NHS WALES INFORMATICS SERVICE · NHS WALES INFORMATICS SERVICE Delivering Information and...
Transcript of NHS WALES INFORMATICS SERVICE · NHS WALES INFORMATICS SERVICE Delivering Information and...
NHS WALES INFORMATICS SERVICE
Delivering Information and Technology
For Better Care
Three Year Plan
2014 – 2017
(January 2014)
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CONTENTS
1. EXECUTIVE SUMMARY ..................................................................................... 4
2. STRATEGIC CONTEXT ...................................................................................... 6
3. LOCAL HEALTH NEEDS AND CHALLENGES ................................................... 7
4. CORPORATE VISION AND OBJECTIVES ......................................................... 9
4.1 Vision ................................................................................................................ 9
4.2 Objectives ......................................................................................................... 9
4.3 Health Technology Assessment and Overview of Deliverables ........................ 9
5. SERVICE CHANGE PLANS AND INITIATIVES ................................................ 13
5.1 Service Development and Programme Plans ................................................. 13
5.2 National Services (Applications) ..................................................................... 15
5.3 Infrastructure Services .................................................................................... 19
5.4 National Programmes and Projects ................................................................ 21
5.5 Information Services ....................................................................................... 25
5.6 Service Delivery Risks .................................................................................... 28
6. QUALITY IMPROVEMENT ................................................................................ 30
6.1 Our Planned Quality Commitments ................................................................ 30
7. ORGANISATIONAL DEVELOPMENT ............................................................... 32
7.1 Our Existing and Planned Workforce Profile ................................................... 32
7.2 Our Planned Organisational Development Commitments .............................. 33
8. FINANCE ........................................................................................................... 36
8.1 National Context ............................................................................................. 36
8.2 Organisational Context ................................................................................... 36
8.3 Revenue and Capital Funding Model .............................................................. 37
8.4 Revenue ......................................................................................................... 39
8.5 Savings Plans ................................................................................................. 42
8.6 Capital ............................................................................................................ 43
8.7 Financial Risk ................................................................................................. 45
9. ESTATES AND CORPORATE SERVICES ....................................................... 47
9.1 Estates ............................................................................................................ 47
9.2 Corporate Services ......................................................................................... 48
10. STEWARDSHIP AND GOVERNANCE ............................................................. 49
10.1 Our Board Arrangements .............................................................................. 49
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10.2 Working with our Stakeholders ..................................................................... 49
10.3 Internal Management and Governance ........................................................ 51
10.4 Performance Management and Reporting .................................................... 51
10.5 Risk Management and Business Continuity ................................................. 52
APPENDICES .......................................................................................................... 53
Appendix 1 – National Services (Applications) ..................................................... 54
Appendix 2 – Infrastructure Services .................................................................... 69
Appendix 3 – National Projects ............................................................................. 73
Appendix 4 – Quality Improvement ....................................................................... 76
Appendix 5 – Financial Controls, Reporting and Audit Arrangements .................. 80
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1. EXECUTIVE SUMMARY
The NHS Wales Informatics Service (NWIS) delivers national information and IT
services to support the provision of integrated care services for citizens across
Wales. The organisation also sets the standard for health informatics professional
leadership and development.
Our strategy is based on the principle that effective and efficient information systems
will give:
Care providers the information they need to deliver better outcomes, more
safely and more efficiently, and
Welsh citizens access to information they need to support their own health
and wellbeing.
Health Boards, NHS Trusts and Local Authorities in Wales had previously planned
and implemented discrete information services for their own local catchment
populations. Now, the National Informatics Programme is coordinated and
implemented by NWIS in partnership with the seven local Health Boards and the
three Trusts. We are also, increasingly, working with Welsh Local Authorities on the
CCIS project.
The over-arching principles we use to plan the way forward are:
Doing things “Once for Wales”
Undertaking clinical and technical design together
Focusing on information services not systems
Making the best use of what we already have
Doing things in common by design or agreement
Ensuring safe migration to new services.
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Our priorities are:
The development of common infrastructure, including data centres, data
networks (e.g. PSBA), mobile platform, data storage facilities including
private cloud capabilities extending across the NHS in Wales
Continue roll-out of systems to accurately identify patients and staff across
Wales
Further development of systems that share essential information and
messages between services, such as the Individual Health Record (IHR) and
Welsh Clinical Communications Gateway (WCCG)
Progress adoption of systems that give better access to patient with systems
such as My Health On-line (MHOL)
Further implementation of the Welsh Clinical Portal’s core clinical processes
such as pathology and radiology requesting and reporting, medicines
management and viewing of clinical information collected by other systems
Further roll-out of common systems, such as new GP Clinical Systems, the
new LIMS for Pathology and Blood Services, and RadIS2 and PACS for
Radiology and imaging services
Developing requirements and procuring a new system to improve document
management and provision and sharing of the patient record, such as the
Welsh Care Records Service
Progress national adoption of a Community Clinical Information System
(CCIS) that bridges the information gap between Health and Social Care for
Health Boards and Local Authorities.
We will continue to develop our three year business plan by working with Local
Health Boards and Trusts to make sure that National and Local IT Plans are
aligned.
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2. STRATEGIC CONTEXT
NWIS responds to a range of national strategies and plans for health and social
care. The current principle drivers in this respect are:
Together for Health (2011) 1 is the five year vision for the NHS, based around
primary and community services, placing prevention, quality and transparency
in healthcare.
Digidol yn Gyntaf – Delivering Welsh Public Services Online (2012) 2 is
reviewing the Welsh public sector digital on-line services with the aim of increasing
the range and quality and uptake by Welsh citizens.
Framework for Delivering Integrated Health and Social Care (2013)3. Welsh
Government has recently ended a consultation on its proposals to develop
closer relationships between health and social care providers to support a
transformation in the quality and effectiveness of care for older people in
Wales.
The Commission on Public Service Governance and Delivery (2013) 4 has been
formed by Welsh Government to review the way that public services are delivered
and run.
1 See http://wales.gov.uk/topics/health/publications/health/reports/together/?lang=en
2 See http://wales.gov.uk/docs/det/publications/130304digitalfirsten.pdf
3 See http://wales.gov.uk/docs/dhss/consultation/130823consultationen.pdf
4 See http://wales.gov.uk/topics/improvingservices/public-service-governance-and-delivery/?lang=en
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3. LOCAL HEALTH NEEDS AND CHALLENGES
Across Wales, Health Boards have been developing plans for the future safe delivery
of services to patients. The following plans have been developed and are at various
stages of engagement and consultation:
South Wales Programme - Involves all Health Boards in South Wales
(Abertawe Bro Morgannwg, Aneurin Bevan, Cardiff & Vale, Cwm Taf, Hywel
Dda, Powys) but proposals only relate to main hospitals in the Cwm Taf,
Cardiff & Vale, Aneurin Bevan and Abertawe Bro Morgannwg areas. Ideas
have been proposed by clinicians about the future of a range of specialist
hospital services: consultant-led inpatient paediatrics, neonatal care,
obstetrics and A&E care. The ideas put forward include concentrating this
expertise on fewer hospital sites - four or five - across South Wales.
Healthcare in North Wales is changing - Betsi Cadwaladr Health Board.
Proposals are based around the following principles: staying at home when it
is safe and appropriate; more care closer to home
Getting the best results from specialised services; better services on fewer
sites; and improved acute hospital services
Your Health: Your Future - Hywel Dda Health Board are running their own
consultation exercise on proposals for change in the West Wales region.
There are strong links between these plans and the South Wales Programme
to make sure specialist services elsewhere in South Wales which are used by
Hywel Dda residents continue to be available.
We will continue to work with Welsh Government, NHS organisations and all other
partners to ensure that their requirements, in the light of changing services, are met
and aligned with national informatics policy.
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In response to these needs and challenges, Informatics strategies have been
developed by NWIS in support of delivering and improving technology services, in
particular:
National Infrastructure Strategy for NHS Wales (2009)
National Security Strategy for NHS Wales (2009)
National Application Strategy for Wales (2010)
GP Clinical Systems Strategy – Delivering next generation systems for
General Practices within Wales (2010)
The continued investment in the implementation of our Informatics strategies
supports the delivery of these seven strategic benefits:
Health system
costs
decreased
Heath System
efficiency
increased
Increased
positive
health
outcomes
Patient safety
is increased
Legal/policy
compliance
increased
Patient
confidence
Increased
Convenience
of care
increased
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4. CORPORATE VISION AND OBJECTIVES
4.1 Vision
We support the improvement of patient care through collaborative provision of high
quality information, systems and technologies; ‘Once for Wales’.
4.2 Objectives
Underpinning this vision, our seven objectives are:
Maximise the value of Informatics investment for Welsh citizens and public
sector health and social care providers
Raise the quality and productivity of existing systems and services
Promote the use of new technology as the enabler for innovation and the
transformation of future services
Incorporate quality and our values in everything we do
Improve the enabling national infrastructure
Be the Welsh informatics employer of choice
Improve the NWIS corporate reputation by being effective and efficient.
4.3 Health Technology Assessment and Overview of Deliverables
Global technology developments have revolutionised many aspects of our personal
lives, including the way we want to communicate with health and social care
services. The NWIS three year business plan recognises this and seeks to harness
and embrace such requirements. Citizens will, therefore, increasingly be at the
centre of our digital thinking and strategy.
The NWIS strategy and programme implementation will be architected and planned
for rapid change using open architectures with interoperability between systems and
technical services a key deliverable.
Our key principles will be:
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Incremental by design
Clinical and technical design must remain valid in the face of public service
redesign in order to support Service change
Enable interoperability using relevant standards
Maintain world class clinical safety as the reliance of care processes on
technology grows
Whatever we do must be affordable and aligned to financial strategy and
objectives. The above technological developments have cost implications for
health organisations and are likely to increase in the future.
The NWIS architecture is illustrated in the diagram below.
Individual HealthRecord
Out of Hours
Overview of Systems Architecture
GP systems (lifelong record)
Welsh Clinical Portal
My Health Online
Patient access –over the internet
e-referrals/discharges
•Radiology IS•Laboratory IMS•Prescribing•Scheduling•Ordering
Current hospitalsystems
New hospital/Community
systems
Clinician access– where careis delivered
The diagram shows the continuous development of new systems which builds on the
existing foundations in Health and transcends organisational boundaries.
The NWIS approach will continue to support the use the service orientated
architecture (SOA). This involves the consolidated use of SOA across Wales and the
re-use of existing SOA components to support new requirements.
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Our three year business plan will deliver:
The completion of current implementations, to include:
o National Master Patient Index (MPI)
o Welsh Clinical Portal (WCP)
o Individual Health Record (IHR in unscheduled care)
o My Health On-Line (MHOL)
o Welsh Clinical Communications Gateway (WCCG)
o Cancer Network Information System (Canisc)
o Laboratory Information Management System (LIMS)
o Radiology Information System (RADIS2)
o Picture Archiving and Communications (PACS)
o Community Child Health System
o Myrddin Patient Administration System
o Hospital Pharmacy System
o National Screening Services Systems
o GP Systems Migration
New schemes to include:
o Welsh Care Records Service (WCRS)5 to provide a national, patient
centred registry and repository for documents and core patient
information.
o National Auditing Services (NIIAS) to strengthen our capabilities for
monitoring and managing access to systems and services across the
national platform
o Emergency Department System, a framework contract that enables
Health Boards to procure a system.
o The development of a patient-centric national alerts and warnings
service to improve patient safety (WCP development).
o Increased scheduling, patient administrative and care planning
capabilities (in the longer term to provide enterprise scheduling)
5 A national, patient centred registry and repository for documents and core patient information.
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o Moving from procurement to implementation of the Community, Mental
Health and Social Care solution (CCIS).
o Develop the blueprint for implementing mobile technologies to support
new apps, such as WCP on smartphones.
o Additional investment in national infrastructure.
