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The Local Digital Roadmap for Warrington
THE LOCAL DIGITAL ROADMAP FOR WARRINGTON
Version 1.0
Our Vision
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The Local Digital Roadmap for Warrington
Glossary of Terms:
Term / Abbreviation
What it stands for
CCG
Clinical Commissioning Group
CIO
Chief Information Officer
CCIO
Chief Clinical Information Officer
CEO
Chief Executive Officer
CSU
Commissioning Support Unit
DCO
Director of Commissioning Operations (NHS England)
DH
Department of Health
EPaCCs
Electronic Palliative Care Coordination System
ePMA
Electronic Prescribing and Medications Administration
EPR
Electronic Patient Record
HSCIC
Health and Social Care Information Centre
LDR
Local Digital Roadmap
LDS
Local Delivery System
LSP
Local Service Provider
MIG
Medical Interoperability Gateway
NWAS
North West Ambulance Service
PF@POC
Paper-free at the Point of Care
RoI
Return on Investment
RTT
Requirement to Treat
SIRO
Senior Information Risk Owner
SRO
Senior Responsible Officer
STP
Sustainability and Transformation Plan
VFM
Value For Money
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Contents
Introduction ..........................................................................................................................................................5
1.
2
3
4
5
6
National and Local Strategic Contexts ..........................................................................................................6
1.1
The national challenges for health and care services ..........................................................................6
1.2
The national response to these challenges..........................................................................................6
1.3
The local challenges for health and care services ................................................................................8
1.4
The local response to these challenges ...............................................................................................8
Local Digital Roadmap Development and Footprint ................................................................................. 12
2.1
Warrington – scope and scale ........................................................................................................... 12
2.2
The Cheshire and Merseyside STP and Local Digital Roadmaps ....................................................... 12
2.3
Local Delivery Systems and Devolution ............................................................................................ 15
The Vision for Digitally Enabled Transformation ....................................................................................... 17
3.1
The Vision.......................................................................................................................................... 17
3.2
The Impact ........................................................................................................................................ 18
The Baseline Position ................................................................................................................................. 20
4.1
The Warrington Digital Landscape .................................................................................................... 20
4.2
Other key achievements to date....................................................................................................... 22
4.3
Current Initiatives ............................................................................................................................. 24
4.4
Rate Limiting Factors......................................................................................................................... 30
4.5
Digital Maturity Self-assessment ...................................................................................................... 30
Readiness ................................................................................................................................................... 33
5.1
Leadership, Governance and Clinician and Care Professionals Engagement ................................... 33
5.2
Approach to Change Management ................................................................................................... 34
5.3
Approach to Benefits Management and Realisation ........................................................................ 35
5.4
Approach to Local Investment .......................................................................................................... 36
5.5
The 2016/17 Programme Structure .................................................................................................. 38
5.6
Using Resources Effectively .............................................................................................................. 39
Capability Deployment .............................................................................................................................. 40
6.1
Paper-free at the Point of Care ......................................................................................................... 40
6.2
The Capability Deployment Schedule ............................................................................................... 41
7
Universal Capabilities Delivery Plan........................................................................................................... 46
8
Information Sharing ................................................................................................................................... 47
9
Standards ................................................................................................................................................... 50
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9.1
NHS Number ..................................................................................................................................... 50
9.2
SNOMED............................................................................................................................................ 50
9.3
GS1 Standards Compliance ............................................................................................................... 50
10
Infrastructure ........................................................................................................................................ 51
10.1
Current state and plans..................................................................................................................... 51
10.2
Future state ....................................................................................................................................... 52
11
Minimising Risks Arising From Technology ........................................................................................... 54
Figures
Figure 1 - Warrington Health and Wellbeing Board ‘Our Vision’ infographic ......................................................9
Figure 2 - Warrington Health and Wellbeing Board Transformation Programmes illustration ........................ 11
Figure 3 - Map illustrating LDR footprints in relation to the wider STP ............................................................ 13
Figure 4 - The Digital Vision for Warrington ...................................................................................................... 17
Figure 5 - The Digital Programmes in Warrington ............................................................................................. 24
Figure 6 - Warrington Care Record Transformation Alignment ........................................................................ 26
Figure 7 - Digital Maturity Self-assessment Theme Level Indicators ................................................................. 32
Figure 8 - Digital Maturity Self-assessment Section Level Indicators ................................................................ 32
Figure 9 - Digital Maturity Trajectory for the 7 PF@POC Capabilities ............................................................... 32
Figure 10 - The Warrington LDR governance arrangements ............................................................................. 33
Figure 11 - The Benefits Lifecycle ...................................................................................................................... 36
Figure 12 - Warrington Shared Infrastructure Blueprint ................................................................................... 52
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Introduction
This document is the Local Digital Roadmap for Warrington and is the third step in the 3-part process to
articulate the baseline, vision and plans for delivering technology enabled change across the Warrington
health and care system over the next 3-5 years. It demonstrates how technology will be harnessed to
accelerate change as well how the Paper-free at the Point of Care by 2020 target will be achieved.
There are five major organisations involved in commissioning and providing health and care services in
Warrington, these are:
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NHS Warrington Clinical Commissioning Group
Warrington Borough Council
Warrington and Halton NHS Hospitals Foundation Trust
Bridgewater Community Healthcare NHS Foundation Trust
5 Boroughs Partnership NHS Foundation Trust
In responding to the significant national and local challenges facing NHS and Local Authority commissioners
and providers, this document provides a narrative description of how technology will enable
transformational change across the Warrington-wide health and care system and demonstrates that:
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There is strong leadership in place across Warrington’s health and care system and a significant
degree of collaboration and partnership working between organisations at an operational level
Clinicians and care professionals are engaged and providing leadership to the system-wide
transformational change programmes
There are robust, system-wide governance arrangements in place, driven by the Health and
Wellbeing Board
Each of the five main constituent organisations has implemented, or is in the process of
implementing, modern, fit-for-purpose IT solutions. These are the building blocks for the Local
Digital Roadmap and aligned with organisational IM&T Strategies
Another major foundation for the Local Digital Roadmap is a single, shared solution for clinicians to
order pathology and radiology tests and receive results, itself part of a wider solution supporting
order communications and results reporting across the region
There is a commitment to the procurement and implementation of an information-sharing platform
across the health and care community – the Warrington Care Record – and a plan in place to deliver
it. This programme is now driving the local interoperability agenda and will build on what has been
delivered to date in the interoperability space
The IT Infrastructure and Information Governance delivery programmes that underpin the
Warrington Care Record and other IT enabled change initiatives are making good progress
This is how in Warrington we will ensure we Become Investment Ready.
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1. National and Local Strategic Contexts
1.1
The national challenges for health and care services
Published in October 2014, the Five Year Forward View identified three significant challenges facing health
and care provision in all industrialised nations’ health systems. These were:
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Changes in patients’ health needs and personal preferences. Long term health conditions -rather than
illnesses susceptible to a one-off cure -now take 70% of the health service budget. At the same time
many (but not all) people wish to be more informed and involved with their own care, challenging the
traditional divide between patients and professionals, and offering opportunities for better health
through increased prevention and supported self-care.
Changes in treatments, technologies and care delivery. Technology is transforming our ability to predict,
diagnose and treat disease. New treatments are coming on stream. And we know, both from examples
within the NHS and internationally, that there are better ways of organising care, breaking out of the
artificial boundaries between hospitals and primary care, between health and social care, between
generalists and specialists—all of which get in the way of care that is genuinely coordinated around what
people need and want.
Changes in health services funding growth. Given the after-effects of the global recession, most western
countries will continue to experience budget pressures over the next few years, and it is implausible to
think that over this period NHS spending growth could return to the 6%-7% real annual increases seen in
the first decade of this century.
It goes on to say that if they remained unchecked at a fundamental level, they would inevitably lead to three
widening gaps:
The health and wellbeing gap: if the nation fails to get serious about prevention then recent progress in
healthy life expectancies will stall, health inequalities will widen, and our ability to fund beneficial new
treatments will be crowded-out by the need to spend billions of pounds on wholly avoidable illness.
The care and quality gap: unless we reshape care delivery, harness technology, and drive down variations in
quality and safety of care, then patients’ changing needs will go unmet, people will be harmed who should
have been cured, and unacceptable variations in outcomes will persist.
The funding and efficiency gap: if we fail to match reasonable funding levels with wide-ranging and
sometimes controversial system efficiencies, the result will be some combination of worse services, fewer
staff, deficits, and restrictions on new treatments.
1.2 The national response to these challenges
In responding to these challenges, the Five Year Forward View sets out a number of strategies and measures
designed to ensure that the NHS remains sustainable in the longer term. These include strategies for:

