES

4.1 Vision

We support the improvement of patient care through collaborative provision of high

quality information, systems and technologies; ‘Once for Wales’.

4.2 Objectives

Underpinning this vision, our seven objectives are:

Maximise the value of Informatics investment for Welsh citizens and public

sector health and social care providers

Raise the quality and productivity of existing systems and services

Promote the use of new technology as the enabler for innovation and the

transformation of future services

Incorporate quality and our values in everything we do

Improve the enabling national infrastructure

Be the Welsh informatics employer of choice

Improve the NWIS corporate reputation by being effective and efficient.

4.3 Health Technology Assessment and Overview of Deliverables

Global technology developments have revolutionised many aspects of our personal

lives, including the way we want to communicate with health and social care

services. The NWIS three year business plan recognises this and seeks to harness

and embrace such requirements. Citizens will, therefore, increasingly be at the

centre of our digital thinking and strategy.

The NWIS strategy and programme implementation will be architected and planned

for rapid change using open architectures with interoperability between systems and

technical services a key deliverable.

Our key principles will be:


Incremental by design

Clinical and technical design must remain valid in the face of public service

redesign in order to support Service change

Enable interoperability using relevant standards

Maintain world class clinical safety as the reliance of care processes on

technology grows

Whatever we do must be affordable and aligned to financial strategy and

objectives. The above technological developments have cost implications for

health organisations and are likely to increase in the future.

The NWIS architecture is illustrated in the diagram below.

Individual HealthRecord

Out of Hours

Overview of Systems Architecture

GP systems (lifelong record)

Welsh Clinical Portal

My Health Online

Patient access –over the internet

e-referrals/discharges

•Radiology IS•Laboratory IMS•Prescribing•Scheduling•Ordering

Current hospitalsystems

New hospital/Community

systems

Clinician access– where careis delivered

The diagram shows the continuous development of new systems which builds on the

existing foundations in Health and transcends organisational boundaries.

The NWIS approach will continue to support the use the service orientated

architecture (SOA). This involves the consolidated use of SOA across Wales and the

re-use of existing SOA components to support new requirements.


Our three year business plan will deliver:

The completion of current implementations, to include:

o National Master Patient Index (MPI)

o Welsh Clinical Portal (WCP)

o Individual Health Record (IHR in unscheduled care)

o My Health On-Line (MHOL)

o Welsh Clinical Communications Gateway (WCCG)

o Cancer Network Information System (Canisc)

o Laboratory Information Management System (LIMS)

o Radiology Information System (RADIS2)

o Picture Archiving and Communications (PACS)

o Community Child Health System

o Myrddin Patient Administration System

o Hospital Pharmacy System

o National Screening Services Systems

o GP Systems Migration

New schemes to include:

o Welsh Care Records Service (WCRS)5 to provide a national, patient

centred registry and repository for documents and core patient

information.

o National Auditing Services (NIIAS) to strengthen our capabilities for

monitoring and managing access to systems and services across the

national platform

o Emergency Department System, a framework contract that enables

Health Boards to procure a system.

o The development of a patient-centric national alerts and warnings

service to improve patient safety (WCP development).

o Increased scheduling, patient administrative and care planning

capabilities (in the longer term to provide enterprise scheduling)

5 A national, patient centred registry and repository for documents and core patient information.


o Moving from procurement to implementation of the Community, Mental

Health and Social Care solution (CCIS).

o Develop the blueprint for implementing mobile technologies to support

new apps, such as WCP on smartphones.

o Additional investment in national infrastructure.


5. SERVICE CHANGE PLANS AND INITIATIVES

5.1 Service Development and Programme Plans

Our priorities for the 3 Year Plan are to:

Fulfil our mandated role and functions efficiently and effectively

Maintain a high quality delivery of the portfolio of National services and

change programmes

Continued refinement of the arrangements with local organisations for the

delivery of National information and infrastructure services

Establish NWIS as a proactive and supportive co-producer within the NHS

Wales Health and Social Care framework to deliver Informatics enabled

improvements in services and outcomes that staff and Welsh citizens will

recognise and value.

We have analysed our internal strengths and weaknesses and external opportunities

and threats and these are described in the table below.

Internal

Strengths

High service quality and service

satisfaction in delivery of 80 National

Informatics Services

Large scale, resilient and scalable

systems and infrastructure

Unique technical skills and expertise –

see below

Large scale NHS holistic informatics

knowledge and expertise – contributing

to transformation of delivery to foster the

roles of citizens, carers and families in

promoting well being.

Only experienced provider of National

Informatics Services in NHS Wales

Weaknesses

Pressure on operational support

resources

Moderate awareness and alignment of

local service realities

Perception of National orientation

Demanding Modernisation Programmes

Reliance on 3rd party contractors for

specialised skills


Internal

Long term record of delivering National

Informatics solutions across NHS Wales

Only quality assured Informatics

organisation in NHS Wales (ISO 9001)

External

Opportunities

Delivering Welsh Government Digital

Strategy and intentions in NHS Wales

Building on our international reputation

and relations

Increasing focus on future Service

transformation e.g. care in the

community

Delivery of core clinical services through

software development toolkit

Deliver new systems and service to

transform NHS Wales

Threats

Public sector austerity and NHS budget

constraints

Changes in local organisation structures

and resources

Local Informatics developments not

aligned with National strategy and plans

Maintaining quality services whilst

investing in Informatics innovation and

transformational improvement

To achieve our 3 Year Plan in the context of NHS strategies and our strengths,

weaknesses, opportunities and threats we will undertake the following Service and

Programme Plan developments.

In 2014/15 we will continue to focus on consistently meeting our existing Service

Delivery and Programme implementation plans in advance of the publication of the

new Informatics Strategy for the NHS in Wales.

The existing NWIS Services and associated change initiatives are broadly classified

as:

National Services (Applications)

Infrastructure services

Programmes and projects

Information services


In addition, we expect our co-producers will need to access our expertise and

support for not only delivering services and functionality they require, but also for

assistance in scoping the requirements for information systems and drafting national

business cases to ensure that they are able to maximise economies of scale

regarding use of availability of information, use of infrastructure, matters related to

information governance, security and technical standards.

Our expertise includes:

Leadership of Informatics, Information and Technical Strategy development

Technical domain strategies, technical blueprint and roadmap development

Technical architecture, clinical and technical design and application build

Delivering National Application & Infrastructure Services

Clinical and Technical assurance

Statistical and analytical expertise

Requirements and business analysis

National Programme, project management and support

National business case production and assurance

Specialised Informatics procurement expertise

Benefits management and measurement

Information governance and development and use of information standards

Service management and technical and user support.

5.2 National Services (Applications)

NWIS National Services (Applications) objectives are underpinned by the aim to

continually improve the current services through further review and development of

the NWIS Service Catalogue to meet the needs of our users.

National Services (Applications) are in various states of maturity:

Mature: Operational systems that are fully transitioned to service. Continuous

development is ongoing and enhancements to services undertaken managed

through service boards working with partner organisations at a local level


Transitional: Newly developed applications in transition to service with local

implementation continuing

New: New services under development in the early stages of the project cycle

and not yet implemented.

A summary list of all our National Services (Applications) is detailed in Appendix 1.

5.2.1 Our Planned Mature Services Commitments

Key objectives for operational systems/services relate to the provision of continued

support managed under robust Service Management arrangements and the delivery

of ongoing enhancements under “service and quality improvement plans” as

required. This list is not exhaustive, but focuses on the main areas.

NWIS has planned the following initiatives for its operational systems/services over

the next three years:

Existing Service Commitments Target

Year(s)

Resource/

budget

Canisc

Migrate CANISC infrastructure onto new hardware and

disentangle from other 3rd party products

Dec 14

Within

resources

Child Health

Complete the development of the new Child Health system

(CYPrIS)

Produce a Mobile Device version of CYPrIS with limited

appropriate functionality

Implementation of CYPrIS across Wales

Implementation of CYPrIS in other Home Countries

Sept 14

Jan 15

Jan 16

Mar 17

Within

Resources

HTTF Bid

Within

resources

SLA

income

Clinical Knowledge Services

Evaluate and ensure the electronic content demonstrates

Ongoing

Within



Year(s)

Resource/

budget

best value for money resources

GP Systems

Migration to New Hosted System(s)

Implement GP to GP transfer

July 15

Mar 16

Within

resources

Hospital Pharmacy

Migration on to new hardware and improved resilience

TBC TBC

Integration Services

Publication of software development toolkit

Replace JCAPS and BizTalk Integration Engines with a

newly procured Integration Engine.

Jun 14

Mar 16

New

Business

Case

Master Patient Index

Development of National Data Quality Service

Continuous integration with systems as they develop

Mar 17

Within

resources

Myrddin (PAS)

Hardware refresh and consolidation for Powys and Cwm

Taf

General application improvements

Sept 14

Within

resources

NRDS

Enhance NRDS to hold appropriate information to support

GP-to-GP transfer.

Develop improved administration system for NRDS.

Sept 14

Mar 15

Within

resources

RadIS2

Implement RADIS2 into Cardiff & Vale

Implement RADIS2 into AMBU West

Merging legacy RADIS2 instances into new Health Board

Instances

Enhance RADIS2 to implement Obstetrics functionality.

May 15

May 15

Mar 15

Aug 14

Within

resources

Screening Services

Rewrite Cervical Screening (subject to procurement tender)

and ongoing support of new service

Jun 17

Business

Case

Web Services



Year(s)

Resource/

budget

Migrate HOWIS onto new infrastructure

Improve the Cascade content management system used to

deliver a number of NHS Wales Websites.

Enhance the new e-learning @nhs.wales to support and

implement the technology enhanced strategy (TEL)

Sept 14

Mar 15

TBC

Within

resources

TBC

Welsh Demographic Service

Migrate WDS onto new infrastructure in readiness to move

to the new Data Centre.

Enhance WDS functionality to support Welsh Birth

Notification, GP patient trace.

Jun 14

Sep 14

Within

resources

5.2.2 Our Planned Transitional & New Service Commitments

We continue to develop and enhance the NWIS IT Services. The following initiatives

for operational systems/services over the next three years include:

Service Commitments Target

Year(s)

Resource/

budget

LIMS

Support the ongoing implementation & full operational service

Jul 15

Within SLA & Resource

Diabetes

Readiness/ Operational support of “live” service

Dec 15

Seek SLA

Community, Mental Health and Social Care System

Technical solution and service delivery, evaluation of options

Design, implementation and on-going support arrangements

Dec 14

Within

resources Business

Case & New SLA

PACS XDSI system

Support installation of hardware within Datacentre(s) and implement registry service

March 15

Within

Resources

National Intelligent Integrated Audit Service:


Mar 15

New SLA


Service Commitments Target

Year(s)

Resource/

budget

Welsh Care Records Service

Technical solution and service delivery, evaluation of options


E-forms development

Jun 15

Apr 16

Jun 16

Within

resources Business

Case & New SLA

5.3 Infrastructure Services

NWIS provides and manages core Infrastructure on behalf of NHS Wales to improve

the way information is delivered and stored.