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5. SERVICE CHANGE PLANS AND INITIATIVES
5.1 Service Development and Programme Plans
Our priorities for the 3 Year Plan are to:
Fulfil our mandated role and functions efficiently and effectively
Maintain a high quality delivery of the portfolio of National services and
change programmes
Continued refinement of the arrangements with local organisations for the
delivery of National information and infrastructure services
Establish NWIS as a proactive and supportive co-producer within the NHS
Wales Health and Social Care framework to deliver Informatics enabled
improvements in services and outcomes that staff and Welsh citizens will
recognise and value.
We have analysed our internal strengths and weaknesses and external opportunities
and threats and these are described in the table below.
Internal
Strengths
High service quality and service
satisfaction in delivery of 80 National
Informatics Services
Large scale, resilient and scalable
systems and infrastructure
Unique technical skills and expertise –
see below
Large scale NHS holistic informatics
knowledge and expertise – contributing
to transformation of delivery to foster the
roles of citizens, carers and families in
promoting well being.
Only experienced provider of National
Informatics Services in NHS Wales
Weaknesses
Pressure on operational support
resources
Moderate awareness and alignment of
local service realities
Perception of National orientation
Demanding Modernisation Programmes
Reliance on 3rd party contractors for
specialised skills
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Internal
Long term record of delivering National
Informatics solutions across NHS Wales
Only quality assured Informatics
organisation in NHS Wales (ISO 9001)
External
Opportunities
Delivering Welsh Government Digital
Strategy and intentions in NHS Wales
Building on our international reputation
and relations
Increasing focus on future Service
transformation e.g. care in the
community
Delivery of core clinical services through
software development toolkit
Deliver new systems and service to
transform NHS Wales
Threats
Public sector austerity and NHS budget
constraints
Changes in local organisation structures
and resources
Local Informatics developments not
aligned with National strategy and plans
Maintaining quality services whilst
investing in Informatics innovation and
transformational improvement
To achieve our 3 Year Plan in the context of NHS strategies and our strengths,
weaknesses, opportunities and threats we will undertake the following Service and
Programme Plan developments.
In 2014/15 we will continue to focus on consistently meeting our existing Service
Delivery and Programme implementation plans in advance of the publication of the
new Informatics Strategy for the NHS in Wales.
The existing NWIS Services and associated change initiatives are broadly classified
as:
National Services (Applications)
Infrastructure services
Programmes and projects
Information services
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In addition, we expect our co-producers will need to access our expertise and
support for not only delivering services and functionality they require, but also for
assistance in scoping the requirements for information systems and drafting national
business cases to ensure that they are able to maximise economies of scale
regarding use of availability of information, use of infrastructure, matters related to
information governance, security and technical standards.
Our expertise includes:
Leadership of Informatics, Information and Technical Strategy development
Technical domain strategies, technical blueprint and roadmap development
Technical architecture, clinical and technical design and application build
Delivering National Application & Infrastructure Services
Clinical and Technical assurance
Statistical and analytical expertise
Requirements and business analysis
National Programme, project management and support
National business case production and assurance
Specialised Informatics procurement expertise
Benefits management and measurement
Information governance and development and use of information standards
Service management and technical and user support.
5.2 National Services (Applications)
NWIS National Services (Applications) objectives are underpinned by the aim to
continually improve the current services through further review and development of
the NWIS Service Catalogue to meet the needs of our users.
National Services (Applications) are in various states of maturity:
Mature: Operational systems that are fully transitioned to service. Continuous
development is ongoing and enhancements to services undertaken managed
through service boards working with partner organisations at a local level
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Transitional: Newly developed applications in transition to service with local
implementation continuing
New: New services under development in the early stages of the project cycle
and not yet implemented.
A summary list of all our National Services (Applications) is detailed in Appendix 1.
5.2.1 Our Planned Mature Services Commitments
Key objectives for operational systems/services relate to the provision of continued
support managed under robust Service Management arrangements and the delivery
of ongoing enhancements under “service and quality improvement plans” as
required. This list is not exhaustive, but focuses on the main areas.
NWIS has planned the following initiatives for its operational systems/services over
the next three years:
Existing Service Commitments Target
Year(s)
Resource/
budget
Canisc
Migrate CANISC infrastructure onto new hardware and
disentangle from other 3rd party products
Dec 14
Within
resources
Child Health
Complete the development of the new Child Health system
(CYPrIS)
Produce a Mobile Device version of CYPrIS with limited
appropriate functionality
Implementation of CYPrIS across Wales
Implementation of CYPrIS in other Home Countries
Sept 14
Jan 15
Jan 16
Mar 17
Within
Resources
HTTF Bid
Within
resources
SLA
income
Clinical Knowledge Services
Evaluate and ensure the electronic content demonstrates
Ongoing
Within
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Existing Service Commitments Target
Year(s)
Resource/
budget
best value for money resources
GP Systems
Migration to New Hosted System(s)
Implement GP to GP transfer
July 15
Mar 16
Within
resources
Hospital Pharmacy
Migration on to new hardware and improved resilience
TBC TBC
Integration Services
Publication of software development toolkit
Replace JCAPS and BizTalk Integration Engines with a
newly procured Integration Engine.
Jun 14
Mar 16
New
Business
Case
Master Patient Index
Development of National Data Quality Service
Continuous integration with systems as they develop
Mar 17
Within
resources
Myrddin (PAS)
Hardware refresh and consolidation for Powys and Cwm
Taf
General application improvements
Sept 14
Within
resources
NRDS
Enhance NRDS to hold appropriate information to support
GP-to-GP transfer.
Develop improved administration system for NRDS.
Sept 14
Mar 15
Within
resources
RadIS2
Implement RADIS2 into Cardiff & Vale
Implement RADIS2 into AMBU West
Merging legacy RADIS2 instances into new Health Board
Instances
Enhance RADIS2 to implement Obstetrics functionality.
May 15
May 15
Mar 15
Aug 14
Within
resources
Screening Services
Rewrite Cervical Screening (subject to procurement tender)
and ongoing support of new service
Jun 17
Business
Case
Web Services
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Existing Service Commitments Target
Year(s)
Resource/
budget
Migrate HOWIS onto new infrastructure
Improve the Cascade content management system used to
deliver a number of NHS Wales Websites.
Enhance the new e-learning @nhs.wales to support and
implement the technology enhanced strategy (TEL)
Sept 14
Mar 15
TBC
Within
resources
TBC
Welsh Demographic Service
Migrate WDS onto new infrastructure in readiness to move
to the new Data Centre.
Enhance WDS functionality to support Welsh Birth
Notification, GP patient trace.
Jun 14
Sep 14
Within
resources
5.2.2 Our Planned Transitional & New Service Commitments
We continue to develop and enhance the NWIS IT Services. The following initiatives
for operational systems/services over the next three years include:
Service Commitments Target
Year(s)
Resource/
budget
LIMS
Support the ongoing implementation & full operational service
Jul 15
Within SLA & Resource
Diabetes
Readiness/ Operational support of “live” service
Dec 15
Seek SLA
Community, Mental Health and Social Care System
Technical solution and service delivery, evaluation of options
Design, implementation and on-going support arrangements
Dec 14
Within
resources Business
Case & New SLA
PACS XDSI system
Support installation of hardware within Datacentre(s) and implement registry service
March 15
Within
Resources
National Intelligent Integrated Audit Service:
Design, implementation and on-going support arrangements
Mar 15
New SLA
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Service Commitments Target
Year(s)
Resource/
budget
Welsh Care Records Service
Technical solution and service delivery, evaluation of options
Design, implementation and on-going support arrangements
E-forms development
Jun 15
Apr 16
Jun 16
Within
resources Business
Case & New SLA
5.3 Infrastructure Services
NWIS provides and manages core Infrastructure on behalf of NHS Wales to improve
the way information is delivered and stored.
NWIS infrastructure broadly falls into two main categories:
National infrastructure that NWIS provides and manages on behalf of NHS
Wales. This includes:
o Two national data centres and the server and storage equipment that
run all of our national applications
o Network links to the Internet and N3 (NHS England/Scotland)
o Remote Access Services that allow NHS Wales’ employees to work
remotely
o Email services
o Video and Audio Conferencing Services
Local infrastructure for NWIS staff, including:
o PCs, Laptops, Printers, File servers, etc
o Wired and Wireless (WiFi) Local Area Networks (LANs)
Additional information about the National Infrastructure can be found in Appendix 2.
This infrastructure is mature and works well. However, investment is needed to
achieve the following objectives:
Maintaining operational services
Increasing capacity and resilience
Enabling new methods of working
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5.3.1 Our Planned Infrastructure Services Commitments
NWIS has planned the following initiatives for its infrastructure systems/services over
the next three years:
Infrastructure Services Commitments
Target Year(s)
Resource/ budget
Maintaining operational services:
Upgrade the National Active Directory to Windows Server 2012
Replacement of National Email Infrastructure (HMS)
Replacement of the network infrastructure in the national data centres
Replacement of hardware for Information Services servers
Replacement of Domain Controllers across NHS Wales
Replacing aging web monitoring/filtering system for NWIS users
Deployment of new SAN for NWIS Client Services
Replacing old NWIS PCs, Laptops, etc
Replacing old NWIS offices LAN infrastructure
General maintenance / upgrades of computer rooms
General maintenance / upgrades of server and storage equipment
Mar 15
Mar 17
Dec 15
Dec 16
Mar 17
Mar 15
Mar 17
Ongoing
Ongoing
Ongoing
Ongoing
Within resources/ Capital needed
Within resources/ Capital needed
Within resources/ Capital needed
Within resources/ Capital needed
Within resources/ Capital needed
Within resources/ Capital needed
Within resources/ Capital needed
Within resources/ Capital needed
Within resources/ Capital needed
Within resources/ Capital needed
Within resources/ Capital needed
Increasing capacity and resilience:
Migration of infrastructure from existing BT Cardiff Data Centre to the BT Newport Data Centre.
New SQL and VMware infrastructure (Provide additional capacity and replace some aging existing infrastructure)
Upgrade of DMZ firewalls and DMZ networking infrastructure (to provide faster access to internet websites and resources – to keep in-line with the demand)
Creation of a DMZ server farm at the Newport Data Centre, to provide resilience for hosted internet websites.
Deploying WLAN Infrastructure for NWIS
Jul 14
Jun 16
Mar 15
Mar 16
Within resources
Within resources/ Capital needed
Within resources/ Capital needed
Within resources/ Capital needed
Within resources/
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Infrastructure Services Commitments
Target Year(s)
Resource/ budget
Offices at Swansea, Mamhilad and Mold.
