Download pdf - Cambridgeshire and Peterborough Local Digital Roadmap ... · Local Digital Roadmap Public Narrative. Cambridgeshire & Peterborough - Local Digital Roadmap 2 3 Cambridgeshire & Peterborough

Cambridgeshire and Peterborough Clinical Commissioning Group

Cambridgeshire and PeterboroughLocal Digital Roadmap Public Narrative

Cambridgeshire & Peterborough - Local Digital Roadmap

2 3


Contents

January 2017

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

2 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

3 Our Footprint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

4 Our Local Digital Roadmap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

4 .1 Roadmap Content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

4 .2 Our Roadmap Development Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

4 .3 Roadmap Approval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

5 Our Digital Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

6 Where are we now? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

6 .1 Digital Maturity Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

6 .2 Sector Progress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

6 .2 .1 Primary Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

6 .2 .2 Secondary Care, Mental Health and Community Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

6 .2 .3 Local Authorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

6 .3 Key Achievements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

6 .3 .1 Primary Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

6 .3 .2 Secondary, Tertiary and Mental Health and Community Care Providers . . . . . . . . . . . . . . . . . . . . . . . . .20

6 .3 .3 Social Care and Local Authority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

6 .3 .4 Independent and Voluntary Sector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

6 .3 .5 Other Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

6 .4 Current Progress Against Our Strategic Themes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

6 .4 .1 Information Sharing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

6 .4 .2 Other Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

7 Delivering Our Digital Ambitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

7 .1 A System Wide View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

7 .2 Delivery of Our Digital Themes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

7 .3 Summary of Projects to Deliver Our Digital Themes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

7 .4 Increasing Our Digital Maturity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

7 .4 .1 Records, Assessments and Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

7 .4 .2 Transfers of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

7 .4 .3 Orders and Results Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

7 .4 .4 Medicines Management and Optimisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

7 .4 .5 Decision Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

7 .4 .6 Remote Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

7 .4 .7 Asset and Resource Optimisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

7 .5 Digital Maturity – Our Future Trajectory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

7 .6 Delivering the Ten Universal Capabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

8 Enabling Our Ambitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39

8 .1 Infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39

8 .2 Mobile Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40

8 .2 .1 Mobile Infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40

8 .3 Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40

8 .3 .1 NHS Number Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

8 .3 .2 SNOMED-CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

8 .3 .3 Dictionary of Medicines and Devices (DM&D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

8 .3 .4 Other Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

8 .4 Collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

8 .4 .1 Unified communications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

8 .4 .2 Shared Infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43

8 .4 .3 Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43

8 .5 Digital Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43


4 5


9 Our Digital Delivery Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44

9 .1 Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44

9 .2 Working Together . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44

9 .3 System Wide vs Local Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45

9 .4 Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45

9 .4 .1 Area Executive Boards (AEBs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46

9 .4 .2 Delivery Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46

9 .4 .3 Cross-cutting Strategy Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

9 .4 .4 Quality Assurance Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

9 .4 .5 The System Delivery Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

9 .4 .6 Digital Delivery Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48

9 .5 Transformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48

9 .6 Measuring our success . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49

9 .6 .1 Monitoring Our Implementation Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49

9 .6 .2 Opportunities for Benchmarking and Peer Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49

9 .7 Risk Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

9 .7 .1 Our Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

9 .8 Areas of Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

9 .8 .1 Data S ecurity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

9 .8 .2 Clinical Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

9 .8 .3 Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

9 .8 .4 Data Protection and Privacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

9 .8 .5 Accessible Information Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

9 .8 .6 Business Continuity and Disaster recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

9 .8 .7 Technical Approaches to Patient Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

9 .8 .8 System Wide Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

9 .9 Rate Limiting Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54

9 .10 Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55

9 .11 Resourcing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56

9 .12 Sources of Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56

9 .12 .1 Local Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57

9 .12 .2 National Funding Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57

9 .12 .3 Identifying Additional Sources of Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58

10 Looking Towards the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58

IntroductionThe population of Cambridgeshire and Peterborough is growing rapidly . People are generally living longer, so we have an ageing population, and more people have long term conditions or higher levels of obesity . We have a total budget of more than £1 .7 billion for NHS services, but we spend about £160million each year more than that . If nothing chan ges, by 2021, this overspend is set to grow to about £504million . These are the health and wellbeing, care and quality, and financial challenges we face .

To address these challenges, the local NHS, general practice and local government have come together under a strong, visible and collective leadership in the form of a Health and Care Executive (HCE) . This team, supported by the strong clinical leadership of a Care Advisory Group (CAG) is developing a major new plan to keep Cambridgeshire and Peterborough Fit for the Future . This five-year Sustainability and Transformation Plan (STP) covers hospital services, community healthcare, mental health, social care and GP services . All organisations in the Cambridgeshire and Peterborough area have agreed this plan, and to work together . Our plan aims to:

• improve the quality of the services we provide

• encourage and support people to take action to maintain their own health and wellbeing

• ensure that our health and care services are financially sustainable and that we make best use of the money allocated to us

• align NHS and local authority plans .

To implement this plan successfully, we must use technology to modernise how we deliver healthcare . To achieve this, we will consider digital less a separate entity operating in a supporting role to the main planning process, but more as the way of doing things . This Local Digital Roadmap (LDR) outlines

how best we can meet the challenges of providing healthcare in a digital world and delivers a plan that will improve our population’s health and wellbeing, outcomes, and experiences of care .

BackgroundIn October 2014, NHS England produced the strategy, ‘Five Year Forward View’ (FYFV), as guidance for all sectors of the NHS . It set out a clear view of the challenges ahead, why change is needed, and what change might look like . It outlined a vision to address the challenges facing the NHS, and to drive better patient outcomes . It proposed that the estimated £30billion gap in NHS funding predicted to appear by 2020-21 could be closed completely if the health service develops new, more efficient care models . Digital and information technology is a key enabler to deliver this transformed future for the benefit of every service user, carer, citizen and professional .

NHS England has subsequently published ‘Personalised Care 2020’, which provides the framework for implementing the necessary changes to model care around the patient, using digital technology to transform the patient’s experience, by improving convenience, quality and effectiveness .

This approach resulted in the division of England into 85 footprints . Work is in progress to develop digital roadmaps across all footprints throughout England, enabling CCGs and provider organisations to prioritise investment in, and implementations of, digital solutions for data sharing and paperless working . The ‘National Information Board (NIB) Framework for Action’ calls for CCGs to produce digital roadmaps outlining how its local health and care economies will achieve the ambition of being paper-free at the point of care, by 2020 .

1

2

Shared

Enable multi-disciplinary working

Better access online

Apps

Information


6 7


Our FootprintCambridgeshire and Peterborough has a committed

and expert health and care workforce . We provide

some excellent services to which people travel from

other parts of the country . We host innovative

research and deliver excellent medical education and

training . We have a resourceful voluntary sector,

strong organisations, active local communities, and

we work alongside research and technology industries

which are world leaders in improving healthcare .

Cambridgeshire and Peterborough CCG is one of

the biggest in the country, with 105 GP practices

as members, that includes three practices in North

Hertfordshire and two in Northamptonshire .

Our CCG serves a patient population of approximately

930,000, which is diverse, ageing, and has significant

inequalities . STP footprints typically map to LDR

footprints, on a one-to-one or one-to-many basis . The

Cambridgeshire and Peterborough STP footprint maps

directly to the Local Digital Roadmap footprint . This

means that we can align our Local Digital Roadmap

vision and ambition with those of the STP . The STP

and LDR boundaries are shown on the map below .

The organisations which make up the Cambridgeshire and Peterborough STP and LDR footprints are shown

below . However, we also recognise that people are supported by a network of formal and informal care;

therefore our roadmap also recognises our partnership work with all organisations involved in the delivery of

care including the voluntary sector .

Our Local Digital RoadmapOur Local Digital Roadmap (LDR) describes our vision for the future, where we are now and our plans to transform the way we deliver care and accelerate change using digital tools and information .

4.1 - Roadmap Content

It includes the following elements:

• Our five-year vision for our digitally-enabled transformation

• A baseline of our current capabilities

• An overview of our ambitions, including a capability deployment schedule and trajectory, outlining how, through driving digital maturity, our staff will increasingly operate ‘paper-free at the point of care’ over the next three years

• Our delivery plan for a set of core capabilities, detailing how progress will be made in fully exploiting the existing national digital assets

• How we will collaborate within our footprint and how digital information is an enabler for this, including our information sharing approach

• How we will deliver our ambitions, including the programme structure and likely sources of funding

As a footprint, our work overlaps with other footprints: For example:

• PSHFT has a ‘catchment’ which provides care split 50:50 between North Cambridgeshire and South

Lincolnshire

• The ambulance trust provides services across the East of England and is driven by a despatching system

rather than a patient-centric system

• Papworth provides the majority of its services to patients from beyond the footprint boundaries

3

4

Nottinghamshire

Lincolnshire

Leicester, Leicestershire and

Rutland

Northamptonshire

Norfolk and Waveney

Bedfordshire, Luton and Milton Keynes

Suffolk

Cambridgeshire and Peterborough

Essex

CCG

NHS Trusts

• Cambridgeshire and Peterborough CCG

• Prime Minister’s GP Access Fund (wave two)

- Primary Care Transformation PeterboroughOther Providers

• Hertfordshire urgent care

Local Authorities

• Cambridgeshire County Council

• Peterborough County Council

Health and Wellbeing Boards

• Cambridgeshire

• Peterborough

Other Partners

• Voluntary organisations

• Patient groups

Other Partners

• Cambridge University Hospitals NHS foundation trust

• Cambridgeshire and Peterborough NHS Foundation Trust (Mental Health, Community and Children’s services)

• Cambridgeshire Community Services NHS Trust (Community and Children’s services)

• Hinchingbrooke Health Care NHS Trust

• Papworth Hospital NHS Foundation Trust

• Peterborough and Stamford Hospitals (Acute)


8 9


This LDR does not replace the informatics strategies

for the organisations within our footprint, however,

it provides a means to bring together, align and

strengthen these plans in a consolidated view of the

programmes required to become as close as possible

to ‘paper free at the point of care’ and to support the

delivery of integrated health and care services . The

roadmap covers the period 2016-2020, with specific

focus upon the first two years 2016-2018 . The LDR

will be a living document and will be updated on a

regular basis, to reflect the development of the STP .

4.2 - Our Roadmap Development Process

To produce this roadmap, we worked collaboratively

with organisations within our footprint involved in the

commissioning and provision of health and social care .

These organisations and stakeholders included GP

Practices, commissioners and provider organisations

across all care settings including Acute, Community

and Mental Health, and Local Authorities . Specific

input was received from the organisations listed

below:

• Cambridge University Hospitals NHS Foundation

Trust

• Cambridgeshire and Peterborough CCG

• Cambridgeshire and Peterborough NHS

Foundation Trust

• Cambridgeshire Community Services NHS Trust

• Cambridgeshire County Council

• Herts Urgent Care

• Hinchingbrooke Health Care NHS Trust

• Papworth Hospital NHS Foundation Trust

• Peterborough and Stamford Hospitals NHS

Foundation Trust

• Peterborough City Council

We designed our roadmap development process to

ensure that it underpins the delivery of both our STP

transformation priorities and the national ‘paper free

at point of care’ ambitions . This will enable us to

deliver the national vision set out in the 5YFV .

Our roadmap development approach (as shown in the

diagram below) was ratified by our Health and Care

Executive, which comprises the Chief Executives of

member organisations . The CCG was also authorised

to complete, approve and submit the completed

LDR document on behalf of the local community of

organisations . Support for, and review of, the LDR

document has been provided by the collaborating

organisations’ Information Communication

and Technology (ICT) representatives . This was

supplemented by input from the NHSE Regional Office

and feedback from care professionals on the digital

initiatives required to enable our sustainability and

transformation process .

We recognise the importance of Chief Clinical

Information Officers (CCIO) and these roles continue

to be introduced across our footprint . Where

a CCIO is in post within an organisation, these

individuals provided input into the process . Our

support and approval process was conducted via

series of workshops, web conferences and individual

correspondence . Information, Communication and

Technology (ICT) leads were given the authority to

contribute and approve their own organisation’s input

into the LDR .

We began our roadmap development process with a

‘requirements gathering’ phase . This ensured we took

account of all relevant requirements . Areas considered

included national initiatives such as FYFV and the

requirements of the ‘paper free’ agenda . Senior

clinical and managerial staff within collaborating

organisations provided details of the digital

transformation priorities and challenges for their

organisations . As part of the STP process, the digital

agenda and the need for the LDR was discussed in

the STP clinical working groups . Their feedback has

ensured that our entire framework and priorities are

based on input and feedback from care professionals

and patient representatives . In addition, information

was drawn from a number of cross-organisational

groups and initiatives, including Vanguard and Better

Care Fund .

We identified our digital themes via a sequence

of cross community digital maturity sessions, web

conferences and via our STP process work groups .

As part of wider STP discussions, the broad elements

of this LDR have been reviewed with our two Health

and Wellbeing Boards . The LDR has been discussed

with our cross-organisational groups, including the

Better Care Fund Information Sharing Group . The

June 2016 LDR has also been shared with LDR leads

from Norfolk, Suffolk and Essex, as part of an effort

to improve cross-community learning and sharing

of expertise . This approach helped to ensure we

put in place strategic system-wide building blocks

and enablers, whilst supporting different localities

and providers to deliver their local requirements for

improving digital maturity .

We expect our roadmap development to be an

evolving and changing process, reflecting our

agreed ‘plan–do–study–act’ cycle approach to

transformational change . We will continue to review

and refine our LDR as part of the STP process, and

will seek patient and citizen involvement particularly

around the establishment of an acceptable ‘consent

to share’ policy and its implementation . We will also

seek wider involvement from the voluntary sector .