NWIS infrastructure broadly falls into two main categories:

National infrastructure that NWIS provides and manages on behalf of NHS

Wales. This includes:

o Two national data centres and the server and storage equipment that

run all of our national applications

o Network links to the Internet and N3 (NHS England/Scotland)

o Remote Access Services that allow NHS Wales’ employees to work

remotely

o Email services

o Video and Audio Conferencing Services

Local infrastructure for NWIS staff, including:

o PCs, Laptops, Printers, File servers, etc

o Wired and Wireless (WiFi) Local Area Networks (LANs)

Additional information about the National Infrastructure can be found in Appendix 2.

This infrastructure is mature and works well. However, investment is needed to

achieve the following objectives:

Maintaining operational services

Increasing capacity and resilience

Enabling new methods of working


5.3.1 Our Planned Infrastructure Services Commitments

NWIS has planned the following initiatives for its infrastructure systems/services over

the next three years:

Infrastructure Services Commitments

Target Year(s)

Resource/ budget

Maintaining operational services:

Upgrade the National Active Directory to Windows Server 2012

Replacement of National Email Infrastructure (HMS)

Replacement of the network infrastructure in the national data centres

Replacement of hardware for Information Services servers

Replacement of Domain Controllers across NHS Wales

Replacing aging web monitoring/filtering system for NWIS users

Deployment of new SAN for NWIS Client Services

Replacing old NWIS PCs, Laptops, etc

Replacing old NWIS offices LAN infrastructure

General maintenance / upgrades of computer rooms

General maintenance / upgrades of server and storage equipment

Mar 15

Mar 17

Dec 15

Dec 16

Mar 17

Mar 15

Mar 17

Ongoing

Ongoing

Ongoing

Ongoing

Within resources/ Capital needed











Increasing capacity and resilience:

Migration of infrastructure from existing BT Cardiff Data Centre to the BT Newport Data Centre.

New SQL and VMware infrastructure (Provide additional capacity and replace some aging existing infrastructure)

Upgrade of DMZ firewalls and DMZ networking infrastructure (to provide faster access to internet websites and resources – to keep in-line with the demand)

Creation of a DMZ server farm at the Newport Data Centre, to provide resilience for hosted internet websites.

Deploying WLAN Infrastructure for NWIS

Jul 14

Jun 16

Mar 15

Mar 16

Within resources




Within resources/


Infrastructure Services Commitments

Target Year(s)

Resource/ budget

Offices at Swansea, Mamhilad and Mold.

Establishing a Major Incident Response Centre at NWIS Brunel Offices

Mar 15

Dec 14

Capital needed Within resources/ Capital needed

Enabling new methods of working:

Deployment of infrastructure for NHS Wales to run Microsoft Lync

Deployment of a Mobile Device Management solution for allowing NWIS to access corporate services from NWIS staff Tablets/SmartPhones (including BYOD)

Investigate use of Microsoft Direct Access

Deployment of Virtual Desktop Infrastructure for NWIS clients

Oct 14

Oct 14

Jun 15

Oct 15

Subject to Health Technology Fund Within resources/ Capital needed

Within resources/ capital needed


5.4 National Programmes and Projects

5.4.1 Our Planned National Programmes and Projects Commitment(s)

We have planned the following enhancements to National Programme and Project

activities over the next three years. We will align our ongoing and new Programme

and Project activities with NHS Wales Local Health Board plans, under the direction

of the National Implementation Management Board. It should be noted that we will

use this Three Year Business Planning process to reaffirm our Programme and

Project commitments, revenue and capital funding for 2014/15 and beyond.

Assuming that national and local funding is confirmed to cover the National

Programme and Project requirements, we expect our more significant and material

activities to include:

Programme & Project Commitment(s) Target

Year(s)

Resource/

budget

Community, Mental Health and Social Care solution:

National procurement complete (Master Service Agreement - (Health Boards to include local funding in their 3 year plans

National Roll Out

Dec 14

Mar 17

Resources Required (Capital and Revenue)



Year(s)

Resource/

budget

Community Pharmacy: Electronic Transmission of Prescription Claims:

Business Case to be produced

Product available - Early Adopter

Product available - National Common Ailments Service:

Roll out to remainder sites Discharge Medicines Review Service (DMR):

Hospital to Pharmacy (Option Appraisal and way forward to be agreed)

Solution to be procured/developed (subject to Business Case)

Implementation

Mar 14 Feb 15 Jun 15

2015 - 2017 TBC (by

WG)

Mar 15

Mar 16

Mar 17

Funding stream to be identified

Revenue required for national support and local implementation

Resources required subject to Business

Case

CANISC:

WCP to Canisc Integration and implementation in Velindre Cancer Centre

Scoping and agreeing integration of Canisc to WCCG

Cancer Documents available across NHS Wales via Document Repository

Multi-disciplinary team module available

Mar 15

Mar 15

Mar 16

Mar 16

Business Case:

approved

Diabetes:

Product Available – Early Adopter

National Rollout

Dec 15 2016/17

Resources subject to

Business Case

GP Links:

Implement national Message Integration between secondary and GP Practises throughout Wales

Oct 14

Within Resources

Hospital e-Referrals (HERS 1):

Completion Implementation of Phase 1 (Electronic interface for Medical Records Departments)

Sept 14

Within Resources

Individual Health Record (IHR):

User Interface Improvement

Scoping of IHR/WCP reconciliation

Improved functionality to be determined and delivered (e.g. Advanced Care Plans and consent model

Dec 14 Mar 15 Apr 17


Business Case

Laboratory Information Management System (LIMS) :



Year(s)

Resource/

budget

LIMS HB Implementation(s) o Core Disciplines o Genetics Module* o Blood Tracking o Blood Transfusion o WTAIL (WBS) o HB Legacy Data Repository

(Blaenavon) Migration complete

Wales Pathology Handbook (WPH):

Phase 2 Clinical Front End (CFE) Scoping

Phase 2 CFE Development

Phase 2 (CFE) release to Service

Phase 3 WPH Revision Scoping

Phase 3 WPH Development

Product Available - national

Point of Care Testing

Business Case

Procurement completion

Implementation

Oct 14 Dec 14 Dec 14 Mar 15 Mar 15 Jul 14 Jul 15

Jul 14 Feb 15 Mar 15 Sept 14 Aug 15 Oct 15

Mar 14 Oct 14 Apr 15

Within Resources and

Capital approved (*Genetics Business Case in progress)

Resources subject to Business Case

Resources subject to Business Case

Master Patient Index (eMPI):

Completion of implementation to support Community and Social care

2014 – Mar 17

Capital required for

Infrastructure (2016)

Medicines Management

Scoping and Options for Hospital Pharmacy and ePrescribing

Procurement / Build

National availability

Sept 14

Dependent upon scope agreed


Business Case

My Health Online (MHOL):

Phase 1 functionality, e.g. Alerts, Mobile App, messaging and online registration Product Available - national

Phase 2 functionality e.g. diary, medical record, carer access Scope confirmation

Apr 15

Apr 16

Funding to be confirmed as part of GP contract,

subject to scope

National Intelligent Integrated Audit Service (NIIAS):

Interim Audit Service for WCP access to IHR

National Solution Available for LHB Call off

Completion of Early Adopter & Full

June 14 Mar 15 Mar 17

Within resources Resources subject to

Business Case



Year(s)

Resource/

budget

Implementation Patient Administration System (Myrddin):

Published Annual Operational Work Plan 2014/15 (Business Cases will be produced where new modules are developed requiring capital investment)

Apr 14 – Mar 17


business case

Picture Archiving and Communications System (PACS):

Completion of National Rollout across NHS Wales

PACs integration: o Assessment of network capacity

and infrastructure o Product available (Fuji sites) –

national o Product available (other sites)

Mar 15

Jun 14

Sept 14 Mar 15

Within resources

Capital may be required

Within resources

Readiness:

Provision of project management support to NHS organisations

Ongoing

Within resources

Radiology Management System (RADIS2):

Decommission of RADIS1 completed across NHS Wales

Deployment of RADIS2 ABMU (subject to LHB decision)

Development Completed: RADIS2 (Requesting) available for deployment

Sept 14

Dec 15

Mar 16

Within Resources

Systems Integration Tools Replacement

Publication of software development toolkit

Procurement complete

Implementation for national messaging

Apr 14 Apr 14 Apr 16

Capital requirement

Welsh Care Record Service (WCRS):

Establish and make available a National framework Contract for EDRMS (Electronic Document Repository Management System) to Local health Boards

Implement a Central Document repository

Create E-Forms for Clinical Data entry

Jun 15

Apr 16 Jun 16

Subject to Full Business Case re Capital Funding

Welsh Clinical Communications Gateway (WCCG):

WCCG Phase 2 o Clinic Letters o Discharges o Supplementary messages o Advice requests o Reporting o Cross border o Canisc

Resources to be

confirmed



Year(s)

Resource/

budget

Product available - national Sept 14 –Mar 17

Welsh Clinical Portal (WCP):

National product of IHR View in WCP available

National product - clinical prioritisation of eReferrals available

Implementation of WCP with LIMS integration in all LHBs

MTED nationally available (current scope)

MTED extended scope nationally available

ADT functionality

Mobile device platform

Community Care Information System integration

National WCP/TRRR – pilot one organisation

Nationally available WCP/TRRR

Patient handover functionality, nationally available

Sep 14 May 15

Mar 15

Apr 14 Mar 15 Mar 15 Mar 15

2015 - 2016

Mar 15

Mar 16

Mar 16


business case

Welsh Demographic Service (WDS):

Welsh Birth Notification service

Implementation to mirror changes to Adoption Legislation

Advanced Trace

GP Registration

Jun 14 Dec 14

Dec 15 Mar 16

Within Resources

Subject to business case

A description of each Project is detailed in Appendix 3.

5.5 Information Services

Information Services have a pivotal role to play in delivering trusted information

critical to decision making and public accountability as well as standardised

measures and national comparisons which are key to improvement. This is at a time

of austerity and there is an expectation of achieving savings through the

rationalisation of information services.

Information Services key objectives are:


1. Improving information quality and data standards

Ensuring the right quality information is provided, using clear governance and

standards in data and data collections

2. Improving access to and interpretation of data through better presentation and

reporting

Ensuring fair and equal access to information

3. Providing relevant information services

Delivering the information that frontline services need to meet their priorities

and acting as the core source for official statistics published by WG and other

bodies for the purposes of national accountability

5.5.1 Our Planned Information Services Commitments

The key priority for Information Services is to ensure the right information is

produced to the right quality at the right time alongside enabling business continuity.

Over the next three years, the demand for, and components of this service, will

remain:

Responding to ad-hoc requests for information

Undertaking specialised statistical analysis

The provision of value-added data extracts to other agencies

The production of agreed performance, health outcome and other measures

Health services research support

The provision of health intelligence.

In addition, standard operating procedures to ensure an agreed understanding of the

requirement, timely turnaround of requests, intelligent presentation of data and

effective quality assurance of outputs are essential and will be further developed.

Whilst embracing the relevant components of Service Management, Information

Services will continue to adopt more agile business processes with an emphasis on

closer collaboration with clients and more devolved ways of working across the

organisation.


We have planned the following information activities over the next three years.