Establishing a Major Incident Response Centre at NWIS Brunel Offices
Mar 15
Dec 14
Capital needed Within resources/ Capital needed
Enabling new methods of working:
Deployment of infrastructure for NHS Wales to run Microsoft Lync
Deployment of a Mobile Device Management solution for allowing NWIS to access corporate services from NWIS staff Tablets/SmartPhones (including BYOD)
Investigate use of Microsoft Direct Access
Deployment of Virtual Desktop Infrastructure for NWIS clients
Oct 14
Oct 14
Jun 15
Oct 15
Subject to Health Technology Fund Within resources/ Capital needed
Within resources/ capital needed
Within resources/ Capital needed
5.4 National Programmes and Projects
5.4.1 Our Planned National Programmes and Projects Commitment(s)
We have planned the following enhancements to National Programme and Project
activities over the next three years. We will align our ongoing and new Programme
and Project activities with NHS Wales Local Health Board plans, under the direction
of the National Implementation Management Board. It should be noted that we will
use this Three Year Business Planning process to reaffirm our Programme and
Project commitments, revenue and capital funding for 2014/15 and beyond.
Assuming that national and local funding is confirmed to cover the National
Programme and Project requirements, we expect our more significant and material
activities to include:
Programme & Project Commitment(s) Target
Year(s)
Resource/
budget
Community, Mental Health and Social Care solution:
National procurement complete (Master Service Agreement - (Health Boards to include local funding in their 3 year plans
National Roll Out
Dec 14
Mar 17
Resources Required (Capital and Revenue)
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Programme & Project Commitment(s) Target
Year(s)
Resource/
budget
Community Pharmacy: Electronic Transmission of Prescription Claims:
Business Case to be produced
Product available - Early Adopter
Product available - National Common Ailments Service:
Roll out to remainder sites Discharge Medicines Review Service (DMR):
Hospital to Pharmacy (Option Appraisal and way forward to be agreed)
Solution to be procured/developed (subject to Business Case)
Implementation
Mar 14 Feb 15 Jun 15
2015 - 2017 TBC (by
WG)
Mar 15
Mar 16
Mar 17
Funding stream to be identified
Revenue required for national support and local implementation
Resources required subject to Business
Case
CANISC:
WCP to Canisc Integration and implementation in Velindre Cancer Centre
Scoping and agreeing integration of Canisc to WCCG
Cancer Documents available across NHS Wales via Document Repository
Multi-disciplinary team module available
Mar 15
Mar 15
Mar 16
Mar 16
Business Case:
approved
Diabetes:
Product Available – Early Adopter
National Rollout
Dec 15 2016/17
Resources subject to
Business Case
GP Links:
Implement national Message Integration between secondary and GP Practises throughout Wales
Oct 14
Within Resources
Hospital e-Referrals (HERS 1):
Completion Implementation of Phase 1 (Electronic interface for Medical Records Departments)
Sept 14
Within Resources
Individual Health Record (IHR):
User Interface Improvement
Scoping of IHR/WCP reconciliation
Improved functionality to be determined and delivered (e.g. Advanced Care Plans and consent model
Dec 14 Mar 15 Apr 17
Resources subject to
Business Case
Laboratory Information Management System (LIMS) :
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Programme & Project Commitment(s) Target
Year(s)
Resource/
budget
LIMS HB Implementation(s) o Core Disciplines o Genetics Module* o Blood Tracking o Blood Transfusion o WTAIL (WBS) o HB Legacy Data Repository
(Blaenavon) Migration complete
Wales Pathology Handbook (WPH):
Phase 2 Clinical Front End (CFE) Scoping
Phase 2 CFE Development
Phase 2 (CFE) release to Service
Phase 3 WPH Revision Scoping
Phase 3 WPH Development
Product Available - national
Point of Care Testing
Business Case
Procurement completion
Implementation
Oct 14 Dec 14 Dec 14 Mar 15 Mar 15 Jul 14 Jul 15
Jul 14 Feb 15 Mar 15 Sept 14 Aug 15 Oct 15
Mar 14 Oct 14 Apr 15
Within Resources and
Capital approved (*Genetics Business Case in progress)
Resources subject to Business Case
Resources subject to Business Case
Master Patient Index (eMPI):
Completion of implementation to support Community and Social care
2014 – Mar 17
Capital required for
Infrastructure (2016)
Medicines Management
Scoping and Options for Hospital Pharmacy and ePrescribing
Procurement / Build
National availability
Sept 14
Dependent upon scope agreed
Resources subject to
Business Case
My Health Online (MHOL):
Phase 1 functionality, e.g. Alerts, Mobile App, messaging and online registration Product Available - national
Phase 2 functionality e.g. diary, medical record, carer access Scope confirmation
Apr 15
Apr 16
Funding to be confirmed as part of GP contract,
subject to scope
National Intelligent Integrated Audit Service (NIIAS):
Interim Audit Service for WCP access to IHR
National Solution Available for LHB Call off
Completion of Early Adopter & Full
June 14 Mar 15 Mar 17
Within resources Resources subject to
Business Case
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Programme & Project Commitment(s) Target
Year(s)
Resource/
budget
Implementation Patient Administration System (Myrddin):
Published Annual Operational Work Plan 2014/15 (Business Cases will be produced where new modules are developed requiring capital investment)
Apr 14 – Mar 17
Resources subject to
business case
Picture Archiving and Communications System (PACS):
Completion of National Rollout across NHS Wales
PACs integration: o Assessment of network capacity
and infrastructure o Product available (Fuji sites) –
national o Product available (other sites)
Mar 15
Jun 14
Sept 14 Mar 15
Within resources
Capital may be required
Within resources
Readiness:
Provision of project management support to NHS organisations
Ongoing
Within resources
Radiology Management System (RADIS2):
Decommission of RADIS1 completed across NHS Wales
Deployment of RADIS2 ABMU (subject to LHB decision)
Development Completed: RADIS2 (Requesting) available for deployment
Sept 14
Dec 15
Mar 16
Within Resources
Systems Integration Tools Replacement
Publication of software development toolkit
Procurement complete
Implementation for national messaging
Apr 14 Apr 14 Apr 16
Capital requirement
Welsh Care Record Service (WCRS):
Establish and make available a National framework Contract for EDRMS (Electronic Document Repository Management System) to Local health Boards
Implement a Central Document repository
Create E-Forms for Clinical Data entry
Jun 15
Apr 16 Jun 16
Subject to Full Business Case re Capital Funding
Welsh Clinical Communications Gateway (WCCG):
WCCG Phase 2 o Clinic Letters o Discharges o Supplementary messages o Advice requests o Reporting o Cross border o Canisc
Resources to be
confirmed
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 25 of 82
Programme & Project Commitment(s) Target
Year(s)
Resource/
budget
Product available - national Sept 14 –Mar 17
Welsh Clinical Portal (WCP):
National product of IHR View in WCP available
National product - clinical prioritisation of eReferrals available
Implementation of WCP with LIMS integration in all LHBs
MTED nationally available (current scope)
MTED extended scope nationally available
ADT functionality
Mobile device platform
Community Care Information System integration
National WCP/TRRR – pilot one organisation
Nationally available WCP/TRRR
Patient handover functionality, nationally available
Sep 14 May 15
Mar 15
Apr 14 Mar 15 Mar 15 Mar 15
2015 - 2016
Mar 15
Mar 16
Mar 16
Resources subject to
business case
Welsh Demographic Service (WDS):
Welsh Birth Notification service
Implementation to mirror changes to Adoption Legislation
Advanced Trace
GP Registration
Jun 14 Dec 14
Dec 15 Mar 16
Within Resources
Subject to business case
A description of each Project is detailed in Appendix 3.
5.5 Information Services
Information Services have a pivotal role to play in delivering trusted information
critical to decision making and public accountability as well as standardised
measures and national comparisons which are key to improvement. This is at a time
of austerity and there is an expectation of achieving savings through the
rationalisation of information services.
Information Services key objectives are:
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 26 of 82
1. Improving information quality and data standards
Ensuring the right quality information is provided, using clear governance and
standards in data and data collections
2. Improving access to and interpretation of data through better presentation and
reporting
Ensuring fair and equal access to information
3. Providing relevant information services
Delivering the information that frontline services need to meet their priorities
and acting as the core source for official statistics published by WG and other
bodies for the purposes of national accountability
5.5.1 Our Planned Information Services Commitments
The key priority for Information Services is to ensure the right information is
produced to the right quality at the right time alongside enabling business continuity.
Over the next three years, the demand for, and components of this service, will
remain:
Responding to ad-hoc requests for information
Undertaking specialised statistical analysis
The provision of value-added data extracts to other agencies
The production of agreed performance, health outcome and other measures
Health services research support
The provision of health intelligence.
In addition, standard operating procedures to ensure an agreed understanding of the
requirement, timely turnaround of requests, intelligent presentation of data and
effective quality assurance of outputs are essential and will be further developed.
Whilst embracing the relevant components of Service Management, Information
Services will continue to adopt more agile business processes with an emphasis on
closer collaboration with clients and more devolved ways of working across the
organisation.
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 27 of 82
We have planned the following information activities over the next three years.
Information Services Commitment(s) Target
Year(s)
Resource/
budget
Raising the profile of information: To align endeavours around the forthcoming National
Information Strategy
Modernise Information systems, with investment in
products and skills more suited to the delivery of visualised business intelligence. This to be achieved by the adoption of the Microsoft SP2014 and associated BI toolset.
Work across NHS Wales to develop a Enterprise Corporate Data Warehouse Strategy. This to include both corporate secondary use data sources and those currently untapped information sources contained with key operational systems (Canisc, Myrddin, LIMS, WCCG etc)
Implementation of Corporate Data Warehouse
To support, develop and facilitate benchmarking
solutions building on the economies of scale achieved by the rationalisation of the NHSW CHKS contract
Development and expansion of the NWIS Information
Standards (reference data, clinical coding, data quality, datasets and MDSs)
Support and promote Wales Informatics Assurance
processes (WISB, Analysis and methodologies Group)
Use of formal business analysis process to identify, specify and help address key “gaps” in the availability of data and information – priorities current include:
o The development of a community services
dataset o Mental Health information requirements o Specialised and tertiary services information
requirements o Outcome, quality and system bases measure
and metrics
Mar 15
Mar 16
Dec 2014
Sep 2017
Mar 16
Mar 15
Ongoing
Ongoing
Within
resources
Subject to Business
Case
Within resources
Subject to Business
case
Within resources
Within resources
Within resources
Within
resources
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 28 of 82
Information Services Commitment(s) Target
Year(s)
Resource/
budget
Primary, Community, Social Care & Mental Health information
o Establishing a primary, community, social care and mental health informatics service
o Putting this service on a secure footing o Addressing immediate priorities (QOF 2014
and beyond) o Developing a primary, community, social care
and mental health Data Warehouse o Practice profiles and other envisaged products
Mar 16
Within
resources
5.6 Service Delivery Risks
The key strategic and operational risks are outlined below. NWIS has monitored
these and other emerging risks under regular review and, based on understanding
the consequences, has developed mitigating actions where possible.