Our LDR is fully integrated in our STP governance and

programme delivery structure, as outlined in section 9 .

4.3 - Roadmap Approval

To help ensure this LDR is in synch with STP plans

and that the ‘golden thread’ of digital runs through

the STP ambitions, we have linked the LDR approval

mechanism with STP processes, wherever possible .

This LDR has been reviewed by the Health and Care

Executive . This full document has been approved

by the CCG on behalf of organisations within

Cambridgeshire and Peterborough, but further

development and approval will see changes that

require further ratification during 2016/17 .

Requirements gathering

Identification of Themes and

Enablers

Review our baseline

Formulate our delivery plan


10 11


Our Digital VisionTo ensure we harness the power of digital tools and

information to meet the needs of our population, we

agreed the following overarching vision for the Local

Digital Roadmap 2016-2020 .

By 2020:

“Patients and Citizens, Health and Social care staff

will have access to quality, timely and accurate

information regardless of place or time to enable

improved decision making and ultimately better

outcomes for both the individual and the community.”

Digital technology is a key enabler for the delivery of

our sustainability and transformation plans for the

future of health and care within our footprint . The

Cambridgeshire and Peterborough STP footprint maps

directly to the Local Digital Roadmap footprint which

enables us to align our Local Digital Roadmap vision

and ambition with those of the STP .

The sustainability and transformation plans for the

Cambridgeshire and Peterborough footprint are

known as Fit for the Future . These plans focus on

how we operate as a system as a whole, rather

than on individual organisations or services . This

approach is clinically-led and highly collaborative . It

sets out a single overall vision for health and care for

Cambridgeshire and Peterborough, including:

• Supporting people to keep themselves healthy

• Primary care (GP services)

• Urgent and emergency care

• Planned care for adults and children, including

maternity services

• Care and support for people with long term

conditions or specialised needs, including mental

ill health .

Our HCE, through discussions with our staff, patients,

carers, and partners has identified four priorities and

developed a 10-point plan to deliver these changes .

The plan includes six themes for change and four

enablers to help us deliver our vision .

This section of the LDR describes our vision and

ambitions for meeting these themes for change . A

key enabler to achieving this is ‘Using technology to

modernise health’ . The sequence of diagrams below

demonstrates how digital technology is a golden

thread which is essential to supporting our vision for

change . The Local Digital Roadmap guidance provided

by NHS England outlines four digital elements which

will contribute towards delivering these challenges:

• Paper-free at the point of care (PF@POC)

Health and Social Care staff will be able to access

patient and citizen data electronically wherever

they or the patient or citizen are .

• Digitally enabled self-care

Patients and citizens will be able to interact

electronically with health and social care providers

about their own health and care . This can include

patient apps .

• Real time analytics at the point of care

The clinical system used by the clinical staff will

have the ability to provide real time analysis of

the data about the patient and citizens across the

health and social care systems including patient/

citizen provided data .

• Whole systems intelligence to support

population health management and effective

commissioning, clinical surveillance and

research – providing access to pseudonymised

data for analysis across the whole footprint

As part of the LDR development process, we have not

only considered these aspects, but also how other

types of digital tools and information can transform

the way we deliver care to meet our themes for

change . The diagrams below also demonstrate how

our vision for digitally enabled transformation will

help address the three national challenges: a) closing

the health and wellbeing gap, b) closing the care and

quality gap c) closing the finance and efficiency gap .

5

At home is bestPeople powered health and wellbeing Neighbourhood care hubs

Safe and effective hospital care, when needed

Responsive urgent and expert emergency care Systematic and standardised care Continued world-famous research and services

We’re only sustainable together Partnership working

Supported delivery (Our enablers)

A culture of learning as a system Workforce: growing our own Using our land and buildings better Using technology to modernise health


12 13


Neighbourhood care hubs

Responsive urgent and expert emergency care

People powered health and wellbeing

Systematic and standardised care

More health and care services will be provided closer to people’s homes and we will help people stay at home when they’re unwell.

We will offer a range of easily accessible support for care and treatment, from telephone advice for urgent problems to the very best hospital emergency services when the situation is life threatening.

We will help people to make healthy choices, keep their independence, and shape decisions about their health and care. We will work with community groups and businesses so people of all ages have good health, social and mental wellbeing support.

Doctors, nurses and other health and care professionals will work together across Cambridgeshire and Peterborough to use the best treatments and technology available.

Our Vision Gaps Addressed Digitally enabled by

To coordinate care better, tailored to the needs of the individual, paying close attention to the health and care services necessary to keep people living at home successfully

Health and WellbeingFinance and Efficiency

PF@POCShared recordsDigital self careRisk stratificationShared infrastructureUnified communications

When people become unwell, we will take every opportunity to spot warning signs, for example during regular health checks and visits to urgent care services

Health and Wellbeing PF@POC Shared recordsReal time analyticsWhole systems intelligenceRemote monitoring

Provide local support to help people live with long-term health conditions .

Health and Wellbeing Digital self careTelehealth and remote monitoring

Joint working between local health and social care, with GPs playing a central role, supported by hospital clinical teams .

Care and QualityFinance and Efficiency

InteroperabilityShared recordsReal time analyticsWhole systems intelligenceShared infrastructureUnified communicationsCollaboration tools


Better coordination, for example referral through NHS 111, close working with the ambulance service


InteroperabilityReal time analyticsShared recordsShared infrastructureUnified communications

To provide clear information to patients about which services are available – and how to reach them – when they have an urgent health need .

Health and Wellbeing Digital self carePatient portal

We have made a commitment that all urgent and emergency care services must meet the recently revised national standards .

Health and Wellbeing Whole system intelligenceReal time analytics

We expect that 24/7 urgent care services will remain on our main three sites .


Real time analyticsWhole systems intelligence


To prevent illness and support people to take control of their own health and wellbeing


PF@POCPopulation health managementRisk stratificationDigital self carePatient apps

To develop health services which work alongside patients and carers, social care and housing providers, and help to build strong communities .

Health and Wellbeing Shared recordsPopulation health managementShared infrastructureUnified communicationsCollaboration tools

Patients become equal partners with those caring for them, and with support and advice, make more decisions about their own treatment

Health and Wellbeing Digital self carePatient appsTelehealth & Remote monitoring

Patients become increasingly confident to manage their own conditions, supported by technology .


Real time analyticsRisk stratificationWhole systems intelligenceDigital self care


To make better use of research evidence – drawn from Cambridgeshire and Peterborough and beyond – will help us to use care and treatments systematically which are proven to be the most effective .


Whole systems intelligence

Where it is important to provide services from several sites across the area, we believe we can use our skills and expertise collectively to achieve better results through doctors and nurses working across more than one hospital site and sharing their expertise .

Finance and Efficiency Care and Quality

PF@POCInteroperabilityShared recordsReal time analytics Whole systems intelligenceShared infrastructureUnified communicationsCollaboration tools

We expect that maternity services will remain at The Rosie Hospital, Hinchingbrooke Hospital, and Peterborough City Hospital .

Health and Wellbeing PF@POCShared recordsWhole systems intelligence


14 15


Continued world-famous research and services

We have world-class specialised care, but we are always looking for ways to be better.

Partnership working

Everyone who provides health, social, and mental health care across Cambridgeshire and Peterborough will plan together and work together.


We will work together with our local research organisations and businesses to deliver world class care .

Health and Wellbeing Finance and Efficiency

PF@POCShared recordsDigital self careRisk stratificationShared infrastructureUnified communications

To achieve consistently better results for people with more serious needs, such as for heart and lung services, or complex surgery, in fewer, specialist units which make best use of the world-class expertise of our specialist consultants .

Health and Wellbeing Finance and Efficiency

PF@POCReal time analyticsWhole systems intelligence


We will work across boundaries: between NHS and local authority social care; GPs and hospital care; and physical health and mental health .


PF@POCInteroperabilityShared recordsDigital self carePopulation health managementIndustry partnerships

We will support our GPs to collaborate more, and work with them to develop sustainable services

Health and Wellbeing PF@POCInteroperabilityShared recordsWhole systems intelligenceCollaboration toolsUnified communications

We will provide better access to resources through sharing and specialisation and closer working between GPs and their colleagues in hospitals .

Health and Wellbeing PF@POCInteroperabilityWhole systems intelligenceShared infrastructureCollaboration toolsUnified communications

We recognise that people are supported by a network of formal and informal care, and aim to work in partnership with local organisations such as faith groups and the voluntary sector .


Digital self careInteroperabilityWhole systems intelligence

We consider the enabler ‘Using technology to modernise health’ to be a golden thread, as it will not only allow

us to deliver our vision for our themes, but it is also essential to the development of our other three enablers .

As can be seen from the exploration above, technology

is a fundamental enabler if we are to deliver our

ambitious vision for change, which we set out in our

Fit for the Future Programme . Good information and

advice will help people to take control of their health .

We will use apps and online tools to provide more

immediate and reliable information to patients and

citizens . It is clear that shared information will help

hospital clinicians, GP practices, community teams,

and social care to work together more effectively . This

information sharing must extend to all providers of

care, including third sector and smaller organisations,

such as podiatrists and pharmacies . Effective use of

technology will help us to optimise service design and

improve the patient experience .

To provide a clear focus and ensure our future plans

align with our vision for change, we have identified six

digital themes:

Our enabler The digital factor

Workforce: growing our own

Helps our staff to develop their clinical skills and grow

professionally .

It also helps to grow informatics skills and

professionalise this important area of expertise . This

in turn leads to an increase of clinicians with the

necessary skills to become effective CCIOs

Using our land and buildings better Facilitates remote and mobile working

A culture of learning as a systemPromotes analysis of information to improve care and

enables sharing of knowledge and expertise

Interoperability

Invest in innovative technology to support our vision

Deliver real-time person level information to improve financial

and clinical performance


Increase Data and information sharing

Adopt a population based approach to population based analytics


16 17


We will increase our data and information sharing

capabilities by becoming paper free at point of care, to

provide shared records – i .e . a single view patient health

and care record wherever care is delivered .

We will enable the transformation of services and care

through the use of new technology including telehealth

and remote monitoring .

We will deliver real time analytics to allow the

monitoring of the day to day cost, utilisation and

outcomes of services within the health care system,

as well as system surveillance of financial and clinical

performance .

We will engage patients in their own care, health and

wellbeing via digital self-care, including the use of

healthcare apps, patient portals and online information

sources .

We will deliver IT capability to facilitate data transfer

between organisations including the use of standards

for data capture and messaging .

Where are we now?We have made significant progress across the footprint in raising our digital capability . There is strong digital

leadership, clinical engagement and governance within organisations across Cambridgeshire and Peterborough .

This is evidenced through the recent Digital Maturity Self-Assessment surveys and also within the membership

of the Sustainability and Transformation programme, of which digital development is an integral part .

Below, we set out our current position in relation to our digital maturity which is based on the core capabilities,

which will contribute to our ability to meet the paper-free challenge and the data sharing agenda .

6.1 - Digital Maturity Assessment

The Digital Maturity programme worked with a

number of partners including the Academic Health

Science Networks and healthcare providers and

CCGs to examine effective use of technology, with

particular focus on capabilities such as digital care

records, transfers of care and medicines management .

The result of this work was a framework that can

be used across acute, mental health, community,

ambulance and social care settings . This framework

is called the Digital Maturity Assessment . It builds on

existing evidence about how investing and effectively

using IT can achieve better patient outcomes, reduce

bureaucracy, improve patient safety and deliver

efficiencies .

This section explores our current digital maturity . It

uses the Digital Maturity Assessment information

to measure the extent to which our healthcare

services are supported by the effective use of digital

technology . We used this information to identify key

strengths and gaps in our provision of digital services

at the point of care, and offer an initial view of our

current ‘baseline’ position .

In order to understand our current ability to meet

the paper-free challenge, we analysed our digital

capability scores in the following seven core capability

focus areas:

1. Records, assessments and plans

2. Transfers of care

3. Orders and results management

4. Medicines management and optimisation

5. Decision support

6. Remote care

7. Asset and resource optimisation

For each provider organisation within our footprint

our scores are shown in the table below as %

achievements against the defined areas .

We also recognise that delivering capability in line

with our digital themes is only part of the story . To

achieve our ambitions we must also put in place the

necessary supporting infrastructure . This will include

unified communications, shared infrastructure and

collaboration tools . Furthering partnerships with

suppliers within the industry will also be a key factor

in our success .

We will adopt whole-systems intelligence to enable the

analysis of footprint-wide data to deliver population

health management, risk stratification, effective

commissioning, clinical surveillance and research .

6

TrustAsset and Resource Optimistation

Decision Support

Medicines Management and Optimisation

Orders and Results Management

Records, Assessments and Plans

Remote and Assistive Care

Transfer of Care

Cambridge University Hospital NHSFT 95 88 94 100 69 50 96

Cambridge and Peterborough NHSFT 45 47 32 51 33 59

Cambridgeshire Community Services NHS

Trust17 63 28 59 83 0 68

Hinchingbrooke Health Care NHS Trust 50 55 46 35 48 33 66

Papworth Hospital NHS Foundation Trust 45 19 11 57 28 33 22

Peterborough and Stamford Hospitals NHSFT 70 42 28 70 39 25 48

Cambridge and Peterborough average 54 52 41 59 53 35 60

National Average 43 36 29 54 43 35 50

Interoperability








18 19


The scores for Cambridge University Hospitals NHS

Foundation Trust are very high and the Trust ranks

second against all NHS Trusts for the average score

across these seven areas of functionality . This

reflects the recent investment the Trust has made in

implementation of the Epic EPR .