Information Services Commitment(s) Target

Year(s)

Resource/

budget

Raising the profile of information: To align endeavours around the forthcoming National

Information Strategy

Modernise Information systems, with investment in

products and skills more suited to the delivery of visualised business intelligence. This to be achieved by the adoption of the Microsoft SP2014 and associated BI toolset.

Work across NHS Wales to develop a Enterprise Corporate Data Warehouse Strategy. This to include both corporate secondary use data sources and those currently untapped information sources contained with key operational systems (Canisc, Myrddin, LIMS, WCCG etc)

Implementation of Corporate Data Warehouse

To support, develop and facilitate benchmarking

solutions building on the economies of scale achieved by the rationalisation of the NHSW CHKS contract

Development and expansion of the NWIS Information

Standards (reference data, clinical coding, data quality, datasets and MDSs)

Support and promote Wales Informatics Assurance

processes (WISB, Analysis and methodologies Group)

Use of formal business analysis process to identify, specify and help address key “gaps” in the availability of data and information – priorities current include:

o The development of a community services

dataset o Mental Health information requirements o Specialised and tertiary services information

requirements o Outcome, quality and system bases measure

and metrics

Mar 15

Mar 16

Dec 2014

Sep 2017

Mar 16

Mar 15

Ongoing

Ongoing

Within

resources

Subject to Business

Case

Within resources

Subject to Business

case

Within resources

Within resources

Within resources

Within

resources


Information Services Commitment(s) Target

Year(s)

Resource/

budget

Primary, Community, Social Care & Mental Health information

o Establishing a primary, community, social care and mental health informatics service

o Putting this service on a secure footing o Addressing immediate priorities (QOF 2014

and beyond) o Developing a primary, community, social care

and mental health Data Warehouse o Practice profiles and other envisaged products

Mar 16

Within

resources

5.6 Service Delivery Risks

The key strategic and operational risks are outlined below. NWIS has monitored

these and other emerging risks under regular review and, based on understanding

the consequences, has developed mitigating actions where possible.

Key Risk(s) Mitigation(s)

National Services (Applications)

Resources will not be sufficiently available to

complete the development of Continual

Service Improvement Plans (CSIPs) for all

required services resulting in no clear

pathway for service development

Service Management Boards

Change Advisory Boards

There could be lack of Health Board/Trust

resource to take forward ITIL alignment

Engagement with Health Boards/Trusts to

identify, commit resource and agree

timescales

Lack of technical resource resilience within

the Operational Services Team could mean

that targets are not met if key resources are

not available

Vacancy Control discussions at monthly

Executive Board meetings (following

submission of business cases)

Systems classed as Medical Devices are

subject to inspection by MHRA (Medicines

and Healthcare Regulatory Authority) to

Achievement and maintenance of ISO

certification against standards. Development

of SOPs to address requirements of



ensure compliance with the Medical Devices

Directive. If not compliant, the MHRA can

act to stop use of systems meaning NWIS

systems/services would be unavailable to

NHS Wales

standards and directives to ensure

compliance with

Infrastructure Services

Failure to invest continuously in network

capacity to keep pace with network traffic.

Design resilience into the infrastructure and

ensure that applications leverage this

capability

Regular testing of failover/disaster-recovery

processes.

Consider network capacity investment in all

plans and developments.

National Programmes and Projects

Lack of Health Board/Trust resource to effect

timely implementation of new

products/developments

Engagement with Health Boards/Trusts to

identify resource and agree timescales

Information Services

Risk of loss of services due to a reliance

upon a series of disparate, and retrospective

and untimely “minimum datasets” and

aggregate returns and legacy products mean

that increased and changing demand cannot

be met

Work with Stakeholders to establish and

implement up to date information

requirements


6. QUALITY IMPROVEMENT

NWIS continuously strives to be acknowledged by its customers, partner

organisations and stakeholders as a centre of expertise and innovation in the

provision of specialist IT and Information Services.

A description of the quality initiatives is given in Appendix 4.

6.1 Our Planned Quality Commitments

In order to demonstrate and excel in the service we deliver, NWIS is committed to

comply with all statutory and regulatory requirements and the requirements of the

International Standards, ISO 9001:2008, ISO 14001:2004, ISO 27001:2005, ISO

20000-1:2011 and Business Continuity ISO 22301:2012 and to continually improve

its effectiveness by the use of performance indicators and review.

NWIS products (systems and services) will also be subject to MHRA (Medicines and

Healthcare products Regulatory Agency) inspection.

Quality Commitment(s) Target

Year(s)

Resource/

budget

Establish and maintain a fully functional Integrated

Management System (IMS) – reporting on quality

performance

Sept

2014

Within

resources

To maintain certification against the following standards for

the entire range of NWIS services

- ISO 9001:2008 (Quality Management)

- ISO 27001:2005 (Security Management) – this will

involve the transition from the 2005 standard to the

new revised ISO 27001:2013 Standard

Dec

2014

Within

resources

To achieve certification for the whole organisation:

- ISO 14001: 2004 (Environmental Management)

- ISO 20000-1:2011.(Service Management)

Sept

2014

Budget

(additional

resource reqd)

To engage with the Medicines and Healthcare products

Regulatory Agency with regard to system compliance with

Sept

2014

Within

resources


Quality Commitment(s) Target

Year(s)

Resource/

budget

Medical Devices Directive

To prepare for assessment against the following standard:

- ISO 22301: 2012 (Business Continuity)

2015 Within

resources


7. ORGANISATIONAL DEVELOPMENT Our workforce is and will be imperative in ensuring that NWIS discharges its ongoing

commitments and works in a co production and collaborative manner with our

partners and Welsh Government.

Because of the specialist nature and complexity of Informatics service innovation,

improvement and deliver, it is critical that an effective workforce plan is implemented

that:

Underpins the Three Year Business Plan and embodies our approach to

leadership, our workforce strategy and learning and development strategy that

has been developed in consultation with a wide range of stakeholders

Delivers the sustained productivity, improved quality and cost efficiency

savings to all directorates

Is adaptable and flexible enough to accommodate unforeseen new service

and project demands

Acknowledges that given the nature of NWIS activities, a certain level of

temporary expertise and resource is required that will enable us to manage

capacity peaks and troughs and avoid recruitment on a permanent basis

Developing the workforce to support Welsh Government Digital Wales

initiatives

7.1 Our Existing and Planned Workforce Profile

The current NWIS establishment directly employed workforce numbers are shown

below. Planned WTE resource required to underpin service growth is also detailed

prior to any subsequently imposed cost improvement/savings plan.

Directorate/Team

Total current

WTE Establishment

% WTE

2014/15 Planned

2015/16 Planned

2016/17 Planned

Executive Management

8 1.6% 8 8 8

Operational Services, Commercial Services and Information Services

386.72 76.1% 400.72 400.72 400.72


Directorate/Team

Total current

WTE Establishment

% WTE

2014/15 Planned

2015/16 Planned

2016/17 Planned

Programmes & Projects 40.36 7.9% 40.36 40.36 40.36

Finance, Business Assurance & Corporate Services

26.07 5.1% 26.07 26.07 26.07

NHS Engagement, Workforce & OD Team

22.76 4.5% 22.76 22.76 22.76

Clinical Informatics

17.10 3.4% 17.10 17.10 17.10

Nursing & Social Care Information

7.0 1.4% 7.0 7.0 7.0

Total 508.01 100% 522.01 522.01 522.01

7.2 Our Planned Organisational Development Commitments

In a period of acknowledged austerity, NWIS aims:

To continue striving to develop structures that are fit for purpose with roles,

skills, flexibilities and competencies of all staff aligned to corporate objectives

Develop desired capacity and capability to fulfil National Service & Project

obligations

Improve the quality and time devoted to Service & Quality Improvements

Develop robust and equitable workforce planning across the directorates and

reduce sickness absence

To be an Employer of Choice

Organisational Development Commitment(s) Target

Year(s)

Resource/

budget

Workforce Development:

Develop new and extended roles to

support new ways of working

Work with Health Boards and Trusts to

identify areas where resource can be

Mar 2015

Sep 2014

Mar 2015

Within

resources

Within

resources



Year(s)

Resource/

budget

shared

Continue to improve workforce data and

analysis, including further embedding of

ESR (Electronic Staff Record) across the

organisation

Within

resources

Learning & development:

Continue the informatics development

programme, including apprenticeships,

graduate interns and management

trainees

Establish a programme of Knowledge

Sharing Events across Wales

Develop the capacity and capability of line

managers to deliver excellent human

resource management in their day to day

management of their staff

Support the wider NHS Informatics

Service in providing tools in terms of

workforce surveys, national identity and

common structures/job descriptions/titles

to ensure a consistent approach

Continue to work with Education Business

Partnerships and schools and career

services to promote informatics as

profession and provide opportunities for

young people

2014 to 2017

2014 to 2017

Mar 2015

2014 – 2017

2014-2017

Within

resources

Within

resources

Within

resources

Within

resources

Within

resources

Co-Production and Engagement:

Strengthening processes for partnership

working and staff engagement and

support, improving decision-making and

supporting staff well-being

Sep 2014

Within

resources

Recruitment:

Integrated service, workforce and financial

2014 - 2017

Within



Year(s)

Resource/

budget

plans will be developed for all services

which outline the future changes to the

shape and size of the workforce. This will

enable effective and responsive

recruitment, re-deployment and re-training

processes to be put in place.

resources

Workforce Health / Equality & Diversity:

Develop a culture of workplace health that

focuses on supporting and improving

employee well-being

Further development of the Health &

Wellbeing Action Plan

Achieve Investors in People (IIP)

accreditation

Continue programme of Equality Impact

Assessments. The Trust’s Single Equality

Scheme and Action Plan, establishes and

promotes the strategic commitment to

equality and diversity through recruitment,

employment, retention, training and

development practices

March 2015

March 2015

March 2015

2014 - 2017

Within

resources

Within

resources

Within

resources

Within

resources

Productivity:

Review Workforce & OD management

processes and practices within NWIS to

improve the quality of staff and support

managerial empowerment and

accountability

Sep 2015

Within

resources


8. FINANCE

8.1 National Context

The scale of the real terms total reduction in Welsh Government central funding for

2014-15 to 2017-18 has required tough decisions to be taken about expenditure

across government and careful consideration of pressures and priorities in all

portfolios. Notwithstanding the (real terms) decrease in funding, issues such as the

implementation and roll out of new national services and unfunded service growth

means that NWIS will face considerable budgetary pressures. These pressures

mean that we will need to deliver maximum value from investment through a focus

on improving the quality of service by prioritising changes which also deliver greater

efficiencies.

8.2 Organisational Context

NWIS will continue to adopt a dynamic approach to financial leadership – this will

involve the Director of NWIS and Director of Finance ensuring that scarce resources

are efficiently and economically utilised. The objective will be to ensure that the

business plan is financially grounded and sustainable and is balanced (with due

regard to flexibly manage resources and expenditure limits over a rolling 3 year

period if required). Consequently, the plan is supported by an achievable (although

challenging) savings target.

In order to continue to have a balanced financial plan in each financial year there is a

savings requirement of 5.4% in 2014/2015, 4.3% in 2015/2016 and a further 5.1% in

2016/2017.