Key Risk(s) Mitigation(s)
National Services (Applications)
Resources will not be sufficiently available to
complete the development of Continual
Service Improvement Plans (CSIPs) for all
required services resulting in no clear
pathway for service development
Service Management Boards
Change Advisory Boards
There could be lack of Health Board/Trust
resource to take forward ITIL alignment
Engagement with Health Boards/Trusts to
identify, commit resource and agree
timescales
Lack of technical resource resilience within
the Operational Services Team could mean
that targets are not met if key resources are
not available
Vacancy Control discussions at monthly
Executive Board meetings (following
submission of business cases)
Systems classed as Medical Devices are
subject to inspection by MHRA (Medicines
and Healthcare Regulatory Authority) to
Achievement and maintenance of ISO
certification against standards. Development
of SOPs to address requirements of
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 29 of 82
Key Risk(s) Mitigation(s)
ensure compliance with the Medical Devices
Directive. If not compliant, the MHRA can
act to stop use of systems meaning NWIS
systems/services would be unavailable to
NHS Wales
standards and directives to ensure
compliance with
Infrastructure Services
Failure to invest continuously in network
capacity to keep pace with network traffic.
Design resilience into the infrastructure and
ensure that applications leverage this
capability
Regular testing of failover/disaster-recovery
processes.
Consider network capacity investment in all
plans and developments.
National Programmes and Projects
Lack of Health Board/Trust resource to effect
timely implementation of new
products/developments
Engagement with Health Boards/Trusts to
identify resource and agree timescales
Information Services
Risk of loss of services due to a reliance
upon a series of disparate, and retrospective
and untimely “minimum datasets” and
aggregate returns and legacy products mean
that increased and changing demand cannot
be met
Work with Stakeholders to establish and
implement up to date information
requirements
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6. QUALITY IMPROVEMENT
NWIS continuously strives to be acknowledged by its customers, partner
organisations and stakeholders as a centre of expertise and innovation in the
provision of specialist IT and Information Services.
A description of the quality initiatives is given in Appendix 4.
6.1 Our Planned Quality Commitments
In order to demonstrate and excel in the service we deliver, NWIS is committed to
comply with all statutory and regulatory requirements and the requirements of the
International Standards, ISO 9001:2008, ISO 14001:2004, ISO 27001:2005, ISO
20000-1:2011 and Business Continuity ISO 22301:2012 and to continually improve
its effectiveness by the use of performance indicators and review.
NWIS products (systems and services) will also be subject to MHRA (Medicines and
Healthcare products Regulatory Agency) inspection.
Quality Commitment(s) Target
Year(s)
Resource/
budget
Establish and maintain a fully functional Integrated
Management System (IMS) – reporting on quality
performance
Sept
2014
Within
resources
To maintain certification against the following standards for
the entire range of NWIS services
- ISO 9001:2008 (Quality Management)
- ISO 27001:2005 (Security Management) – this will
involve the transition from the 2005 standard to the
new revised ISO 27001:2013 Standard
Dec
2014
Within
resources
To achieve certification for the whole organisation:
- ISO 14001: 2004 (Environmental Management)
- ISO 20000-1:2011.(Service Management)
Sept
2014
Budget
(additional
resource reqd)
To engage with the Medicines and Healthcare products
Regulatory Agency with regard to system compliance with
Sept
2014
Within
resources
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 31 of 82
Quality Commitment(s) Target
Year(s)
Resource/
budget
Medical Devices Directive
To prepare for assessment against the following standard:
- ISO 22301: 2012 (Business Continuity)
2015 Within
resources
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 32 of 82
7. ORGANISATIONAL DEVELOPMENT Our workforce is and will be imperative in ensuring that NWIS discharges its ongoing
commitments and works in a co production and collaborative manner with our
partners and Welsh Government.
Because of the specialist nature and complexity of Informatics service innovation,
improvement and deliver, it is critical that an effective workforce plan is implemented
that:
Underpins the Three Year Business Plan and embodies our approach to
leadership, our workforce strategy and learning and development strategy that
has been developed in consultation with a wide range of stakeholders
Delivers the sustained productivity, improved quality and cost efficiency
savings to all directorates
Is adaptable and flexible enough to accommodate unforeseen new service
and project demands
Acknowledges that given the nature of NWIS activities, a certain level of
temporary expertise and resource is required that will enable us to manage
capacity peaks and troughs and avoid recruitment on a permanent basis
Developing the workforce to support Welsh Government Digital Wales
initiatives
7.1 Our Existing and Planned Workforce Profile
The current NWIS establishment directly employed workforce numbers are shown
below. Planned WTE resource required to underpin service growth is also detailed
prior to any subsequently imposed cost improvement/savings plan.
Directorate/Team
Total current
WTE Establishment
% WTE
2014/15 Planned
2015/16 Planned
2016/17 Planned
Executive Management
8 1.6% 8 8 8
Operational Services, Commercial Services and Information Services
386.72 76.1% 400.72 400.72 400.72
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 33 of 82
Directorate/Team
Total current
WTE Establishment
% WTE
2014/15 Planned
2015/16 Planned
2016/17 Planned
Programmes & Projects 40.36 7.9% 40.36 40.36 40.36
Finance, Business Assurance & Corporate Services
26.07 5.1% 26.07 26.07 26.07
NHS Engagement, Workforce & OD Team
22.76 4.5% 22.76 22.76 22.76
Clinical Informatics
17.10 3.4% 17.10 17.10 17.10
Nursing & Social Care Information
7.0 1.4% 7.0 7.0 7.0
Total 508.01 100% 522.01 522.01 522.01
7.2 Our Planned Organisational Development Commitments
In a period of acknowledged austerity, NWIS aims:
To continue striving to develop structures that are fit for purpose with roles,
skills, flexibilities and competencies of all staff aligned to corporate objectives
Develop desired capacity and capability to fulfil National Service & Project
obligations
Improve the quality and time devoted to Service & Quality Improvements
Develop robust and equitable workforce planning across the directorates and
reduce sickness absence
To be an Employer of Choice
Organisational Development Commitment(s) Target
Year(s)
Resource/
budget
Workforce Development:
Develop new and extended roles to
support new ways of working
Work with Health Boards and Trusts to
identify areas where resource can be
Mar 2015
Sep 2014
Mar 2015
Within
resources
Within
resources
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 34 of 82
Organisational Development Commitment(s) Target
Year(s)
Resource/
budget
shared
Continue to improve workforce data and
analysis, including further embedding of
ESR (Electronic Staff Record) across the
organisation
Within
resources
Learning & development:
Continue the informatics development
programme, including apprenticeships,
graduate interns and management
trainees
Establish a programme of Knowledge
Sharing Events across Wales
Develop the capacity and capability of line
managers to deliver excellent human
resource management in their day to day
management of their staff
Support the wider NHS Informatics
Service in providing tools in terms of
workforce surveys, national identity and
common structures/job descriptions/titles
to ensure a consistent approach
Continue to work with Education Business
Partnerships and schools and career
services to promote informatics as
profession and provide opportunities for
young people
2014 to 2017
2014 to 2017
Mar 2015
2014 – 2017
2014-2017
Within
resources
Within
resources
Within
resources
Within
resources
Within
resources
Co-Production and Engagement:
Strengthening processes for partnership
working and staff engagement and
support, improving decision-making and
supporting staff well-being
Sep 2014
Within
resources
Recruitment:
Integrated service, workforce and financial
2014 - 2017
Within
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 35 of 82
Organisational Development Commitment(s) Target
Year(s)
Resource/
budget
plans will be developed for all services
which outline the future changes to the
shape and size of the workforce. This will
enable effective and responsive
recruitment, re-deployment and re-training
processes to be put in place.
resources
Workforce Health / Equality & Diversity:
Develop a culture of workplace health that
focuses on supporting and improving
employee well-being
Further development of the Health &
Wellbeing Action Plan
Achieve Investors in People (IIP)
accreditation
Continue programme of Equality Impact
Assessments. The Trust’s Single Equality
Scheme and Action Plan, establishes and
promotes the strategic commitment to
equality and diversity through recruitment,
employment, retention, training and
development practices
March 2015
March 2015
March 2015
2014 - 2017
Within
resources
Within
resources
Within
resources
Within
resources
Productivity:
Review Workforce & OD management
processes and practices within NWIS to
improve the quality of staff and support
managerial empowerment and
accountability
Sep 2015
Within
resources
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 36 of 82
8. FINANCE
8.1 National Context
The scale of the real terms total reduction in Welsh Government central funding for
2014-15 to 2017-18 has required tough decisions to be taken about expenditure
across government and careful consideration of pressures and priorities in all
portfolios. Notwithstanding the (real terms) decrease in funding, issues such as the
implementation and roll out of new national services and unfunded service growth
means that NWIS will face considerable budgetary pressures. These pressures
mean that we will need to deliver maximum value from investment through a focus
on improving the quality of service by prioritising changes which also deliver greater
efficiencies.
8.2 Organisational Context
NWIS will continue to adopt a dynamic approach to financial leadership – this will
involve the Director of NWIS and Director of Finance ensuring that scarce resources
are efficiently and economically utilised. The objective will be to ensure that the
business plan is financially grounded and sustainable and is balanced (with due
regard to flexibly manage resources and expenditure limits over a rolling 3 year
period if required). Consequently, the plan is supported by an achievable (although
challenging) savings target.
In order to continue to have a balanced financial plan in each financial year there is a
savings requirement of 5.4% in 2014/2015, 4.3% in 2015/2016 and a further 5.1% in
2016/2017.
Key Financial Objectives for the Organisation include:
Revenue Breakeven within 3 year flexibility (subject to approved robust
savings plans)
Remain within Capital Resource Limit
Meet Public Sector Payment Target
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 37 of 82
8.3 Revenue and Capital Funding Model
NWIS receives the majority of its funding from the Welsh Government to cover the
day-to-day running costs of IT services and projects during each Financial Year. This
takes the form of both revenue and capital allocations for operational and strategic
developments.
Financial forecasts are summarised below:
Forecast Revenue Position 2014/15 2015/16 2016/17
£M £M £M
Forecast Income 57.02 56.97 56.97
Forecast Expenditure 60.27 59.4 60.01
Savings Plan/Target -3.25 -2.43 -3.04
Net End of Year Forecast 0.00 0.00 0.00
In order to achieve breakeven significant savings will need to be obtained (see Section 8.5).
Forecast Capital Investment
2014/15 2015/16 2016/17
£M £M £M
Total Funding 9.390 6.890 5.890
Total Schemes Spend 11.705 6.928 5.890
Surplus/(Deficit) -2.315 -0.038 0.000
Planned capital schemes exceed available funding, NWIS will look to Welsh Government and further reduction of costs in order to allow all to be completed.
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 38 of 82
8.3.1 Revenue Funding
The majority of NWIS revenue income is sourced from Welsh Government (86%)
including an allocation for capital charges (depreciation). All other anticipated income
(14%) relates to the payment of services provided by NWIS. There are also a range
of services provided to NHS Wales, England, Northern Ireland and the private sector
for which users provide funding directly. Typically these income streams have more
of a “trading” relationship and consequently can be more volatile in nature due to
changes in service levels/terminations.