A more engaged relationship with patients, carers and citizens in order to promote wellbeing and
prevent ill-health
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Introducing new models of care and managing systems and networks of care, not just organisations
Making out-of-hospital care a much larger part of what the NHS does
Integrating systems around the patient
In addition to these strategies, six approaches are set out that have been designed to aid delivery. These are:
1.
2.
3.
4.
5.
6.
Backing diverse solutions and local leadership
Creating aligned national NHS leadership
Supporting a modern workforce
Exploiting the information revolution
Accelerating useful health innovation
Driving efficiency and productive investment
Warrington is part of the wider Cheshire and Merseyside Sustainability and Transformation Plan (STP) and
has been working closely with the STP team on the STP-level return in general and specifically on the Digital
Section of that return from a Local Digital Roadmap perspective. This is covered in more detail in Section 2.2
of this document.
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1.3 The local challenges for health and care services
In addition to the national health and care challenges set out above, that impact Warrington just as much as
they do elsewhere across the country, there are a number of specific local variations and inequalities that
demand local action, including1:
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By 2030, it is predicted the over 65 population in Warrington will have increased by nearly 60% from
2010 levels, increasing the burden on future health and care service provision
Life expectancy is slightly lower than the average for England (there are also some significant
inequalities in life expectancy within Warrington between the most and least deprived areas)
Smoking related deaths are significantly worse in Warrington than in most other parts of the country
Consumption of alcohol to unsafe levels has increased slightly, and does not follow the usual pattern
of deprivation, in that the least deprived areas have the highest proportion of people drinking to
unsafe levels
Alcohol‐related hospital admissions amongst those aged under 18 years are higher in Warrington
than the average for England. Rates are substantially higher in the most deprived areas of the
borough, and the gap appears to be widening
The prevalence of obesity is increasing locally. Whilst the increase is relatively small, this is in
contrast to the national picture (which has plateaued) and rates are very high amongst certain
population groups, for example, middle‐aged men
The rate of new cancers in Warrington is higher than the national average for England
The rate of hospital admissions due to substance misuse amongst young people aged 15 to 24 years
in Warrington is also significantly higher than the average for England
Rates of unplanned or emergency admissions to hospital amongst the over 65’s are significantly
higher than the average for England
Ischaemic Heart Disease (IHD) is the biggest contributor locally to the comparatively higher rates of
CVD deaths: IHD death rates consistently exceed the average for England by over 20%
Quality of life, as measured by healthy life expectancy, is also poorer for older people in Warrington,
compared with the average for England
1.4 The local response to these challenges
In response to the long term national and local health and care challenges, the Warrington Health and
Wellbeing Board has set out a vision and strategy2 that, in practice will mean:
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People are the focus of delivery, regardless of the organisations providing or commissioning
Outcomes for people take priority over output or process targets and measures
Frequent users of public services are encouraged to make better choices and contribute to their
communities through the development of services designed to encourage and facilitate responsible
behaviour
Multi-agency provision of services, across sectors, are the norm, service silos and duplication are
eliminated
Technology will transform our ability to predict need, provide advice and deliver service
To continue to support local people effectively and efficiently, and access new opportunities for even better
services, a number of guiding principles have been agreed locally. They must underpin all health and
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2
https://www.warrington.gov.uk/download/downloads/id/8771/2013-14_jsna_summary.pdf
http://www.warringtontogether.co.uk/media/1017/health-and-wellbeing-2015-18-low-res.pdf
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wellbeing work in Warrington to realise success for the health and wellbeing strategy. They provide a ‘check’
by which local commissioning plans can be developed, considered and commented on, in order to ensure
that they align with the aims and vision of this strategy.
These principles are:
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Tackling inequalities
Promoting prevention
Providing care closer to home and enabling self-care
Strengthening communications and improving engagement
Personal responsibility
Ensuring consistent safe and quality care
Investing in integration
Promoting safety and improved quality of life
Providing high quality integrated services
Under the Health and Wellbeing Board “Together we…” branding, the following infographic has been
developed to illustrate the future vision for health and care service provision across Warrington:
FIGURE 1 - WARRINGTON HEALTH AND WELLBEING BOARD ‘OUR VISION’ INFOGRAPHIC
In delivery terms, 3 transformation programmes have been established (illustrated in Figure 2 below):
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Starting well: there is a strong body of evidence that emphasises the importance of health and wellbeing in
childhood and before birth, with long-term benefits of ensuring that all children have access to the best start
in life. If we are to improve the health and wellbeing of our population further and more quickly we have to
focus on the key issues in the early stages of life. Key outcomes identified:
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Healthier start in early years, including achieving school readiness
Less children living in relative poverty
Narrow the gap in educational outcomes
Reduce risky behaviours
Improved levels of emotional wellbeing
Living Well: adults form a large segment of our population. Choices and behaviours during adulthood can
have profound impacts on people’s health and wellbeing for the rest of their lives and one of the main
challenges in adulthood include the preventing of chronic illness later in life. This will be achieved by early
intervention and prevention. Key outcomes identified:
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People will live longer and healthier lives by reducing gaps in life expectancy between our
disadvantaged groups and communities and the rest of Warrington (improved lifestyle choices) and
improving outcomes for those with cancer and cardio-vascular disease
Improve health and wellbeing in our workforce
Improved levels of mental health
Reduced levels of unsafe alcohol consumption
Early intervention and prevention of ill health
Redesign of our care and support services
Ageing Well: in Warrington 16% of people are aged over 65 years which is in line with the England average
however our over 65 population is expected to grow by a much higher percentage than the England average
by 2030. The likelihood of the common long term conditions (e.g. cancer, heart disease, hypertension,
stroke, respiratory disease, diabetes) all increase with age. The rise of other health issues such as visual
impairment, mental ill health and physical disabilities also increase with age and all have a significant impact
on people’s independence and need for care and support. By promoting health in our populations we can
delay and/or prevent their need for treatment services. This will also support people in their desire to remain
independent and to lead full and active lives in older age. Key outcomes identified:
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Services which promote health, independence and wellbeing and develop community capacity to
reduce loneliness and reliance
Care which is more preventative, personalised and anticipatory
Care received by the right person, in the right place, at the right time
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FIGURE 2 - WARRINGTON HEALTH AND WELLBEING BOARD TRANSFORMATION PROGRAMMES ILLUSTRATION
The outcome from delivering the vision will be:
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Improved healthy life expectancy
A reduction in inequalities
Fewer people experiencing social deprivation
An increase in preventative services which support people to tackle issues before they become
problems
More sustainable services which have been designed around current and future needs of local
people
More ownership and involvement from citizens in the design, delivery and evaluation of services
Our population receiving the right services, at the right time, in the right place
This will be achieved by transforming our public services to ensure that people are the focus of delivery,
regardless of organisations providing or commissioning, and that there is a rebalancing of focus from
expensive specialist services to universal effective preventative ones.
The ability to harness technology in order to accelerate change is recognised as one of the critical enablers
to delivering these transformation programmes. This Local Digital Roadmap has been through a
collaborative development and review process with the full participation of all of the above-named
organisations and sets out how this will be achieved.
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2 Local Digital Roadmap Development and Footprint
2.1 Warrington – scope and scale
This Local Digital Roadmap (LDR) covers the Warrington footprint which is served by five main health and
care commissioning and provider organisations. These organisations are:
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NHS Warrington Clinical Commissioning Group
Warrington Borough Council
Warrington and Halton NHS Hospitals Foundation Trust
Bridgewater Community Healthcare NHS Foundation Trust
5 Boroughs Partnership NHS Foundation Trust3
Warrington has a population size of 212,000 and is bordered by Cheshire, Merseyside and Greater
Manchester.
In addition to these five organisations, North West Ambulance Service (NWAS) and a number of Third Sector
organisations including St Rocco’s Hospice (a registered charity), make up a significant part of the health and
care landscape. Added to this and to complete the picture, Warrington has:
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31 dental practices
14 opticians
48 pharmacies
19 nursing homes
14 residential homes
2.2 The Cheshire and Merseyside STP and Local Digital Roadmaps
Warrington is part of the wider Cheshire and Merseyside Sustainability and Transformation Plan (STP)
footprint. 40 commissioning and provider organisations (12 of which are CCGs) are included in the Cheshire
and Merseyside STP which serves a population size of 2.4 million. Under the umbrella of the Cheshire and
Merseyside STP, 4 LDR submissions are being made:
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Merseyside
Eastern, South and West Cheshire and Vale Royal
Wirral
Warrington
This is shown diagrammatically below:
3
Whilst the 5 Boroughs Partnership NHS Foundation Trust is one of the five main partner organisations that make
up Warrington’s health and care system, their substantive LDR submission is being made under the Merseyside
Local Digital Roadmap and so is not included here
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FIGURE 3 - MAP ILLUSTRATING LDR FOOTPRINTS IN RELATION TO THE WIDER STP
As will be reflected in the Cheshire and Merseyside STP submission under the Digital Section, at an STP level
we have a strong track record of digital achievements including advanced shared care records programmes,
European leaders in assistive technology adoption, population health management, high penetration of NHS
number across health and social care, a single radiology system and national pioneers in citizen identity and
verification management.
Working together as an STP, we have also agreed three digital ambitions that have an associated scope and
set of outcomes. These are shown below:
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Digital Ambitions
Scope
That Means
1. Digitally
Empowered
Individuals
Enable people to utilise digital technologies to manage own care
Individuals interacting with their care services digitally through a ‘digital no wrong door’ and a
‘personalised front door’
Enabling people to take control and work in partnership in relation to
their health and wellbeing
Patients can access online services using their choice of device and app to manage their care
Ensuring digital inclusion for all
Use assistive technology to manage their care and interact with professionals
Digital skills for workforce & citizens
Access information about their own health and conditions to support them to self-care
Single approach to citizen identity
2. Connected
Health and
Social Care
Economies
Ensure that information is available to the right people, in the right
place, at the right time
Every health and social care practitioner will have the ability to directly access the information
they need, in near real time, wherever it is held, digitally on a 24x7 basis
Improve quality, safety and patient experience by eliminating paper
processes and records that cause inefficiency and delays in care
resulting in organisations operating paper free at the point of care
We will have further consolidated and rationalised our Electronic Patient Record systems in and
out of hospitals
We will have structured, digital clinical records across all providers in the pathways of care
Reduce fragmentation & duplication
Eradicate unwarranted variation
Our workforce will be digitally skilled with the appropriate technology and culture to enable
rather than disable effective working through technology
Support a technologically enabled workforce to fully benefit from
digital solutions
Enhancing care and quality, whilst ensuring greater system efficiency
3. Exploiting the
Digital
Revolution
Move towards ‘intelligence led healthcare’ by utilising advanced
analytics, greater industrial partnership and engaging Information
Governance as a structure for safe development rather than a
blockage to progress
Build on the work of the North West Coast Genomic Medicine Centre
to embed and normalise genomic medicine into heath and care
services
A direction towards intelligence led services allowing care to be delivered in the most efficient
and effective manner
Closer working relationships with academia and industry to take advantage of new, cutting
edge innovation and expertise
Exploitation of population health capabilities
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To deliver our digital ambitions there are a range of programmes within each LDR, the below are themes
demonstrating how we will achieve them with some cross cutting areas:
1. A set of Digital Principles
2. Information Sharing / Governance Framework
3. Digital Maturity of all Health and Social Care Providers (including Primary Care Digital
Transformation)
4. Rationalisation of systems in and out of hospital
5. Interoperability between systems
6. Upscaling of Assistive Technology
7. Advanced Analytics / Population Health
8. Consolidated infrastructure at LDR level and connectivity between LDRs where clinical services
overlap
2.3 Local Delivery Systems and Devolution
2.3.1 Local Delivery Systems
In relation to Local Delivery Systems (LDSs), there are three being formed under the Cheshire and Merseyside
STP. From a CCG perspective these are:
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North Mersey (Knowsley, Liverpool and South Sefton CCGs)
The Alliance (Halton, Southport and Formby, St Helens and Warrington CCGs)
Cheshire and Wirral (Eastern, South Cheshire, Vale Royal, West Cheshire and Wirral CCGs)
In terms of The Alliance LDS digital transformation and from an acute provider perspective, The Alliance LDS
covers three acute trusts namely, Warrington and Halton Hospitals NHS Foundation Trust, St Helens and
Knowsley Teaching Hospitals NHS Trust and Southport and Ormskirk Hospital NHS Trust. These three
organisations have formed an Informatics Steering Group, the objectives of which are:
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Digital Transformation to enable the 3 organisations to be clinically and financially sustainable
Align to the wider LDR strategy and submissions for the participating Trusts
Align to the Cheshire and Merseyside STP digital vision
Three LDS digital ambitions have been identified, along with scope and outcomes for each. The LDS digital
ambitions are:
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Digital Self Care
Digital Access at the Point of Care
Exploiting the Digital Roadmap
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2.3.2 Devolution
In devolution terms across England, the emerging picture is that of a combined local authority covering
Warrington and Cheshire with an elected mayor and significant devolved funding. However the scope
currently does not extend to health and all proposals in relation to devolution are subject to public
consultation.
This configuration means Warrington points two ways – north for Acute services, south for Primary Care,
Social Care and Commissioning. To this end our Warrington plans enable sharing across other STP digital
solutions.
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3 The Vision for Digitally Enabled Transformation
3.1 The Vision
In order to address the three national challenges of closing the health and wellbeing gap, closing the care
and quality gap, and closing the finance and efficiency gap, Warrington’s vision for digitally enabled
transformation echoes the Health and Wellbeing Board vision (set out in Section 1.4) and will be brought
together through the creation of the Warrington Care Record – the digital exchange platform for Warrington
(see Section 4.3.3).
This is aligned with the wider STP digital approach (set out in Section 2.2), and the four elements (Lots) of the
Warrington Care Record can be directly mapped to the 4 key areas that the local vision encompasses:
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Paper-free at the Point of Care (Lots 1 and 2)
Digitally enabled self-care (Lot 4)
Real-time data analytics at the point of care (Lots 1 and 2)
Whole systems intelligence to support population health management and effective commissioning,
clinical surveillance and research (Lot 3)
An infographic has been developed to illustrate the vision for digitally enabled transformation for
Warrington:
FIGURE 4 - THE DIGITAL VISION FOR WARRINGTON
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The Warrington Delivery Programme to realise this vision is expanded in Section 4.3 and this programme is
aligned to the national capabilities in Section 6.
3.2
The Impact
Child
Ideal state
Oliver is a 6 year old boy who has epilepsy. Oliver’s mother is the main carer and Oliver spends time at his
grandparents who help his mother when she needs a break. One weekend night Oliver is found
unresponsive in bed whilst at his grandparents and is taken into hospital after the paramedic has issued the
rescue drugs. He has recently been seen by his GP who has been treating Oliver’s medication with a view to
reducing the amount in line with specialist advice. Oliver’s mother had previously provided consent for AED
staff at Hospital to see vital information including care plans and medication contained within his Warrington
Care Record. This enabled the care team to manage Oliver’s presenting symptoms in a timelier manner,
whilst mitigating any possible clinical risks by restarting medications which had been withdrawn from Oliver’s
treatment plan. There was no contact with a specialist. Oliver avoided a stay in hospital and returned to his
grandparents that night.
What actually happened
One weekend night Oliver is found unresponsive in bed whilst at his grandparents and is taken into hospital
after the paramedic has issued the rescue drugs.
The AED staff had no idea about Oliver’s past medication history and tried in vain to contact Oliver’s
specialist for advice. After discussion with the Children’s center in Manchester Oliver restarted medication
previously withdrawn due to reactions. These reactions were not documented in Oliver’s electronic record
on either site. Oliver was admitted over the weekend and Oliver’s mother was contacted and returned home
from holiday to oversee the organisation of his care.
Adult
John has hypertension and visits his GP twice a year for observation. His GP, as part of the neighbourhood
initiative, enables video consultations and digital workflow across all services, supported by process change,
and utilising shared patient data and patient-captured data from in-home devices. Rollout of the enabling
Warrington Care Record platform and the single Warrington infrastructure allows patients with hypertension
patients, with direct digital access to Primary Care, releasing the traditional Primary Care capacity. The
platform is based on open standards and supports multi-agency care through shared patient records and
workflow management.
John, using the technology to track and share aspects of his physical health, sets himself the goal of
increasing his physical activity. Small changes such as walking instead of taking the car, using the stairs
instead of the escalator made him feel much healthier. The GP tracks this using the Warrington Care Record.
The solution enables the clinician/care provider to monitor trends in the patient’s condition, and give
appropriate advice/guidance via email or high definition video conferencing within the infrastructure
platform. This in turn alleviates the need for trips to the surgery, freeing up patient appointments (approx.
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1,200 appointments in one practice of the 26 in the CCG), and related over-stretched resources for the care
provider team.
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4 The Baseline Position
4.1 The Warrington Digital Landscape
Each organisation has its own plans in place to introduce or develop its own internal electronic patient
records. These are aligned to organisational IM&T strategies, which are themselves linked to business plans
and objectives.
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NHS Warrington CCG/Primary Care – building on the existing GP systems e.g. rolling out Summary
Care Record and mobile working. This includes Warrington Health Plus, who during 2014 and 2015
delivered local neighbourhood services across Warrington together through telemedicine and risk
stratification as part of the Prime Ministers Challenge Fund.
Warrington Borough Council – replacing existing systems in the Families and Wellbeing Directorate
with a single electronic client record system, Mosaic from Servelec Corelogic
Warrington and Halton NHS Hospitals Foundation Trust – recently implemented Lorenzo under the
Local Service Provider (LSP) Agreement
Bridgewater Community Healthcare NHS Foundation Trust – rolling out TPP SystmOne
5 Boroughs Partnership NHS FT – rolling out Servelec Rio
4.1.1 NHS Warrington CCG/Primary Care
The CCG shares its strategic Director of Informatics Services with Warrington and Halton Hospitals NHS
Foundation Trust, however its Practices receive support services from the Midlands and Lancashire
Commissioning Support Unit (CSU).
20 of the 26 GP Practices use TPP SystmOne (in common with Bridgewater Community Healthcare NHS
Foundation Trust, local Hospice and the Out of Hours service). Of the remaining six Practices, five use EMIS
Web and one INPS Vision. The CSU has implemented the MIG (via Bridgewater) to support the exchange of
information with these 6 Practices, for example discharge documents from the Acute Trust. The roll out of
the Summary Care Record is virtually complete and the community Electronic Prescribing Programme is
being accelerated. Mobile working is being rolled out with TPP SystmOne.
4.1.2 Warrington Borough Council
The Families and Wellbeing Directorate currently holds client data largely on electronic systems but is in the
process of implementing an electronic client record system (Mosaic from Corelogic) that will replace its
current adults’ and children’s social care systems. By the end of this year it will have a new work flow based
electronic social care assessment and review system for all of its clients that is also integrated with for
example payments and charging. This is due to go live in October 2016 and will use the NHS Number as the
unique identifier. The new system will realise significant benefits in terms of process and the potential to
better integrate services, improved access to and portability of records, and the ability to meet the
requirements of the Care Act.
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4.1.3 Warrington and Halton NHS Hospitals Foundation Trust
The Hospitals’ informatics service provides support to all its service areas via a range of inter-connected or
freestanding systems, from a number of different suppliers.
The Trust’s medical records are now part-way towards a digital patient record and hence there is a mixed
economy of digital and paper-based files for each patient. Inactive paper records are stored off site and
there is considerable movement of records between the Warrington and Halton sites using courier services.
There are many problems with these arrangements, particularly limited (and no mandatory) training in case
note handling and administration, poor use of tracking facilities and unstructured off-site storage.
The Trust has invested in some of the infrastructure necessary to support electronic records and clinical
support tools, including more mobile working. It also has a number of pilot initiatives underway to create
elements of an electronic patient record (EPR) or to develop electronic communications with other
organisations. Examples of this include an electronic document management system creating a scanned
record of historical case-notes, the development of electronic records and workflow via Portals in A&E and
Outpatients and the electronic communication of certain discharge documents.
Its main focus has been the successful completion of its implementation of a core EPR system (the Lorenzo
system) that replaced systems that were nearing the end of their lives and it provides the facilities to replace
paper by electronic patient records. This will bring major benefits to the Trust internally and also create the
opportunity to share information with other organisations.
The Trust has a range of other informatics priorities, such as:






Real-time patient workflow/ADT
Better support for peripatetic staff e.g. giving community midwives real time access to appointment
scheduling
Automated/speedier discharges e.g. better advance planning of TTOs with pharmacy
Reducing 30-day readmissions through targeting patients at risk i.e. supporting better post-discharge
care and improving levels of patient self-management
Electronic prescribing and medicines management (including better connectivity to GP systems)
The standardisation of diagnostic test ordering and the introduction of community-wide orders and
results
4.1.4 Bridgewater Community Healthcare NHS Foundation Trust
The Trust has rolled out TPP SystmOne - which is also used by the majority of Warrington GPs - to create a
single electronic clinical record for all its patients. It expects to achieve 75% coverage of its clinical services
within the next year but this will depend on changes to service delivery processes to fully embrace the
implications of mobile working/technology.
The majority of patient records in the Warrington locality are currently held on paper-based systems, which
are separate held for each service. The TPP PAS functionality has replaced all the legacy iPM and Childhealth
systems. Some teams are now starting to go live with TPP using fully templated EPR functionality and an
online/offline mobile PC based mobile application.
Bridgewater has made a significant investment in mobile devices, with associated support and training for
clinical staff. At the same time the Trust has a number of other informatics issues such as:

The rationalisation of shared IT infrastructure such as wide-area networks
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



The establishment of single sign on facilities for all clinical staff
Improvements to VFM
The extension of telehealth services from the current pilots
The roll out the ICE Orders/Results system
The Greater Manchester data exchange hub is used for the electronic communication of some discharge
documents from a range of services.
The MIG is being used in Warrington for sharing between Out of Hours services and non-SystmOne GP
Practices and on a wider footprint to share GP datasets and EPaCCs data into a range of services.
4.1.5 5 Boroughs Partnership NHS Foundation Trust
The Trust’s aims are that all service users will have a comprehensive electronic record that is accurate and
accessible at any time and from anywhere, to support efficient, safe and collaborative health care. To
achieve this, it has replaced its PAS (iPM) and two other partial electronic record systems with RiO – a single
Trust-wide electronic clinical, demographic and administrative system. This major undertaking has involved
significant changes to ways of working in all parts of the Trust.
The RiO EPR will support improvements in the clinical quality, safety and cost effectiveness of its front line
services. It will also improve data quality and resilience and facilitate the more effective and extensive use of
clinical pathways, across multiple services. Patients will eventually have only an electronic record, which will
be available whenever needed and as such will also offer significant opportunities for communicating or
sharing patient information with other organisations.
4.2 Other key achievements to date








There is a single, shared solution for clinicians in primary and secondary to order pathology and
radiology tests and receive test results. This is itself part of a wider solution supporting order
communications and results reporting across the region.
There is a single Picture Archiving and Communications System (PACS) solution in use to support
Radiology services across Cheshire and Merseyside meaning it is possible to share radiology images
across organisations and reducing the need for radiology examinations to be repeated on an
organisational basis
The national Summary Care Record is in regular use in a number of Acute and Community settings across
Warrington
The national Electronic Prescription Service (EPSr2) has been deployed to 100% of Warrington’s GP
Practices and 60% of repeat prescriptions use the EPS service
Acute outpatient services (managed in Lorenzo) are available to be booked through the national eReferral Service (e-RS) and the Accenda referral gateway service (paired with the e-RS) is deployed to
100% of GP Practices for referrals to be made
Warrington care home telehealth presence
Risk stratification within some neighbourhoods to manage patients with long term conditions
The 5 Boroughs Partnership implementation of IAPTus to support delivery of early intervention
psychological therapies
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