Key Financial Objectives for the Organisation include:

Revenue Breakeven within 3 year flexibility (subject to approved robust

savings plans)

Remain within Capital Resource Limit

Meet Public Sector Payment Target


8.3 Revenue and Capital Funding Model

NWIS receives the majority of its funding from the Welsh Government to cover the

day-to-day running costs of IT services and projects during each Financial Year. This

takes the form of both revenue and capital allocations for operational and strategic

developments.

Financial forecasts are summarised below:

Forecast Revenue Position 2014/15 2015/16 2016/17

£M £M £M

Forecast Income 57.02 56.97 56.97

Forecast Expenditure 60.27 59.4 60.01

Savings Plan/Target -3.25 -2.43 -3.04

Net End of Year Forecast 0.00 0.00 0.00

In order to achieve breakeven significant savings will need to be obtained (see Section 8.5).

Forecast Capital Investment

2014/15 2015/16 2016/17

£M £M £M

Total Funding 9.390 6.890 5.890

Total Schemes Spend 11.705 6.928 5.890

Surplus/(Deficit) -2.315 -0.038 0.000

Planned capital schemes exceed available funding, NWIS will look to Welsh Government and further reduction of costs in order to allow all to be completed.


8.3.1 Revenue Funding

The majority of NWIS revenue income is sourced from Welsh Government (86%)

including an allocation for capital charges (depreciation). All other anticipated income

(14%) relates to the payment of services provided by NWIS. There are also a range

of services provided to NHS Wales, England, Northern Ireland and the private sector

for which users provide funding directly. Typically these income streams have more

of a “trading” relationship and consequently can be more volatile in nature due to

changes in service levels/terminations.

Source of Funds

2014/15 2014/15 2015/16 2016/17

% £M £M £M

Welsh Government 86% 48.90 48.62 48.62

Welsh Health Boards 8% 4.45 4.45 4.45

Welsh Trusts 5% 2.67 2.61 2.61

NHS England 1% 0.45 0.45 0.45

Private/Other 1% 0.55 0.55 0.55

Grand Total 100 57.02 56.97 56.97


8.3.2 Capital Funding

Capital funds are received exclusively from Welsh Government and are grouped by:

Discretionary Capital Funding: Internally prioritised schemes

Strategic Capital Funding: Accessed by way of business case (subject to

ministerial approval) and are, in general, larger schemes.

Source of Capital

2014/15 2015/16 2016/17

£M £M £M

Discretionary 1.890 1.890 1.890

Strategic 7.500 5.000 4.000

Total 9.390 6.890 5.890

There are also subsequent revenue implications as a result of capital spend, these can encompass:

Future Support

Maintenance

Training

Capital Charges (Depreciation) For the planning purposes it is assumed that Welsh Government will fund capital charge costs.

8.4 Revenue

8.4.1 Income and Cost Assumptions

The following assumptions have been made within the plan:

Welsh Government Income Funding will be “Flat Cash” over the next three

years

There is to be no inflationary uplift for NHS Wales agreements.

A zero increase in NHS Tariffs.

General contractual risk managed from the risk contingency reserve.


Savings initiatives can be met, subject to risk and sensitivity analysis and

continuous budgetary control throughout the medium term financial forecasted

plan

In estimating the annual cost increases a number of items were identified for inclusion. These are summarised below: Pay

A “zero base” approach has been adopted for all pay costs with each directorate identifying the resource required to provide services adequately.

Public sector pay increases will be limited to 1% per year

Staff entitlement to incremental progression

Uplift of Superannuation liability from 2015/16

Removal of National insurance rebates in 2016/17

Non pay

A combination of “zero base” approach has been used in order to eradicate any

“spare” financial capacity at an early stage and also to identify additional resource

consequences of new projects/implementations allied with general non staff

inflationary uplifts.

Local pressures

Unfunded Service Growth such support of the new applications and systems post

implementation.

8.4.2 Application of Revenue Funds

NWIS income is allocated across the four investment categories and additionally to

fund Strategy/Support Directorates and Overheads. Over 38% of NWIS income is

used to fund Infrastructure Services which includes provision of the National

Datacentre.

Application of Funds (by Service Group)

2014/15 2014/15 2015/16 2016/17

% £M £M £M

National Services (Applications) 15% 9.29 8.79 9.04


Application of Funds (by Service Group)

2014/15 2014/15 2015/16 2016/17

% £M £M £M

Infrastructure Services 38% 23.1 23.04 23.38

National Programmes & projects 12% 7.15 7.04 6.79

Information Services 4% 2.42 2.56 2.66

Strategy, Support & Overheads 30% 18.31 17.97 18.14

Grand Total 100 60.27 59.4 60.01

Application of Funds (By Spend Group)

2014/15 2014/15 2015/16 2016/17

% £M £M £M

Staff 37% 22.36 23.82 24.7

Non Staff & Estates 45% 27.31 25.69 25.62

Depreciation 13% 7.54 7.54 7.54

SLAs & Disbursements 5% 3.06 2.35 2.15

Grand Total 100% 60.27 59.4 60.01

Figures are gross and are subject to savings plans. 8.4.4 Statement of Comprehensive Net Income

Forecast income and expenditure for the next three years is outlined below.

Income & Expenditure Summary

2013/14 2014/15 2015/16 2016/17

£M £M £M £M

Welsh Government 46.69 48.90 48.62 48.62

Welsh Health Boards 3.01 4.45 4.74 4.74

Welsh Trusts 3.51 2.67 2.61 2.61

NHS England 0.45 0.45 0.45 0.45

Private/Other Income 0.56 0.55 0.55 0.55

Total Income 54.22 57.02 56.97 56.97

Staff 20.50 22.36 23.82 24.70

Non Staff 19.68 24.69 23.02 22.96


Income & Expenditure Summary

2013/14 2014/15 2015/16 2016/17

£M £M £M £M

Agency/External Consultancy 1.28 0.24 0.23 0.21

Depreciation 7.54 7.54 7.54 7.54

Disbursements 1.95 2.27 1.55 1.36

Estate 2.36 2.37 2.44 2.44

SLAs 0.91 0.80 0.80 0.80

Total Expenditure 54.59 60.27 59.40 60.01

Surplus/(Deficit) 0 -3.25 -2.43 -3.04

Just over 39% of costs forecast for 2014/15 is derived from staff with the remainder

being a combination of non staff elements and depreciation. This may appear be a

slightly lower ratio than in other NHS organisations as NWIS incurs significant non

staff expenditure by way of all Wales contracts and agreements.

8.4.5 Cash Flow

NWIS treasury management services are provided by Velindre NHS Trust.

Management of cash balances is dependent upon Trust strategy.

8.5 Savings Plans

The initial forecast position presented varying deficits across the financial years (as

detailed in the table below). The deficit has been addressed by assigning agreed

organisation wide savings plans.

The savings initiatives are very challenging and managing the balance between

impact on stated objectives and financial breakeven will be a key activity.

Details of savings plans to support the balanced financial plan are as follows:

Savings Plans 2014/15 2015/16 2016/17

Staff Vacancy/Turnover Management 0.54 0.68 0.68


Staff Resource Requirement Review 1.05 1.05 1.05

Non Staff CIP Target (non recurring) 1.66 0.70 1.11

Estate Savings Target 0.00 0.00 0.20

Total 3.25 2.43 3.04

Required Total (£M) -3.25 -2.43 -3.04

Significant resource is required in order to support upcoming projects. This is

targeted for review with the intention of releasing funds by reorganising existing

capacity or revising delivery dates.

8.6 Capital

The NWIS Capital Plan is consistent with strategic goals and corporate objectives.

The source of capital funding reflects the funding provisionally allocated to NWIS in

the Welsh Government All Wales Capital Programme over the next three years.

8.6.1 Capital Assumptions

Any planned deficits will be managed by NWIS and the Welsh Government

through the regular Capital Review meetings

Depending on the type and value of investment, capital spend will be subject

to agreed business case protocols and approved by the appropriate authority.

8.6.2 Capital Spending Plans

Planned capital investments are reported below.

Planned Capital Investment

2014/15 2015/16 2016/17

£M £M £M

Business Intelligence Systems Modernisation 0.130 0.080 0.080

Canisc 0.330 0.330 0.330

Community, Mental Health and Social Care Solution 0.150 0.020 0.000


Planned Capital Investment

2014/15 2015/16 2016/17

£M £M £M

Common Ailments Service 0.100 0.250 0.250

Corporate Data Warehouse 0.150 0.200 0.200

Development of Primary Information Service 0.120 0.120 0.120

Diabetes 0.100 0.286 0.250

Discretionary Capital –GPSS/ Software etc 0.237 0.500 1.364

Electronic Transmission of Prescription Claims 0.050 0.000 0.000

GP Links 0.060 0.043 0.043

Individual Health Record (IHR) 0.128 0.038 0.000

Information Standards 0.230 0.230 0.230

Infrastructure Replacement Plan 3.520 2.815 1.215

National Intelligent Integrated Audit Solution 2.900 0.023 0.023

Laboratory Information Management System (LIMS) 0.731 0.733 0.733

Patient Administration System (Myrddin) 0.800 0.000 0.000

Radiology Management System (Radis 2) 0.085 0.000 0.000

Systems Integration Tools Replacement 0.035 0.000 0.000

Welsh Clinical Portal (WCP) 0.110 0.110 0.110

Welsh Clinical communications Gateway (WCCG) 0.989 0.650 0.442

Welsh Care Records Service (WCRS) 0.750 0.500 0.500

Total 11.705 6.928 5.890

Surplus/(Deficit) -2.315 -0.038 0.000

8.6.3 Assets – Current Condition and Performance

NWIS invests in IT assets, both tangible and intangible, on behalf of NHS Wales.

NWIS does not have any land or property assets. The current condition and

performance of assets are continually reviewed and assessed and future investment

decisions are made upon the basis of assets required to support information

technology developments in NHS Wales.


Intangible software developments are continually enhanced to satisfy the

requirements of the NHS. These developments need to be supported by hardware

and infrastructure that is fit for purpose and that is adequately supported and

maintained. The NWIS capital programme makes provision for a refresh and renewal

programme of assets based upon their condition and suitability of purpose.

For Audit purposes, a validation exercise is performed on an annual basis and part

of this exercise is to review the condition of assets and their estimated useful lives to

the organisation. This informs the future investment programme and helps to identify

asset disposal.

8.7 Financial Risk

NWIS will closely monitor the risk associated with its financial plans to ensure activity

is delivered within financial resources to achieve a break-even position.

Financial risk is managed as an integral part of the NWIS overall Risk Management

Strategy referred in Section 10.5.


Revenue

Cost Improvement - NWIS is required to find

significant annual savings/cost reductions to

service unfunded cost pressures and growth. The

achievement of this, in an environment where the

generation of additional income is likely to be more

difficult, represents a major challenge both for

2014/15 and beyond.

Strict saving plan management , with

Executive Board monthly performance

reporting

Contractual Risk – Negotiations with suppliers and

NHS Wales organisations typically surrounding

payment and system implementation timetables

are likely to impact the NWIS financial plan going

forward.

Generation of a contingency reserve.



Possible shrinkage in the English customer base –

English users of the Child Health System are

currently re-evaluating their overall strategy which

may impact their requirement and NWIS revenue

streams.