Source of Funds
2014/15 2014/15 2015/16 2016/17
% £M £M £M
Welsh Government 86% 48.90 48.62 48.62
Welsh Health Boards 8% 4.45 4.45 4.45
Welsh Trusts 5% 2.67 2.61 2.61
NHS England 1% 0.45 0.45 0.45
Private/Other 1% 0.55 0.55 0.55
Grand Total 100 57.02 56.97 56.97
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 39 of 82
8.3.2 Capital Funding
Capital funds are received exclusively from Welsh Government and are grouped by:
Discretionary Capital Funding: Internally prioritised schemes
Strategic Capital Funding: Accessed by way of business case (subject to
ministerial approval) and are, in general, larger schemes.
Source of Capital
2014/15 2015/16 2016/17
£M £M £M
Discretionary 1.890 1.890 1.890
Strategic 7.500 5.000 4.000
Total 9.390 6.890 5.890
There are also subsequent revenue implications as a result of capital spend, these can encompass:
Future Support
Maintenance
Training
Capital Charges (Depreciation) For the planning purposes it is assumed that Welsh Government will fund capital charge costs.
8.4 Revenue
8.4.1 Income and Cost Assumptions
The following assumptions have been made within the plan:
Welsh Government Income Funding will be “Flat Cash” over the next three
years
There is to be no inflationary uplift for NHS Wales agreements.
A zero increase in NHS Tariffs.
General contractual risk managed from the risk contingency reserve.
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 40 of 82
Savings initiatives can be met, subject to risk and sensitivity analysis and
continuous budgetary control throughout the medium term financial forecasted
plan
In estimating the annual cost increases a number of items were identified for inclusion. These are summarised below: Pay
A “zero base” approach has been adopted for all pay costs with each directorate identifying the resource required to provide services adequately.
Public sector pay increases will be limited to 1% per year
Staff entitlement to incremental progression
Uplift of Superannuation liability from 2015/16
Removal of National insurance rebates in 2016/17
Non pay
A combination of “zero base” approach has been used in order to eradicate any
“spare” financial capacity at an early stage and also to identify additional resource
consequences of new projects/implementations allied with general non staff
inflationary uplifts.
Local pressures
Unfunded Service Growth such support of the new applications and systems post
implementation.
8.4.2 Application of Revenue Funds
NWIS income is allocated across the four investment categories and additionally to
fund Strategy/Support Directorates and Overheads. Over 38% of NWIS income is
used to fund Infrastructure Services which includes provision of the National
Datacentre.
Application of Funds (by Service Group)
2014/15 2014/15 2015/16 2016/17
% £M £M £M
National Services (Applications) 15% 9.29 8.79 9.04
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 41 of 82
Application of Funds (by Service Group)
2014/15 2014/15 2015/16 2016/17
% £M £M £M
Infrastructure Services 38% 23.1 23.04 23.38
National Programmes & projects 12% 7.15 7.04 6.79
Information Services 4% 2.42 2.56 2.66
Strategy, Support & Overheads 30% 18.31 17.97 18.14
Grand Total 100 60.27 59.4 60.01
Application of Funds (By Spend Group)
2014/15 2014/15 2015/16 2016/17
% £M £M £M
Staff 37% 22.36 23.82 24.7
Non Staff & Estates 45% 27.31 25.69 25.62
Depreciation 13% 7.54 7.54 7.54
SLAs & Disbursements 5% 3.06 2.35 2.15
Grand Total 100% 60.27 59.4 60.01
Figures are gross and are subject to savings plans. 8.4.4 Statement of Comprehensive Net Income
Forecast income and expenditure for the next three years is outlined below.
Income & Expenditure Summary
2013/14 2014/15 2015/16 2016/17
£M £M £M £M
Welsh Government 46.69 48.90 48.62 48.62
Welsh Health Boards 3.01 4.45 4.74 4.74
Welsh Trusts 3.51 2.67 2.61 2.61
NHS England 0.45 0.45 0.45 0.45
Private/Other Income 0.56 0.55 0.55 0.55
Total Income 54.22 57.02 56.97 56.97
Staff 20.50 22.36 23.82 24.70
Non Staff 19.68 24.69 23.02 22.96
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 42 of 82
Income & Expenditure Summary
2013/14 2014/15 2015/16 2016/17
£M £M £M £M
Agency/External Consultancy 1.28 0.24 0.23 0.21
Depreciation 7.54 7.54 7.54 7.54
Disbursements 1.95 2.27 1.55 1.36
Estate 2.36 2.37 2.44 2.44
SLAs 0.91 0.80 0.80 0.80
Total Expenditure 54.59 60.27 59.40 60.01
Surplus/(Deficit) 0 -3.25 -2.43 -3.04
Just over 39% of costs forecast for 2014/15 is derived from staff with the remainder
being a combination of non staff elements and depreciation. This may appear be a
slightly lower ratio than in other NHS organisations as NWIS incurs significant non
staff expenditure by way of all Wales contracts and agreements.
8.4.5 Cash Flow
NWIS treasury management services are provided by Velindre NHS Trust.
Management of cash balances is dependent upon Trust strategy.
8.5 Savings Plans
The initial forecast position presented varying deficits across the financial years (as
detailed in the table below). The deficit has been addressed by assigning agreed
organisation wide savings plans.
The savings initiatives are very challenging and managing the balance between
impact on stated objectives and financial breakeven will be a key activity.
Details of savings plans to support the balanced financial plan are as follows:
Savings Plans 2014/15 2015/16 2016/17
Staff Vacancy/Turnover Management 0.54 0.68 0.68
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 43 of 82
Staff Resource Requirement Review 1.05 1.05 1.05
Non Staff CIP Target (non recurring) 1.66 0.70 1.11
Estate Savings Target 0.00 0.00 0.20
Total 3.25 2.43 3.04
Required Total (£M) -3.25 -2.43 -3.04
Significant resource is required in order to support upcoming projects. This is
targeted for review with the intention of releasing funds by reorganising existing
capacity or revising delivery dates.
8.6 Capital
The NWIS Capital Plan is consistent with strategic goals and corporate objectives.
The source of capital funding reflects the funding provisionally allocated to NWIS in
the Welsh Government All Wales Capital Programme over the next three years.
8.6.1 Capital Assumptions
Any planned deficits will be managed by NWIS and the Welsh Government
through the regular Capital Review meetings
Depending on the type and value of investment, capital spend will be subject
to agreed business case protocols and approved by the appropriate authority.
8.6.2 Capital Spending Plans
Planned capital investments are reported below.
Planned Capital Investment
2014/15 2015/16 2016/17
£M £M £M
Business Intelligence Systems Modernisation 0.130 0.080 0.080
Canisc 0.330 0.330 0.330
Community, Mental Health and Social Care Solution 0.150 0.020 0.000
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 44 of 82
Planned Capital Investment
2014/15 2015/16 2016/17
£M £M £M
Common Ailments Service 0.100 0.250 0.250
Corporate Data Warehouse 0.150 0.200 0.200
Development of Primary Information Service 0.120 0.120 0.120
Diabetes 0.100 0.286 0.250
Discretionary Capital –GPSS/ Software etc 0.237 0.500 1.364
Electronic Transmission of Prescription Claims 0.050 0.000 0.000
GP Links 0.060 0.043 0.043
Individual Health Record (IHR) 0.128 0.038 0.000
Information Standards 0.230 0.230 0.230
Infrastructure Replacement Plan 3.520 2.815 1.215
National Intelligent Integrated Audit Solution 2.900 0.023 0.023
Laboratory Information Management System (LIMS) 0.731 0.733 0.733
Patient Administration System (Myrddin) 0.800 0.000 0.000
Radiology Management System (Radis 2) 0.085 0.000 0.000
Systems Integration Tools Replacement 0.035 0.000 0.000
Welsh Clinical Portal (WCP) 0.110 0.110 0.110
Welsh Clinical communications Gateway (WCCG) 0.989 0.650 0.442
Welsh Care Records Service (WCRS) 0.750 0.500 0.500
Total 11.705 6.928 5.890
Surplus/(Deficit) -2.315 -0.038 0.000
8.6.3 Assets – Current Condition and Performance
NWIS invests in IT assets, both tangible and intangible, on behalf of NHS Wales.
NWIS does not have any land or property assets. The current condition and
performance of assets are continually reviewed and assessed and future investment
decisions are made upon the basis of assets required to support information
technology developments in NHS Wales.
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Intangible software developments are continually enhanced to satisfy the
requirements of the NHS. These developments need to be supported by hardware
and infrastructure that is fit for purpose and that is adequately supported and
maintained. The NWIS capital programme makes provision for a refresh and renewal
programme of assets based upon their condition and suitability of purpose.
For Audit purposes, a validation exercise is performed on an annual basis and part
of this exercise is to review the condition of assets and their estimated useful lives to
the organisation. This informs the future investment programme and helps to identify
asset disposal.
8.7 Financial Risk
NWIS will closely monitor the risk associated with its financial plans to ensure activity
is delivered within financial resources to achieve a break-even position.
Financial risk is managed as an integral part of the NWIS overall Risk Management
Strategy referred in Section 10.5.
Key Risk(s) Mitigation(s)
Revenue
Cost Improvement - NWIS is required to find
significant annual savings/cost reductions to
service unfunded cost pressures and growth. The
achievement of this, in an environment where the
generation of additional income is likely to be more
difficult, represents a major challenge both for
2014/15 and beyond.
Strict saving plan management , with
Executive Board monthly performance
reporting
Contractual Risk – Negotiations with suppliers and
NHS Wales organisations typically surrounding
payment and system implementation timetables
are likely to impact the NWIS financial plan going
forward.
Generation of a contingency reserve.
___________________________________________________________________ NWIS 3 Year Plan 2014-2017, v26 Page 46 of 82
Key Risk(s) Mitigation(s)
Possible shrinkage in the English customer base –
English users of the Child Health System are
currently re-evaluating their overall strategy which
may impact their requirement and NWIS revenue
streams.
With the redevelopment of the new
system English users will be targeted,
allied to a revised pricing mechanism.
Central budget reductions – Reductions in funding
from Welsh Government would severely impact the
organisations ability to deliver stated objectives
and financial breakeven.
Continue ongoing dialogue with Welsh
Government identifying possible
impact and where there is inflexibility
within the plan.
LIMS Implementation Slippage – the slippage of
any dates will impact on revenues receivable and
possibly future years liabilities should
implementation not be fully rolled out during the
financial year 2014/15.
Monitor current implementation plan to
ensure timely notification of financial
impact of any slippage and
target/identify further saving
requirement.
Funding of parallel running costs may
need to be “time limited”.
The anticipated increased demand on services
which may affect resource requirements include
further transition from project to operational
services.
Look at skill mix, with a view to
increasing capacity by “multi-skilling”.
Possible increased resource need for 24/7 cover
for critical services.
Review and maximise support
provision and on-call availability.
Capital
Insufficient capital funding would impede the ability
of NWIS to meet its stated objectives.
Continue meeting with Welsh
Government in order to secure Capital
Funding (see 8.6.1).
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9. ESTATES AND CORPORATE SERVICES
9.1 Estates
Due to its All Wales remit, NWIS has a presence across the country. Currently, staff
are based within offices in a number of locations as highlighted in Figure 3.