The 5 Boroughs Partnership implementation of RiO workflow is configured to generate alerts in situ and
via email or SMS as necessary
The 5 Boroughs Partnership ‘Patient Status at a Glance’ (PSAAG) tool implemented to facilitate rapid
discharge
The 5 Boroughs Partnership Ward management system implemented to prompt for tasks and overdue
actions
The 5 Boroughs Partnership Psychiatric Assessment Service provided from the Warrington Hospital site is
fully digital with referrals to the service being made via the Warrington-wide order communications and
results reporting system and all clinical noting being completed on the Acute EPR Lorenzo
Structured, electronic clinical noting is now common practice using Lorenzo in areas of the Acute Trust
The Medical Interoperability Gateway (MIG) for non-TPP GP systems and integration for TPP systems is
deployed across all GP practices
Inpatient & Day Case Electronic Discharge Summaries from Acute Trust to GPs are compliant with the
Academy of Medical Royal College headings standards
A self-check-in and triage system integrated with Lorenzo is in use within Warrington Hospitals
Emergency Department
The Acute Trust runs a monthly ‘Facebook the midwife’ session so that expectant mothers can message
the midwifery team with questions about their maternity care and childbirth
Specialist medicine multi-disciplinary teams are using teleconferencing to support end of life care
planning
Shared network infrastructure and WiFi to create a Warrington Community of Interest Network (COIN)
and connection to wider Lancashire COINs to allow staff connectivity to roam from site to site
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4.3 Current Initiatives
As illustrated below in Figure 6 below, under the revised governance arrangements, there are currently three
active Warrington wide digital programmes working to the IT Partnership Board (Warrington Care Record,
Information Sharing Programme and Infrastructure) and two local provider initiatives (Medicine
Management and Digital Providers) to achieve the ultimate aim of Citizen and Patient access to digital
services and records.
FIGURE 5 - THE DIGITAL PROGRAMMES IN WARRINGTON
The IT Infrastructure Programme; the Better Information Sharing Programme; and the Warrington Care
Record Programme shown above fit within the overall Health and Social Care digital programme. Each of
these supports multi-disciplinary working by health and care professionals working across the constituent
Warrington partner organisations and they are critical enablers of the new ways of working outside of local
providers. Whilst significant progress has been made to date in all three programmes, no one organisation is
able to fund the projects and further system wide funding is required for each in order to progress them
across Warrington from their respective current positions and to complete their delivery.
4.3.1 IT Infrastructure Programme
Under the IT Infrastructure Programme there are three Warrington-wide work streams:
1. Active Directory: the immediate aim for this is for Warrington and Halton Hospitals to become part of
the broader Midlands and Lancashire Commissioning Support Unit (CSU) Active Directory ‘Forest’
(Bridgewater and Warrington CCG are already part of this). This will enable health professionals to log
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on to devices at locations other than their ‘home’ location and access securely the same systems and
services they would access within their own organisations. With the design phase completed,
implementation will require migration from existing services to the new wider Active Directory service.
Migration options are being considered and may need the support of a third party migration service to
complete the work. This would require additional funding.
2. Network Infrastructure: this will see the joining up of organisational WiFi networks across Warrington,
enabling health and care workers with mobile devices to connect to WiFi networks in health and care
settings other than their ‘home’ organisation. This will mean health and care staff have access to the
local and national online services they need to carry out their day to day tasks regardless of which
provider organisation they are physically working in, without having to work in ‘offline’ mode. Again,
Midlands and Lancashire CSU are progressing this work in collaboration with the other constituent
organisations and CCG funding for this work is in place. Bridgewater already federate the NWSIS WiFi
service across the locality and its wider operating areas.
3. Unified Communications: this is dependent on work streams 1 and 2 and will see the introduction of
instant messaging, voice and video service capability (e.g. cisco jabber, Skype for business, etc.) across
Warrington. This will enable seamless communications channels for health and care workers across
organisational boundaries. Currently in conceptual design phase, no delivery plan or funding is in place
for this work.
4.3.2 Better Information Sharing Programme
The Better Information Sharing Programme sits in the Information Governance space and is the result of the
CCG Select Committee Inquiry (SCI) into the Sharing of Patient/Service User Information. Completed in
Spring 2015, the completion of the SCI is also now referred to as Stage 1 of the Better Information Sharing
Programme. There were 8 recommendations resulting from the SCI, 6 of which were converted into enabler
projects making up the Better Information Sharing Programme and these are critical enablers of the
Warrington-wide IT Partnership Programme.
The 6 projects are:
1.
2.
3.
4.
5.
6.
Privacy and Consent
Communications and Relationships with Patients/Service Users
Culture, Confidence and Willingness
Information Governance
Information Capture and Sharing
IT Systems, Interoperability and Security
The remaining 2 recommendations were ‘Managing Changes and Improvements’ and ‘Sharing beyond Nonstatutory or non-Health and Social Care Organisations’ and these are being dealt with separately.
Whilst the PID for Stage 3 of the Better Information Sharing Programme has been approved, there is no
funding in place to continue the work required and therefore this programme is currently on hold.
See Section 8 for further detail on work to date and how this programme is being taken forward.
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4.3.3 Warrington Care Record – providing a Warrington Digital Hub
Focused around local citizens, the Health and Care Community have invested in procuring a single, shared
information platform. A core group of health and care, operational and IM&T staff from the constituent
organisations has been actively involved in progressing the Warrington Care Record programme to date,
having worked through the Strategic Outline Case (completed in August 2014) and Outline Business Case
(completed in September 2015) stages.
This platform will provide a digital hub across Warrington and serve the wider STP footprint based on open
APIs to strengthen the system integration options. The functionality will join our record to support the
Warrington Health and Wellbeing Board Transformation Programmes as shown diagrammatically below:
FIGURE 6 - WARRINGTON CARE RECORD TRANSFORMATION ALIGNMENT
The Outline Business Case was presented to the Health and Wellbeing Board in January 2016 and a
procurement project is underway. This will culminate with an identified preferred supplier and a completed
Full Business Case (FBC). The finalised FBC will be presented to the appropriate governance bodies for
endorsement in each organisation prior to its presentation at the Warrington-wide governance fora (set out
in Section 5.1) for final approval (the investment decision).
The approach to procurement is Lot-based and encompasses 4 Lots. The rationale behind this is three-fold.
Firstly, the Lots reflect a sense of logical progression with Lot 1 meeting the data sharing technology platform
requirements in order to establish the data sharing culture in the shortest possible timescales. Lot 1 will
provide the base on which to build additional capability (Lots 2 – 4) that meets the specific needs of
Warrington’s citizens and the health and care community in the new ways of collaborative working on health
and care provision across organisational boundaries. Secondly, the Lot-based approach can be seen as an
enabler allowing the participating organisations to ensure they are only investing in the Lot based systems
and services that have been specified to meet the care community’s requirements, and to get the best value
from the best products and services that are currently available. Thirdly, the care community considers that
the specified Lot based approach will maximise Potential Provider competition within each Lot.
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In summary, the Lots are:




Lot 1: A data sharing technology platform with front end user interface and back-end interfaces to
core organisational and national systems; a health and care community-wide citizen index (using the
NHS number as the unique identifier); consent to share management controls; role based access
controls; simple citizen access; secure access from mobile and desktop devices across multiple
device operating systems; and end-user access audit reporting. This will be underpinned by
openAPIs to allow further integration into local systems
Lot 2: Capturing additional data by health and care professionals using eForms that are created and
based on pathways of care; supporting workflow and rules based decision-making; and the creation
of care correspondence.
Lot 3: Population health functionality utilising data warehouse capability and analytics tools, in order
to help identify the particular health and care needs of the Warrington population (including risk
stratification across health and care), using data from the care community’s main source systems.
Lot 4: Developing citizen access to include personal data from ‘apps’ and monitoring/measurement
devices i.e. the more ‘innovative’ end of the procurement. Whilst these are optional requirements
for the purposes of the procurement in that they are not reflected in the care community’s Potential
Provider budget for the procurement, the care community’s intends to procure this functionality
either from a successful Lot 1-3 Potential Provider or from a successful Lot 4 Potential Provider. The
care community recognises that some of the Lot 4 functionality in question is relatively niche and
specialist in nature and that solutions to satisfy some of these requirements may be ‘in
development’ or, indeed, may not yet exist. It also recognises that the successful Lot 4 Potential
Provider will only be in a position to propose how best to develop its Lot 4 solution until it fully
understands the nature of the successful Lot 1-3 solutions. Accordingly, the PQQ response
document questions in respect of Lot 4 focus on generic appraoches as opposed to focusing on
specific solution issues.
The 4 procurement Lots can be mapped directly to the 4 outline areas for LDR vision for digitally enabled
transformation as stated in Section 3 above. The mappings are:




Paper-free at the Point of Care (Lots 1 and 2)
Digitally enabled self-care (Lot 4)
Real-time data analytics at the point of care (Lots 1 and 2)
Whole systems intelligence to support population health management and effective commissioning,
clinical surveillance and research (Lot 3)
The Lot 1 technology required to underpin the data-sharing platform will have the following characteristics in
order to provide clinicians and carers with real-time access to key source data that resides within the
relevant source systems:


Unified, secure access – single sign-on capability with users required to authenticate only once per
user session
Integration — the real-time connection of data from multiple back-end source systems into new
front-end components with an integrated navigation between these components
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





Customisation — users can customise the look and feel of their environment based on attributes of
the user and metadata of the available content
Personalisation — where customisation is in the hands of the user, personalisation is embedded
within the solution and is primarily about matching content with the user. Based on a user profile,
personalisation uses rules to match the "services", or content, to the specific user
Access control — the ability for the platform to limit the content and services users have access to in
order to make it appropriate for their role
Citizen search — the ability to search for content based on the citizens NHS Number
Omni channel enablement — present content optimally on all channels and devices
Audit — track and monitor user behaviour (such as navigation, clicks, downloads, page exits and
such) and generate reports for audit purposes
In order to create the Warrington Care Record, the following source systems will be drawn on to create the
digital hub:






GP – SystmOne from TPP and the MIG for GP practices using EMIS
Acute – Lorenzo from CSC
Community – SystmOne from TPP
Mental Health – RiO from Servelec Healthcare
Care Services – Mosaic from Servelec Corelogic
National transaction systems – Personal Demographics Service, Summary Care Record, Child
Protection Information Sharing
The key benefits of the investment in the Warrington Care Record will include:









Joint teams, e.g. common assessment teams being able to access the same source of information,
thereby speeding up assessments, reducing costs and improving consistency of approach (and
patient experience)
Better/safer services resulting from the automatic communication of information between the
different services dealing with a patient
A reduction in wasted time e.g. unnecessary visits, tests and phone calls chasing up missing
information
Reductions in inappropriate referrals between services due to fuller information being available at
the point of diagnosis or treatment/management decisions
The ability for separate services to work on common treatment plans or pathways e.g. End of Life
pathways, thus saving time through avoiding gaps or overlaps in services and improving patient
experiences
Saving time and increasing opportunities to deliver services more flexibly if the latest information
about a patient is available in community settings or patients’ homes
Reducing the movement/loss/unavailability of current patient records and the costs of handling
them
Reducing readmissions though fuller information being available pre-referral or to support patients
post-discharge in the community
The ability to plug the Warrington Care Record data exchange platform into other data exchange
platforms under the STP footprint
See also Appendix 4 - Warrington LDR Information Sharing Approach.
4.3.4 Digital Providers
High quality Local Provider electronic patient records are key to our digital programme.
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Warrington and Halton NHS Foundation Trust serves the population of Warrington and their strategic aim is
to continue to digitise the patient notes, either through extending the use of Lorenzo as an ePR or building
the ability to scan the paper legacy which exists. This scanning software will also have to provide capability
to allow The STP ‘Alliance’ group of hospital providers the access to newly created Lorenzo digital notes and
legacy Warrington paper records. Eventually ‘The Alliance’ plan is for a common EPR for all Adult Acute
services, seamlessly linked with Children’s acute services, Community based services and social care within
Mersey but this is beyond the life of this roadmap. Digitalisation of the Acute has been seen over the last 3
years as a key enabler for providing safe, efficient, flexible, patient-centered and cost effective care and
significant local investment has made this a reality.
Further to this, Lorenzo now delivers new functionality such as clinical decision support, patient alerts,
clinically coded documentation determined at the point of data entry, real time reporting, and patient record
sharing with Primary Care through the Summary Care Record. The plan is to extend this use of the Summary
Care Record through the MIG and into the Warrington Care Record.
In our community settings, we have consolidated onto a single system supplier (TPP) across a significant part
of the footprint area. Our strategic aim is to build on this further over the next three years to drive up digital
maturity in out of hospital based care and provide further foundations to deliver high quality patient care.
This single system is also the majority system used in Primary Care.
This approach within our hospitals and community will not only enable the levels of digital maturity in our
economy to thrive but it will deliver the level of service transformation articulated through our STP and LDS
plans and support our digital ambition to truly exploit the digital revolution.
Within Mental Health, 5 Boroughs continue to rollout RiO with the plan to reduce variation in the delivery of
care.
Social Care will go-live with new system to allow use of the NHS Number as a primary enabler to join up the
ability for providers to contribute to our digital programme.
Significant local investment in Change Management is resulting in reducing the variation of clinical delivery
and already increasing the handover of care between organisations.
4.3.5 EPaCCs
An Electronic Palliative Care Co-ordination System (EPaCCs) project has been set up to ensure that end-of-life
preferences can be captured and shared across organisations and services:


EPaCCs data items will be captured by a range of health and care professionals (either electronically
or on paper) and will be stored in GP systems
Warrington CCG originally purchased the MIG to share data for the non-TPP practices (6 of 26) but
for GP data only, the CCG have purchased the EPaCCs MIG module for all the Warrington practices
including the TPP practices so in terms of how EPaCCs data is shared, it will be available for all
patients and all 26 practices to all providers via the MIG
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4.3.6 Medicines Management
Our aim for e-prescribing between GP practices and community pharmacies are for all prescriptions to be
sent digitally using the national Electronic Prescribing Service (EPS) system.
Our ambitions for e-prescribing within the acute setting has already started with medicine reconciliation on
admission being cross-checked with Primary Care information stored on the Spine. We then prescribe the
TTO medicines on discharge and send this through to Primary Care as part of the digital Discharge Summary.
Over time we expect the Warrington Care Record to share the in hospital medication history with all
providers so to complete this we will implement Lorenzo Electronic Prescribing and Medications
Administration (ePMA) over the next few years.
4.3.7 Complex Dependency Programme
The Cheshire-wide Complex Dependency Programme is a council-lead transformation programme aimed at
providing improved and integrated social care services for families and individuals with complex care needs,
across a number of organisational boundaries. Social workers, housing, education and police are among the
intended users of the information system which will support this programme, which is anticipated to support
approximately 35,000 citizens across Cheshire. The IT element of this programme is currently in a
procurement phase, and at the time of writing is executing the final evaluation activities as part of the
Invitation to Tender (ITT) stage.
The specific nature of this transformation programme, coupled with the wider footprint, means that it is
intending to link to a significantly higher number of source systems across a much broader set of public
sector agencies than the Warrington Care Record. It consequently has a significantly different set of
requirements and outcomes that it is aspiring to meet. More information on the Complex Dependency
Programme can be found at http://www.candwleadersboard.org.uk/what-we-do/complex-dependencyprogramme.
4.4 Rate Limiting Factors



Funding – the availability of sufficient funding for the development of a shared care record, against
the backdrop of increasing financial challenges across the whole community
Capability and Capacity – the ability of each organisation to resource the project, especially when
they have major internal EPR Projects underway
Public Support – the support of the public for a programme to share clinical records across
organisational boundaries, particularly if any major national programmes such as a reactivation of
the Care.Data Programme are undergoing consultation with the public
4.5 Digital Maturity Self-assessment
The Digital Maturity Self-assessment applies to three of the five health and care organisations in Warrington,
namely:



Warrington and Halton NHS Hospitals Foundation Trust (WHH)
Bridgewater Community Healthcare NHS Foundation Trust
5 Boroughs Partnership NHS Foundation Trust (5BP)
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The summary returns including the Capability Deployment Trajectory for all three are below.
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Digital Maturity Self-assessment 2015/16 – Theme Level Indicators
FIGURE 7 - DIGITAL MATURITY SELF-ASSESSMENT THEME LEVEL INDICATORS
Digital Maturity Self-assessment 2015/16 – Section Level Indicators
FIGURE 8 - DIGITAL MATURITY SELF-ASSESSMENT SECTION LEVEL INDICATORS
Capability group
Records, assessments and plans
Transfers of care
Orders and results management
Medicines management and optimisation
Decision support
Remote care
Asset and resource optimisation
Average scores across providers
Baseline score
Target
Target
(Feb 16)
(end 16/17)
(end 17/18)
47.0
60.3
74.3
39.7
61.7
76.3
56.7
61.3
72.7
22.0
22.0
56.3
27.7
34.3
45.7
16.7
20.0
34.0
23.3
30.0
51.7
Target
(end 18/19)
82.7
84.7
78.0
78.3
62.3
46.7
63.3
90.0
Average scores across providers
80.0
Records, assessments and
plans
70.0
Transfers of care
60.0
50.0
Orders and results
management
40.0
Medicines management and
optimisation
30.0
Decision support
20.0
Remote care
10.0
Asset and resource
optimisation
0.0
Baseline score
Target
(Feb 16)
(end 16/17)
Target
(end 17/18)
Target
(end 18/19)
FIGURE 9 - DIGITAL MATURITY TRAJECTORY FOR THE 7 PF@POC CAPABILITIES
See Appendix 2 for the Capability Deployment Trajectory.
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5 Readiness
5.1 Leadership, Governance and Clinician and Care Professionals Engagement
In addition to individual leadership within organisations, results available in the Digital Maturity Selfassessments, a robust governance exists across Warrington in relation to digital development for
Warrington’s health and care transformation plans, this has been simplified for illustration purposes below.
FIGURE 10 - THE WARRINGTON LDR GOVERNANCE ARRANGEMENTS
Each of the healthcare organisations has an appointed Chief Clinical Information Officer (CCIO) who is
engaged with the Warrington digital transformation programme and providing the clinical leadership and
drive required. In turn they are engaging with their health and care colleagues within their own
organisations to take forward any organisation-level issues and actions.
The organisations Chief Clinical Information Officers (CCIOs), Senior Information Risk Owners (SIROs) and
Caldicott Guardians are listed below.
Name
Paul Sherry
Diane Mathews
Ellis Clarke
Jason DaCosta
Professor Simon Constable
Mich Tomonaga
Nick Armstrong
Lynton Green
Organisation
Warrington and Halton Hospitals
Warrington and Halton Hospitals
Warrington and Halton Hospitals
Warrington and Halton Hospitals
Warrington and Halton Hospitals
Warrington CCG
Warrington CCG
Warrington Borough Council
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CCIO
Deputy CCIO
Nursing CCIO
SIRO
Caldicott Guardian
CCIO
SIRO
SIRO
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Steve Peddie
Karen Slade
Gareth Davies
Sukru Ercan
Gail Briers
Louise Sell
Warrington Borough Council
Bridgewater
Bridgewater
5 Boroughs Partnership
5 Boroughs Partnership
5 Boroughs Partnership
Caldicott Guardian
CCIO/Caldicott Guardian
SIRO
CCIO
SIRO
Caldicott Guardian
5.2 Approach to Change Management
The vision for Warrington is for an advanced integrated clinical and administrative digital hub that will
service care processes across the Warrington borough and extend into the wider STP footprint from early
2017.
Procured through 4 Lots the digital hub will facilitate the integration of clinical and administrative functions,
increase patient choice and improve overall quality of care. Organisational change will be supported by a
Change Management team which significantly improves the amount of clinical engagement, the quality of
implementation and process change.
The Warrington Care Record digital hub will be far more than an upgrade to existing systems. Accompanied
by positive organisational change, engagement and change resources we will be able to significantly identify
the service improvement opportunities in line with the transformational strategic direction. This work has
already started and forms the business case for the digital hub. As a group of organisations we will promote
efficient use of resources across the health communities of the STP by providing increased visibility of
patients, carers and citizens needs so bringing greater coordination of services.
5.2.1 Purpose of business change
The purpose of business change is to give an overview of the capabilities of the digital hub and show
stakeholders, either citizens, staff or our leaders how successful deployment will help achieve the NHS vision
of integrated health and wellbeing services. The business change service will help organisations and citizens
understand the fit of our technology against current NHS policy and initiatives by:

Detailing the innovative new capabilities of the digital services such as Patient Health Records and
highlight a number of key service improvements which when used in conjunction with IT
deployment will achieve NHS wider organisational change objectives

Describe the approach for successful deployment of the technology and highlight the likely
challenges (people, process and technology) facing deployment and suggest mitigations to ensure
smooth transition

Describe the tools, collateral and support on offer which will be developed by the Business Change
Team to assist the citizens to successfully implement the changes to improve care and support for
carers
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5.2.2 Approach to Business Change
The release of open digital enabled system will require varying degrees of organisational change depending
upon the age of the organisations IT platforms.
The largest challenge facing successful use is to train, educate and most importantly convince all users of the
system of the benefits of fully utilising the improved system and adopting the new ways of working.
The implementation of the digital hub will be rolled-out using an incremental approach with multiple
projects in line with the lot based procurement. The approach is designed to make the most of the
opportunities for this release whilst taking account of the likely challenges before, during and after each
project.
To achieve the most benefit from the digital hub, local Primary Care neighbourhood communities will want
to plan their local programmes of IT-enabled change and decide what change needs to happen before,
during, and after the deployment of the new IT capability.
5.2.3 The Business Change Team
The successful roll out of software, use of the new systems and in particular utilisation of extended
capabilities will require a large degree of business change across the healthcare community.
The Business Change Team (BCT) is a central team within the Design, Build and Test function of the digital
hub and will be responsible for developing the approach and deliverables to aid successful uptake of
solutions.
The team will be resourced as outlined in our Warrington Care Record Outline Business Case with a business
change lead, benefits lead and stakeholder engagement lead embedded in the project team.
5.3 Approach to Benefits Management and Realisation
Through the development of the Warrington Care Record Strategic outline Case (SOC) and Outline Business
Case (OBC), a benefits log has been developed into an initial set of quantifiable and non-quantifiable benefits
and then classified as:



Cash-Releasing – financial returns that can be legitimately put back in the budget, e.g. Staff costs
Non Cash-Releasing – financial returns that are put back into the system e.g. Clinical time saved that
can be put into other areas such as developing a new system or clinic
Societal – a benefit to the patient or staff that cannot be quantified in financial terms e.g. improved
clinical interventions for a patient or improved work life balance for staff
This will be further developed for the Full Business Case in order that the investment decision can be made,
based on fully developed and robust metrics.
The same approach will be adopted for all digital projects and programmes, in line with the process
illustrated below (process starts at Identify).
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FIGURE 11 - THE BENEFITS LIFECYCLE
Once implemented, benefits will be pro-actively tracked and managed throughout the LDR lifecycle. Benefits
will be reported through the Benefits Realisation Plan which will also show how they will be measured and
realised, and the schedule of when this will take place. In addition, it also show appropriate milestones when
benefits reviews will be carried out to ensure the project benefits delivery remains on track. This will be
supported by a Benefits Tracker tool which outlines on a month by month basis progress for each benefit
against its planned target.
This list will be regularly reviewed and updated to ensure that all benefits arising as a result of the
programme are captured and reported through the governance described above and aligned to the wider
Warrington programme.
5.4 Approach to Local Investment
A set of investment objectives for the development of a shared Warrington Care Record, were developed
during the business case development process from an analysis of the key elements of the overall Health and
Wellbeing Board’s Transformation Programme and the main strategic aims of the Warrington organisations.
The investment objectives are:
5.4.1 Outcomes and experiences



