REPORTItem No: 10

SUBJECT:

TO:

Lead Officerfor ReportAUTHOR:

DATE:

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Health&Social CareNorth Lanarkshire

Health & Social Care Integration Technology Programme

Joint Integration Board

Chief Accountable Officer

Carolyn Mitchell, eHealth IM&T Project Manager

April 2016 − −

GOAL/OUTCOME

To provide an update to the Joint Integration Board on defining and developing Health &Social Care North Lanarkshire's IT programme.

SUMMARY OF KEY ISSUES

2.1 Health and Social Care integration, with its redefinition of complex service structures,relationships and cross boundary working presents significant difficulties for technicalinfrastructures that have been developed over many years.

2.2 New ways of working and the pace of changes in technology mean that modernisation oftechnology can be as challenging as modernisation of the culture. Increasingly, users expectIT tools and systems that can swiftly adapt and respond to their needs not drive theirprocesses.

2.3 The need to share information across professionals and with HSC service users themselvesmean that IT solutions must make sharing easier whilst maintaining security; protectingusers from sensitive and personal information being disclosed inappropriately or incontravention of Scottish legislation.

3.

3.1

4.

RECOMMENDATIONS

Joint Integration Board note the content of the attached report, agree the continueddevelopment of the Programme Plan and schedule regular JIB updates.

BACKGROUND AND CONTEXT

4.1 This paper focuses on HSC integration in North Lanarkshire between NLC and NHSL. The nextphase will consider the requirements of other partners in the north. Different IT priorities,activities and approaches may apply in South Lanarkshire.

4.2 Since taking up a contract in February 2016, the eHealth IM&T Project Manager for HSCI,North Lanarkshire has worked with personnel from NHS Lanarkshire, North Lanarkshire

Council and, to a lesser extent, South Lanarkshire Council to understand the issuessurrounding, and the technology necessary, for HSCNL to

Support a modern, mobile, integrated workforce and

• Provide citizen empowering ICT i.e. utilising technology to enable citizens to becomemore self sufficient, making health and social care information more accessible andreducing the need for face to face interventions, whilst improving health and wellbeing

4.3 The Project Manager has provided an update and highlighted issues in her report attachedas Appendix B.

4.4 Appendix C provides a draft programme plan but it must be stressed that this reflects workto date. As such, there is clearly more work to be done, particularly in relation to identifyingthe costs and resources required to deliver what is an ambitious but achievable programmeof activities.

S. CONCLUSIONS

5.1 HSCNL has some well established and innovative programmes of work in progress e.g. inrelation to Technology Enabled Care, mobile working etc. These programmes provide a firmfoundation on which to build and plans are in place to develop them further.

5.2 However, there are some significant infrastructure challenges that need to be addressed toenable staff to work as an integrated team.

5.3 The next stage is further refinement of the programme plan, incorporating the requirementsfor integration with other sectors and identifying options, timescales and costs to facilitatethe development of business cases for appropriate investments in technology to supporteffective Health & Social Care integrated delivery, management and strategy development.

6. IMPLICATIONS

6.1 NATIONAL OUTCOMESSuccessful implementation of the programme will provide tools to support HSCNL inachieving the 'nine National Health and Wellbeing Outcomes.

6.2 ASSOCIATED MEASURE(S)None

6.3 FINANCIALProjects within the programme access funding from a number of sources.

The full level of investment required to deliver the programme needs to be assessed as partof the next stage and as options are appraised and business cases developed.

6.4 PEOPLEHealth and Social Care integration programme and the introduction of new technologies willresult in changes to the way that people work. These need to be addressed through relevantcommunication, training and staff development.

6.5 INEQUALITIESReducing inequalities is a key driver of digital health initiatives.

1 http://www.gov.scot/Topics/Health/PoIicy/Adult−Health−SocialCare−Integration/Outcomes

There is a significant link between groups who are digitally excluded and those who are atrisk of poor health. Supporting service users into adopting technology enabledcare/telehealth etc. helps to overcome this.

Mobile and flexible working can contribute to reducing inequalities in the workplace.

7. BACKGROUND PAPERS2NHS Scotland's eHealth Strategy 2014−20173Scottish Government HSC Information Sharing Strategic Framework 2014−2020

8. APPENDICES

Appendix A − Health and Social Care Integration North Lanarkshire − ehealth IM&T ProjectManager's Update

Appendix B − HSCI − Draft IT Programme Action Plan! Update

C) 1jvrChief Accountable Officer,Health & Social Care North Lanarkshire

2 http://www.gov−scot/Resource/0047/00472754.pdfhttp://www.gov.scot/Publications/2015/02/2900/3

Appendix AHealth and Social Care Integration North Lanarkshire − ehealth IM&T Project Manager's Update

181h April 2016

1. Background

Just as Health and Social Care Integration (HSCI) is driven by national priorities and frameworks, so theunderpinning technology within Lanarkshire must be shaped by national as well as local drivers:4Scottish Government HSC Information Sharing Strategic Framework 2014−2020 vision is stated as:

"By 2020, digitally enabled information sharing solutions will be in place in Scotland so thateveryone, including citizens, involved in health and social care can:

access and interact with the services and information they require quickly and easily atthe point it is needed, and in accordance with the law;

• provide or enter information once, which can then be reused proportionately;

• share information appropriately, with the relevant people, to support efficient,effective and safe care;

• have a common understanding of the information they share and confidence in itsaccuracy, quality, integrity and security."