The other Trusts rank between 64 and 72, out of 240,

with the exception of Cambridge and Peterborough

NHS Foundation Trust, which ranks 125 out of 240 .

As shown below, the footprint is achieving better

than the national average in all areas, except Remote

and Assistive Care, where scores are uniformly low,

but still around the national average . However, it is

important that those organisations at a lower level of

digital maturity progress to a higher level of maturity,

to ensure effective information sharing . This situation

is in common with all other footprints .

In order to continue to improve our levels of digital

maturity, we plan to leverage the knowledge and

expertise within the local and national digital

exemplars, for the benefit of our wider health

economy .

6.2 - Sector Progress

Overall, we are making good progress and have a

firm foundation for the future . We have a number

of organisations who have already implemented an

Electronic Patient Records (EPR): Cambridge University

Hospitals are using Epic and Cambridgeshire and

Peterborough NHS FT is using RiO for Mental Health

and SystmOne for Community Services . Many other

organisations have well defined plans and are making

good progress towards implementing an EPR: with

Papworth due to implement Lorenzo in June 2017,

and Peterborough and Stamford Hospitals with an

approved business case for a new PAS .

6.2.1 - Primary CareCambridgeshire and Peterborough has 105 GP

practices all of which use GP Systems of Choice

(GPSoC) approved systems, and have met the national

contract requirements for digital enabled services,

such as Patient Online, Summary Care Records,

GP2GP transfer, e-Referral System and EPS R2 .

Provision and use of services digitally to patients

within Primary Care tends to be higher than the

national average . For example, approximately 20%

active patients are using Patient Online services .

6.2.2 - Secondary Care, Mental Health and Community ServicesCambridge University Hospitals NHS Foundation

Trust recently achieved recognition for its digital

achievements from the Healthcare Information and

Management Systems Society (HIMSS), reaching

Stage 6 of the international Electronic Medical

Record Adoption Model (EMRAM) . This is a result

of its programme to implement the Epic EPR and

underpinning infrastructure . This programme has

delivered functionality across the core capabilities

which have been widely rolled out across the Trust .

The other Trusts within our footprint have started

the journey to paperless working but will require

investment to complete projects and fully implement

more advanced functionality, such as medications

management, requests and results, and support for

transfers of care and record sharing .

6.2.3 - Local AuthoritiesThe Social Care Digital Maturity Self-Assessment

uses the same structure as the NHS England Digital

Maturity Self-Assessment, but the areas have been

tailored for social care . Its emphasis is on supporting

local work and sharing good practice, and is sector-

led .

The digital maturity self-assessments completed by

Local Authorities across the country show significant

gaps around the capabilities and infrastructure

requirements, and this was reflected in the self-

assessments for both Cambridgeshire County Council

and Peterborough City Council . Officers from the two

local authorities are working with NHS partners to

ensure that these requirements are reflected in Better

Care Fund plans and in the STP . Investment will be

required in order to deliver these requirements .

6.3 - Key Achievements

We have made significant progress in the delivery

of our digital ambitions to date . A summary of key

recent achievements includes the following .

6.3.1 - Primary Care• Meeting or exceeding national contract

requirement for Primary Care IT services . Examples

include:

• GP LSP to GPSOC transition was completed

three months ahead of national contract

requirement

• Patient Online national target 10% for 16/17

local percentage already @ 20%

• Higher than average Electronic Referral Service

(eRS) usage

• All GP practices on GPSOC approved systems

• Significant infrastructure upgrades

• Establishment of new practices within the area

• Prime Ministers Challenge Fund – Greater

Peterborough Network

• 7 day a week IT support provision for GP practices .

• All Cambridgeshire and Peterborough GP practices

submittedw an IG Toolkit self-assessment .

Baseline Digital Maturity Assessment

Cambridge and Peterborough average National average

Asset and Resource Optimisation

Transfer of Care Decision Support

Medicines Management and OptimisationRemote and Assistive Care

Records, Assessments and Plans

Orders and Results Management

60

50

40

60

20

10

0


20 21


6.3.2 - Secondary, Tertiary and Mental Health and Community Care Providers• Overall, these organisations have achieved a

higher standard of digital maturity compared to

the national average

• Infrastructure upgrades and significant systems

and organisational change developments have

been delivered

• Increased use of clinical systems across multiple

sites and specialties

• Mobile working initiative for clinical staff .

6.3.3 - Social Care and Local Authority • Creation of Better Care Fund Data Sharing

programme in 2015 (includes representation

for health and care in Cambridgeshire and

Peterborough)

• New procurements for next generation social care

system

• Infrastructure upgrades across the area

• Extensive online services for citizens

• NHS number compliance

• Extensive upgrade to broadband infrastructure

across the area to above national averages,

through the Connecting Cambridgeshire initiative .

More than 100,000 homes and businesses across

the county have been upgraded, taking total

superfast coverage to over 93% completed in

2015 . Peterborough City Council is also running

an ambitious City Fibre project .

• Cambridgeshire County Councils ‘Learn Together’

initiative for schools providing online description

and access to services that the council provides .

Includes the ability to book courses and access

health and social care information

• Peterborough achieved the status of World Smart

City at the Barcelona World Smart City Expo, for

creating smart solutions to city challenges .

6.3.4 - Independent and Voluntary Sector • Increased sharing of information between sectors

• Increased involvement in decision making about

new service provision .

6.3.5 - Other Areas• Cross-organisational working as part of the Better

Care Fund:

• Data Sharing

• 7 Day Services

• Person-Centred Systems

• Information Advice and Guidance

• Healthy Ageing and Prevention .

• Urgent and Emergency Care Vanguard initiative .

6.4 - Current Progress Against Our Strategic ThemesA great deal of cross-organisational work is already

underway or soon to start . These developments

increase the use of digital technology to improve

the efficiency of services, provide services in new

ways, and in some cases provide services that were

not possible until the digital changes had or will be

delivered .

6.4.1 - Information SharingAll providers use email and/or SMS to communicate

with patients . Providers are able (with consent) to

access nearly 900,000 summary care records (SCR) for

patients within Cambridgeshire and Peterborough,

and have access to millions of SCR for visitors,

students etc . The provision of SCR to community

pharmacists is well underway .

As an example of practical information sharing, the

following table describes in summary how individual

health organisations can access GP structured

information (subject to patient consent) . The

organisations involved are committed to increasing

the use of GP information .

TPP SystmOne shared patient record . Note during 2016/17 should also be able to access EMIS Web and vice

versa from within clinical system .

Access to record technically available and used within parts of the respective organisation, increasing access

to GP record (with appropriate consent) .

Trusts do not have full access to GP patient record .

We have also made progress against our ambition to use digital capability to share electronic information with

patients and citizens . The following table shows our progress areas .

Organisation GP Record Clinical view of GP record Summary Care Records

CUH

CPFT

111/OOH (HUC)

Papworth

CCS

PSHFT

HHCT

GP Practices

Organisation Shares electronic information with patients

Type of electronic sharing in place

CUH Choose Well Cambridge – available now gives patients advice re the right level of care to access .

Patient Portal - MyChart - the app available to patients who have signed up to the CUH Epic patient portal . CUH have deployed this in their Obesity service and are just starting deployment in Oncology . This app is written by Epic

CPFT

111/OOH (HUC)

CCS

PSHFT

HHCT

Papworth Pilot re use of Patient Knows Best for some patients within Thoracic medicine . Looking to expand .

GP Practices Patient Online

Cambridgeshire County Council

SMS

Peterborough City Council

Transactional activities


22 23


6.4.2 - Other InitiativesThe following table is a list of key current initiatives;

we have indicated where these projects improve our

core capability related to paper-free at point of care,

and where they contribute to progress against a

digital theme . Some of these initiatives are foundation

projects, which will enable us to deliver our vision . As

our Local Delivery Roadmap continues to evolve, and

the Digital Delivery Group within the STP will continue

to contribute to, and coordinate the range of digital

initiatives in progress .

Delivering Our Digital AmbitionsThis section sets out how we will use digital tools and information to transform the way we provide care and

deliver our digital vision .

7.1 - A System-wide View

To deliver our vision for change we have set in place

a planned programme of work which will support

our digital themes . As an important part of this

work programme we must also increase the digital

maturity of all organisations within our footprint . It is

particularly important that we focus on raising digital

maturity across the Core Capabilities, identified as key

in achieving paper-free working at point of care . This

will ensure organisations within our footprint collect

a broad set of useful data . This is vital, not only to

meet our requirement to share meaningful data about

individual patients, but also to allow us to transform it

into meaningful information, knowledge and wisdom .

It is therefore important that those organisations at

a lower level of digital maturity progress to a higher

level of maturity to ensure effective information

sharing, business intelligence and the opportunity for

footprint-wide analytics .

To help ensure that organisations use existing national

systems and capabilities to share information, 10

universal capabilities have been identified as targets

for health and care organisations, to support the

cross-organisation sharing of information . The

following diagram shows how these 10 universal

capabilities align with the Core Capabilities identified

in the Digital Maturity Assessment framework .

Initiative Description Core Capability Theme

Integrated Urgent

Care service

Provision of integrated 111 and Out of Hours service with the

provision of additional clinical hub, which places additional

expertise within the IUC service to support patients early in

order to direct the patient to correct service .

Decision support Increase data

and information

sharing

Neighbourhood

teams

Provision of information to teams working with patients at

home, to provide improved care delivery .

Records, assessments

and plans

Increase data

and information

sharing

Patient Online Providing patients with the ability to book GP appointments

online, order repeat prescriptions, view results online and view

clinical letters online .

Increase data

and information

sharing

Summary Care

Records, and SCR

to Community

Pharmacies

Providers able (with consent) to access nearly 900,000 SCR for

patients within Cambridgeshire and Peterborough, and have

access to millions of SCR of visitors, students etc . The provision

of SCR to community pharmacists is well underway .


and plans

Increase data

and information

sharing

Electronic Referral

Service

Nearly 80% of all referrals from GP practices to secondary care

are now done electronically via eRS . The new functionality

within eRS provides opportunities to add value to this process .

Transfers of care Interoperability

Health and Care

Network, network

integration,

provision of Wi-FI

to staff and the

public

Ongoing projects exist to join networks to allow staff to access

systems wherever they are, and to provide free public Wi-Fi

across the health and care estate .

Enabler Enabler

Hospital merger

and moves

IT changes consequent to GP practice mergers, secondary care

potential provider merger (Hinchingbrooke and Peterborough

Trusts), move of Papworth to Cambridge Biomedical site, all of

which provide digital opportunities to deliver services to staff

and patients in new ways .

Enabler Enabler

Support to delivery

of 7 day services

Provision of technical support to GP practices, 7 days per week . Enabler Enabler

Business

intelligence and

system monitoring

The introduction of tools such as SHREWD provides new ways

to view and monitor the delivery of health and care within the

footprint area .

Asset and resource

optimisation

Deliver real-time,

person-level

information to

improve financial

and clinical

performance

Use of health apps The EAHSN has brokered discussions between Trusts and

a number of health app providers, some Trusts are actively

trialling these apps for instance uMotif for Cardiology,

SmartCare CF for Cystic Fibrosis and Helicon Health for Stroke .

Choose Well Cambridge – available now gives patients advice

re the right level of care to access .


and plans

People powered

health and

wellbeing

7


24 25


There are a further two core capabilities -orders

and results management, and asset and resource

optimisation, for which there are no associated

universal capabilities, as these are focused more on an

individual organisation’s internal work processes .

In addition, there are a number of enablers which are

essential to delivering digital change; these include

supporting infrastructure, governance structures and

standards .

Some of the required changes to deliver our

ambitions sit within individual organisations and

others require system-wide changes across our

footprint . In some areas the changes are dependent

on national initiatives, or the actions of other partners/

neighbouring footprints . Our initial focus is on

delivering existing and planned commitments and

optimising previous investment . However, to ensure

a cohesive approach to delivery it is essential that we

consider all current and planned initiatives within the

context of our wider vision for change and digital

themes .

The following sub-sections begin with an overview of

planned initiatives in support of our digital themes .

Then we set out our plan of action to increase the

level of digital maturity within our footprint, and

finish with a summary of our delivery approach and

timelines for the core capabilities . These inputs (plus

our delivery plans for our enablers – covered in the

next section) are all part of our overarching plan to

deliver our digital vision .

7.2 - Delivery of our Digital Themes

Allowing health and care professionals within our

footprint to access and share information across care

settings is key to delivering our priorities for change .

It will help us in our ambition to build services around

our patients and allow us to address the care and

quality gap . A key enabler to this data sharing is

interoperability, that is, developing the technical and

data standards to enable transfer of information

between providers .

As described in our current capabilities section above,

a number of organisations share information with

patient and practice consent every day, through the

use of TPP SystmOne . This provides a patient-centric

record across all organisations using the system, with

access possible from external organisations .

Information is also routinely shared between 111/

OOH, GP practices, and community services . Other

organisations also share information in support of End

of Life Care initiatives . Summary Care Records, GP2GP

solutions, and eReferrals are all actively used across

Cambridgeshire and Peterborough .