NWIS is keen to optimise usage of the Estate and will take into account the
opportunity to implement flexible working practices and travel substitution by the
utilisation of hot desking and video and audio conferencing where possible.
The organisation manages a number of Data Centres which, by their nature, need to
be in secure locations, services are currently migrating to centres at Blaenavon and
Newport. Additional national data centre capacity has recently been sourced to
facilitate this.
Within the existing estate, NWIS has a number of different arrangements for servers
(local and regional) and a review is currently focused on rationalisation.
Within the next two years, leases on two of the larger properties, Brunel House
(Cardiff) and Bocam Park (near Bridgend), are due to expire. NWIS has already
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engaged with the NHS Wales Shared Services Partnership – Facilities Services
(NWSSP-FS) to access expert advice with regard to the optimum location of offices.
Planned Estate Commitment(s) Target Year(s) Resource/
budget
Development of a Business Case recommending the
way forward for the Brunel and Bocam Park properties
Apr 14 Within
resources
Development of an Estates Strategy (based on the
outcome of the Business Case)
Apr 14 Within
resources
Review local data centre arrangements with a view to
rationalisation
Sep 14 Within
resources
Estate Rationalisation (based on outcome of Business
Case)
Sep 14 to Dec
15
Within
resources (or
capital spend to
save?)
9.2 Corporate Services
Key objectives for Corporate Services relate to the provision of continued support
managed under firm operational, quality and business assured processes. The table
below focuses on the main planned initiatives over the next three years.
Corporate Services Commitment Target Year(s) Resource/
Budget
Continue to develop the NWIS Risk Management
Structure to reflect current/future need
2014-17 Within resource
Review and update the NWIS Business Continuity Plan Apr 2014 Within resource
Test Business Continuity Plan as per test programme 2014-2017 Within resource
Ensure appropriate arrangements are in place for access
to Trust corporate services
2014-17 Within resource
Continue to develop organisational performance
reporting mechanisms
2014-17 Within resource
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10. STEWARDSHIP AND GOVERNANCE
10.1 Our Board Arrangements
The NHS Wales Informatics Services (NWIS) is a non-statutory organisation hosted
by Velindre NHS Trust. There is an NHS Wales Informatics Management Board
(NIMB) which is accountable for all informatics activity undertaken by the NHS in
Wales. All Health Boards, NHS Trusts and Welsh Government are represented on
the Board.
A hosting agreement for NWIS activities is in place with Velindre NHS Trust, together
with a service level agreement for a number of corporate services.
NWIS reports to several Velindre Trust Board Committees, including the Audit
Committee, Quality & Safety Committee and Information Governance and IM&T
Committee. In addition, attendance is made to a number of other sub-committees
and Trust Groups. Regular reports are tabled at these Committees and Groups
providing the Trust with assurance that there is compliance with policy and
procedures.
10.2 Working with our Stakeholders
NWIS has robust governance structures in place to ensure performance is managed,
targets are met and that there is a culture of continuous improvement. There are
structures in place for Operational (Mature) Services and for Programmes, which
includes new product developments and procurements.
Operational Services are overseen by Service Management. The National Service
Management Board (NSMB) has embarked on a programme of work that includes
the NHS Wales adoption of ITL best practice for service management and the
establishment of a National Service Desk structure addressing both national and
local requirements. Each Operational Service has a governance structure overseen
by their own Service Management Board (SMB).
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There is an NWIS Assurance Process for Programme Governance which is
overseen by the National Architecture Design Board (NADB) and the Patient Safety
Approval Board (PSAB) to ensure any new product/service is clinically safe (see
Clinical Risk Management Process diagram below). This consists of three stages:
Strategic Fit (NADB) and Service Specification (NADB)
Initial Implementation in a Live Environment and agreement of Service
Management Arrangements (PSAB)
Authority to Implement (NADB)
Clinical Risk Management Process:
Following implementation, new products/systems will transfer to Operational
Services Governance arrangements.
Finally, in the broader sense of Stakeholder Engagement, the NWIS Engagement
Directorate supports all NWIS business activities by ensuring that NWIS has an
effective and productive relationship with NHS Wales, its constituent organisations
and the wider public sector.
Step 1
Clinical Risk & Safety
Assessment Plan
Presented to PSAB
Step 2
Clinical Risk Assessment
(Details of clinical risk
workshops and risk register)
Step 3
Clinical Risk Assessment
Report
Presented to PSAB
Step 4
Clinical Safety Case Report
Step 5
Post Pilot Review Report
Step 6
Pre Release Stage Report
(Clinical Authority to
Release)
Presented to PSAB
NADB approval Stage 1
Design Brief
Strategic Fit
NADB approval stage 2
Service Specification
NADB approval Stage 3
Product Release / Authority to Implement
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10.3 Internal Management and Governance
The NWIS Executive Board, headed by the Director of NWIS, meet every month and
receives a number of performance management reports (detailed below). This
provides the Executive Board with assurance that activities are being appropriately
managed.
NWIS has also established a Business Planning Group which has representation
from all service and project areas who are responsible for the identification of
activities and objectives to be included in the plan and for monitoring and reporting
progress against the plan.
Other management groups include:
Risk Management and Quality Improvement Group
Internal Controls Group
Safety, Health and Environmental Group
Health and Wellbeing Group
Education, Training and Organisational Development Steering Group
10.4 Performance Management and Reporting
NWIS has developed a performance management model that ensures there are
appropriate levels of performance management through reporting arrangements, at
operational and service level, through projects and programmes, ultimately reporting
to the Executive Board.
An Organisational Performance Dashboard has been designed and is presented on
a monthly basis to Executive Board. This provides a RAG status (and statistics
where appropriate) against activities across the organisation including:
Financial Performance & Business Assurance
Planning
Operational Services Performance
Service Level Agreements
Commercial Services
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Governance (Risk Exposure & Internal Controls)
Assurance – Clinical and Technical
Workforce and Organisational Development
Programmes and Projects
The Executive Board also receive reports from Chairs of NWIS Management Groups
on a regular basis.
NWIS adheres to the overall financial control, reporting and auditing requirements
set out by Welsh Government and to the local policies and procedures of Velindre
NHS Trust and NWIS. Appendix 5 provides additional information.
On an annual basis, NWIS will carry out an assessment against the Welsh
Government’s Doing Well, Doing Better Standards for Health Services in Wales and
the outcome will form the basis of action plans to improve performance.
10.5 Risk Management and Business Continuity
Registers of service, departmental and project risks are in place. Where deemed
necessary, risks are escalated (using the NWIS Risk Management Standing
Operating Procedure) to the Corporate Risk Register which is reviewed monthly by
both the Risk Management and Quality Improvement Group and the Executive
Board. Risks are also considered and evaluated across Directorates to identify the
impact and escalation of corporate risk. The Risk Management and Quality
Improvement Group has the responsibility of providing assurance, control and
reporting to the Executive Board on the effectiveness of the system of integrated
governance, risk management and internal control, including security, information
governance and data quality risks.
NWIS has a Business Continuity Plan in place which incorporates IT DR (Information
Technology Disaster Recovery) Plans. These plans are required to be tested at
agreed intervals.
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APPENDICES
Please note the mandated appendices required by Welsh Government
are contained in an Excel Workbook and submitted separately to this
document.
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Appendix 1 – National Services (Applications)
Support Arrangement (Service Grouping)
Service Category (Service Levels)
Services and Descriptions
Information Services
Data Acquisition/Warehouse
Infrastructure Standard Data Acquisition and Warehouse
MPI Clinical Critical Master Patient Index (MPI)
The Master Patient Index (MPI) is a system that makes it easier to ensure patients are correctly identified and minimises the number of duplicate health records held for each patient. It will reduce the number of patient search results returned for clinicians using the |Welsh Clinical Portal and ensure the correct patient is identified
Demographics Clinical Standard Welsh Demographics Service
The Welsh Demographic Service (WDS) describes a number of information systems and services that manage demographic information for Welsh residents. WDS can be considered to exist already, in the form of current information systems. However, it must be made consistent with the National Architecture, providing support to the other information systems being developed in line with the National Architecture, and to address the changes to existing systems that make up the WDS as a result of the National Programme for IT in NHS England (NPfIT).
NHS Numbers for Babies (NN4B)
Business Intelligence Admin Standard Analysis & Reporting Service
Analysis & Reporting provides LHBs and other commissioning organisations together with external bodies requesting information from commissioners with specialist, value added, business intelligence support together with an ad-hoc information analysis service & data request service.
Publishing Services
Publishing Services is responsible for the collection and maintenance of data held in a number of national databases. This information is then made
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Support Arrangement (Service Grouping)
Service Category (Service Levels)
Services and Descriptions
available via NHS information and clinical data websites, e.g. ePEDW, Health Maps Wales.
Information Standards Admin Standard Data Standards
This service develops a range of data standards for exclusive use by NHS Wales users and provides administration support to the Welsh Information Standards Board (WISB). The service is also responsible for the maintenance of the NHS Wales Data Dictionary.
Clinical Coding
The Clinical Coding service deals with queries from clinicians across Wales regarding the correct use of Clinical codes related to diagnosis and treatment
Primary Care Information Admin Standard Primary Care Information Service
Infrastructure Services
National Data Centres Infrastructure Critical National Data Centres
Two data centres are used for hosting NHS Wales’ national IT services. This is in alignment with the Welsh Public Sector data Centre Strategy and the NHS Wales Infrastructure Strategy.
Authentication & Messaging Infrastructure Critical Messaging/Email Services/ Authentication Services
A new secure national directory and email service (known as NADEX) has replaced the fragmented approach to logon security and email management. The national directory service allows users to log on to systems and services regardless of where they access a computer, while a national email service provides a single up-to-date address book and allows health professionals to share diaries with colleagues across organisations within NHS Wales. It also provides an email address "for life" for as long as staff remain within NHS Wales.
Hosted Messaging Services
The Hosted Messaging Service provides a centralised messaging platform, allows closer end user working through the use of email, and provides a common address book and the ability to share
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Support Arrangement (Service Grouping)
Service Category (Service Levels)
Services and Descriptions
calendars. It includes enhanced messaging features such as archiving and allows for mobile messaging.
National Encryption Service
Recent breaches of data protection laws by organisations across the UK public sector have enhanced the need to ensure person identifiable information is protected, particularly when the information is vulnerable, such as when it is transported outside organisation on laptops, memory sticks or CDs. To protect against such events within NHS Wales, a framework contract of standard encryption products and services, which can be used to ensure organisations protect sensitive information, has been established.
National Monitoring Services Infrastructure Critical National Monitoring Services
The non-intrusive monitoring of national infrastructure.
Telephony and Video Infrastructure Critical Telephony
Telephony comprises the Welsh Health Telephone Network (WHTN) and is a telephone network used across the whole of NHS Wales.
Video and Audio Conferencing
Video and Audio Conferencing services provides visual and audio communications amongst users in NHS Wales.