Sitting alongside and supporting this is 5NHS Scotland's eHealth Strategy 2014−2017 with the vision that"By 2020 eHealth in Scotland will:

• Enable information sharing and communications that facilitate integrated health and social careacross all settings from the patient's home to the hospital.

• Provide information processing, analysis and intelligence that supports and complements thework of health and social care professionals and improves the safety and quality of care.

• Support people to manage their own health and wellbeing and live longer, healthier lives athome or in a community setting.

• Contribute to a partnership between the Scottish Government, NHSScotland, the researchsector and industry to enable Scotland to be a long term leader in digitally enabled care."

The approach to developing and utilising technology for HSCI in North Lanarkshire, aligns with these visions.

The LDSP Board Technical Group (North Lanarkshire) agreed the aim of the HSC North Lanarkshire's ITprogramme as being to

• Support a modern, mobile, integrated workforce and

• Provide citizen empowering ICT i.e. utilising technology to enable citizens to become more selfsufficient, making health and social care information more accessible and reducing the need forface to face interventions, whilst improving health and wellbeing.

2. Introduction

This paper focuses on HSCI in North Lanarkshire. Different IT priorities, activities and approaches may applyin South Lanarkshire.

http://www.gov.scot/Publications/2015/02/2900/3http://www.gov.scot/Resource/0047/00472754.pdf

Since taking up a contract in February 2016, the eHealth IM&T Project Manager for HSCI in northLanarkshire has worked with personnel from NHS Lanarkshire, North Lanarkshire Council and, to a lesserextent, South Lanarkshire Council to

• Determine high level HSCI technology requirements and existing or planned provision in NorthLanarkshire

• Define programme content

• Develop outline programme plan

• Establish the strategic Health & Social Care Integration IT Group for North Lanarkshire.

• Establish a Health and Social Care Integration Technical subgroup.

• Deliver specific elements of the programme

3. Programme Content

In defining programme content it has been useful to group activities into:1. Shared organisation for administration and management.

2. Flexible/mobile working.

3. Sharing service user information amongst professionals.

4. Service users' access to HSC information and services.

5. Management information and business intelligence to inform strategy and resource targeting.

6. Technology Enabled Care/Telehealth

The Draft Action Plan at Appendix C provides a brief summary of requirements, activities and issuesidentified in discussions to date.

4. Issues and Challenges

Whilst integration brings HSC service delivery teams together, it does not mean that they all need access toall of the data that their colleagues collect, but there is some key information that must be shared and somekey challenges to integration where technical solutions are required.

In some cases, there are solutions available which can be developed and rolled out relatively easily, someare under development and others would require a significant investment.

With a host of disparate systems, structures and varying degrees of staff access to IT within individualpartner organisations it is not surprising that there are challenges to integration between organisations withdifferent structures, infrastructures, suppliers and information governance arrangements.

IT systems, structures and processes that may be viewed as important for Health and Social Care Integrationmay not match individual organisation strategies or priorities. This can impact on ability or timescales toreach agreement on solutions, resource allocation, budget provision etc.

The HSCI Technical Group will strive to address the technical requirements and propose solutions that arecoherent and consistent but there will be the need for direction, approvals, negotiation on strategy andbusiness process change at a more senior level between and within the partner organisations. It is

anticipated that these will be taken forward via the HSC Technology Group, Health & Social Care SeniorLeadership Team and appropriate NHSL and NLC management structures, with resources assigned toindividual projects as required.

It should be noted that there are differences between the solutions and timescales for changes applied inNHSL, NLC and SLC and this presents significant risks through the likelihood that practitioners may assumethat the same systems apply across the entire partnership e.g. a direct link between NLC and NHSL is usedfor securely delivering email between the two organisations but is not established in the south nor withother partners. It would be helpful to agree a roadmap across north and south to minimize

staff confusionpotential security risksexcessive resource demands on NHSL IT depts. from duplicate/different systemimplementations

Apppendix C highlights some of the issues linked to specific deliverables but in general terms, integrationchallenges include:

4.1 Joint IT Service DeliveryIn the event of joint IT service delivery, there should be clear, joint working agreements and arrangementsbetween partners addressing

• Rights and responsibilities for partner organisations, as suppliers, hosts and users of systems andinformation.

• Strategic developments, including potential harmonisation of systems and approaches.

• Ownership of technology and systems.

• Resource provision and budget contributions.

• Implications of sharing systems or networks with other partners e.g. 3 ' sector organisations orprivate providers and

• Balancing information sharing requirements with legislative constraints and partner agency policies

These could initially be a set of basic principles, with guidance or templates that can be developed furtherwhen formal agreements for different projects are required as individual solutions or provisions may havedistinct governance arrangements.