Records, assessments and plants

Professionals across care settings made

aware of information on learning disability and

communication preferences

GPs can refer electronically to secondary care

Clinicians in unscheduled care settings can access child protection

information with social care professionals notified accordingly

Patients can book appointments and order repeat presriptions from their GP practice

GPs and community pharmacists can utilise electronic prescriptions

Professionals across care settings made aware of end-of-life

preference information

Clinicians in U&EC settings can access key GP-held

information for patients identified by GPs as most likely to present (in U&EC)

GPs receive timely electronic discharge

summaries from secondary care

Patients can access their GP record

Social care receive timely electronic

admission, discharge and withdrawal

notices from secondary care

Transfers of care

Decision support

Remote care

Medicines

management

and optimisation

Our Delivery Plan

Our Digital Themes

Our Enablers

Raising Digital

Maturity

Ten Universal

Capabilities

Interoperability


26 27


We have defined a plan of work which will increase our interoperability over the next 5 years . The following

diagram provides a view of the capabilities which will be enabled by our plan of work .

Some of these changes are enabled by the adoption

of open interfaces as they are released by suppliers .

Examples of technical developments that our local

health and care organisations are working to adopt

are described below:

GP Connect InitiativeThe GP Connect Initiative will standardise the way

INPS, Microtest and TPP integrate . Each principal

clinical system will integrate with a new Digital

Interoperability Platform, a NHS Digital Spine service

which any approved consumer system will also be

able to access .

This will provide access to patient information held in

GP systems, via the Digital Interoperability Platform .

Future developments will also enable all other systems

in other care settings to provide relevant information

through this route .

Nationally, GP clinical suppliers working with NHS

Digital (formerly HSCIC) will deliver this capability by

March 2017 .

Our aspiration is to use this information sharing

functionality to support the delivery of our services .

Transfers of Care - Hospital eDischargeCambridge University Hospitals and Papworth are

currently piloting the use of the AoMRC headings

for eDischarge, with a view to rolling this out across

the hospitals by December 2016 . The Cambridge

University eDischarge approach uses the national

Clinical Data Architecture (CDA) Standards, which

will provide the capability for the recipients to use

the discrete data contained within the eDischarge

notification within their own systems . Other acute

Trusts are adopting eDischarge standards and are

planning to deliver in line with national targets .

Acute CareOur priorities in this area include expanding access

to a patient portal, giving patients full access to their

records, as well as the opportunity to transact with

the hospital (for example, arrange appointments) .

Community CareWe also have plans to deliver web-based portals for

community clinicians to access records and consult

with clinicians regarding the care of patients .

Social Care RecordsBoth our Local Authorities are planning to replace or

upgrade their care records systems during the next

two years . These modern systems will allow for service

user accessibility and better interfacing with health

records . In addition, the ability to work remotely will

support a move to closer to real time information

capture and exchange .

Other Interoperability InitiativesOther interoperability initiative which will allow health

and care professionals within our footprint to access

and share information across care settings include:

• Care networks: Supporting the information

exchange required to allow staff access to

shared knowledge about patients across the care

network .

• Ambulance: Supporting EEAST develop its digital

transformation programme which includes

increased use of Summary Care Records (SCR) by

Ambulance staff, including access to enhanced

SCR, improvements in technical integration with

Emergency Departments and deployment of new

devices to allow ambulance staff improved access

to information . Supporting the development of

the EEAST clinical care hub and hear and treat

services .

• Integrated urgent care and clinical hub: An

integrated 111 and Out of Hours service with the

provision of access to additional clinical advice via

a clinical hub went live on October 2016 . This was

dependant on new telephony and clinical system

changes .

• Minor injuries units: Continue the process of

improving the mechanism to share (with patient

consent) clinical information .

• Embedded mental health: Supporting the

information requirements of clinical staff who are

working within police control rooms .

• Discharge: Improving discharge from hospitals

supported by improved access to information and

data .

• Ageing Well: Supporting the ‘eyes and ears’

approach where all NHS and council staff have

the means, information, authority and skills to

offer access or referral to additional services for

individuals they may encounter who are becoming

vulnerable .

• 24/7 standards: Continue to provide technical

support to service delivery 24/7 and where

necessary work to improve the support service

arrangements .

• Patient choice hub: Continue to support patient

choice through the use of the increasing

functionality being released via the Electronic

Referral System programme of work .

• Patient access to Maternity Records: Provided by

K2 Midwifery System in Peterborough .

Current State

Future State

End 17/18

Cap

abilities en

abled

by in

form

ation

sharin

g

End 18/19 End 20/21

Digital approach

Community Pharmacists can view

patients Summary Care Record

Patients are able to be transferred

electronically from secondary to primary

care

Social Care recieve data electronically

from health providers

Patients are able to book into other providers using

Electronic Referral Service/NHS UK

Patients able to access GP

records online

Patients able to access GP

records online

Health and Social Care using NHS

Number as patient /citizen identifier

Acute Pharmacy Teams able to check patients

medications online

GP records available to view in Unscheduled Care Settings

GP receive structured discharge

summaries from secondary care

Near real-time cross organisational

monitoring of system pressures

EoL Care Plans shared cross

health

Information Sharing

Agreement in Place

Integrated Urgent Care

Hub


28 29


As described in the overview of our interoperability

ambitions we are currently working to ensure

information sharing is routinely undertaken where this

is legally and technically possible across organisations

of all types . However, effective information sharing

also underpins our ambitions for digital change and

therefore further capability is planned . As described

earlier, our overarching vision for digital change is that

by 2020:

“Patients and Citizens, Health and Social care staff

will have access to quality, timely and accurate

information regardless of place or time to enable

improved decision making and ultimately better

outcomes for both the individual and the community.”

Our strategic approach to improve and simplify

data and information sharing is to implement an IT

platform which will allow (where appropriate and with

appropriate consent obtained) access to a number

of provider’s patient information systems . This single

view of the patient record will integrate primary

care, mental health, community care and social care

patient information via the NHS number . Initially we

will develop this for our urgent and emergency care

teams (NHS 111/Clinical Hub) and Joint Emergency

Team (JET) through hand-held devices, as well as in

Emergency Departments, where we will allow access

to core patient data about diagnoses, medication,

prior health encounters and resuscitation status to

help minimise inappropriate non-elective admissions .

Our ambitions in this area are to progress from

viewing information through to using structured

information, and onto using this structured

information to provide advanced decision support .

However, to ensure we share a complete set of useful

information, we must continue to make progress

in increasing the digital maturity of organisations

within our footprint . Where possible, this data must

be structured and use appropriate data standards . To

improve the quality and safety of the care we deliver,

and to support the decision making of our staff, this

shared information must be available in real time and

include care plans and patient preferences .

To help improve the health of the citizens within our

footprint, it is essential to engage people in their

own health and wellbeing . To facilitate this, we will

introduction a number of patient-focused initiatives,

including the use of health apps . Primary areas of

focus will be apps suitable for our ageing population

and those with long term conditions . These apps

will give advice about symptom significance and

management, and in some circumstances will foster

introductions to wider disease-specific patient self-

help circles . This project will be closely allied to the

STP’s Prevention Strategy and with that of public

health, local and district councils . Specific areas where

we have plans to introduce apps include:

• Prevention: Provision of health advice through a

variety of digital means will be supported locally,

including both national and local health and care

mobile apps .

• As described in our current progress section,

the EAHSN has brokered discussions between

Trusts and a number of health app providers . We

will continue to actively trialling these apps for

instance uMotif for Cardiology, SmartCare CF

for Cystic Fibrosis and Helicon Health for Stroke .

We will also continue to explore areas where

health and care apps can contribute to the health

and wellbeing of our patients and the wider

community .

• Psychological wellbeing . The Cambridgeshire

and Peterborough community of organisations

will continue to provide information about

services digitally . A local initiative undertaken

between the Integrated Urgent Care service and

Cambridgeshire and Peterborough Foundation

Trust to allow access to additional mental

health support via 111, is an example of this

commitment .

• Self-Care: Providing information and services to

support patients better manage their own long

term condition is already underway through a

variety of national and local digital means . These

technological aids are very likely to improve in

usefulness over the lifetime of the STP and LDR .

• ICU patient communication app: this app allows

ventilated patients to indicate how they are feeling

and what is concerning them . This is now being

developed to get it to a place where it could be

shared with other hospitals .

• NCCU patient diary: this app will collate

information into a patient diary for critical care

patients . This will give them some reference to

what happened to them whilst they were in

ICU . This approach has been shown to help with

reducing post-traumatic stress .

• Chronic pain diary: providing a secure, flexible

SMS-based chronic pain diary for use in routine

pain service clinics .

• Extend the roll out of MyChart to CUH patients:

this app is available to patients who have signed

up to the CUH Epic patient portal . It is currently

deployed in the Obesity service and is being rolled

out to Oncology . This app is written by Epic .

We will use innovative technology to transform the

way we deliver care . In partnership with providers of

tele-health and monitoring equipment we will develop

virtual outpatient wards in certain disease specific

groups . A range of wireless enabled devices will be

used to give both active patient monitoring during

exacerbation (e .g . COPD), and patient reassurance

and security when they are isolated . We outline some

of our ongoing initiatives below .

• Housing and Business . Community plans to work

with partner organisations and housing developers

to deploy smart technology that promotes

independence for older people as well as wider

benefits of active lifestyle .

We will also explore the possibilities of working

with other partners to facilitate innovation . In this

area we can engage The Eastern Academic Health

Science Network (EAHSN) to provide a brokerage

service between our organisations and innovators .

This approach may identify additional innovative

solutions . A small element of non-recurrent funding

is also available to support initial adaption and

implementation of innovations . Alongside this, the

Eastern AHSN can provide enabler support in the form

of service improvement methodology and networking

to support the implementation phase .

In addition, as part of feasibility studies for new

technology, the associated service changes can be

modelled using a Scenario Generator provided by

SIMUL8 Healthcare, in conjunction with EAHSN . This

will enable areas for improvement to be identified,

new ideas tested out and, most importantly, allow

us to understand the impact of a change without

taking any significant unnecessary risks . The Scenario

Generator is a simulation tool which works by

generating a virtual population with the demographics

of an actual population, and with conditions which

are randomly allocated, in line with known prevalence

data .





30 31


We will create a platform to analyse data on capacity

within the system, and person-level operational

data on utilisation, cost and potentially even

outcomes, which will be used in real time to help

providers manage their resources . This will allow

both monitoring of the day to day status of services

within the health and care system, but also system

surveillance of financial and clinical performance .

We will adopt a population-based approach to health

analytics, which will enable us to track patients across

the system, particularly those with poor outcomes and

incurring high costs, with the aim of understanding

what we could change to improve the way we provide

care . This will also allow us to predict who to target

with intensive proactive case management . It will be

imperative to turn population data into information

that allows for intelligent patient insight and effective

decision making . This data will also enable the

tracking of progress of new care initiatives, and

monitoring of their impact .

Our ambition is to create a data source which can be

used to proactively identify issues in service delivery

or clinical outcomes . We are currently scoping a

partnership with Datalytics on the development

of an information platform development for

activity modelling, risk stratification, prediction and

simulation .

There is also an opportunity to work with partners

such as the Academic Health Science Centre and

Cambridge University Health Partners to develop

a technology platform to connect real world data

for research, subject to appropriate information

governance and consent .

This approach gives an opportunity for example:

• to support improved pharmacology vigilance as

follow up to drug trials

• identification of multiple uses for drugs

• improved understanding of patient disease

progress based on machine learning

• analysis of pathways to improve primary and

secondary care prevention

7.3 - Summary of Projects to Deliver Our Digital Themes

The following table summarises the projects which are proposed to be managed through the LDR lifecycle with

input from all participating organisations .

Improvement Area Project Due Date Theme or enabler

Direct cross

community Care

Paper Free at Point of Care 31 .03 .20 Enabler

Shared multi agency patient / citizen record 31 .03 .18Provide a shared health and

care record

Patient and citizen held records (including

summary care records, end of life records,

special patient notes, mental health crisis plans,

and pharmacy access to care records)

31 .03 .18Provide a shared health and

care record

Organisational change opportunities (Merger,

relocations etc .) 30 .03 .21 Enabler

Information Quality improvement . NHS number

use 31 .03 .18 Enabler

Secondary Use

Health analytics, real time system monitoring 31 .03 .18

Invest in health analytics

to support whole systems

intelligence

Pseudonymisation at source 31 .03 .18



intelligence

Business Intelligence use of data 31 .03 .18



intelligence

Investing in People

Digital skills for professionals 31 .03 .20 Enabler

Digital skills for citizens and patients 31 .03 .20Engage, educate and

empower our patients

Patient Online including remote patient access

to health and care services31 .03 .20

Engage, educate and

empower our patients

Technology and

Infrastructure

Shared Wi-Fi, infrastructure for professional and

citizen – all health and care locations *31 .03 .18 Enabler

Telecommunication sharing 31 .03 .18 Enabler

Health and Social Care Network development 31 .03 .18 Enabler

Mobile and remote working for professionals * 31 .03 .18 Enabler

Digital opportunities ( tele medicine, tele

monitoring, GS1, remote monitoring, internet

of things)

31 .03 .18

Invest in innovative

technology to support our

vision

Standardisation of shared investments 31 .03 .18 Enabler

Develop Cyber Security 31 .03 .18 Enabler

* Initial accepted bids for the Estates Technology and Transformation Funding (supporting Primary Care)





32 33


7.4 - Increasing our Digital MaturityTo deliver our ambitions we need to ensure that all

information relating to a patient’s care is recorded

online . This means we must increase our digital

maturity and achieve the paper-free at point of care

targets outlined in the Five Year Forward View .

7.4.1 - Records, Assessments and Plans Programmes to replace patient record systems

for Hinchingbrooke and Papworth Hospitals are

underway; this will enable increased data coverage

and capability for patient access to records and data

sharing .

National initiatives for access to the child protection

register at point of care, and access to the summary

care record at point of care are part of the work plan

to improve maturity in this capability .