With the redevelopment of the new

system English users will be targeted,

allied to a revised pricing mechanism.

Central budget reductions – Reductions in funding

from Welsh Government would severely impact the

organisations ability to deliver stated objectives

and financial breakeven.

Continue ongoing dialogue with Welsh

Government identifying possible

impact and where there is inflexibility

within the plan.

LIMS Implementation Slippage – the slippage of

any dates will impact on revenues receivable and

possibly future years liabilities should

implementation not be fully rolled out during the

financial year 2014/15.

Monitor current implementation plan to

ensure timely notification of financial

impact of any slippage and

target/identify further saving

requirement.

Funding of parallel running costs may

need to be “time limited”.

The anticipated increased demand on services

which may affect resource requirements include

further transition from project to operational

services.

Look at skill mix, with a view to

increasing capacity by “multi-skilling”.

Possible increased resource need for 24/7 cover

for critical services.

Review and maximise support

provision and on-call availability.

Capital

Insufficient capital funding would impede the ability

of NWIS to meet its stated objectives.

Continue meeting with Welsh

Government in order to secure Capital

Funding (see 8.6.1).


9. ESTATES AND CORPORATE SERVICES

9.1 Estates

Due to its All Wales remit, NWIS has a presence across the country. Currently, staff

are based within offices in a number of locations as highlighted in Figure 3.

NWIS is keen to optimise usage of the Estate and will take into account the

opportunity to implement flexible working practices and travel substitution by the

utilisation of hot desking and video and audio conferencing where possible.

The organisation manages a number of Data Centres which, by their nature, need to

be in secure locations, services are currently migrating to centres at Blaenavon and

Newport. Additional national data centre capacity has recently been sourced to

facilitate this.

Within the existing estate, NWIS has a number of different arrangements for servers

(local and regional) and a review is currently focused on rationalisation.

Within the next two years, leases on two of the larger properties, Brunel House

(Cardiff) and Bocam Park (near Bridgend), are due to expire. NWIS has already


engaged with the NHS Wales Shared Services Partnership – Facilities Services

(NWSSP-FS) to access expert advice with regard to the optimum location of offices.

Planned Estate Commitment(s) Target Year(s) Resource/

budget

Development of a Business Case recommending the

way forward for the Brunel and Bocam Park properties

Apr 14 Within

resources

Development of an Estates Strategy (based on the

outcome of the Business Case)

Apr 14 Within

resources

Review local data centre arrangements with a view to

rationalisation

Sep 14 Within

resources

Estate Rationalisation (based on outcome of Business

Case)

Sep 14 to Dec

15

Within

resources (or

capital spend to

save?)

9.2 Corporate Services

Key objectives for Corporate Services relate to the provision of continued support

managed under firm operational, quality and business assured processes. The table

below focuses on the main planned initiatives over the next three years.

Corporate Services Commitment Target Year(s) Resource/

Budget

Continue to develop the NWIS Risk Management

Structure to reflect current/future need

2014-17 Within resource

Review and update the NWIS Business Continuity Plan Apr 2014 Within resource

Test Business Continuity Plan as per test programme 2014-2017 Within resource

Ensure appropriate arrangements are in place for access

to Trust corporate services


Continue to develop organisational performance

reporting mechanisms



10. STEWARDSHIP AND GOVERNANCE

10.1 Our Board Arrangements

The NHS Wales Informatics Services (NWIS) is a non-statutory organisation hosted

by Velindre NHS Trust. There is an NHS Wales Informatics Management Board

(NIMB) which is accountable for all informatics activity undertaken by the NHS in

Wales. All Health Boards, NHS Trusts and Welsh Government are represented on

the Board.

A hosting agreement for NWIS activities is in place with Velindre NHS Trust, together

with a service level agreement for a number of corporate services.

NWIS reports to several Velindre Trust Board Committees, including the Audit

Committee, Quality & Safety Committee and Information Governance and IM&T

Committee. In addition, attendance is made to a number of other sub-committees

and Trust Groups. Regular reports are tabled at these Committees and Groups

providing the Trust with assurance that there is compliance with policy and

procedures.

10.2 Working with our Stakeholders

NWIS has robust governance structures in place to ensure performance is managed,

targets are met and that there is a culture of continuous improvement. There are

structures in place for Operational (Mature) Services and for Programmes, which

includes new product developments and procurements.

Operational Services are overseen by Service Management. The National Service

Management Board (NSMB) has embarked on a programme of work that includes

the NHS Wales adoption of ITL best practice for service management and the

establishment of a National Service Desk structure addressing both national and

local requirements. Each Operational Service has a governance structure overseen

by their own Service Management Board (SMB).


There is an NWIS Assurance Process for Programme Governance which is

overseen by the National Architecture Design Board (NADB) and the Patient Safety

Approval Board (PSAB) to ensure any new product/service is clinically safe (see

Clinical Risk Management Process diagram below). This consists of three stages:

Strategic Fit (NADB) and Service Specification (NADB)

Initial Implementation in a Live Environment and agreement of Service

Management Arrangements (PSAB)

Authority to Implement (NADB)

Clinical Risk Management Process:

Following implementation, new products/systems will transfer to Operational

Services Governance arrangements.

Finally, in the broader sense of Stakeholder Engagement, the NWIS Engagement

Directorate supports all NWIS business activities by ensuring that NWIS has an

effective and productive relationship with NHS Wales, its constituent organisations

and the wider public sector.

Step 1

Clinical Risk & Safety

Assessment Plan

Presented to PSAB

Step 2

Clinical Risk Assessment

(Details of clinical risk

workshops and risk register)

Step 3

Clinical Risk Assessment

Report

Presented to PSAB

Step 4

Clinical Safety Case Report

Step 5

Post Pilot Review Report

Step 6

Pre Release Stage Report

(Clinical Authority to

Release)

Presented to PSAB

NADB approval Stage 1

Design Brief

Strategic Fit

NADB approval stage 2

Service Specification

NADB approval Stage 3

Product Release / Authority to Implement


10.3 Internal Management and Governance

The NWIS Executive Board, headed by the Director of NWIS, meet every month and

receives a number of performance management reports (detailed below). This

provides the Executive Board with assurance that activities are being appropriately

managed.

NWIS has also established a Business Planning Group which has representation

from all service and project areas who are responsible for the identification of

activities and objectives to be included in the plan and for monitoring and reporting

progress against the plan.

Other management groups include:

Risk Management and Quality Improvement Group

Internal Controls Group

Safety, Health and Environmental Group

Health and Wellbeing Group

Education, Training and Organisational Development Steering Group

10.4 Performance Management and Reporting

NWIS has developed a performance management model that ensures there are

appropriate levels of performance management through reporting arrangements, at

operational and service level, through projects and programmes, ultimately reporting

to the Executive Board.

An Organisational Performance Dashboard has been designed and is presented on

a monthly basis to Executive Board. This provides a RAG status (and statistics

where appropriate) against activities across the organisation including:

Financial Performance & Business Assurance

Planning

Operational Services Performance

Service Level Agreements

Commercial Services


Governance (Risk Exposure & Internal Controls)

Assurance – Clinical and Technical

Workforce and Organisational Development

Programmes and Projects

The Executive Board also receive reports from Chairs of NWIS Management Groups

on a regular basis.

NWIS adheres to the overall financial control, reporting and auditing requirements

set out by Welsh Government and to the local policies and procedures of Velindre

NHS Trust and NWIS. Appendix 5 provides additional information.

On an annual basis, NWIS will carry out an assessment against the Welsh

Government’s Doing Well, Doing Better Standards for Health Services in Wales and

the outcome will form the basis of action plans to improve performance.

10.5 Risk Management and Business Continuity

Registers of service, departmental and project risks are in place. Where deemed

necessary, risks are escalated (using the NWIS Risk Management Standing

Operating Procedure) to the Corporate Risk Register which is reviewed monthly by

both the Risk Management and Quality Improvement Group and the Executive

Board. Risks are also considered and evaluated across Directorates to identify the

impact and escalation of corporate risk. The Risk Management and Quality

Improvement Group has the responsibility of providing assurance, control and

reporting to the Executive Board on the effectiveness of the system of integrated

governance, risk management and internal control, including security, information

governance and data quality risks.

NWIS has a Business Continuity Plan in place which incorporates IT DR (Information

Technology Disaster Recovery) Plans. These plans are required to be tested at

agreed intervals.


APPENDICES

Please note the mandated appendices required by Welsh Government

are contained in an Excel Workbook and submitted separately to this

document.


Appendix 1 – National Services (Applications)

Support Arrangement (Service Grouping)

Service Category (Service Levels)

Services and Descriptions

Information Services

Data Acquisition/Warehouse

Infrastructure Standard Data Acquisition and Warehouse

MPI Clinical Critical Master Patient Index (MPI)

The Master Patient Index (MPI) is a system that makes it easier to ensure patients are correctly identified and minimises the number of duplicate health records held for each patient. It will reduce the number of patient search results returned for clinicians using the |Welsh Clinical Portal and ensure the correct patient is identified

Demographics Clinical Standard Welsh Demographics Service

The Welsh Demographic Service (WDS) describes a number of information systems and services that manage demographic information for Welsh residents. WDS can be considered to exist already, in the form of current information systems. However, it must be made consistent with the National Architecture, providing support to the other information systems being developed in line with the National Architecture, and to address the changes to existing systems that make up the WDS as a result of the National Programme for IT in NHS England (NPfIT).

NHS Numbers for Babies (NN4B)

Business Intelligence Admin Standard Analysis & Reporting Service

Analysis & Reporting provides LHBs and other commissioning organisations together with external bodies requesting information from commissioners with specialist, value added, business intelligence support together with an ad-hoc information analysis service & data request service.

Publishing Services

Publishing Services is responsible for the collection and maintenance of data held in a number of national databases. This information is then made





available via NHS information and clinical data websites, e.g. ePEDW, Health Maps Wales.

Information Standards Admin Standard Data Standards

This service develops a range of data standards for exclusive use by NHS Wales users and provides administration support to the Welsh Information Standards Board (WISB). The service is also responsible for the maintenance of the NHS Wales Data Dictionary.

Clinical Coding

The Clinical Coding service deals with queries from clinicians across Wales regarding the correct use of Clinical codes related to diagnosis and treatment

Primary Care Information Admin Standard Primary Care Information Service

Infrastructure Services

National Data Centres Infrastructure Critical National Data Centres

Two data centres are used for hosting NHS Wales’ national IT services. This is in alignment with the Welsh Public Sector data Centre Strategy and the NHS Wales Infrastructure Strategy.

Authentication & Messaging Infrastructure Critical Messaging/Email Services/ Authentication Services

A new secure national directory and email service (known as NADEX) has replaced the fragmented approach to logon security and email management. The national directory service allows users to log on to systems and services regardless of where they access a computer, while a national email service provides a single up-to-date address book and allows health professionals to share diaries with colleagues across organisations within NHS Wales. It also provides an email address "for life" for as long as staff remain within NHS Wales.

Hosted Messaging Services

The Hosted Messaging Service provides a centralised messaging platform, allows closer end user working through the use of email, and provides a common address book and the ability to share





calendars. It includes enhanced messaging features such as archiving and allows for mobile messaging.