Achieving patient perceptions of single (and best possible) services being provided
Whole person approach
Better enablement of self-management and self-care
5.4.2 Commissioning


Joined up commissioning
Proactive commissioning/analysis/risk stratification
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

Measurement of effects of commissioning programmes
Development of Public health information/planning
5.4.3 VFM/Cost Reduction


Overall reductions in costs
More effective use of resources
5.4.4 Pathway – based services



Increasingly seamless services
Proactive management of certain conditions/patient groups e.g. LTC or older people
End of life services
5.4.5 More Appropriate Care




Reducing unplanned care
Increasing selection of most appropriate services
Effective/appropriate prescribing/reducing costs
Reducing variations in primary care
5.4.6 Safety


Reducing clinical risk caused by the lack of information on citizens at the point of care
More appropriate/joined up prescribing
5.4.7 Settings


Supporting care in citizens’ homes and other settings
More self-sufficiency possible
5.4.8 Service Redesign


Citizen-centred care is the overall driving principle
Continuous service evaluation and redesign possible
5.4.9 Quality of Care



Better access to Mental Health services
Better coordination of Mental Health, physical and social care services
Equity, accessibility and choice
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5.5 The 2016/17 Programme Structure
5.5.1 Project Management
To achieve paper free, each project outlined in Section 6 will be governed and managed in accordance with
Projects in a Controlled Environment (PRINCE2) best practice, as already used by all five organisations.
A Project Manager is already in place along with some initial PMO support. Section 5.6 sets out the
additional resources that will be needed to plan and deliver the project, and to realise the changes and
benefits that are the ultimate aims of this development. These include the project, technical and training etc
staff needed for the 2-year period of implementation, and the change and benefits staff needed to help
Warrington’s health and social care services exploit the potential of shared records over the 5 –year life of
the project.
In addition a Senior Responsible Owner (SRO) has already been identified – Andy Davies, NHS Warrington
CCG Chief Clinical Officer.
Rollout will be Primary Care led and broken into individual neighbourhoods.
5.5.2
Governance
As already indicated, each project is to be managed as an integral part of the programme that is already in
place to transform the way in which health and social care services are delivered across Warrington. A joint
IMT Partnership Board is already in place to oversee the delivery of all IT related issues for this programme as
shown earlier in Figure 10.
A PRINCE project board comprises of:



Senior business role (to represent the organisational interests)
Senior user role (to represent the end users’ interests)
Senior technical role (to represent technical issues, including supply-side)
In addition best practice suggests that it should include:



The SRO
Commissioners’ interests
Stakeholder interests
Many of these roles are already represented on the current Board, but a number of changes to its
membership will inevitably be needed to meet all these requirements. As the project involves five
organisations, an early decision will be needed as to whether each organisation needs to supply a
representative for all 3 PRINCE roles or whether some roles may be combined. The former approach would
mean the Board would comprise a minimum of 24 people - 6 x 3 PRINCE roles, plus SRO, Supplier,
Procurement Adviser and it is suggested, the Warrington Transformation Director, together with the Project
Director and PMO representative. This would be a challenging number of people to function as a Project
Board, carrying out the functions of:
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










Approval of the project aims, plans, phasing and contingency arrangements
Approval of regular highlight reports and the authorisation of and major deviations from plan
Authorisation of the start and completion of each phase
Ensuring that the necessary resources are committed to the project
Resolution of any conflicts within the project
Oversight of the resolution of any problems with any external bodies
Authorisation of the implementation of any contingency plans and resources
Reporting on progress against plans to the Transformation Board
The management of Risks and of the Programme Assurance process
Ensuring the delivery of all contractual obligations – by the Supplier and by the five Warrington
organisations, for the duration of the project
Ensuring the formal closure of the Project
5.6 Using Resources Effectively
NHS Warrington CCG will focus resources on funding the people and technology to deliver the Warrington
Digital Programme so the efficiency and service improvement that result in paper free, are realised. These
resources include




Access to BCF funding to resource a Programme Manager to oversee the projects of Better
Information Sharing Programme. Each of these projects will be resourced from existing provider
resources backed off by CQUIN monies to enable participation. E.G. communications will consist of
the provider communication teams working together led by the Programme Manager.
Build project team costs including change and training into the Warrington Care Record project
business case, with transformational project support from the Warrington CCG PMO office.
Access Primary Care capital to ensure public and staff WiFi access across all Primary Care sites so
enabling the Warrington Single Infrastructure.
Local provision for Digital Providers is expected to be found by each provider funded either through
BAU activity & CQUIN investment, National Driving Digital Maturity Investment Fund and the Estates
and Technology Transformation Fund.
NHS Warrington CCG will actively pursue collaboration across a broader programme set within The Alliance
LDS and Cheshire Devolution, we will endeavour to utilise and support the delivery of transformational
change programmes through strategic alignment. Such programmes are vanguards, Connected Health Cities,
100,000 Genomes Project, Northern Health Sciences Alliance and PACS.
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6 Capability Deployment
6.1 Paper-free at the Point of Care
NHS Warrington CCG as the lead commissioner for each provider organisation over the last three years has
worked closely with providers, supporting investment proposals through our Director of IM&T to provide
assurance both that plans are deliverable and aligned with the principles of the Warrington Digital Vision and
the Warrington Digital Programmes.
To achieve these plans we continue to invest in CQUIN initiatives and create the pressure for change.
Implementation of the capabilities improves Warrington’s digital maturity and the planned trajectory against
each of these capabilities is shown in Section 4.5.
Our plans will drive up our levels of digital maturity and achieve paper free are outlined below mapped with
the capabilities we expect to achieve by delivering the Warrington Digital Programmes. How these 7 Paperfree at the Point of Care (PF@POC) capabilities map to our Digital Programme and also the STP Digital
Ambitions (see Section 2.2) is shown in the tables below (see also Appendix 1 for the Capability Deployment
Schedule and See Appendix 2 for the Capability Deployment Trajectory).
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6.2 The Capability Deployment Schedule
6.2.1
Records, Assessments and Plans
Who
Bridgewater,
5BP, WHH
What
EPaCCS
Bridgewater,
5BP, WHH
Rollout of local ePRs
Community
Pharmacy
Use of the Summary Care
Record
Primary Care
Extend use of Map of
Medicine and localise for
Warrington
Primary Care, Standardise Templates in
Bridgewater
TPP
Primary Care
WHH, Primary
Care,
Bridgewater,
5BP
NWAS, WHH
Warrington
Citizens
Standardise SNOMED
Complex, dependant family
information shared across
Cheshire
Capability group
Warrington
Programme 16/17 Status
Records, assessments and plans
Digital
Providers
Project
Implementation
ongoing
Records, assessments and plans
Digital
Providers
Project
Implementation
ongoing
Records, assessments and plans
Digital
Providers
Project
Implementation
ongoing
16/17
Records, assessments and plans
Digital
Providers
Project
Implementation
ongoing
17/18
Records, assessments and plans
Digital
Providers
Project Scope
Starting
17/18
Records, assessments and plans
Digital
Providers
Project Scope
Starting
Records, assessments and plans
Digital
Providers
Project
Implementation
ongoing
Records, assessments and plans
Digital
Providers
Project Scope
Starting
Records, assessments and plans
Warrington Procurement
Care Record Underway
18/19
Records, assessments and plans
Digital
Providers
18/19
Records, assessments and plans
Warrington Procurement
Care Record Underway
Year
16/17
16/17
16/17
17/18
Triage Ambulance Patients at
Handover
17/18
Patient access to online
assessments, records and
plans
18/19
WHH, Social
Electronic Document
Care
Management System
Bridgewater,
5BP, WHH,
Social, Primary
Care
Document Sharing
Document1
Project Scope
Starting
Alignment with
STP Digital
Ambition
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
1. Digitally
Empowered
Individuals
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
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6.2.2 Transfers of Care
What
Year
Capability group
Warrington
Programme 16/17 Status
WHH, Primary Electronic Discharge
Care
Summaries
16/17
Transfers of care
Digital
Providers
Project
Complete
Transfers of care
Digital
Providers
Project
Implementation
Ongoing
Transfers of care
Digital
Providers
Project
Implementation
Ongoing
Transfers of care
Digital
Providers
Project
Implementation
Ongoing
Transfers of care
Digital
Providers
Project
Implementation
Ongoing
Transfers of care
Digital
Providers
Project
Implementation
Ongoing
Transfers of care
Warrington
Care Record Procurement
- Lot 2
Underway
Transfers of care
Warrington
Care Record Procurement
- Lot 2
Underway
Transfers of care
Warrington
Care Record Procurement
- Lot 2
Underway
Transfers of care
Warrington
Care Record Procurement
- Lot 1
Underway
Transfers of care
Warrington
Care Record Procurement
- Lot 2
Underway
Transfers of care
Warrington
Care Record Procurement
- Lot 2
Underway
Who
Primary Care
Maximise GP2GP transfer
16/17
WHH, Primary Digital Single Assessment to
Care, Social
facilitate faster transfer from
Care
Wards
16/17
Primary Care,
WHH
WHH, Primary
Care,
Bridgewater,
5BP
Uplift in e-Referral Usage
Complex, dependant family
information shared across
Cheshire
WHH, Primary Structured forms in ICE to
Care
support transfer of care
Social, Primary e-Referral through to Social
Care
Care
Bridgewater,
Primary Care
WHH, Primary
Care, Social
Care,
Bridgewater,
5BP
WHH,
Bridgewater
WHH, Social
WHH, 5BP
e-Referral through to
Community Services
Unify Messaging through
Warrington Care Record
17/18
17/18
17/18
18/19
18/19
18/19
Electronic Discharge
Summaries from Acute to
Community
18/19
Electronic Discharge
Summaries and other
documentation from Acute to
Social Care
18/19
Electronic Discharge
Summaries and other
documentation from Acute to
Mental Health
18/19
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Alignment with
STP Digital
Ambition
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
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6.2.3 Orders and Results Management
Who
WHH,
Bridgewater,
Primary Care,
5BP
Alignment with
STP Digital
Ambition
2. Connected
Project
Health and
Implementation Social Care
Ongoing
Economies
2. Connected
Project
Health and
Implementation Social Care
Ongoing
Economies
2. Connected
Health and
Social Care
Not Started
Economies
What
Year
Capability group
Warrington
Programme 16/17 Status
Use of ICE to request and
review diagnostic tests
across all providers
16/17
Orders and results management
Digital
Providers
Cardiology Imaging and
Orders incorporated into ICE
and PACS
17/18
Orders and results management
Digital
Providers
18/19
Orders and results management
Digital
Providers
Orders and results management
Warrington
Care Record Procurement
- Lot 1
Underway
WHH
WHH,
Bridgewater,
Primary Care,
5BP
PACS reprocurement
WHH, Primary
Care, Social
Care,
Bridgewater, All results from all providers
5BP
available
18/19
2. Connected
Health and
Social Care
Economies
6.2.4 Medicines Management and Optimisation
Who
What
Year
Capability group
WHH
Medicines and allergies
reconciliation from Spine
16/17
Medicines management and optimisation
WHH
All anti-cancer treatments are
prescribed electronically
16/17
Medicines management and optimisation
WHH
In-Patient Prescribing to
complete Medicine and TTO
prescribing
17/18
Medicines management and optimisation
Primary Care
Bi-directional Spine updates
17/18
Medicines management and optimisation
Community Pharmacies
dispense Acute stay TTOs
17/18
Medicines management and optimisation
All medication history
available electronically
18/19
Medicines management and optimisation
WHH,
Community
Pharmacy
WHH, Primary
Care, Social,
Bridgewater,
5BP
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Alignment with
STP Digital
16/17 Status
Ambition
2. Connected
Project
Health and
Medicines
Optimisation
Social Care
Management Ongoing
Economies
2. Connected
Project
Health and
Medicines
Implementation Social Care
Management Ongoing
Economies
2. Connected
Health and
Medicines
Procurement
Social Care
Management Underway
Economies
2. Connected
Health and
Medicines
Social Care
Management Not Started
Economies
2. Connected
Project
Health and
Medicines
Implementation Social Care
Management Ongoing
Economies
2. Connected
Warrington
Health and
Care Record - Procurement
Social Care
Lot 1
Underway
Economies
Warrington
Programme
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The Local Digital Roadmap for Warrington
6.2.5 Decision Support
Who
What
Primary Care
Maximise the use of Primary
Care protocols and concepts
embedded in clinical systems 16/17
Primary Care
Map of Medicine for Peads,
Ortho, Gastro, Cardiology
Primary
Care/WHH
Warrington Referral Gateway
pathways expanded
16/17
Bridgewater
Integrated CP-IS in OOH
Service
WHH
WHH, Primary
Care,
Bridgewater,
5BP
WHH, Primary
Care,
Bridgewater,
5BP, Social
WHH, Primary
Care,
Bridgewater,
5BP, Social
WHH, Primary
Care,
Bridgewater,
5BP, Social
Clinical observations and
alerts in Lorenzo
Year
16/17
16/17
17/18
Child Protection Information
included in national summary
record
17/18
Complex, dependant family
information shared across
Cheshire
Use of Warrington Care
Record to flag patients and
support decision making
Risk Stratification beyond
Primary Care
17/18
18/19
18/19
Alignment with
STP Digital
Ambition
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
Capability group
Warrington
Programme 16/17 Status
Decision support
Digital
Providers
Project
Implementation
Ongoing
Decision support
Digital
Providers
Project
Implementation
Ongoing
Decision support
Digital
Providers
Project
Implementation
Ongoing
Decision support
Digital
Providers
Project
Implementation
Ongoing
Decision support
Digital
Providers
Project
Implementation
Ongoing
Decision support
Digital
Providers
Project
Implementation
Ongoing
Decision support
Digital
Providers
Project
Implementation
Ongoing
Decision support
Warrington
Care Record Procurement
- Lot 1
Underway
3. Exploiting the
Digital Revolution
Decision support
Warrington
Care Record Procurement
- Lot 3
Underway
3. Exploiting the
Digital Revolution
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6.2.6 Remote Care
Who
What
Primary Care, Telehealth deployment
Care Homes
around neighbourhoods
Year
Capability group
16/17
Remote care
Remote care
Digital
Providers
Remote care
Digital
Providers
Remote care
Digital
Providers
Remote care
Digital
Providers
Remote care
Digital
Providers
Remote care
Warrington
Care Record Procurement
- Lot 4
Underway
1. Digitally
Empowered
Individuals
Remote care
Warrington
Care Record Procurement
- Lot 4
Underway
1. Digitally
Empowered
Individuals
Remote access to records
Bridgewater
using TTP Mobile
16/17
Primary Care,
Warrington
Read code access to Primary
Citizens
Care records for patients
16/17
MiCheckIn Remote outpatient
checking in apps and
WHH
feedback
16/17
WHH
5BP
WHH, Primary
Care, 5BP,
Bridgewater,
Council,
Citizens
WHH, Primary
Care, 5BP,
Bridgewater,
Council,
Citizens
Mobile access to Lorenzo
records using Direct Connect 16/17
Silver Cloud - use of digital
access for mental health
services
17/18
Assistive home technology to
increase patient adoption
across disease pathways
18/19
Virtual Consultations with
patients
Alignment with
STP Digital
Ambition
1. Digitally
Empowered
Individuals
2. Connected
Project
Health and
Optimisation
Social Care
Ongoing
Economies
Project
1. Digitally
Optimisation
Empowered
Ongoing
Individuals
Project
1. Digitally
Implementation Empowered
Ongoing
Individuals
2. Connected
Project
Health and
Optimisation
Social Care
Ongoing
Economies
Project
1. Digitally
Implementation Empowered
Ongoing
Individuals
Warrington
Programme 16/17 Status
Project
Digital
Optimisation
Providers
Ongoing
18/19
6.2.7 Asset and Resource Optimisation
Capability group
Warrington
Programme 16/17 Status
Asset and resource optimisation
Digital
Providers
Project
Implementation
Ongoing
Asset and resource optimisation
Digital
Providers
Project
Implementation
Ongoing
Asset and resource optimisation
Digital
Providers
Project
Optimisation
Ongoing
16/17
Asset and resource optimisation
Digital
Providers
16/17
Asset and resource optimisation
Digital
Providers
Project
Implementation
Ongoing
Project
Implementation
Ongoing
Asset and resource optimisation
Digital
Providers
Project
Implementation
Ongoing
Asset and resource optimisation
Digital
Providers
Project
Scopting
Underway
Asset and resource optimisation
Warrington
Care Record Procurement
- Lot 4
Underway
Who
What
Council
Rollout of NHS Number as the
unique identifier
16/17
WHH
e-Rostering and nursing safe
care rota
16/17
Use of e-Whiteboard to
manage patient status
WHH
WHH, Primary
Care,
Bridgewater,
5BP
Unified Directory of Services
5BP
Data Warehouse
Implementation
WHH
Patient flow tracking
WHH,
Bridgwater,
5BP
WHH, Primary
Care,
Bridgewater,
5BP, Council,
Citizens
Location of clinical assets
tracked and 3GS standard
implemented
Digital Home Care tracking
Year
16/17
17/18
18/19
18/19
Document1
Alignment with
STP Digital
Ambition
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
1. Digitally
Empowered
Individuals
2. Connected
Health and
Social Care
Economies
2. Connected
Health and
Social Care
Economies
1. Digitally
Empowered
Individuals
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The Local Digital Roadmap for Warrington
7 Universal Capabilities Delivery Plan
In summary Warrington either already meets or plans to meet the 10 universal capabilities:










Professionals across care settings can access GP-held information on GP-prescribed medications,
patient allergies and adverse reactions. Warrington are already meeting this capability through use
of the Spine.
Clinicians in urgent and emergency care settings can access key GP-held information for those
patients previously identified by GPs as most likely to present (in U&EC). Warrington are already
meeting this capability through use of the Spine and TPP access in Urgent and Emergency Care
Settings.
Patients can access their GP record, the plan is to provide read code access through Primary Care
systems and then full care record access through Warrington Care Record Lot 4.
GPs can refer electronically to secondary care is already happening through e-Referral with more
specialities coming on line as the rollout of Warrington Referral Gateway continues.
GPs receive timely electronic discharge summaries from secondary care is already happening with
discharge summaries target being 80% of discharges and mandatory Royal College fields populated
with optional fields where there is data available. We will continue to agree with Emergency
Medicine what headings should be incorporated in an eDischarge but it is likely that the
requirements will be based upon the AoMRC requirements with ED related additions.
Social care receive timely electronic Assessment, Discharge and Withdrawal Notices from acute care
is happening as part of the e-Single Assessment Form accessed on all Wards through Lorenzo ewhiteboards.
Clinicians in unscheduled care settings can access child protection information with social care
professionals notified accordingly is planned via the Spine.
Professionals across care settings made aware of end-of-life preference information via EPaCCs.
GPs and community pharmacists can utilise electronic prescriptions through the rollout of EPS.
Patients can book appointments and order repeat prescriptions from their GP practice through the
rollout of Primary Care Patient Access and the Warrington Care Record Lot 4.
See Appendix 3 for the Universal Capability Delivery Plan.
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8 Information Sharing
A significant amount of work and progress has been made to date on enabling information sharing both
across, and beyond, Warrington. This includes the creation of a Warrington Information Sharing Toolkit that
was formally approved for use on 30 June 2014. Further information on this can be found on the Warrington
Information Sharing Hub http://www.warringtontogether.co.uk/intelligence-and-data/information-sharing/
The Better Information Sharing Programme summarised in Section 4.3.2 has a number of strategic and
programme drivers. These are:
8.1.1 Strategic Drivers
The benefits from this programme will support the following strategic drivers:
1.
2.
3.
4.
5.
Greater move towards integration
Whole person approach
Safety of care
Improving patient/service user experiences
Improving the efficiency and effectiveness of direct care provision thereby reducing the overall cost of
health and social care provision
6. NHS National Conditions (Better Care Fund) which requires the NHS Number as the primary personal
identifier across health and social care
8.1.2 Programme Drivers
Although the vast majority of care professionals want to share provided they can be assured it is safe, there
are a number of reasons currently cited by some care professionals for not doing so. Patients/service users
also expect care professionals to share safely and appropriately and their requirements are not being met.
Finally, organisations require all its employees to work efficiently and effectively together and variable levels
of information sharing impedes the free flow of information. So the drivers for this programme include:
1. Patients/service users expect all care professionals to share their data safely and appropriately for the
purpose of diagnosis and treatment. They generally want all their relevant medical conditions taken into
account and shared on a need to know basis.
2. Benefits and risks of data sharing are not clearly understood.
3. Lack of understanding of Information Governance which is often seen as a barrier.
4. Lack of understanding of how and what to share (what can and cannot be legally shared). It is
consequently safer and easier not to share - a ‘culture of anxiety’ as expressed in the Caldicott Reviews.
Concerns about, for example, possible sanctions, inadequate data safeguards, when implicit or explicit
consent should be used
5. Lack of resources and time within consultations (GPs) to inform the patient, gain and record their
consent and set their sharing preferences. Furthermore, patients are often not sufficiently informed to
make the decision and a small minority require significant time from care professionals to provide this
information and respond to their concerns and queries.
6. Culture or custom and practice.
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7. Concerns that patients/service users will withhold sensitive but important information to health
professionals if they believe their privacy may be breached.
8. Wider fears around security and confidentiality.
9. IT systems not interoperating which is hampering timely information flow between organisations. Note
that, conversely, benefits expected from current cross-community IT plans will be reduced if information
is not flowing across boundaries.
10. Lack of a primary personal identifier. It is accepted by all that this is the NHS Number but Social Care
systems do not consistently record it and some NHS organisations use it but have a local number as the
primary identifier.
11. Variable data quality – deemed safer not to share rather than share potentially misleading information.
12. A lack of a simple overall sharing agreement or consistent protocols to aid staff when making decisions
to share or not share patient/service user information to aid care.
Caldicott states that sharing should be practiced wherever it is in the best interests of patients and should
happen unless there is a good reason not to. The GMC and other national professional guidelines state that
there is a duty to share and recommend data sharing as good practice. They endorse the seventh
information sharing principle given in the second Caldicott Review: that “the duty to share information can
be as important as the duty to protect patient confidentiality” and state that “health and social care
professionals should have the confidence to share information in the best interests of the patients…”
In summary, addressing the above issues will reduce the risk to integrated care and see improvements in the
quality of care and the efficiency of the care process, reduce anxiety and confusion among care professionals
and service users and reduce the risk to benefits that can be realised from the IT Infrastructure investment.
8.1.3 Benefits Summary
A summary of the major benefits for the six projects comprising the overall programme is given below.
Benefits will be reviewed, quantified and time-scaled in conjunction with Benefits Owners during the early
months of Stage 3. An overall Benefits Plan will need to be signed off by each organisation and used by the
Integrated IT Partnership Board to monitor progress and delivery.
Project 1 - Privacy and Consent
a. Increased sharing of GP information in particular - more care professional confidence and clarity
around consent will result in more patients being asked to share and/or the increased use of implicit
consent (especially by GPs), where agreed, will obviate the need to ask.
b. SystmOne users (of the enhanced Data Sharing Model) will find it easier to share and other care
professionals (eg OOH GPs, Emergency Physicians) will be able to access SystmOne held information
Project 2 – Communications and Relationships
a. More informed patients will allow a more effective relationship with their care professionals and will
reduce the time required by care professionals to seek consent.
b. Improved patient experience as patients will be more comfortable knowing that their information is
being held securely
c. GPs will spend less time handling patients’ queries
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Project 3 – Culture, Confidence and Willingness
a. The majority of GPs and other care professionals will understand and trust all aspects of information
sharing and will be confident that sharing is safe, legal and will not expose them to sanctions or
litigation.
b. Responses to GPs and other care professionals who have concerns or queries will be quick, simple
and clear.
Project 4 – Information Governance
a.
b.
c.
d.
Information Governance rules and guidance will be simpler to understand and apply
IG will be seen as supporting health and social care
Use of IG will be built into commissioning contracts and into job contracts
IG staff will work together as a virtual team or strong cohesive network to ensure the resources are
used flexible across Warrington
e. GPs and other care professionals will be indemnified or fully insured against accidental harm caused
by the use of shared data.
Project 5 – Information Capture and Sharing
a. Care professionals will have clinically relevant data available at the point of need
b. Data quality will be acceptable; NHS Number will be used as the primary person identifier
c. Safe, legal information sharing will be practised throughout Warrington facilitated by an Information
Assurance Contract, Information Sharing Framework (including Privacy Impact Agreements and
organisation-level sharing agreements) which will have senior care professional and management
signed off to demonstrate that appropriate policies, guidance, processes, tools, safeguards, roles,
skills and knowledge are in place.
d. Improved sharing will improve efficiency and deliver cost improvements
Project 6 – IT systems, interoperability and security
a. Safe, secure, efficient and effective information sharing will be supported by the Warrington Care
Record and organisational systems.
b. The capture, flow and quality of data needed to deliver good quality care will be improved by the
new processes initiated by the Better Information Sharing and Integrated IT programmes.
See also Appendix 4 - Warrington LDR Information Sharing Approach.
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9 Standards
9.1 NHS Number
Across Warrington NHS organisations the current adoption of the NHS number as the primary identify for
patients under the care of health providers is universal. Health organisations have adopted and adhere to
the requirements as set out in the ISB0149-01 (ISN 32/2008) & ISB0149-02 information standard boards
(http://webarchive.nationalarchives.gov.uk/+/http://www.isb.nhs.uk/library/dscn/dscn2008/dataset/32200
8.pdf )
Within Social Care, regular spine batch tracing of adults services records is currently undertaken in to ensure
that a high percentage of clients NHS numbers are known to social care.
During 2016/17 the new Social Care system will connect directly to the Spine to ensure all citizens
demographic information is regularly traced against PDS to ensure full compliance.
9.2 SNOMED
Within Warrington and Halton NHS Foundation Trust, the adoption of SNOMED CT is in place as the single
common terminology in all in patient care settings using Lorenzo for diagnosis, past medical history and
available for use within procedures. The Emergency Department is using SNOMED CT already for diagnosis
and treatments.
The Warrington Care Record plans to support SNOMED vocabulary. SNOMED CT will be a fundamental
requirement.
9.3 GS1 Standards Compliance
GS1 standards incorporated within barcodes and RFID technologies are increasingly used to provide
improved patient safety, deliver greater regulatory compliance and drive operational efficiencies. The GS1
compliance table below shows Warrington and Halton NHS Foundation Trust’s current baseline state in
relation to GS1 standards, and highlights future plans to further deploy and develop the use of this
technology. Primary Care and Social Care organisations are out of scope for the GS1 standards compliance.
GS1 Compliance
Provider
Baseline
Plans
Warrington and Halton NHS Foundation
Trust
The trust is in the process of planning the
implementation of the GS1 standard
Expect full compliance by 18/19
Bridgewater Community Healthcare NHS
Foundation Trust
No current requirement
Review as part of future
development plans
5 Boroughs Partnership NHS Foundation
Trust
Not used
No plans currently
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10 Infrastructure
10.1 Current state and plans
Our vision for IT and infrastructure is to provide a best in class data network and connected services and
connect to the surrounding Community of Interest Network (COIN). The infrastructure will be focused on
connecting both the patient and the clinician to everything from anywhere. Over the last 3 years across
Warrington Primary Care, CCG and Hospital Provider the desktop rollout replaces static desktops with
Windows tablets. Over 1,000 machines were deployed last year to truly mobilise the workforce.
Warrington’s Server and Network infrastructure must therefore be capable of supporting current and future
requirements and ensure that care of patients and service users is not compromised. Our current plans
include joining up our separate resilient and highly available networks and offering single Warrington
Community of Interest Network (COIN) for citizen access to WiFi from one network across Social and Health
buildings.
Our vision for infrastructure is that it needs to enable, rather than disable our front line staff and our citizens.
By joining up our server infrastructure across Warrington to the Lancashire COIN, we will ensure we can:

Access all appropriate clinical and corporate systems relevant to their role from any NHS or Social
Care building across Merseyside using secure corporate Wi-Fi across Lancashire

Access all appropriate clinical and corporate systems relevant to their role from a none work setting
e.g. patients or staff members home

Utilise secure end to end communication methods, such email, shared calendars across the whole
Merseyside workforce (NHS Mail2)

Access a range of services such as common unified communication platform, enabling video
conferencing, instant messaging and flexible telephony solutions through our common Cisco and
NHS Mail platforms.
Not only will our infrastructure be required to deliver information in a secure and accessible way, but it must
also provide the ability to interact via consumer devices and ‘wearables’. The Warrington COIN will allow
devices such as Fitbit, jawbone and the Apple Watch when coupled with a smartphone to become the
primary method of generating and interacting with online health data. Therefore, a modern and accessible
NHS must be capable of interacting with and utilising these devices and the data they produce when our
service users wish to do so, providing them with the capability of monitoring their own health. Our new
homes will be digital ready and able to provide this information across Warrington.
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10.2 Future state
FIGURE 12 - WARRINGTON SHARED INFRASTRUCTURE BLUEPRINT
The table below identifies a number of key schemes we will deliver to achieve this future state:
Initiative
Description
Enhanced mobile access solutions
Continue rollout of Direct Access to existing
scalable mobile access solutions which already
provide a first class user experience
Shared Wi-Fi Access
Connecting local access controllers to enable all
Health and Social Care staff to connect to corporate
WiFi from all Health and Social Care locations
across Warrington
Consolidated and strategically situated data centres
By 2020 we plan to move to state of the art energy
efficient data centres, across The Alliance and the
council.
Common mobile/agile working devices
Providing enhanced user experience through state
of the art consumer devices enabled for the
corporate environment, whilst maximising
economies of scale through economy wide
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purchasing
Common Unified Communications platform
Providing innovative means of communication for
both staff and patients through the use of
collaboration tools such as instant messaging and
video conferencing via NHS Mail 2, skype and our
common Cisco platform
Shared Active Directory
Providing the ability to logon to any machine
independent of organisational ownership of
hardware and access corporate/clinical resources
as we connect to the Lancashire Domain bringing
Warrington Primary Care, Bridgewater and the
Hospital together.
Shared Corporate e-mail system
Adoption of a common and secure email solution
across Merseyside, such as NHS Mail 2 allowing the
sharing of calendars
Joining Telephony Systems
Exploring the provision of shared/joined telephony
solutions across Merseyside, achieving efficiencies
through free calling between organisations, whilst
providing the facility to access calls from multiple
locations
Connectivity to wider North West Coast initiatives
Ensuring the economy is interconnected with
neighbouring economies across the North West
Coast
Online Citizen Identity
Enabling a secure method for patients and public to
securely access health and social care services
online
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11 Minimising Risks Arising From Technology
Risks
Mitigations
1. Finance
Sufficient local funding isn’t available (particularly
ongoing revenue support)
Discussions are ongoing amongst the Directors of
Finance to explore external funding and reinvesting
benefits to fund implementations.
2. Benefits
Benefits don’t get delivered
(particularly cost savings)
as
planned
The application of the Cranfield benefits
management approach and the establishment of
benefits owners.
The project doesn’t get properly embedded in the
Transformation Programme but is regarded as an
IT initiative
Fully engage delivery groups/staff in deciding on
priorities for sharing at all stages.
Providers can’t give appropriate priority to this
Project due to of their participation in other
projects within and outside Warrington
Agreement on roles and commitments will be
subject to sign off by the Health Summit
3. Governance and Transformation
Commissioners will place pressure for change and
participation through contract
Agreement
decisions
to
coincide
with
organisational planning cycles to allow signup
4. Stakeholders
Clinicians and care providers are not engaged
effectively
Current CCIOs are engaged and this project will
utilise the additional clinical leadership approaches
of the Transformation Programme and will provide
extra resources to strengthen them
5. Data Sharing
Ensure that the data sharing forum is addressing
these issues from start and that the IG and Caldicott
leads of each organisation are actively involved.
Completion of the Better Information Sharing
Programme – see Section 8
All IG issues are unable to be resolved
6. Data Management
Responsibility for the data (and therefore its
management) held in any joint system is unable to
Each organisation will be responsible for its own
data. Standards for data capture and transfer will
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be agreed
be established at outset. Lead person responsible
for data and technical architecture. SIROs involved
in signing off individual data extractions.
Agreed levels of data quality are not achieved
Mandatory training for all users of major systems to
be introduced in every organisation that wants to
have access to shared data
7. Technical
IT infrastructure is not in place to allow fast and
mobile access to shared data
The project board will ensure that there is a
dedicated work stream for this issue
8. IT services
Individual organisational priorities and situations
change over time
Inevitable! Monitor progress regularly and take
early decisions to switch priorities if this is
appropriate course of action
Each of the Warrington health and care commissioning and provider organisations has in place robust
processes for managing risk that is enshrined in formal local governance arrangements. Similarly, a robust
risk management process is operating for the health and care transformational programmes that are
underway across Warrington, in line with the formal governance arrangements that are in place (see Section
5.1).
Risks associated with the Warrington Local Digital Roadmap will be managed both via the existing individual
organisations and the cross economy programme governance arrangements as outlined above.
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