All acute hospitals will implement access for their A&E

clinicians to see local GP records and care plans by

2017/18 .

New social care systems for both Adult and Children’s’

services are planned by 2018/19, and these will enable

integration through use of the NHS number, and

interoperability to receive hospital discharge notices .

7.4.2 - Transfers of Care Organisations will work to meet targets for use of the

national e-Referrals system, provision of standardised

electronic discharge summaries and use of the

Summary Care Record .

Additional infrastructure such as integration engines

will be implemented, where necessary . Appropriate

national and local data sharing agreements will be

required to deliver the transfer of care agenda .

7.4.3 - Orders and Results Management The organisations which are upgrading their patient

record systems will improve their digital maturity in

this area once the requests and results functionality

is rolled out, together with integration with their

laboratory services providers .

The community provider will also benefit from access

to existing electronic orders and results systems in

2016/17, ahead of a shared record platform .

Replacement of the local PACS imaging solution

at Papworth Hospital, with the regional PACS

in 2016/17, will improve capability for image

interchange .

7.4.4 - Medicines Management and Optimisation All Acute Trusts have plans to implement electronic

prescribing and medicines administration, in line with

their current EPR programme schedules through to

2018/19 .

In 2017/18, the Out of Hours service is planning to

implement SystmOne electronic prescribing, which is

already implemented for GP users .

Community pharmacies will be given access to the

national shared care record in 2016/17 .

7.4.5 - Decision Support Peterborough and Stamford Hospitals and

Hinchingbrooke Hospital will implement Nervecentre

in 2016/17, which will provide access to clinical

observations and real time alerting .

The child protection information sharing system will

become available to social care providers in 2017/18 .

The use of data from across the footprint for whole-

system business intelligence will be facilitated by the

delivery of the national technical solution for de-

identified patient level data sets in 2017/18 .

7.4.6 - Remote Care Mobile working across community and social care is

planned through 2016/17 and 2017/18 .

The Connecting Cambridgeshire programme will

provide 95% coverage of super-fast broadband

by 2017/18, which will facilitate the use of mobile

devices, particularly in community and social care .

Out of hours services will implement a new mobile

working solution in 2019/20 .

Telemedicine services will be developed and extended

through 2017/18 and 2018/19 .

7.4.7 - Asset and Resource OptimisationUse of asset management and GS1 for real time asset

location is planned for all acute organisations .

Real time analytics from a shared record platform

will be able to be used for near real time cross

organisational monitoring of system pressures .

7.5 - Digital Maturity – Our Future TrajectoryWe have estimated the effect of planned progress against the core capabilities for the Digital Maturity

Assessment, and expect to move forward across the Cambridgeshire and Peterborough footprint, as shown

below . NB . Includes Herts Urgent Care

Average scores across providers

Capability groupBaseline score (Feb 16)

Target (end 16/117)

Target (end 17/18)

Target (end 18/19)

Records, assessments and plans 56 .3 62 .3 71 .6 77 .5

Transfers of care 65 .6 70 .3 76 .1 82 .5

Orders and results management 58 .3 63 .2 71 .5 78 .7

Medicines management and optimisation 37 .3 40 .2 59 .2 83 .6

Decision report 57 .4 62 .6 75 .4 84 .9

Remote care 24 .9 41 .5 51 .7 77 .5

Asset and resource optimisation 59 .1 70 .0 73 .8 82 .8

90.0

80.0

70.0

60.0

50.0

40.0

30.0

20.0

10.0

0.0

Ave

rage

sco

res

acro

ss p

rovi

ders

Baseline score Feb 2016

Target end 2016/17

Target end 2017/18

Target 2018/19

Records, assessments and plans

Transfers of care

Orders and results management

Medicines management and optimisation

Decision support

Remote care

Asset and resource optimisation


34 35


7.6 - Delivering the 10 Universal Capabilities

The following summary describes some of the

initiatives in progress and planned to meet the 10

nationally required universal capabilities . We have

made good progress in many areas, for example:

• Patients can access their GP record

• GPs can refer electronically to secondary care

• GPs receive timely electronic discharge summaries

from secondary care

• GPs and community pharmacists can utilise

electronic prescriptions

Additional work is required to deliver the following

by 2018, but plans are in place and the partner

organisations have committed to the delivery of the

universal capabilities by the end of March 2018 .

• Social care organisations receive timely electronic

assessment, discharge and withdrawal (ADW)

messages from secondary care . (Implementation

of ADW messages does require action by both

acute trusts and social care . There will be the need

for social care systems to be able to receive and

action these ADW messages . The expectation is

that in upgrading and or replacing current social

care systems this provide this functionality, subject

to investment in APIs and change management

activities)

• Clinicians in unscheduled care settings can access

child protection information

• Children’s services professionals are notified of

unscheduled care attendance

• Clinicians in U&EC settings can access key GP-held

information for patients identified by GPs as most

likely to present (in U&EC)

• Professionals across care settings made aware of

end-of-life preference information

• Professionals across care settings made aware

of information on learning disability and

communication preferences .

A detailed summary of our progress against each universal capability is shown in the table below .

Ref Key requirement Initiative programme Implementation Date Status

A

Professionals across care settings can access GP-held information on GP-prescribed medications, patient allergies and adverse reactions

Summary Care Records

2016-2018

Locally already achieved - 111/ OOH, MIU, Ambulance, Emergency Departments and Acute Pharmacies can access this information from SCR .

Community pharmacy access to SCR is part of the national project

There is a need to build upon ability to view already in place, to encourage active use . Also to interface this information within key systems in use across the LDR area to present information in the users primary system

B

Clinicians in U&EC settings can access key GP-held information for patients identified by GPs as most likely to present (in U&EC)

111/OOH Procurement – Integrated Urgent Care

ED access to GP held information (SystmOne / EMIS)

GP information within ED system

Emergency department can access all GP information . The new Integrated Urgent Care system will enable access to GP held records, no plans to restrict to cohort of patients most likely to attend

NHS Digital to confirm roadmap for suppliers to complete GPSOC

Pairing Integration Assurance Process .

Active

Some access available .

Subject to system providers completing GPSOC

CPatients can access their GP record

105 practices (SystmOne and EMIS Web)

Complete

From April 2016 all GP practices can offer access to coded data to patients

Active . As outlined in GP contract requirements

DGPs can refer electronically to secondary care

Electronic Referral System

Technically complete

Further activities to promote use of eRS will continue .

Active

Currently 70% bookings from GP to secondary care via eRS

Aim to increase use of eRS during 2016 to 80%

E

GPs receive timely electronic discharge summaries from secondary care

Secondary care send discharge summaries electronically

Use of coded discharge summaries (EMIS Web and TPP SystmOne can technically receive coded discharge summaries)

Any electronic format Completed - 1 October 2015

Format using AoMRC Headings

Completed - December 2016

CDA document messaging standard target Q4 2018

Active

CDA structured messages dependent upon secondary care ICT supplier compliance, e .g .CUH CDA capability will be delivered in 17/18


36 37


Ref Key requirement Initiative programme Implementation Date Status

F

Social care receive timely electronic assessment discharge and withdrawal notices from secondary care

Social care services currently receive information electronically

Transfer of information electronically is in place at most Trusts . Details not routinely collected .

Active

Baseline information being gathered

G

Clinicians in unscheduled care settings can access child protection information with social care professionals notified accordingly

Implementation of Child Protection Information System

2017/18

NHS organisations committed to use CPIS . Implementation scheduled for Cambridgeshire and Peterborough Q1 17/19

Active . PCC and CCC leading

Dependent on resource availability

TPP SystmOne due to be compliant end of 2016

H

Professionals across care settings made aware of end-of-life preference information

Variety of methods in place to share end of life preference information .

End of Life Dashboard in place . Used by over 60 practices .

End of life information is a special note in GP systems available for access from ED, Urgent care and Acutes .

Active

Continue to support roll out to GP practices

I

GPs and community pharmacists can utilise electronic prescriptions

EPS R2EPS R2 roll out due to complete 2017/18

Active

100% GP practices EPS R2 compliant

60 plus community pharmacies receive EPS R2 data

Possible EPS Phase 4 early adopter

JPatients can transact electronically with their GP practice

Booking appointments

Repeat prescriptions

Access to summary record

Technically completed

Active

Work to communicate and encourage increased usage

Ref Key requirement Current resource Future resource

A

Professionals across care settings can access GP-held information on GP-prescribed medications, patient allergies and adverse reactions

SCR use will continue to be supported by individual organisations

As part of sharing initiative use of enhanced SCR may be subject of funding proposal .

B

Clinicians in U&EC settings can access key GP-held information for patients identified by GPs as most likely to present (in U&EC)

Integrated Urgent Care Implementation Team (dedicated funded project team, funded clinical lead etc .)

Trusts have access to view of GP record .

Once initial IUC implementation completed programme of work up to April 2017 .

C Patients can access their GP record

CCG has allocated staff resource both to the technical enablement of GP practice systems (completed) and also supporting GP practice staff offer and enable online access to patients

CCG to continue to provide support resource to enable GP practices help patients access their GP record

DGPs can refer electronically to secondary care

All GP can electronically refer to secondary care .

CCG has a dedicated eRS resource to support patients, practices and Trusts use eRS more effectively .

GP Practices and Trust are committed to achieving 80% of all referrals via eRS

CCG continues to fund eRS resource

EGPs receive timely electronic discharge summaries from secondary care

All Trusts currently send some or all of their discharge summaries electronically

Work to understand the timeliness of this is underway

Trusts continue to improve timeliness of electronic discharge summaries .

The following table gives a further insight into the continued resource commitment required to deliver the

Universal Capabilities .


38 39


Ref Key requirement Current resource Future resource

F

Social care receive timely electronic assessment, discharge and withdrawal notices from secondary care

Trust send a proportion of ADW messages electronically

Trusts committed to the continued improvement in the percentage of ADW message sent electronically .

G

Clinicians in unscheduled care settings can access child protection information with social care professionals notified accordingly

Trust have sent formal notification to national CPIS team intent to implement CPIS

CCG is working with national CPIS representatives to understand implementation issues and support measures to introduce CPIS locally

Potential funding sources to support local authorities implement CPIS are being identified

Once confirmation of CPIS availability, implementation and training resources will be identified for participating organisations .

HProfessionals across care settings made aware of end-of-life preference information

Trusts providing data electronically to support dashboard

CCG has staff resource working with GP practices to use EoL dashboard

CCG continues to support EoL dashboard

IGPs and community pharmacists can utilise electronic prescriptions

CCG has dedicated resource supporting EPS R2 implementation

Continue to support EPS R2 roll out

JPatients can transact electronically with their GP practice

CCG has provided support to practices to enable patients to transact with GP practices (Patient Online)

Enabling Our AmbitionsWe recognise that delivering capability in line with our

digital themes and increasing our digital maturity is

only part of the story . We must also have in place the

necessary infrastructure, governance and standards .

In addition, we need to ensure our workforce, patient

and carers have the necessary skills to use our digital

information and tools .

8.1 - InfrastructureTo build the digital future we outlined in our

ambitions, we require firm foundations . Below we

outline the infrastructure required to underpin these

changes .

• General practice at scale: The technological

changes, information exchange, new digital

services are already being deployed to support

the delivery of General Practice work at scale .

A number of partnerships, federations, mergers

have been supported technically, and these

developments will continue to be supported . The

ease of implementing these changes is facilitated

by technical decisions made over several years,

which anticipated this requirement .

• Acute consolidation: The merger of

Hinchingbrooke and Peterborough Trusts and the

move of Papworth Hospital provide opportunities

for digital transformation, which the respective

organisation and wider community are working

to achieve . Work continues to support the greater

integration and merger of Peterborough and

Stamford Hospitals NHS Foundation Trust with

Hinchingbrooke Health Care NHS Trust by April

2017, and the move of Papworth Hospital NHS

Trust to the Cambridge University Hospitals (CUH)

site .

• Back office: A number of systems have already

been deployed to allow organisations to work

collaboratively and reduce some back office costs .

As the ongoing work to examine opportunities for

back office teams to work collaboratively identifies

further opportunities, the technical changes and

system changes required will be delivered

• Other partnership development will also be

supported with technological and digital

developments, including provision of systems and

services to aid voluntary sector delivery of services .

For example, access to secure email exchange

services, community connectivity etc .

• Neighbourhood teams: We will continue to

support and increase the provision of equipment

and access to information for these community

based teams .

• Community experts: We will deploy the technical

changes to allow the neighbourhood teams to

access advice from community experts .

• Sharing knowledge: We will continue the roll out

of secure access of their care records to patients as

well as providing staff access to online information

resources .

• Embedded mental health: Supporting mental

health staff work within primary care . For example

the PRISM scheme is supporting mental health

professional’s work with GPs and within GP

practices with the mental health staff being able

to access mental health clinical systems from

within the practice .

• Other service changes supported by access to

information will also be undertaken to support the

development of care hubs .

• Infrastructure investment will be required to

support the new or continued implementation

of systems within health and social care

organisations, including EPIC at CUH, CCC and

PCC (local authorities) replacement of adult and

children’s systems, ePrescribing implementations

etc . PCC is considering closer alignment of adult

social care system with CCC .

• Meeting ICT requirements, as set out in national

contracts, e .g . electronic standard format

discharge summaries by December 2016 .

8


40 41


8.3.1 - NHS Number ComplianceAll statutory health and social care organisations within Cambridgeshire and Peterborough use NHS Number

as one of their patient or citizen identifiers . For NHS organisations, this is the primary patient identifier for

correspondence .