National Encryption Service

Recent breaches of data protection laws by organisations across the UK public sector have enhanced the need to ensure person identifiable information is protected, particularly when the information is vulnerable, such as when it is transported outside organisation on laptops, memory sticks or CDs. To protect against such events within NHS Wales, a framework contract of standard encryption products and services, which can be used to ensure organisations protect sensitive information, has been established.

National Monitoring Services Infrastructure Critical National Monitoring Services

The non-intrusive monitoring of national infrastructure.

Telephony and Video Infrastructure Critical Telephony

Telephony comprises the Welsh Health Telephone Network (WHTN) and is a telephone network used across the whole of NHS Wales.

Video and Audio Conferencing

Video and Audio Conferencing services provides visual and audio communications amongst users in NHS Wales.

Network Services Infrastructure Critical Network Services

Networks Services provides development, support and maintenance of the Digital All Wales Network (DAWN2) Local Area Network (LAN). The DAWN2 LANs consist of: 1. All network infrastructure devices that comprise the NHS Wales owned (and centrally managed) DAWN2 environment. 2. All infrastructure supporting a DeMilitarised Zone (DMZ) or a Server Hosting environment. 3. External Links to the National NHS Network (N3) and Internet for both business critical and non critical internet traffic

Public Sector Broadband Aggregation

The Public Sector Broadband





Aggregation (PSBA) Service is a mechanism to deliver a wide range of broadband, voice, video and data services to Public Sector Organisations across a secure, fast and reliable infrastructure throughout Wales. The PSBA Service is an externally supplied and managed Service provided by Logicalis UK (LUK). As such LUK manage all Incidents, Problems & Changes. The Public Sector Broadband Aggregation (PSBA) Management Service is a service provided by NWIS to monitor the PSBA Service provided by LUK on behalf of NHS Wales Organisations with their best interest in mind.

Token Management

Operational Security Consultancy

Admin Standard Operational Security Consultancy

This Service provides an IT Security consultancy Service to Local Health Boards and Trusts across NHS Wales for the following Operational Security Services: • Code of Connection • Penetration Testing • Security Awareness Training • Security Investigations and Forensics

Operational Security Consultancy

Infrastructure Standard Secure Filesharing Portal

SFSP enables secure, encrypted exchange/transfer of information between parties within NHS Wales and further afield. This is a web based service and is accessible from https://securefileshare.wales.nhs.uk/. The Service allows user to upload large documents, spreadsheets and multimedia files (pictures, video and sound/music files) onto a secure location within the SFSP server and can be retrieved/downloaded by the recipient based on the permissions/rules applied by the Local or National administrators.

Corporate Applications

Service Management Toolset Service Point

Admin Critical Service Management Toolset Service Point

ServicePoint is a Service





Management system based around ITIL principles and has a number of modules: - Calls (Incidents & Service Requests), - Problems, - Change, - Release, - Event. It is used by IT departments within NHS Wales for the logging and management of IT Support Calls, and allows for the sharing of call records between support organisations across Wales.

NHS Wales eLibrary Admin Standard NHS Wales eLibrary

An online knowledge resource for NHS Wales. The service is aimed at effective healthcare delivery by providing quality, relevant and timely information to support NHS Wales professionals in evidence based decision making.

Learning @NHS Wales Admin Standard Learning @ NHS Wales

The service covers the provision of specialist skills and expertise in supporting the NHS Wales virtual learning environment. This includes operational and user support, hosting, maintenance and enhancements of the e-learning environment.

HOWIS & Related Web Apps Admin Standard HOWIS & Related Web Apps

• The service covers the provision of specialist skills and expertise in Intranet and Internet information technologies to the NHS in Wales. • This includes operational and user support, hosting, maintenance and enhancements of the Health of Wales Information Service (HOWIS), Health in Wales, the NHS Wales Content Management System (CMS), and their constituent parts.

Corporate Applications Admin Standard WG Web Apps

A suite of intranet and internet based web tools.

PHW Web Apps

The PHW Web Apps service comprises the following web-based tools:

Form Builder. Toolset that clients can use to quickly





assemble web-based data collection forms.

Outbreak/Surveillance Applications. Tool to record outbreak information within NHS Wales.

NHS Wales Shared Services Programme Web Apps

A suite of web based tools available on both the Intranet and Internet.

HIW Web Apps A suite of Internet web-based tools that allow Health Inspectorate Wales to undertake their statutory duties such as organisational self-assessment and inspection scheduling.

NHS Wales Corporate Web Apps

A suite of web-based tools for an organisation to use to manage staff resources

Specialty Training

Internet web-based system that allows Junior Doctors to apply for post-graduate specialty training programmes in Wales Fundamentals of care standards.

ActionPoint

ActionPoint is a flexible, easy to use call management system developed to log non IT related service calls.

Health Informatics Career Framework (HICF)

The Health informatics Career Framework is a web-based tool that provides information on roles and career pathways in health informatics.

National Forms Service Clinical Critical National Forms Service

Components of this service are FOP and ORBEON.

Screening Services Clinical Standard Bowel Screening Wales

Cervical Screening Support

Abdominal Aortic Aneurysm

NHAIS Support Arrangement Admin Standard NHAIS Exeter System

Hospital Applications

Canisc Clinical Critical Canisc

Canisc is a clinical information system developed then continuously expanded and improved since 1991 by the Clinical Information Unit (CIU) at Velindre Hospital. Canisc allows any number of organisations to record assessments, treatments and follow-up care into a common patient





case note, which any health care professional caring for that patient can access, thus giving a full picture of each individual’s care wherever that person happens to be treated. An increasing number of organisations across Wales are using the system in a variety of ways: Cancer teams, NHS and non-NHS palliative care providers, the colposcopy service, Welsh Movement Disorders e-Network and Cancer Genetics are all using ISCO/Canisc to collect patient data.

Canisc Reporting Service Admin Standard Canisc reporting

LIMS Clinical Critical Laboratory Information Management System

The new LIMS computer system is a national application to be used by Pathology Laboratories located in Health Boards and Trusts throughout Wales. Having a single national application will provide an opportunity to harmonise practice, improve clinical governance, increase capacity and flexibility, and to meet future demand and new service developments

Wales’ Pathology Handbook Clinical Critical Wales’ Pathology Handbook

The Wales' Pathology Handbook (WPH) is a web-based knowledge source for all clinical staff. It provides national and local catalogues of requestable tests, rules and guidance for electronic requesting (via the Welsh Clinical Portal and GP Test Requesting) and a web-based knowledge resource for all clinical staff. Critically, WPH provides point of care decision support for clinicians about laboratory tests

Welsh Pathology Handbook Legacy

The Wales' Pathology Handbook (WPH) is a catalogue of requestable tests, rules and guidance for electronic requesting via the Welsh Clinical Portal (WCP). It is also a web-based pathology knowledge resource for all clinical staff.

CHIRP Clinical Critical Cancer Histopathology Reporting

The aim of the Cancer Histopathology project is to integrate existing Laboratory Information Management Systems with the





national Canisc System by introducing standard reporting 'templates' linked electronically to the LIMS, which will then automatically feed into Canisc.

Welsh Clinical Portal Clinical Critical Welsh Clinical Portal (WCP)

Doctors, nurses and health professionals working in hospitals rely on a combination of computer systems and paper records to record information about patients and their care. This helps them provide treatment to those in need of it. The portal provides fast access to information about medication, referrals and discharges, allows health professionals to request tests and results from various sources and ultimately improves patient safety and a reliance on paper records. It also gives doctors and nurses a personalised workspace with access to their own relevant patient lists. Healthcare staff can log on at terminals anywhere in the hospital and view patient records and results from a range of systems on one screen. Designed and tested by doctors and health professionals in NHS Wales, the Welsh Clinical Portal is being developed in incremental phases, first allowing doctors to view pathology results and general patient information. In time it will provide all the information and processes needed to support care centred on the patient including ordering tests, creating and viewing electronic documents (e.g. discharge summaries, letters), and enabling pharmacists to maintain more accurate medications records.

Test Requesting and Results Reporting (TRRR)

TRRR is a set of per-Health Board databases consisting of electronic test request orders and pathology and radiology results.

Radiology Services Clinical Critical RADIS1

PACSiS

The system will provide a user interface that will allow clinical users to search for a patient; list all images and reports available for a patient; view reports and images on the desktop and route diagnostic quality





images to a PACS or a diagnostic workstation for reporting or review. Future development will allow clinical systems such as Welsh Clinical Portal and RadIS2 to search the PACS integration system directly. The system will comprise a centrally managed system to store the patient index and image & report register; local brokers to interface with individual PACS and RadIS2 systems and web services to mange enquiries into the system.

RADIS2

Most hospitals in Wales use a radiology information system which has been in place for the last 18 years. This system, called RadIS, increasingly needs to deal with greater volumes of information and is asked to perform ever more complex functions. To meet this need, the original system has been improved and upgraded to create Radis2. This is the first stage of a Radiology Management System (RMS) project, and it provides a firm foundation for integrating radiology systems across Wales. This will allow secure shared access to diagnostic imaging services, results, images and management information across organisations.

Myrddin Clinical Critical Myrddin

Myrddin CiS is a Patient Administration System delivered to the desktop primarily using Citrix Metaframe although full client installation is supported. This allows for a simple installation at the client machine and also allows the system to be delivered via the All-Wales Network to other sites and GP Practices, by means of an internet browser. The aim is to provide a modern, user-friendly and dependable system that will support the patient administration and Order Communications functions for all clinical services

Community Applications

National IHR Clinical Critical National IHR

The most complete record of a patient’s care is kept by their GP. Sometimes, doctors in an out-of-hours clinic, or unscheduled care





setting need quick access to that vital information, but it’s not available because the GP’s surgery is closed for the evening or weekend. Working closely with health professionals, NWIS has developed the Individual Health Record (IHR). This new electronic bridge between urgent and primary care settings gives doctors and nurses the information they need to help them make important decisions about how the patient is treated.

Community Child Health

The Community Child Health 2000 (CCH2000) system covers a range of functionality including child registration and demographics, immunisation scheduling and registration, pre-school and school health, safeguarding children, audit, dental and vision screening, special needs requirements.

New Born Hearing Screening

Development, Maintenance and Support of the Newborn Hearing Screening software which is used to manage the All Wales Newborn Hearing Screening Programme.

Prescription Data Capture Clinical Standard Prescription Data Capture

Social Services Interfaces Clinical Standard Substance Misuse

Enables the collection of substance misuse activity records from Welsh agencies for collation onto the National Substance Misuse Database. Support services include data collection and reporting.

Comms Gateway Clinical Standard Welsh Clinical Communications Gateway (WCCG)

The Welsh Clinical Communications Gateway allows clinical messages to be sent securely from the GP to the Hospital. The system can manage messages 'from any to any' healthcare setting including other GPs or professions allied to medicine, from consultant to consultant or from organisation to organisation.

GP Test Requesting (GPTR)

The GP Test Requesting Project will provide a solution which will enable primary care clinicians, to request Pathology Tests from GP Practices using INPS, EMIS and ISOFT GP





Systems. The application will utilise components from the Welsh Clinical Communication Gateway (WCCG), Welsh Clinical Portal’s Test Requesting and Results Reporting (TRRR) Data base and Wales Pathology Handbook (WPH).