Network Services Infrastructure Critical Network Services
Networks Services provides development, support and maintenance of the Digital All Wales Network (DAWN2) Local Area Network (LAN). The DAWN2 LANs consist of: 1. All network infrastructure devices that comprise the NHS Wales owned (and centrally managed) DAWN2 environment. 2. All infrastructure supporting a DeMilitarised Zone (DMZ) or a Server Hosting environment. 3. External Links to the National NHS Network (N3) and Internet for both business critical and non critical internet traffic
Public Sector Broadband Aggregation
The Public Sector Broadband
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Support Arrangement (Service Grouping)
Service Category (Service Levels)
Services and Descriptions
Aggregation (PSBA) Service is a mechanism to deliver a wide range of broadband, voice, video and data services to Public Sector Organisations across a secure, fast and reliable infrastructure throughout Wales. The PSBA Service is an externally supplied and managed Service provided by Logicalis UK (LUK). As such LUK manage all Incidents, Problems & Changes. The Public Sector Broadband Aggregation (PSBA) Management Service is a service provided by NWIS to monitor the PSBA Service provided by LUK on behalf of NHS Wales Organisations with their best interest in mind.
Token Management
Operational Security Consultancy
Admin Standard Operational Security Consultancy
This Service provides an IT Security consultancy Service to Local Health Boards and Trusts across NHS Wales for the following Operational Security Services: • Code of Connection • Penetration Testing • Security Awareness Training • Security Investigations and Forensics
Operational Security Consultancy
Infrastructure Standard Secure Filesharing Portal
SFSP enables secure, encrypted exchange/transfer of information between parties within NHS Wales and further afield. This is a web based service and is accessible from https://securefileshare.wales.nhs.uk/. The Service allows user to upload large documents, spreadsheets and multimedia files (pictures, video and sound/music files) onto a secure location within the SFSP server and can be retrieved/downloaded by the recipient based on the permissions/rules applied by the Local or National administrators.
Corporate Applications
Service Management Toolset Service Point
Admin Critical Service Management Toolset Service Point
ServicePoint is a Service
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Support Arrangement (Service Grouping)
Service Category (Service Levels)
Services and Descriptions
Management system based around ITIL principles and has a number of modules: - Calls (Incidents & Service Requests), - Problems, - Change, - Release, - Event. It is used by IT departments within NHS Wales for the logging and management of IT Support Calls, and allows for the sharing of call records between support organisations across Wales.
NHS Wales eLibrary Admin Standard NHS Wales eLibrary
An online knowledge resource for NHS Wales. The service is aimed at effective healthcare delivery by providing quality, relevant and timely information to support NHS Wales professionals in evidence based decision making.
Learning @NHS Wales Admin Standard Learning @ NHS Wales
The service covers the provision of specialist skills and expertise in supporting the NHS Wales virtual learning environment. This includes operational and user support, hosting, maintenance and enhancements of the e-learning environment.
HOWIS & Related Web Apps Admin Standard HOWIS & Related Web Apps
• The service covers the provision of specialist skills and expertise in Intranet and Internet information technologies to the NHS in Wales. • This includes operational and user support, hosting, maintenance and enhancements of the Health of Wales Information Service (HOWIS), Health in Wales, the NHS Wales Content Management System (CMS), and their constituent parts.
Corporate Applications Admin Standard WG Web Apps
A suite of intranet and internet based web tools.
PHW Web Apps
The PHW Web Apps service comprises the following web-based tools:
Form Builder. Toolset that clients can use to quickly
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Support Arrangement (Service Grouping)
Service Category (Service Levels)
Services and Descriptions
assemble web-based data collection forms.
Outbreak/Surveillance Applications. Tool to record outbreak information within NHS Wales.
NHS Wales Shared Services Programme Web Apps
A suite of web based tools available on both the Intranet and Internet.
HIW Web Apps A suite of Internet web-based tools that allow Health Inspectorate Wales to undertake their statutory duties such as organisational self-assessment and inspection scheduling.
NHS Wales Corporate Web Apps
A suite of web-based tools for an organisation to use to manage staff resources
Specialty Training
Internet web-based system that allows Junior Doctors to apply for post-graduate specialty training programmes in Wales Fundamentals of care standards.
ActionPoint
ActionPoint is a flexible, easy to use call management system developed to log non IT related service calls.
Health Informatics Career Framework (HICF)
The Health informatics Career Framework is a web-based tool that provides information on roles and career pathways in health informatics.
National Forms Service Clinical Critical National Forms Service
Components of this service are FOP and ORBEON.
Screening Services Clinical Standard Bowel Screening Wales
Cervical Screening Support
Abdominal Aortic Aneurysm
NHAIS Support Arrangement Admin Standard NHAIS Exeter System
Hospital Applications
Canisc Clinical Critical Canisc
Canisc is a clinical information system developed then continuously expanded and improved since 1991 by the Clinical Information Unit (CIU) at Velindre Hospital. Canisc allows any number of organisations to record assessments, treatments and follow-up care into a common patient
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Support Arrangement (Service Grouping)
Service Category (Service Levels)
Services and Descriptions
case note, which any health care professional caring for that patient can access, thus giving a full picture of each individual’s care wherever that person happens to be treated. An increasing number of organisations across Wales are using the system in a variety of ways: Cancer teams, NHS and non-NHS palliative care providers, the colposcopy service, Welsh Movement Disorders e-Network and Cancer Genetics are all using ISCO/Canisc to collect patient data.
Canisc Reporting Service Admin Standard Canisc reporting
LIMS Clinical Critical Laboratory Information Management System
The new LIMS computer system is a national application to be used by Pathology Laboratories located in Health Boards and Trusts throughout Wales. Having a single national application will provide an opportunity to harmonise practice, improve clinical governance, increase capacity and flexibility, and to meet future demand and new service developments
Wales’ Pathology Handbook Clinical Critical Wales’ Pathology Handbook
The Wales' Pathology Handbook (WPH) is a web-based knowledge source for all clinical staff. It provides national and local catalogues of requestable tests, rules and guidance for electronic requesting (via the Welsh Clinical Portal and GP Test Requesting) and a web-based knowledge resource for all clinical staff. Critically, WPH provides point of care decision support for clinicians about laboratory tests
Welsh Pathology Handbook Legacy
The Wales' Pathology Handbook (WPH) is a catalogue of requestable tests, rules and guidance for electronic requesting via the Welsh Clinical Portal (WCP). It is also a web-based pathology knowledge resource for all clinical staff.
CHIRP Clinical Critical Cancer Histopathology Reporting
The aim of the Cancer Histopathology project is to integrate existing Laboratory Information Management Systems with the
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Support Arrangement (Service Grouping)
Service Category (Service Levels)
Services and Descriptions
national Canisc System by introducing standard reporting 'templates' linked electronically to the LIMS, which will then automatically feed into Canisc.
Welsh Clinical Portal Clinical Critical Welsh Clinical Portal (WCP)
Doctors, nurses and health professionals working in hospitals rely on a combination of computer systems and paper records to record information about patients and their care. This helps them provide treatment to those in need of it. The portal provides fast access to information about medication, referrals and discharges, allows health professionals to request tests and results from various sources and ultimately improves patient safety and a reliance on paper records. It also gives doctors and nurses a personalised workspace with access to their own relevant patient lists. Healthcare staff can log on at terminals anywhere in the hospital and view patient records and results from a range of systems on one screen. Designed and tested by doctors and health professionals in NHS Wales, the Welsh Clinical Portal is being developed in incremental phases, first allowing doctors to view pathology results and general patient information. In time it will provide all the information and processes needed to support care centred on the patient including ordering tests, creating and viewing electronic documents (e.g. discharge summaries, letters), and enabling pharmacists to maintain more accurate medications records.
Test Requesting and Results Reporting (TRRR)
TRRR is a set of per-Health Board databases consisting of electronic test request orders and pathology and radiology results.
Radiology Services Clinical Critical RADIS1
PACSiS
The system will provide a user interface that will allow clinical users to search for a patient; list all images and reports available for a patient; view reports and images on the desktop and route diagnostic quality
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Support Arrangement (Service Grouping)
Service Category (Service Levels)
Services and Descriptions
images to a PACS or a diagnostic workstation for reporting or review. Future development will allow clinical systems such as Welsh Clinical Portal and RadIS2 to search the PACS integration system directly. The system will comprise a centrally managed system to store the patient index and image & report register; local brokers to interface with individual PACS and RadIS2 systems and web services to mange enquiries into the system.
RADIS2
Most hospitals in Wales use a radiology information system which has been in place for the last 18 years. This system, called RadIS, increasingly needs to deal with greater volumes of information and is asked to perform ever more complex functions. To meet this need, the original system has been improved and upgraded to create Radis2. This is the first stage of a Radiology Management System (RMS) project, and it provides a firm foundation for integrating radiology systems across Wales. This will allow secure shared access to diagnostic imaging services, results, images and management information across organisations.
Myrddin Clinical Critical Myrddin
Myrddin CiS is a Patient Administration System delivered to the desktop primarily using Citrix Metaframe although full client installation is supported. This allows for a simple installation at the client machine and also allows the system to be delivered via the All-Wales Network to other sites and GP Practices, by means of an internet browser. The aim is to provide a modern, user-friendly and dependable system that will support the patient administration and Order Communications functions for all clinical services
Community Applications
National IHR Clinical Critical National IHR
The most complete record of a patient’s care is kept by their GP. Sometimes, doctors in an out-of-hours clinic, or unscheduled care
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Support Arrangement (Service Grouping)
Service Category (Service Levels)
Services and Descriptions
setting need quick access to that vital information, but it’s not available because the GP’s surgery is closed for the evening or weekend. Working closely with health professionals, NWIS has developed the Individual Health Record (IHR). This new electronic bridge between urgent and primary care settings gives doctors and nurses the information they need to help them make important decisions about how the patient is treated.
Community Child Health
The Community Child Health 2000 (CCH2000) system covers a range of functionality including child registration and demographics, immunisation scheduling and registration, pre-school and school health, safeguarding children, audit, dental and vision screening, special needs requirements.
New Born Hearing Screening
Development, Maintenance and Support of the Newborn Hearing Screening software which is used to manage the All Wales Newborn Hearing Screening Programme.
Prescription Data Capture Clinical Standard Prescription Data Capture
Social Services Interfaces Clinical Standard Substance Misuse
Enables the collection of substance misuse activity records from Welsh agencies for collation onto the National Substance Misuse Database. Support services include data collection and reporting.
Comms Gateway Clinical Standard Welsh Clinical Communications Gateway (WCCG)
The Welsh Clinical Communications Gateway allows clinical messages to be sent securely from the GP to the Hospital. The system can manage messages 'from any to any' healthcare setting including other GPs or professions allied to medicine, from consultant to consultant or from organisation to organisation.
GP Test Requesting (GPTR)
The GP Test Requesting Project will provide a solution which will enable primary care clinicians, to request Pathology Tests from GP Practices using INPS, EMIS and ISOFT GP
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Support Arrangement (Service Grouping)
Service Category (Service Levels)
Services and Descriptions
Systems. The application will utilise components from the Welsh Clinical Communication Gateway (WCCG), Welsh Clinical Portal’s Test Requesting and Results Reporting (TRRR) Data base and Wales Pathology Handbook (WPH).