All statutory organisations are committed to the use of NHS Number as primary identifier and to include it

within all correspondence etc . by 2017/18 where this has not yet been achieved .

Take up of and use of NHS Number is a measure within the Digital Maturity self-assessment . The reported

compliance across the footprint is shown below .

Other providers of patient and citizen services are

contractually required to use NHS Number in all

correspondence etc . However, gaps may exist within

the third sector where small organisations provide

specialist support to patients and citizens . At present

a record of use of NHS Number by all the small

providers of services is not centrally recorded .

To improve the use of NHS Number, and meet the

2017/18 target, partner organisations are committed

to improve their ability to verify the NHS number

automatically, and to include this in all electronic

correspondence . To that end, CCC is replacing current

social care systems (Cambridgeshire County Council

Adult Social Care Implementation – Mosaic 2017/18),

and one area of anticipated improvement is the

automatic validation of NHS Number . Peterborough

City Council also has plans to replace its current adult

social care record system within similar timelines . A

project is underway to create a children and families

multi-agency portal within the Children’s Social Care

record, which will also support improved coverage of

NHS Number .

Use of the NHS number is part of contracts with

smaller providers, and the improvement path in NHS

Number uses will be monitored as part of this process .

The above steps will improve and reduce the

gaps where they exist in NHS number use, with

organisations committed to meet the 2017/18 target .

Further initiatives are in progress or required to meet

the needs of the following drivers:

• Primary Care GP IT . Implementation of IT elements

of GP Five Year Forward View, GPSOC changes,

GP IT Operating Model, GP contract requirements .

2016 onwards

• Supporting ICT elements of the multiple GP

practice mergers, federations, extensions, moves

and creation of brand new practices . Planned for

2016/17 onwards .

• Better Care Fund Data Sharing programme

2016/17 priority schemes:

• Neighbourhood team fast track pilots .

• Sharing access to existing systems .

• Eyes and ears / Indicators of vulnerability

• Information governance .

8.2 - Mobile Working

An effective mobile working infrastructure is required

to fully exploit the Paper-free at the Point of Care

capabilities . The organisations within the footprint

have identified a number of projects required to

improve mobile working capability, particularly for

community-based staff .

Our approach is to ensure our staff have access to

appropriate devices and user interfaces are tailored to

the device in use . We also take account of potential

connectivity issues and put in place processes for

mobile device management . We recognise that mobile

working is not just about providing working devices, it

is also about the transformation of working practices .

Our approach to mobile working will not only mobilise

professionals within their normal place of work, but it

will also provide them with the ability to work in other

care settings . These include patient homes, residential

homes and other potential touch-down points across

the community .

8.2.1 - Mobile InfrastructureThe current status of the mobile working

infrastructure is varied across Cambridgeshire and

Peterborough . In part, the current use of mobile

technology outside of health and care sites is limited

by the commercial infrastructure (Wi-Fi and mobile

mast provision) . While the respective broadband

initiatives undertaken by partner local authorities are

increasing access, there remain gaps in provision .

• A number of providers have confirmed that they

have plans to further develop their mobile working

infrastructure and these are described in the

capabilities deployment schedule .

• Current system-wide initiatives to develop the

mobile working infrastructure are being led

by the respective local authorities . Further roll

out of the Connecting Cambridgeshire and

Peterborough City Fibre initiatives will deliver

high-speed broadband across Cambridgeshire and

Peterborough .

8.3 - Standards

The use of data standards is essential for effective

information sharing . This section reviews the current

level of compliance with relevant standards across the

footprint .

Organisation90% plus NHS Number usage

on correspondence

Plan to Achieve 90% plus NHS

usage by 2017/2018

CUH Complete Complete

Papworth Complete Complete

GP practices

PSFHT

CPFT

HHCT

Cambridgeshire County Council

Peterborough City Council

Independent Providers


42 43


8.4.2 - Shared InfrastructureWhere practical we will share infrastructure across the

local health and care system . This has the potential

to not only provide benefits in terms of cost savings,

but may also enhance the opportunity for data and

information sharing .

A number of NHS organisations and elements of

independent providers and local government already

share physical sites and infrastructure . Shared estate

work, under the maximising public estates work,

has also necessitated the sharing of networks and

telephony infrastructure . The sharing of this type of

infrastructure is almost routine .

Cambridgeshire County Council provide access to

social care systems to people in other organisations

(with appropriate safeguards in place), to ensure that

they can see relevant data, in order to make the best

possible decisions .

Papworth plan to implement a hybrid cloud solution

in 2018 . This will integrate its local IT infrastructure

with cloud services .

The development of shared data centres, or joint call

centres is currently under investigation .

8.4.3 - Governance Our ambition is to share more efficiently and

effectively . With appropriate consent and security

arrangements in place, collaboration and sharing of

information can take place regardless of organisation

or place . Cambridgeshire and Peterborough

have a well-established multi-agency Information

Sharing Framework, maintained by Cambridgeshire

County Council on behalf of organisations within

Cambridgeshire and Peterborough . All key local

health and social care organisations have signed

this agreement . However, although the majority of

major statutory organisations are signatories to this

agreement, not all providers are . In general, the

providers yet to sign the agreement tend to either be

very small organisations or provide limited services

to Cambridgeshire and Peterborough patients and

citizens .

Smaller organisations are being encouraged to

complete reduced Information Governance toolkit

assessments . Some smaller organisations have

also been sponsored and supported by larger local

organisations, so that they can operate within the

technical and governance arrangement of the larger

sponsor organisation . This approach is likely to

continue until simplified compliance measure are

developed and approved at a national level .

A consent model is being developed under the Better

Care Fund arrangements to cover information sharing

between health and social care systems, both at a

personally-identifiable level for the purpose of direct

care delivery, and at a pseudonymised or aggregated

level for the purpose of risk stratification and demand

profiling .

8.5 - Digital Skills

We recognise that digital literacy and digital inclusion

are key enablers of our digital vision . To address these

areas, we have launched the following initiatives:

• Digital skills for professionals

• Digital skills for citizens and patients

These initiatives will also take account of our equalities

obligations, both in terms of the Equality Act 2010

and section 14 of the NHS Act 2006 .

8.3.2 - SNOMED-CT Cambridgeshire and Peterborough organisations will

rely on system supplier roadmaps for the adoption

of SNOMED-CT to support the direct management

of care . CUH is already SNOMED-CT compliant .

Papworth will be compliant in June 2017 . SystmOne

is targeted to support SNOMED from 2018, however

there are indications this may be delayed .

8.3.3 - Dictionary of Medicines and Devices (DM&D)Systems will provide DM&D compliance as part of the

roll-out of e-Prescribing functionality . CUH already use

the DM&D, Papworth will use DM&D from June 2017 .

SystmOne and Emis both use DM&D .

8.3.4 - Other StandardsWe anticipate the publication of national Information

Governance Alliance documents in 2016, which will

include new standards in relation to pseudonymisation

and anonymisation . We will include compliance with

these standards in a future version of the LDR plans .

We will continue to take forward the requirements

from the Health and Social Care (Safety and Quality)

Act 2015 .

8.4 - Collaboration

In line with our focus on partnership described in

our vision, we believe it is essential that health and

care professionals from different organisations are

able to collaborate . We have a blended approach to

collaboration, which takes account of infrastructure,

governance and transformation . This system-wide

view will allow more effective prioritisation, the

targeting of resources, increased opportunities

for joint initiatives, common solutions and shared

expertise . It will also allow more effective decisions on

where in the system benefits should be realised . We

explore how we will achieve collaboration below .

8.4.1 - Unified communications It is essential that health and care professionals from

different organisations are able to collaborate, and

this requires a unified approach to communications .

To enable this communication we must improve our

current infrastructure, including telephony and email .

During the lifetime of the LDR local NHS organisations

will all be using NHS Mail 2, as either their only email

system or as a principal clinical communication tool .

At present it is unknown if NHS Mail 2 will be

extended further into social care, the third sector

etc . If this was allowed nationally this would provide

significant opportunities for collaboration . A request

for clarification of NHS Mail plans for this has been

raised, and we await a response .

There is already a small measure of telephony

collaboration between some partner organisations .

The opportunities provided by the new range of

telephony solutions, including hosted telephony, are

starting to provide options for greater cooperation .

Papworth and CUH have a planned telephony

collaboration with the intention of putting in place

a unified telephony service by April 2018 . CPFT

has introduced a Single Point of Access call centre

which provides a one contact route for patients to

all its services . It is expected that during the latter

part of 16/17 greater examination of the options for

telephony collaboration will be undertaken .

We also have ambitions to harness the power of

digitally enabled communications, including instant

messaging, video and web-conferencing, presence

solutions, and enterprise collaboration tools . The Health

and Social Care Network will be an enabler of this in

the future . It is expected that organisations will utilise

the new functionality that NHS Mail 2 provides to

support instant messaging, presence information etc .


44 45


The eight commitments made in the MoU include:

1 . One ambition: to return Cambridgeshire and

Peterborough to financial, clinical and operational

sustainability by developing an Accountable Care

Organisation (ACO), acting as a single leadership

team, with mutual understanding, aligned

incentives and coordinated action with external

parties (e .g . regulators)

2 . One set of behaviours: all Partners agree explicitly

to exhibit the beneficial behaviours of an

accountable care system

3 . One long-run plan: collectively responsible for

delivering the STP and capturing the saving

opportunities identified . We believe in the plan we

have submitted

4 . One programme of work: all system projects will

be aligned to the HCE, and under supervision of a

delivery or design group

5 . One budget: within NHS contracting, a number

of financial incentive design options will be

considered

6 . One set of governance arrangements: the HCE

and the groups reporting to it (AEB, the CAG (and

strategic sub-committees), the FD Forum and the

eight Delivery Groups), will be the vehicle through

which system business is conducted

7 . One delivery team: resources are in place to deliver

the STP

8 . One assurance and risk management framework:

Crucial to strengthening trust and creating a sense

of shared accountability, will be evolving the HCE

from a forum for making strategic decisions, to

one where Partners can be assured of the delivery

of System-wide improvements

9.3 - System Wide vs Local Approach

We have set the following processes in place to

balance the requirements of local organisation

projects and system wide projects . The proposed split

of work between system and organisational business

will be agreed by the HCE, with new work not

starting without HCE ratification . The proposed split

of system work between what is undertaken once

across Cambridgeshire and Peterborough, and what is

undertaken on an area-basis will be according to:

• Phase of project life cycle: design projects must be

done once across C&P

• Locus of relationships: delivery projects should be

local where vertical relationships dominate, and

C&P-wide where horizontal (for example across

acute trusts) relationships dominate

• Subsidiarity: change happens bottom-up, and

neighbourhoods across C&P differ significantly

Each System project will have a CEO Sponsor and a

named Senior Responsible Officer (SRO), at executive

level . Each system project will have a delivery objective

– a savings, activity shift or quality improvement target

(or a combination), and delivery date . Some system

projects will have an agreed investment plan . The

collective impact of system projects will be measured

against an agreed definition of success .

Our Digital Delivery ApproachThis section describes our approach to delivering

our plan . It includes an assessment of our leadership

capabilities, an overview or our governance structures,

and highlights the importance of the transformation

aspects of delivering our digital vision .

9.1 - Leadership

There are significant and high levels of digital

leadership, clinical engagement and governance

within the organisations across Cambridgeshire and

Peterborough . This is evidenced by the assessment of

these factors through the recent Digital Maturity Self-

Assessment surveys and by the membership of the

Sustainability and Transformation Programme .

We also have several cross-organisational groups

and initiatives that provide significant high level

organisational input and leadership . These include,

but are not limited to, the Better Care Fund

arrangements, the Vanguard initiative (now part

of the wider STP process), Integrated Urgent Care

programme and implementation project . Most, if not

all, cross-organisational changes have senior staff in

digital leadership and direction roles .

We recognise the crucial part that chief information

officers, chief clinical information officers and others

play at board and senior levels in local organisations in

leading the delivery of this agenda . This is reflected in

the setup of our Health and Care Executive, and the

governance structure of our delivery group, which is

described in the section below .

9.2 - Working Together

As described in this Local Digital Roadmap, the

local health economy within Cambridgeshire and

Peterborough CCG has agreed a single Sustainability

and Transformation Plan (STP) for 2016 – 2021, which

was submitted to NHS England and NHS Improvement

in October 2016 . In order to deliver this plan we

must manage risk (financial, operational, quality and

reputational) through a number of jointly agreed

commitments (outlined below), to which our partner

organisations have agreed . The most important of

these commitments relate to a new set of behaviours

intended to build long-standing, trusting relationships

that replicate those of an accountable care system .

These behaviours are outlined in the newly agreed

Cambridgeshire and Peterborough STP Memorandum

of Understanding (MoU) between organisations .

9


46 47


9.4.3 - Cross-cutting Strategy GroupsThere will initially be three cross-cutting Strategy

groups: Sustainable General Practice, Parity of Esteem/

Mental Health, Ageing/ BCF .

These groups will be responsible for steering/quality

assuring projects that span multiple delivery groups

and, in particular, implementing the GPFV, MH

Taskforce and BCF . They may develop business plans

for future savings and investments that pertain to

more than one project group, across multiple delivery

groups .

9.4.4 - Quality Assurance GroupsWe have two quality assurance groups . The Care

Advisory Group (CAG) is responsible for reviewing

care model design proposals from the delivery groups,

horizon scanning for innovations and reconciling any

differences . The Financial Performance & Planning

Group, will develop a framework for contracting and

incentives, aligning planning assumptions, quality

assuring savings and investment proposals, and

tracking savings progress .