Hospital eReferrals (HERS)

The Hospital e-Referrals Project is an IT solution to receive and manage electronic clinical messages within and between health boards which can maximise the benefits of the national e-clinical communications system the Welsh Clinical Communications Gateway. It will initially allow health records departments to receive and manage electronic clinical messages and add patients to an outpatient waiting list. Electronic referrals will be transferred from health records departments (or other areas that may hold records) to clinicians for on-line prioritisation in the Welsh Clinical Portal. The Portal will have a new Referrals Prioritisation tool integrated within it. Eventually, there should no longer be a need to print referrals other than to store in casenotes for medico-legal reasons.

Common Ailments Service

The common ailments service will enable patients to present to their local pharmacy with a defined list of common ailments, their pharmacist will provide a consultation and issue a prescription free of charge to the patient

National Complex Care Database

The National Complex Care Database allows the administration section of each locality to enter, monitor and process Continuing Health Care (CHC) and Funded Nursing Care (FNC) applications and subsequent care packages. Financial costs are entered under each package to allow the LHB finance department to run various reports to project financial costs and report on reductions, savings and spend. The system also allows the users to enter retrospective reviews, finance





invoices from care packages, panel dates, care package reviews, Nursing Needs Assessment Decision Record (NNADR) reviews, Multi Disciplinary Team (MDT) Meetings and Respite Care. A complete and comprehensive list of care providers is available and administered which includes all the standard costs of care and the types of care each provider provides. In addition, a number of administration reports are available for analysis purposes.

Integration and Reference Applications

Integration Services Clinical Critical Integration Services

The design, development, deployment and support of integration services required to support interoperability between the various components of the NWIS national architecture. All of which will be actively monitored to ensure early identification and resolution of connectivity problems

National Reference Data Service

Clinical Critical National Reference Data Service (NRDS)

The design, development, deployment and support of integration services required to support interoperability between the various components of the NWIS national architecture. All of which will be actively monitored to ensure early identification and resolution of connectivity problems. In order to share clinical information between systems and across organisations, NHS Wales needs to establish a common vocabulary. This vocabulary will cover clinical vocabulary such as terms for symptoms, diseases and procedures as well as administrative language such as the names of requesters, organisations, hospital locations and department names. The data sets which describe international, national or local terms and codes for this information are referred to as reference data. The National Reference Data Service will provide a strategic approach for all national applications to use a common and





consistent set of reference data. The service will establish and maintain lists of nationally agreed reference data and provide a means for applications to source and query all required reference data from a single point of connection via a national integration hub and allow organisations to maintain local sets of reference data and cross-reference these to national datasets to allow information sharing between legacy systems.

Hospital Pharmacy Clinical Critical Hospital Pharmacy

Pharmacy is one of the three key departmental systems used in hospitals, along with radiology and pathology. The pharmacy system allows stock to be ordered and invoiced electronically, records and labels all medication, downloads details automatically from the hospital's patient administration system (PAS) and links to various robots to pick the medicines to be dispensed and delivers them to the stock room.

Contractor Services Clinical Standard Performers List

Primary Care clinical contractors are required to be on the medical performers list of a Local Health Board (LHB) before they can work in Wales. The Performers List is an internally developed database with a front end website, handling the day to day management of contracts relating to independent contractors (general practitioners, dental practitioners, pharmacists and optometrists). Information held on the list includes, but is not restricted to, the following: • Name • Address • Telephone Number • Title • Qualifications • CRB checks This information can be accessed by Local Health Boards for approval and monitoring purposes. Access to the performers list is also available via the world wide web, for any patient wishing to check the registration of an independent contractor.





Four main lists comprise the Performers List service: • GP (referred to as medical) • Ophthalmic • Dental (Private and NHS) • Pharmaceutical Basic (public domain) information on each of the lists can be accessed via the NHS Wales intranet. Nominated Health Board users can access more detailed information on premises and contractors (within that Health Board only). Business Support staff within NWIS Shared Services use the lists for generating address labels.

PRISM Clinical Standard Predictive Risk Stratification Model (PRISM)

PRISM is a predictive risk stratification tool, able to stratify GP practice populations against their risk of having an emergency admission. The information provided by PRISM will be available for use by GPs and community nurses to provide additional care, increased support or preventative treatments to help avoid deterioration in an individual's health and keep people out of hospital

Primary Care Services

2DRX Support Arrangement Clinical Standard 2DRX

2DRx is the name for the 2D-barcoded prescription model for the Electronic Transfer of Prescriptions.

My Health Online Clinical Standard My Health Online

My Health Online (MHOL) is a bilingual NHS Wales website where patients undertake various health tasks and access their personal health information securely via the internet. This is convenient for patients and encourages empowerment and self care. GP practices save time as they do not need to answer the phone or search and enter details onto their clinical systems.

GP MSS Compliant System Support Arrangement

Clinical Critical EMIS Web

GP Minimum System Specification Complaint System

INPS Vision 360

GP Minimum System Specification Complaint System





GP Transitional Support Arrangement

Clinical Critical EMIS Web Transition

GP Transitional System

INPS Vision 360 Transition

GP Transitional System

GP Legacy System Support Arrangement

Clinical Critical EMIS Legacy

GP Legacy Systems

INPS Vision Legacy

GP Legacy Systems

GP Non Core System Support Arrangement

User Defined EMIS Non Core Service

GP non core systems

INPS Vision Non Core Service

GP non core systems

NWSSP Services

Prescribing and Dispensing Services

Admin Standard Admin Standard

Contractors Reimbursement System

Business Support Systems

Medicines Management System

Data Exchange


Appendix 2 – Infrastructure Services

This Appendix seeks to give the reader a basic understanding of the systemic arrangements which make up Infrastructure Services. Wide Area Network (WAN)

The figure below gives a simplified schematic overview of the network links that

make up the NHS Wales Wide Area Network (WAN).

The PSBA network is the Wide Area Network (WAN) that provides the links between

the IT systems at all NHS Wales sites (hospitals, GP surgeries, clinics, data centres,

etc). The PSBA network is used by a number of public sector organisations, and

each one has their own Virtual Private Network (VPN) on this network. NHS Wales

has a VPN which is used by all NHS organisations which allows information to be

passed between any connected sites. In some cases, hospital sites are linked

directly to other hospital sites using point-to-point connections, which in turn have

one or more connections (for resilience) to the NHS Wales WAN.

NHS Wales WAN.

(PSBA Network)

Hospital

GP Surgery

GP SurgeryGP Surgery

Hospital

ClinicHospital

Clinic

DataCentre 2

DataCentre 1

Internet

N3 (NHS England)

DMZ

(Hosted within

the above data

centres)

Remote

Access

Solutions

Public

Facing

Websites


N3 is NHS England’s Wide Area Network and NWIS provide and manage a pair of

resilient circuits between the NHS Wales WAN and N3. This is to allow the sharing of

information with NHS organisations in England.

NWIS also have a pair of resilient connections to the internet. These traverse

through a series of security systems in two DMZs (De-Militarised Zones). A DMZ is a

protected network zone that sits between the NHS Wales WAN and the Internet and

provides the following to NHS Wales employees:

Access to the internet for general web browsing

Remote Access Services that allow NHS employees to work remotely

Public facing internet websites

Data Centres

The data centres are the physical buildings in which we host our server and storage

systems. Data centres are purpose built facilities with the following key features:

Reliable power sources for the equipment. This is typically provided by using

generators and UPSs (Battery backup systems).

Reliable cooling systems to remove the heat from the server systems.

Good security (physical security, audited access control mechanisms, CCTV,

etc).

Automatic fire detection and suppression systems.

NWIS use two data centres for hosting national systems:

1. NWIS have a dedicated data hall (room) within the Shared Resource Service

(SRS) data centre at Blaenavon.

2. NWIS use a managed data centre provided by BT. This is currently in Cardiff

Bay, but the services will be moved to BT’s Newport Data Centre in 2014.

NWIS also have a number of legacy server rooms in some of the NWIS offices that

host NWIS internal services (e.g. file and print servers).


Server and storage systems

These are used to store and process the data associated with NWIS provided

systems/applications. A schematic representation of these is in the figure below.

Key components are described below

The Local Area Networks (LANs) are the networks within a data centre,

typically comprising LAN Switches, Routers, Firewalls and Load Balancers.

Storage Area Networks (SANs) are hardware devices typically containing

hundreds of hard disks to create a large, fast and very reliable pool of disks

which can be used by a number of connected servers to store their data.

Virtual Server Farms are groups of physical servers running software known

as ‘hypervisors’. This allows many different server operating systems to run

on one physical server, reducing the number of physical servers that are

needed, thus saving considerable money.

PSBA Network

Storage

Area

Network

Virtual

Server

Farm

File

Servers

Web

Servers

Database

Clusters

Local

Area

Network

Storage

Area

Network

Virtual

Server

Farm

File

Servers

Web

Servers

Database

Clusters

Local

Area

Network

Direct WAN connection

Data replication

Data centre 1 Data centre 2

Geographically dispersed (>10 miles apart)


Database Clusters are groups of two or more servers running database

software, providing resilience, sharing the processing load and in the event of

one server failing, the load is taken up by the remaining servers.

Backup systems are used to provide an off-line copy of data. Typically,

several copies are kept and these can be automatically/manually taken off-

site to protect against a disaster at the site such as a fire, flood or explosion.

In order to protect against a major failure of the systems at one data centre, the data

is continually replicated to an alternative data centre so that the service can continue

to be provided from that other data centre. Failover to the other data centre can vary

from a few seconds to many hours, depending on the technology used.

Other core infrastructure systems

Some of the other key components of the national infrastructure managed by NWIS

are:

The National Active Directory (known as CYMRU). This is a database that

holds account information for every user in NHS Wales and for every PC and

Server. One of the key roles of the Active Directory is to authenticate users

when they log on to their PC and also into a number of clinical systems.

Email services. NWIS provide two key services relating to email:

o Routing of emails in/out of NHS Wales

o Hosting of mailboxes for a number of NHS Wales organisations

Video and Audio Conferencing Services across the NHS Wales network

and linked to VC units in NHS England and the JANET (Higher Education)

network.

Domain Name Service (DNS). This is used to provide the IP address

(globally unique internet address) for a user friendly ‘domain An internal DNS

is also used within NHS Wales to connect internal users to internal IT

systems.


Appendix 3 – National Projects NWIS Main Projects Description Community, Mental Health and Social

Care Solution

The provision of electronic services and tools to help Community Health staff to integrate care with other professionals, schedule work and records and share information across social care

Electronic Transmission of Prescription Claims

Will automate the existing prescription pricing system between community pharmacies in Wales and the Prescribing Services Unit (PSU) within NWSSP (Shared Services).

Common Ailments Service A scheme whereby patients are encouraged to consult a community pharmacy rather than their GP, for a defined list of common (minor) ailments.

Discharge Medicines Review Service

(DMR)

This will provide a patient’s local community pharmacy with a copy of their discharge medicines to allow for continuous patient care in conjunction with their GP Practice

Chronic Conditions Service:

This will provide chronic conditions support to patients in their local community pharmacy in conjunction with care from their GP Practice

CANISC This is a summary electronic record which is available at all times, providing clinical information on cancer patients across Wales. The information may also be used for monitoring national standards, cancer research and clinical audit.