4.2 Infrastructure ChangesInfrastructure changes and improvements are needed to support integrated working and service delivery.Some staff and service users have limited access to online systems due to lack of network coverage orexperience problems as a result of poor performance.

Infrastructure structural changes are also needed to enable HSC staff to securely and easily access systemsacross partner networks and to support integration of systems.

Both NHSL and NLC are moving to SWAN (Scottish Wider Area Network) so this should help withinfrastructure but SLC don't intend to go onto SWAN.

4.3 Systems Procurement and PlanningIT provision within HSC is inconsistent, with many Allied Health Professionals within NHSL still reliant onpaper based systems, which do not lend themselves to easy sharing or management of information. Thisneeds to be addressed, particularly as there is a drive to shift the balance of service provision from 'acute' to'community' and increase service user self assessment/self−help.

For others, systems are not 'joined up' and even practitioners working in the same professional groupings donot necessarily have access to shared drives or common systems. They may have access to eCare which is amulti agency information sharing platform unique to the Lanarkshire Partnership and governed by theLanarkshire Data Sharing Partnership Board, but this is not used for sharing all relevant information forteams working on health or social care packages.

An added complication is that HSC staff in the north may use different systems from those in the south e.g.Social Workers using MySwis/Swis+. If Social Workers have to work across council boundaries in future thenthey may have to use 2 different IT systems for their case information.

As IT systems reach end of life or end of contract there is an opportunity for consolidation throughprocuring solutions which integrate more effectively e.g. through joint procurement of a single system withrelevant modules; separate systems with (proven) effective integration or; systems where data can bedrawn into a consolidated view or combined for analytics etc. Consolidation of contracts with singlesuppliers who may be providing and supporting a number of systems with different contract end dates canalso lead to reduced costs.

Definition of IT solution requirements should consider needs beyond recording information specifically usedby health and social care professionals through to minimising interventions, facilitating digital health,meeting the information needs of service users and capturing meaningful outcomes data, which can providea continuous feedback loop to inform commissioning and service design.

IT systems should always support the business not drive it. With moves to new ways of working, alternativemanagement structures, the need for greater efficiencies and improved business intelligence then businessanalysis and process reviews are an increasingly vital part of the process that should be adequatelyresourced as part of specification development.

This need for pre−procurement analysis, taking it beyond the business to the service user, is reinforced bythe Person−Centred Care Resource Centre assertion that 6"lmplementing digital health requires a change inthinking: the technology must be designed around the needs and aspirations of people who use services; itmust be incorporated into how services work, rather than being seen as 'bolt on'; and it must be flexible sopeople are able to 'mix and match' the different technologies with more traditional approaches, to create acombination that works for each individual."

4.4 Technical Skills and SupportThere is a combination of in−house and externally developed systems and provision of IT technical supportacross the partner agencies.

In order to ensure that HSC services and solutions are sustainable in an environment where systems have tobe available 24/7/365 there is a need to ensure technical skills and resources are available and continuallydeveloped within the partnership or adequately provisioned or accessible through support contracts.

For delivery of individual projects it is likely that there will be a need to buy in temporary resources to boostcapacity and skillsets. This should be factored into business case development and budget projections.

4.5 Practitioner DevelopmentIT literacy is a skill that is often taken for granted in the 'digital age' but there are still HSC staff who areaffected by the digital divide and not confident in utilising technology or who do not have access to relevantIT systems.

HSC service users may need to be supported and enabled to use technology that works for them. The bestplaced people to do this are often the professionals that service users interact with.

6

It is important to ensure that as technology is rolled out, HSC staff are provided with adequate training andsupport to develop the technical skills and confidence to change their own practice and to enable them tosupport service users into new ways of accessing services and information.

HSC staff training and awareness raising should not only cover improvements that technology brings but alsoits constraints and limitations e.g. not all significant service user information is viewable electronically;differences between north and south Lanarkshire systems and processes etc.

4.6 Service User ApplicationsThe 7Tinder Foundation reported a significant link between groups who are digitally excluded and those whoare at risk of poor health. The Technology Enabled Care/Telehealth projects in Lanarkshire aim to addressthis.

As indicated in previous sections, it is important that service users' views inform the introduction of newtechnology and that they are adequately provisioned and supported in using it at times and in locations thatsuit them.

5 ConclusionHSCNL has some well established and innovative programmes of work in progress e.g. in relation toTechnology Enabled Care, mobile working etc. These programmes provide a firm foundation on which tobuild and plans are in place to develop them further.

However, there are some significant infrastructure and system challenges that need to be addressed toenable staff to work as an integrated team.

The need to replace the Midis system, where support ceases in 2018, provides an opportunity to modernise,integrate and expand the user base but such solutions are likely to be more expensive than existing systems.

The next stage is further refinement of the programme plan, incorporating the requirements for integrationwith other sectors and identifying options, timescales and costs to facilitate the development of businesscases for appropriate investments in technology and resources to support effective Health & Social Careintegrated delivery, management and strategy development.

'http://www.tinderfoundation.orq/our−thinkinq/bloq/djqital−inclusjon−route−reducing−health−inequalities

http://www.tinderfoundation .orq/sites/default/files/diqitalnation−201 5−webb.pdf

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