9.4.5 - The System Delivery UnitTo ensure pace and a system-wide focus, the HCE has

agreed to establish a new small central team, called

the System Delivery Unit (SDU), which will:

• maintain a long term strategy for developing

the beneficial behaviours of an accountable

care system, updating the work programme as

required, and updating national bodies as required

• ensure partner behaviours put the system above

organisational interest, where the system gains

would exceed individual losses

• manage interdependencies across a wide range of

improvement areas

• support individual organisations to ensure that

local investments in digital capability are aligned to

the LDR and the STP

• provide the necessary support and challenge to

diagnose new problems, design suitable solutions,

demonstrate what changes work in practice and

to spread solutions so they become engrained in

day to day practice

• track performance, quality and financial metrics

using a balanced scorecard, and monitor

implementation of the delivery plan

• promote a common set of approaches to

improvement and widespread adoption of

improvement techniques, as part of developing a

shared culture of learning

• link closely to new care models described in the

Five Year Forward View, and consider how the

application of the new care models form part of

the medium term solution for this local health

economy

• engage with staff, patients, service users and the

public to develop solutions .

The Unit will have teams, of mixed background and

seniority, working on the following:

• Developing and maintaining the system’s long

term plans

• ostering system leadership and a quality

improvement culture (including the use of tools

like Right Care)

• System-wide financial modelling and population

health analytics to support delivery planning,

tracking benefits realisation and evaluation

• Programme delivery and oversight, including

ensuring other aspects of the STP are on track

and, in particular, ensuring the strategies for key

enablers (digital, workforce, culture/ organisational

development, and estates) are supporting of the

STP’s vision for Cambridgeshire and Peterborough .

9.4 - Governance

As part of our approach to sustainability and transformation we have rationalised the governance structures

within our footprint . Our new governance structure has been designed to address the need for balance

between local and system-wide requirements, and is shown in the diagram below .

9.4.1 - Area Executive Boards (AEBs)

There are three Area Executive Partnerships / A&E

Delivery Groups):

• Greater Peterborough

• Hunts & Fens

• Cambridge & Ely

Each AEB is responsible for ensuring implementation

(including savings realisation), where a common

design can be tailored locally . Supervised projects

will be a mix of proactive care (e .g . integrated

neighbourhoods), and reactive care (e .g . in-hospital

flow, attendance avoidance) . The AEB also fulfils the

nationally defined responsibilities of A&E Delivery

Groups, with a Part A/Part B structure and two

chairs . The Terms of Reference of the AEBs are being

developed by the COOs . AEBs are responsible for:

• monitoring local implementation

• collating feedback from each locality on adequacy

of implementation of C&P wide improvement

projects

• identifying new local issues for HCE consideration

9.4.2 - Delivery GroupsThere are eight delivery groups:

• Care pathways: UEC, Elective, Primary Care &

Integrated Neighbourhoods, Women & Children

• Enablers: Workforce & OD, Digital

• Shared Services

• System Delivery

Each delivery group is responsible for ensuring

implementation (including savings realisation)

of design projects and delivery projects, where

implementation needs to happen consistently

across the patch . Each project will require a savings

and investment plan, which will also identify the

anticipated benefits associated with the project,

including those which are cash-releasing . Some

projects will be associated with The Carter Review

or the Better Care Fund, and progress will also be

reported to national bodies . Delivery groups will

horizon-scan – identifying future opportunities

consistent with the objectives of the STP . Further detail

regarding the role of the Digital Delivery group is

included later in this section .

HWBs x 2

Care advisory group

Shared Services Delivery GroupPrimary Care & Integrated

Neighbourhoods Delivery Group

Digital Delivery GroupUrgent and Emergency Care

(UEC) Delivery Group

Workforce & OD Partnership Board

Elective Delivery Group

System Delivery Unit (SDU)Women & Children’s

Delivery Group

Mental Health Strategy Group

Ageing Well Strategy Group

Sustainable General Practice Strategy Group

Financial Performance & Planning

Group

Regional bi-partieIndividual Boards x 7 Council Committees

Area Executive Board (AEB)/ A&E Delivery

Boards

HCE (Independent Chair, CAG Chair as deputy

49

Cambridgeshire & Peterborough - Local Digital RoadmapCambridgeshire & Peterborough - Local Digital Roadmap

48

9.6 - Measuring our success

9.6.1 - Monitoring Our Implementation PlanThe System Delivery Unit is responsible for monitoring

implementation of the STP plan and giving assurance

to the HCE about delivery of the plan . The SDU will

provide timely, and regular reporting to the Delivery

Groups, Area Executive Boards, the CAG, the FD

Forum and the HCE to give mutual assurance that the

Delivery plan is on track .

A set of new monitoring dashboards will be

developed by the SDU for this purpose and agreed

by the HCE and/or relevant CEO sponsor . To minimise

the burden on our staff, where possible, existing data

items will be used as metrics to monitor progress,

even if these are not normally shared . In exceptional

circumstances new data items may be collected .

We have set out our core capability milestones by

year, and we will use local metrics to monitor and

manage our progress towards them . The national

digital maturity assessment initiatives are expected to

be repeated on an annual basis .

We have set out our universal capability delivery plan

activities by quarter . This will allow us to monitor and

manage the activities required to meet the required

targets . We will use local metrics to review actual

versus planned progress at quarter-end . We recognise

that work is underway to develop national metrics to

cover the full set of universal capabilities .

In addition, we will measure our success against the

new CCG Improvement and Assessment Framework .

This framework incorporates two indicators relevant

to paper-free at the Point of Care . The first is

confirmation that the CCG is represented within a

‘signed-off’ Local Digital Roadmap . The second is

a composite indicator covering digital interactions

between primary and secondary care . It consists of

four components that can be mapped directly to the

universal capabilities .

9.6.2 - Opportunities for Benchmarking and Peer ReviewOur ambition is to improve our services, therefore

we need to understand variations in how care is

delivered within our region and across England .

One way we can achieve this is by engaging the

Eastern Academic Health Science Network (EAHSN)

to deliver a benchmarking service which would track

provider and commissioner data across a series of key

indicators . This approach will help to identify clinical

variation (process, workforce, medicines optimisation

etc .) and administrative variation as opportunities for

productivity improvements . The EAHSN can also help

to broker links with peers as an additional opportunity

for sharing experiences about what works .

9.4.6 - Digital Delivery GroupAs described above, the Digital Delivery Group is an enabler work group . It not only has responsibility for the

delivery of the projects it owns (as shown in Summary of Projects to Deliver Our Digital Themes) it also has

responsibility to input into the other projects for which digital is an enabler . This activity will be coordinated by

the System Delivery Unit which has a responsibility to ensure that areas for digital enablement are flagged up to

the Digital Delivery Group . The STP priorities, as starred in the list of current projects below, can only progress

through ICT enablement .

The Digital Delivery Group will also play a role in the development and refresh of local IM&T strategies, to

ensure that local investments are consistent and in support of the system-wide LDR .

9.5 - Transformation

We recognise that focusing on the deployment

of technology alone without a credible change

management approach will not realise the potential

of digital transformation and deliver our ambitions .

We will focus not only on achieving optimisation

but also on achieving maximum take-up of digital

tools and information . We will ensure changes to

clinical workflows and pathways are driven by clinical

engagement and our staff and patients are supported

and trained .

Under the newly agreed Cambridgeshire and

Peterborough STP Memorandum of Understanding

(MoU) between organisations, there is an agreed

approach to the delivery of change . This will provide

the basis for change management across the

community . It is expected that the SDU will play a

vital part in coordination of change between delivery

groups and between organisations .

We will look for opportunities to share learning

across organisations within our footprint . We will

also explore options for sharing learning with

organisations within other footprints . For example,

the EASHSN offers support in convening professional

or geographic networks to work on specific areas .

Our Delivery Plan

Imp

rove

men

t sc

hem

esD

eliv

ery

g

rou

p Area executive board/a&e

delivery boards (x3)

Area based integrated urgent care

Time to care test beds and

roll out

In hospital now

Shared services

Clinical support services

Back office

Productive health

workforce

Market forces factor

Estates

Procurement

UEC

Out of hospital integrated

Acute frailty & ageing recovery

pathway

Ambulance efficiencies

Stroke pathway

Psychiatric liaison

New care models

Women & children

Parental mental health

Establishing a maternity

network

Community & acute

paediatrics

Children & family health & wellbeing

Elective

Improved removal

pathways

Cardiology

Orthopaedics

Ophthalmology

Other specialities

Patient choice hub

ENT

Outpatients

Primary care & integrated

neighbourhoods

Long term conditions:

diabetes

Long term conditions: respiratory

Long term conditions: CVD/stroke

Proactive & prevention care model

Mental health

Self care

Healthy ageing

Digital delivery

Direct cross community care

Secondary use

Local digital roadmap

Investing in people

Technology & infrastructure

Workforce & organisational development

Training and wider

development

Workforce planning

Primary care woekforce

development

Leadership and OO

Strategic delivery unit

Impact tracking

& evaluation

System analytics

Aligned incentives

System planning

Spreading a QI culture

Consistent messaging


50 51


9.8.6 - Business Continuity and Disaster recoveryThe Digital Delivery Group will assure that new

systems implemented across the STP are procured

with an appropriate level of resilience to provide

workable business continuity arrangements . We will

specify the disaster recovery approach for central

systems .

9.8.7 - Technical Approaches to Patient SafetyGS1 standards incorporated within barcodes and RFID

are increasingly used to provide improved patient

safety, deliver greater regulatory compliance and drive

operational efficiencies . We are moving forward with

the adoption of these standards . The following table

describes local compliance within organisations .

9.7 - Risk Management

9.7.1 - Our ApproachEffective management of risk is crucial to the

successful delivery of our ambitions . Inevitably, not

everything will go as planned, and we have already

identified some areas where there is a risk that

planned benefits may not be realised . Some of these

risks will be best managed individually, but most

can only be effectively managed with a joint focus .

Across our partner organisations we have committed

to a transparent approach and joint mitigations .

This approach applies to a broad definition of

risk including reputational, clinical, governance,

performance against targets and financial risks . This

will minimise risks to patient safety and organisational

reputation associated with the use of technology . We

have agreed the following approach:

• A HCE Risk Register maintains emerging risks

to both the agreed delivery plan and agreed

mitigations .

• System Delivery Groups, Area Executive Boards,

the CAG and the FD Forum may raise with the

Programme Director an emerging risk and a

written Requirement for Risk Mitigation by the

HCE . This requirement will reflect a perceived risk

that the Sponsor CEO considers he/she is unable

to mitigate within the Group .

• Project SROs are expected to deliver all actions to

the pre-agreed timetable of milestones – repeated

risks and issues regarding process delays due to

poor project management and oversight, which

are within the control of the SRO, will be escalated

by the Programme Director to the employing CEO .

• For the purposes of this agreement, risk is not

narrowly defined; examples include reputational,

clinical, governance, performance against targets

and financial risks .

• Select risks will be reviewed by Boards each

month, as determined by the Programme Director

and Independent Chair .

9.8 - Areas of Risk

When managing risk we will take account of all

relevant aspects of risk including human factors,

technology factors and procedures and process

factors . How we handle specific types of risk is

outlined below:

9.8.1 - Data Security The National Data Guardian review of data security

is underway . This is expected to produce a set

of leadership responsibilities and data security

standards – for example, that a strategy is in place

for protecting systems from cyber-threats based on a

proven framework such as Cyber Essentials, and that

unsupported operating systems, software or internet

browsers are not being used within the IT estate .

9.8.2 - Clinical Safety The Digital Delivery Group will assure that existing

national regulations for clinical safety are met, both

that suppliers provide clinical safety assurance for their

software products, and that a clinical safety review is

included in all implementation projects .

9.8.3 - Data Quality As systems are integrated into a shared record or

analytics platform, key data quality measures will be

applied to the data sources, and targets will be set

which should be achieved before data will flow into

the shared platforms . We have prioritised the project

for implementation of the NHS number across the

STP footprint as one of the headline Direct Cross

Community Care projects .

9.8.4 - Data Protection and Privacy Each contributing organisation will be responsible

for ensuring compliance with data protection and

privacy regulations within their estate . Where there

is a common platform, the hosting organisation will

assume the data protection responsibility as the data

processor .

9.8.5 - Accessible Information Standards Suppliers will be required to conform to national

standards for data structure and messaging . Wherever

possible, central systems will provide open APIs to

enable integration with clinicians’ frontline systems .

Provider Current Position (baseline) Future Plans for Adoption

Cambridge University Hospitals

NHS Foundation TrustTBC TBC

Cambridgeshire and Peterborough

NHS Foundation TrustTBC TBC

Cambridgeshire Community

Services NHS TrustTBC TBC

Hinchingbrooke Health Care NHS

TrustTBC TBC

Papworth Hospital NHS Foundation

Trust

GS1 used within Theatres

RFID not currently used

GS1 to be expanded post

relocation to New Papworth

Hospital Site

Peterborough and Stamford

Hospitals NHS Foundation TrustNot currently used

RFID to be introduced as part of

New Papworth Hospital relocation

At present plans to take forward

still to be confirmed


52 53


9.8.8 - System-wide RisksWe have identified the following system wide strategic, operational and implementation risks arising from the

LDR .

Category Description Potential Impact Mitigation Measures

Strategic

All partner organisations have operational and therefore technical links with organisations outside of the Cambridgeshire and Peterborough Footprint.

Cambridgeshire and Peterborough patients and citizens are not constrained by geographical boundaries.

It is possible that the STP/LDR plans and priorities of these other communities are different to that of Cambridgeshire and Peterborough.