Diabetes The aim of the National Diabetes Project is to deliver a single diabetes Informatics system for Wales. This will provide a clinical, multidisciplinary record, outpatient workflow, and share information across primary, secondary and community healthcare settings.

GP Links With the introduction of the new single, national All Wales Pathology Laboratory information Management System (LIMS), there is a requirement to consolidate the messaging solution to the General Practices. This will also include the transmission of Radiology reports and other ad hoc information.

GP Test Requesting (GPTR) GPTR is an Electronic Pathology Test requesting service for General Practice so users can request tests and review results.

Hospital e-Referrals (HERS 1) – Medical To electronically administrate the registration


NWIS Main Projects Description Records of patients from WCCG to Hospital PAS. Individual Health Record (IHR) Enables health staff in Out of Hours to see

the important part of the GP record in an emergency

Laboratory Information Management System (LIMS)

This project is a collaboration between the Pathology Service, the Pathology Modernisation Agenda for Wales & NWIS, to procure and implement a replacement Laboratory Information Management System

Wales Pathology Handbook Will provide national and local catalogues of requestable tests, rules and guidance for electronic requesting

Point of Care (POCT) The aim of this project would be to provide software and infrastructure to link all appropriate POCT devices (e.g. Glucose testing) in any suitable setting (primary or secondary care, pharmacy etc) to capture all the information and store it in the patient records held on the Heath Board repositories. This could then be accessed by both Welsh Clinical Portal users and GP’s

Master Patient Index (eMPI) Links patient identity records across a range of IT systems. The result is a single “gold standard” identity record which will help minimise the number of duplicate records and support LHB mergers

National Intelligent Integrated Audit Service (NIIAS)

Addresses the need to monitor access to patient records across NHS Wales in order to address known and suspected breaches of privacy

Medicines Management Hospital Pharmacy and ePrescribing

My Health Online (MHOL) A secure NHS Wales website which enables patients to book appointments, order GP repeat prescriptions and change their contact details online

Patient Administration System (Myrddin) This is the NHS Wales Patient Administration System (PAS). Modules include PAS, A&E, Maternity, Theatre and Clinical Letter Creation. Some LHBs have taken all modules whereas others have taken one, usually the PAS.

Picture Archiving and Communications

System (PACS):

Implementation is being planned for a National PACS system (Picture Archiving and Communications System). The procurement has been run by BCU Health Board and NWIS

Radiology Management System (RADIS2) The RADIS2 system is a second generation Radiology system developed by NWIS used across Wales. This project consolidates the number of operational instances of RadIS down to one per Health Board


NWIS Main Projects Description Systems Integration Tools Replacement Procurement to replace the existing JCAPS

messaging solution. Welsh Care Records Service A national procurement of a document

repository to hold scanned medical records plus other documents and records.

Welsh Clinical Communications Gateway (WCCG)

Gives GPs the ability to electronically refer patients to other healthcare settings. The current roll out focuses on referrals from GPs to medical record departments

Welsh Clinical Portal (WCP) A secure health space, uniting key patient information from the different NHS Wales computer systems. Current functionality includes patient lists, electronic pathology test requesting and results viewing, graphing and tabulation, radiology reporting and PACS Viewing.

IHR View in WCP Will provide access to the IHR from within the Welsh Clinical Portal for clinicians in unscheduled care settings across secondary care

Hospital e-Referrals (HERS 2) – clinical prioritisation of eReferrals

To facilitate electronic consultant prioritisation of electronic referrals

WCP Medicines Transcribing and e-Discharges (MTeD)

This project allows clinical staff to manage patient medication administered in secondary care and send an electronic copy in a Discharge Advice Letter, back to the patient’s GP Practice.

WCP Clinical ADTs Functionality to allow WCP users to Admit, Discharge or Transfer patients without logging in to PAS

Welsh Demographic Service (WDS):

Enabling the retrieval throughout Wales of NHS numbers for babies from the PDS, via the WDS, ahead of the closure in England of NN4B in June 2014.


Appendix 4 – Quality Improvement

NWIS has established an Integrated Management System based on its current

certifications against ISO 9001:2008 and ISO 27001:2005. Over the coming years,

this overarching management system will be enhanced to include the requirements

of ISO 14001:2004 (Environmental Management), ISO 20000-1: 2011 (Service

Management) and ISO 22301 2012 (Business Continuity Management). An

overview of each of these standards is provided below:

ISO 9001:2008 ISO 9001:2008 sets out the criteria for a Quality Management System. The standard

is based on a number of quality management principles including a strong customer

focus, the motivation and implication of top management, the process approach and

continual improvement.

NWIS has established an Integrated Management System (IMS) to report on its

performance and improvement, promoting awareness of customer requirements

throughout the organisation


Figure 1: Quality Management System

ISO 14001:2004

ISO 14001:2004 specifies requirements for an Environmental Management System

(EMS) and applies to those environmental aspects that the organisation can control

and influence. It is applicable to any organisation that wishes to establish,

implement, maintain and improve an environmental management system and to

assure itself of conformity with its stated environmental policy.

During 2012/13, NWIS commenced development of an EMS with a view to achieving

ISO 14001 across main sites by the end of 2013 and across the whole organisation

by March 2014.

NWIS environmental targets and objectives include the promotion of:


Efficient use of energy and resources in an economical and environmentally

sound manner through conservation, promotion and where economically

viable invest energy/resource saving technology and management

Waste management and minimisation and encouragingmeasures for the

recycling of materials

ISO 27001:2005

The standard requires the establishment and maintenance of an effective information

security management system, using a continual improvement approach governing

the security of information and network systems covering Multimedia Services, Data

Centre Services, Data Services, Network Services and Service Desk. The standard

has recently been updated to ISO 27001:2013 and there will be a transition project

taking place over the next few years to achieve compliance with all requirements of

the 2013 standard.

ISO 20000-1:2011

ISO 20000-1:2011 refers to a Service Management System (SMS) and specifies

requirements for the design, transition, delivery and improvement of services to fulfil

agreed service requirements.

The IT Infrastructure Library® (ITIL) adopted by NWIS is the most widely accepted

approach to IT service management in the world. ITIL is a cohesive best practice

framework, drawn from the public and private sectors internationally. It describes the

organisation of IT resources to deliver business value, and documents processes,

functions and roles in IT Service Management (ITSM). ITIL is supported by a

comprehensive qualifications scheme, accredited training organisations and

implementation and assessment tools.

ISO 22301:2012

NWIS has developed a Business Continuity Plan that enables key operational

services to continue to be provided where circumstances prevent normal day to day


operations. This will be tested on a regular basis to ensure it remains fit for purpose.

The organisation is working towards securing ISO certification for Business

Continuity in 2014/15.

The following activities/arrangements are also integral to the establishment of a

quality organisation, providing safe services of a high quality, to our service users:

Medicines and Healthcare products Regulatory Agency Inspection

Some NWIS products (systems and services) are classed as Medical Devices and

as such, will be subject to Medicines and Healthcare products Regulatory Agency

(MHRA) inspection.

During 2013/14, NWIS will continue to liaise with MHRA to ensure compliance with

regulations.

Improving Quality Together

Improving Quality Together was launched in March 2013. It aims to ensure that

NHS Wales provides the highest quality and safest care for the people in Wales.

Improving Quality Together is a standardised framework of core improvement skills

for all NHS Wales’ staff and contractors, which builds upon recognised local, national

and international expertise. All staff will be given the opportunity to develop their

skills and gain accreditation in quality improvement methodology.

Quality Objectives and Review

Through the annual business planning process, NWIS ensures that objectives

needed to meet requirements for services and products are established at relevant

functions and levels within the organisation. The objectives are measurable,

consistent with the Management System’s policies and continually reviewed in

accordance with the requirements of the standards, covering the full range of IT

systems and associated support services.


Appendix 5 – Financial Controls, Reporting and Audit Arrangements

Financial Controls

Welsh Government

On an annual basis, Welsh Government notifies NWIS of its revenue and capital allocations. These may be subject to review and change during the course of the year depending upon NHS Wales’ priorities and demands. NWIS is required to prepare monthly financial Monitoring Returns for submission to the Welsh Government in accordance with the reporting timetable notified at the start of each year. These Returns disclose actual performance to date and forecast year end outturn and are supported by a commentary by the Director of Finance. Meetings are held between WG and NWIS as and when required throughout the year. NWIS is required to breakeven on its revenue funding allocation and to meet the CRL capital target.

Velindre

As a hosted organisation, NWIS is required to comply with the SFIs, SOs and FCPs of Velindre NHS Trust. All financial control requirements of Velindre are adhered to and this ensures that the financial activity of NWIS is accurately reflected in the Trust’s financial ledgers. NWIS is a user of Velindre’s Oracle ledger system and all the financial controls and limits are applicable to NWIS. The control and availability of the ledger is managed by the Trust.

NWIS

Financial control within NWIS is based upon the requirements of both the Welsh Government and Velindre. In addition, NWIS enhances and supplements these controls by having its own internal procedures and reporting arrangements where applicable, for example the Balanced Scorecard, the Organisational Scorecard and Internal Audits.


Financial Reporting Arrangements

Welsh Government

As a hosted NHS organisation, NWIS is subject to Welsh Government reporting requirements both independently and via Velindre Trust. NWIS responds to reporting requirements from Welsh Government during the course of the year. Financial reporting requirements are primarily managed through the monthly Monitoring Returns and supporting Director of Finance commentary.

Velindre

As a hosted organisation, NWIS is required to comply with the reporting requirements of Velindre NHS Trust. All financial reporting requirements of Velindre are adhered to and this ensures that the financial activity of NWIS is accurately reflected in the Trust’s financial ledgers for Audit purposes. The financial activity of NWIS is included within the consolidated Monitoring Returns of the Trust. Submission of monthly reports, budget plans and ad hoc reports are made to the Trust in accordance with reporting deadlines.

NWIS

In addition to meeting the above reporting requirements of Welsh Government and Velindre, NWIS produces its own internal reports to Directors, budget holders and others on a regular basis. The aim of these is to enhance the financial controls operating within NWIS. Reports are produced on a regular basis detailing actual performance, budgeted performance and forecast outturn performance.


Auditing

Welsh Government

NWIS is subject to Welsh Government audit requirements both internal and external and Gateway Reviews where applicable.

Velindre

As a hosted organisation, NWIS is required to comply with the audit requirements of Velindre NHS Trust. All financial control requirements of Velindre are adhered to and this ensures that the financial activity of NWIS is accurately reflected in the Trust’s financial ledgers for Audit purposes. NWIS attends the Trust’s Audit Committee, Audit planning and post Audit de-brief meetings.

NWIS

In addition to meeting the above auditing requirements of Welsh Government and Velindre, NWIS performs its own Internal Audits on an ad hoc basis to supplement statutory audits. The aim of these is to enhance the financial controls operating within NWIS.

Other relationships

NWIS has developed supplementary auditing relationships for specific advice and support with external advisers, for example, to determine accounting treatment of particular developments and schemes, and used to provide assurance to Externals Auditors at the end of the financial year.