It is also possible that they are developing technical solutions that have poor technical and operational fit with the Cambridgeshire and Peterborough LDR.

Good communication with other neighbouring STP / LDR programmes. The potential establishment of regional STP/LDR footprint to ensure specialist providers e.g. EEAST, Papworth to address items of risk cross community.

Use of national standards and systems

Technical initiatives to consider not only data and information flows within Cambridgeshire and Peterborough but also external to the area.

As our patients are often “out of area” information sharing at a patient level rather than an organisational level will be a key mitigation measure.

Strategic

The Digital Delivery Programme as described within this LDR needs to be flexible enough to respond to clinical and organisational change.

If the digital programme is not agile enough there is a danger that technical changes required may not be available.

There is a tension as digital and technical changes need to be measured and in some cases undertake formal clinical safety review processes.

Inclusion of digital / technical representation in each of wider STP improvement area groups.

Use of common systems and infrastructure wherever possible to reduce interoperability and technical information sharing issues

Operational

The digital delivery programme does not reflect the patients, citizens clinical, managerial and wider health and care professional day to day operational needs for quality, accurate and timely information

If clinical, care and managerial information is not consistent, inaccurate, unavailable etc . this will have a material impact on the efficiency of the delivery of health and care services

Organisation clinical, social care and managerial leads together with patient representatives involved in each of the developmental areas

STP / LDR linkage to individual organisations IM&T / digital transformation groups.

Category Description Potential Impact Mitigation Measures

Implementation

The scale of technical change involved within the wider STP as well as the LDR is significant. There is a risk that scale and pace of technical change will not keep pace with STP / LDR needs.

Should the technical developments not be able to be delivered in time or to the quality standard required it is possible that the organisational change required will not be delivered.

It is also likely to negatively impact the wider benefits achieved as part of the change .

Each project and programme to identify technical resources required interdependencies etc. to ensure resource is identified prior to project start.

Implementation

Systems supplier’s capacity to meet our and other STP/LDR technical developments requirements and challenges

Should providers of systems not be able to meet STP / LDR development timescales this will potentially delay service changes

Involve current suppliers and support organisations with development of STP/LDR technical implementation plans.

Cooperate with neighbouring STP / LDR communities to coordinate developments. The additional benefit is that this may result in shared savings in implementation costs and also promote cross organisation issue.

Implementation

Individual organisational pressures and key drivers may have a negative impact cross community technical developments

There is the possibility that technical changes made to meet internal organisational requirements may not support wider cross organisational information sharing / interoperability work .

Engage organisations to consider how individual technical developments will impact cross community developments.

Implementation

Individual organisations data quality may not support the wider use of that data for business intelligence and health analytics

Data quality issues within an organisation can be worked around but when data is shared the context may be lost and data becomes misleading or invalid

The interoperability work-streams for each organisation should include a focus on developing data collection and data quality management.


54 55


Issues with National Systems / Solutions

Rate Limiting FactorsCambridgeshire and Peterborough area patient and

citizen population is growing by several thousand

people a year . This makes it more difficult to target

training for all patients and citizens on the health and

social care systems available for use . As there is an

ongoing need to identify new patients and citizens .

Training of health and social care staff in the technical

use of technology plus the opportunities information

provides .

The scale of change which can be delivered within

challenging timescales is impacted by the level of

resource available . This work must be balanced with

the need to deliver services on a daily basis .

MitigationsPatient and Citizen training programme

Professional training programme

Inclusion of digital technology requirements within

service change and business case development as a

standard part of the change process .


Rate Limiting FactorsFinancial challenges resulting in less funding being

available locally for ICT developments .

Lack of knowledge about how to access the central

funding promised to local communities to progress

and then maintain the LDR is a current limiting factor .

Many developments will progress only if central

funding is made available and then sustained funding

is made available .

Mitigations Organisations continue to bid for funds against

national and other schemes for additional funds to

support technical development within and across the

community of organisations

9.9 - Rate Limiting Factors

As part of the Local Roadmap Development process, we have identified a number of rate limiting factors . This

process is essential to ensure that where possible we can address or mitigate these issues .


Rate Limiting FactorsGPSOC GP clinical systems providers are required to

follow national development path rather than local

requirements . The national development path does

not fully reflect local priorities .

Multiple national delays in releasing software

developments across a suite of national system

developments, these often do not meet published

timetable resulting in a lack of confidence in the

availability of system e .g . NHS Mail 2 implementation

much delayed . This inhibits local organisations ability

to proceed with national solutions .

MitigationActively working with and supporting suppliers

to implement collaborative technical changes .

Supporting progress through NHS Digital (previously

HSCIC) GPSOC supplier development process .

Through working with GP clinical suppliers we have

secured understanding of their development roadmap

for 2016 onwards .

Providing advice and guidance for potential suppliers

around technical requirements . Introducing potential

suppliers into national supplier forums etc .

We will continue to contribute to national forums

around technical developments that will support local

progress .

Infrastructure Issues

Rate Limiting FactorsPhysical network and communications infrastructure

within Cambridgeshire and Peterborough does limit

the ability to use mobile technology and in some cases

the physical networking is also poor . Cambridgeshire

County Council and Peterborough City Council

are very active in working to improve connectivity

and have achieved much more than the national

average but there are areas where infrastructure does

limit what can be done . In addition, the national

decision not to provide equitable N3 provision to

GP Practice locations means that some practices are

disadvantaged compared to others as they cannot

access network connections with the required

performance levels to support the use of some of the

newer technologies .

Not all of the current health and social care systems

allow disconnected working, which limits use of

systems external to buildings .

A large number of staff work in community

settings . The funds required to support these staff is

considerable and needs to be provided on a recurrent

basis . This level of funding is not available within the

local community . Provision of external funding on a

recurrent basis would provide significant benefit in

advancing use of technology at the point of care .

MitigationThe CCG has approached the Health and Social Care

Network (HSCN) team to seek assurance around

equity of provision for the new HSCN service from

2017 .

Together with developers we are supporting the

provision of additional GP Primary Care capacity

including the technical aspects to deliver new services .

Major area of work currently and over the lifetime of

the LDR .


56 57


the next five years as a means of delivering savings,

efficiencies and improved quality . We expect new

investments to come from multiple sources over the

life of this digital roadmap .

This LDR is a ‘gateway’ to funding . We will align

our future request for digital funding, including

our progress towards paper-free at the Point of

Care, to our digital ambitions outlined in this Local

Digital Roadmap . We have the necessary board level

engagement and clinical leadership that is essential to

successfully deliver this agenda . Our progress to date

and our plans outlined in this Local Digital Roadmap,

including the requirement for further investment in

infrastructure, demonstrate our understanding of how

we can use digital capability as the golden thread to

help us transform the way we deliver care .

We are ready to invest effectively in the digital

agenda . We have introduced local governance which

we will leverage to oversee and assure the creation of

robust ‘fit for purpose’ business cases which follow

NHS standards to support local investment requests .

We recognise that a consideration of granting the

funding requested in business cases will be alignment

with the LDR .

9.12.1 - Local FundingLocally organisations continue to invest funding

in digital developments with business cases and

change initiatives including a number of important

developments .

Each organisation is currently using its own resources

to maintain and develop digital services for use by

its own staff, to provide services electronically to

patients and citizens, and to facilitate information

sharing between organisations . The investments

involved are set out in individual organisational plans .

To deliver this LDR, local committed/prioritised capital

investment in local IM&T initiatives must continue . We

will ensure that any investment is strategically aligned

with out LDR .

9.12.2 - National Funding InitiativesThe amount of national funding will directly impact

the speed of implementation of a number of the LDR

developments . At present it is uncertain how much

funding will be made available each year for each LDR

area .

If full national funding required is not received locally

this will reduce the elements of the LDR that can

be delivered . A number of the projects to fulfil our

ambitions as laid out in the Local Digital Roadmap are

funding dependent . These are:

• Interoperability mechanisms and our shared record

ambitions

• Self-care mechanism including apps

• Shared infrastructure including unified

communications and telephony

Potential targets for investments include the £900

million Estates and Technological Transformation

Fund, the £1 .8 billion Driving Digital Maturity

Investment Fund and Vanguard funding .

The Estates and Technology Transformation Fund

(ETTF) is a multi-million pound programme to

accelerate the development of infrastructure to enable

the improvement and expansion of joined-up out of

hospital care for patients . Additional capital will also

be invested in general practice beyond the ETTF which

means that the overall total investment in capital

assets up to 2020/21 will be £900 million .

The Driving Digital Maturity Investment Fund is made

up of both capital and revenue . The process for

accessing and criteria for allocating this funding is

currently being agreed .

It is also anticipated national funding will be made

available to continue central GPSOC funding post

2018 for GP clinical systems . Should no funding be

available centrally this will be a significant limiting

factor as developmental funding would need to be

directed to maintain current provision . NHS England

has not allocated any protected funding to the CCG

to support the implementation of the ‘Securing

Excellence in GP IT Services 2016-2018 Operating

Model’ or the wider Primary Care IT aspects of the

LDR .

9.10 - Benefits

Our governance structure and transformation

approach will ensure we optimise workflows and

pathways across our footprint . We expect this to lead

to quality benefits, for example, shared information

will help to ensure better informed clinical decisions

are made at the point of care . This will also lead

to direct economic benefits, such as time saved by

avoiding unnecessary home visits and a reduction in

duplicate diagnostic tests . In addition, the patient

experience will improve as care givers will have access

to previous information, so patients won’t have to

repeat their answers to the same questions . We

have embedded the identification, realisation and

tracking of benefits into our governance structure .

As the Cambridgeshire and Peterborough STP moves

into active implementation, the shared benefits

management and measurement approach for all

digital developments across all organisations will

develop further .

We will make use of national benefit management

and measurement tools where these are made

available .

In addition, we have identified the following areas of

potential savings from collaboration:

• Cross-organisational utilisation and access to

systems and infrastructure that already in place

that have been purchased by other partner

organisations . This already takes place on a regular

basis .

• Continue to share use of hardware and networks

within joint buildings and locations including

telecommunications

• Removal of paper transfer between organisations

• Joint training resource provision

• Sharing of specialist or expensive technical

resource specialist

• Use of national frameworks for procurement of

technology

• Use of national systems in preference to locally

procured systems e .g . for Health use of NHS .net

email

9.11 - Resourcing We recognise the scale of change required in

delivering our ambitions, and all the partner

organisations have committed to aligning their staff

and, by prior HCE agreement, funds to deliver these

changes . This may include prioritising the availability

of staff for planning activities and implementation,

the voluntary secondment/loan of staff and other

such pragmatic arrangements . This approach

recognises that delivering the STP is essential to each

organisation’s individual sustainability strategy .

Through the delivery planning process, each prioritised

project will be allocated staff, from across partners’

organisations . These, ‘aligned’ staff will be expected

to dedicate the bulk of their time to the system work

– with up front negotiations about what may need

to be stopped as a result . SROs and if necessary CEO

sponsors, will be expected to escalate to the employer

if they feel staff are not being released as agreed .

The employing Partner will be expected to rectify

the situation within two weeks . The SDU will make

transparent the relevant WTE contributions (clinical

and managerial) from each organisation, to ensure the

burden of effort is fairly shared .

In addition, there are other assets which can help us

to deliver our ambitions, including local communities

and Health and Wellbeing Boards . We will explore

how existing relationships with the Universities,

Charitable trusts, local business, informal carers and

other public services (like the Fire Service) can be

leveraged . All Partners will highlight opportunities for

using these assets .

Where our staff don’t have the required skills and

expertise to deliver the scale and nature of the change

required, we will recognise and address this . It’s

important that our people are in the right roles .

9.12 - Sources of FundingOur Sustainability and Transformation Plans describe

the underlying financial position and plan for our

footprint plus the need for significant recurrent

savings to be delivered . However, it also recognises

the role of digital tools and information in enabling

efficient care and service transformation . There will

therefore need to be further investment in digital over


58

9.12.3 - Identifying Additional Sources of FundingWe intend to explore additional avenues for securing

funds . For example, the Eastern Academic Health

Science Network (EAHSN) can provide support in

providing information about organisations that might

be able to assist with funding a commercial product

or service, as well as sources of national, regional

NHS, government or third sector funding, outside of

the committed transformation fund . In addition to

supporting the identification of alternative funding

sources, EAHSN offers an independent bid review

service to maximise the chance of successful bids

which would secure additional funding .

The EASN is also offering support to providers to

implement new solutions to address productivity

challenges . A small element of non-recurrent

funding is available to support initial adaption and

implementation of innovations .

Looking Towards the FutureWe will develop and improve our Local Delivery

Roadmap on a rolling basis . Future versions will

address gaps that exist in initial versions – for

example, extending coverage to encompass partners

who are not part of the mainstream health and care

system, but play a significant role in our patients’

pathways . We will also update our LDR in response to

evolving local priorities as new models of care emerge

and current clinical processes are reviewed – for

example, identifying a new capability for deployment

in or re-phasing the deployment of one already

on the schedule . We will need to flex our plans in

response to the funding and business case decision

making processes, and take into account the latest

assessments of digital maturity .

We will also review and respond to new strategies,

policies and reviews . For example, we understand a

children’s digital health strategy, a new strategy for

nursing, midwifery and care staff, and an updated GP

IT operating model are all under development . We

will continue to horizon scan the digital technology

landscape and marketplace to ensure we continue to

take account of new innovations .

We will also take opportunities to learn from other

footprints identifying best practice, lessons learnt,

both positive and negative . This will improve our

understanding of how successful digitally enabled

transformation takes place and allow us to review

and refresh our LDR to provide an increasingly

comprehensive view over time .

10