Hospital eReferrals (HERS)
The Hospital e-Referrals Project is an IT solution to receive and manage electronic clinical messages within and between health boards which can maximise the benefits of the national e-clinical communications system the Welsh Clinical Communications Gateway. It will initially allow health records departments to receive and manage electronic clinical messages and add patients to an outpatient waiting list. Electronic referrals will be transferred from health records departments (or other areas that may hold records) to clinicians for on-line prioritisation in the Welsh Clinical Portal. The Portal will have a new Referrals Prioritisation tool integrated within it. Eventually, there should no longer be a need to print referrals other than to store in casenotes for medico-legal reasons.
Common Ailments Service
The common ailments service will enable patients to present to their local pharmacy with a defined list of common ailments, their pharmacist will provide a consultation and issue a prescription free of charge to the patient
National Complex Care Database
The National Complex Care Database allows the administration section of each locality to enter, monitor and process Continuing Health Care (CHC) and Funded Nursing Care (FNC) applications and subsequent care packages. Financial costs are entered under each package to allow the LHB finance department to run various reports to project financial costs and report on reductions, savings and spend. The system also allows the users to enter retrospective reviews, finance
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Support Arrangement (Service Grouping)
Service Category (Service Levels)
Services and Descriptions
invoices from care packages, panel dates, care package reviews, Nursing Needs Assessment Decision Record (NNADR) reviews, Multi Disciplinary Team (MDT) Meetings and Respite Care. A complete and comprehensive list of care providers is available and administered which includes all the standard costs of care and the types of care each provider provides. In addition, a number of administration reports are available for analysis purposes.
Integration and Reference Applications
Integration Services Clinical Critical Integration Services
The design, development, deployment and support of integration services required to support interoperability between the various components of the NWIS national architecture. All of which will be actively monitored to ensure early identification and resolution of connectivity problems
National Reference Data Service
Clinical Critical National Reference Data Service (NRDS)
The design, development, deployment and support of integration services required to support interoperability between the various components of the NWIS national architecture. All of which will be actively monitored to ensure early identification and resolution of connectivity problems. In order to share clinical information between systems and across organisations, NHS Wales needs to establish a common vocabulary. This vocabulary will cover clinical vocabulary such as terms for symptoms, diseases and procedures as well as administrative language such as the names of requesters, organisations, hospital locations and department names. The data sets which describe international, national or local terms and codes for this information are referred to as reference data. The National Reference Data Service will provide a strategic approach for all national applications to use a common and
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Support Arrangement (Service Grouping)
Service Category (Service Levels)
Services and Descriptions
consistent set of reference data. The service will establish and maintain lists of nationally agreed reference data and provide a means for applications to source and query all required reference data from a single point of connection via a national integration hub and allow organisations to maintain local sets of reference data and cross-reference these to national datasets to allow information sharing between legacy systems.
Hospital Pharmacy Clinical Critical Hospital Pharmacy
Pharmacy is one of the three key departmental systems used in hospitals, along with radiology and pathology. The pharmacy system allows stock to be ordered and invoiced electronically, records and labels all medication, downloads details automatically from the hospital's patient administration system (PAS) and links to various robots to pick the medicines to be dispensed and delivers them to the stock room.
Contractor Services Clinical Standard Performers List
Primary Care clinical contractors are required to be on the medical performers list of a Local Health Board (LHB) before they can work in Wales. The Performers List is an internally developed database with a front end website, handling the day to day management of contracts relating to independent contractors (general practitioners, dental practitioners, pharmacists and optometrists). Information held on the list includes, but is not restricted to, the following: • Name • Address • Telephone Number • Title • Qualifications • CRB checks This information can be accessed by Local Health Boards for approval and monitoring purposes. Access to the performers list is also available via the world wide web, for any patient wishing to check the registration of an independent contractor.
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Support Arrangement (Service Grouping)
Service Category (Service Levels)
Services and Descriptions
Four main lists comprise the Performers List service: • GP (referred to as medical) • Ophthalmic • Dental (Private and NHS) • Pharmaceutical Basic (public domain) information on each of the lists can be accessed via the NHS Wales intranet. Nominated Health Board users can access more detailed information on premises and contractors (within that Health Board only). Business Support staff within NWIS Shared Services use the lists for generating address labels.
PRISM Clinical Standard Predictive Risk Stratification Model (PRISM)
PRISM is a predictive risk stratification tool, able to stratify GP practice populations against their risk of having an emergency admission. The information provided by PRISM will be available for use by GPs and community nurses to provide additional care, increased support or preventative treatments to help avoid deterioration in an individual's health and keep people out of hospital
Primary Care Services
2DRX Support Arrangement Clinical Standard 2DRX
2DRx is the name for the 2D-barcoded prescription model for the Electronic Transfer of Prescriptions.
My Health Online Clinical Standard My Health Online
My Health Online (MHOL) is a bilingual NHS Wales website where patients undertake various health tasks and access their personal health information securely via the internet. This is convenient for patients and encourages empowerment and self care. GP practices save time as they do not need to answer the phone or search and enter details onto their clinical systems.
GP MSS Compliant System Support Arrangement
Clinical Critical EMIS Web
GP Minimum System Specification Complaint System
INPS Vision 360
GP Minimum System Specification Complaint System
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Support Arrangement (Service Grouping)
Service Category (Service Levels)
Services and Descriptions
GP Transitional Support Arrangement
Clinical Critical EMIS Web Transition
GP Transitional System
INPS Vision 360 Transition
GP Transitional System
GP Legacy System Support Arrangement
Clinical Critical EMIS Legacy
GP Legacy Systems
INPS Vision Legacy
GP Legacy Systems
GP Non Core System Support Arrangement
User Defined EMIS Non Core Service
GP non core systems
INPS Vision Non Core Service
GP non core systems
NWSSP Services
Prescribing and Dispensing Services
Admin Standard Admin Standard
Contractors Reimbursement System
Business Support Systems
Medicines Management System
Data Exchange
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Appendix 2 – Infrastructure Services
This Appendix seeks to give the reader a basic understanding of the systemic arrangements which make up Infrastructure Services. Wide Area Network (WAN)
The figure below gives a simplified schematic overview of the network links that
make up the NHS Wales Wide Area Network (WAN).
The PSBA network is the Wide Area Network (WAN) that provides the links between
the IT systems at all NHS Wales sites (hospitals, GP surgeries, clinics, data centres,
etc). The PSBA network is used by a number of public sector organisations, and
each one has their own Virtual Private Network (VPN) on this network. NHS Wales
has a VPN which is used by all NHS organisations which allows information to be
passed between any connected sites. In some cases, hospital sites are linked
directly to other hospital sites using point-to-point connections, which in turn have
one or more connections (for resilience) to the NHS Wales WAN.
NHS Wales WAN.
(PSBA Network)
Hospital
GP Surgery
GP SurgeryGP Surgery
Hospital
ClinicHospital
Clinic
DataCentre 2
DataCentre 1
Internet
N3 (NHS England)
DMZ
(Hosted within
the above data
centres)
Remote
Access
Solutions
Public
Facing
Websites
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N3 is NHS England’s Wide Area Network and NWIS provide and manage a pair of
resilient circuits between the NHS Wales WAN and N3. This is to allow the sharing of
information with NHS organisations in England.
NWIS also have a pair of resilient connections to the internet. These traverse
through a series of security systems in two DMZs (De-Militarised Zones). A DMZ is a
protected network zone that sits between the NHS Wales WAN and the Internet and
provides the following to NHS Wales employees:
Access to the internet for general web browsing
Remote Access Services that allow NHS employees to work remotely
Public facing internet websites
Data Centres
The data centres are the physical buildings in which we host our server and storage
systems. Data centres are purpose built facilities with the following key features:
Reliable power sources for the equipment. This is typically provided by using
generators and UPSs (Battery backup systems).
Reliable cooling systems to remove the heat from the server systems.
Good security (physical security, audited access control mechanisms, CCTV,
etc).
Automatic fire detection and suppression systems.
NWIS use two data centres for hosting national systems:
1. NWIS have a dedicated data hall (room) within the Shared Resource Service
(SRS) data centre at Blaenavon.
2. NWIS use a managed data centre provided by BT. This is currently in Cardiff
Bay, but the services will be moved to BT’s Newport Data Centre in 2014.
NWIS also have a number of legacy server rooms in some of the NWIS offices that
host NWIS internal services (e.g. file and print servers).
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Server and storage systems
These are used to store and process the data associated with NWIS provided
systems/applications. A schematic representation of these is in the figure below.
Key components are described below
The Local Area Networks (LANs) are the networks within a data centre,
typically comprising LAN Switches, Routers, Firewalls and Load Balancers.
Storage Area Networks (SANs) are hardware devices typically containing
hundreds of hard disks to create a large, fast and very reliable pool of disks
which can be used by a number of connected servers to store their data.
Virtual Server Farms are groups of physical servers running software known
as ‘hypervisors’. This allows many different server operating systems to run
on one physical server, reducing the number of physical servers that are
needed, thus saving considerable money.
PSBA Network
Storage
Area
Network
Virtual
Server
Farm
File
Servers
Web
Servers
Database
Clusters
Local
Area
Network
Storage
Area
Network
Virtual
Server
Farm
File
Servers
Web
Servers
Database
Clusters
Local
Area
Network
Direct WAN connection
Data replication
Data centre 1 Data centre 2
Geographically dispersed (>10 miles apart)
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Database Clusters are groups of two or more servers running database
software, providing resilience, sharing the processing load and in the event of
one server failing, the load is taken up by the remaining servers.
Backup systems are used to provide an off-line copy of data. Typically,
several copies are kept and these can be automatically/manually taken off-
site to protect against a disaster at the site such as a fire, flood or explosion.
In order to protect against a major failure of the systems at one data centre, the data
is continually replicated to an alternative data centre so that the service can continue
to be provided from that other data centre. Failover to the other data centre can vary
from a few seconds to many hours, depending on the technology used.
Other core infrastructure systems
Some of the other key components of the national infrastructure managed by NWIS
are:
The National Active Directory (known as CYMRU). This is a database that
holds account information for every user in NHS Wales and for every PC and
Server. One of the key roles of the Active Directory is to authenticate users
when they log on to their PC and also into a number of clinical systems.
Email services. NWIS provide two key services relating to email:
o Routing of emails in/out of NHS Wales
o Hosting of mailboxes for a number of NHS Wales organisations
Video and Audio Conferencing Services across the NHS Wales network
and linked to VC units in NHS England and the JANET (Higher Education)
network.
Domain Name Service (DNS). This is used to provide the IP address
(globally unique internet address) for a user friendly ‘domain An internal DNS
is also used within NHS Wales to connect internal users to internal IT
systems.
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Appendix 3 – National Projects NWIS Main Projects Description Community, Mental Health and Social
Care Solution
The provision of electronic services and tools to help Community Health staff to integrate care with other professionals, schedule work and records and share information across social care
Electronic Transmission of Prescription Claims
Will automate the existing prescription pricing system between community pharmacies in Wales and the Prescribing Services Unit (PSU) within NWSSP (Shared Services).
Common Ailments Service A scheme whereby patients are encouraged to consult a community pharmacy rather than their GP, for a defined list of common (minor) ailments.
Discharge Medicines Review Service
(DMR)
This will provide a patient’s local community pharmacy with a copy of their discharge medicines to allow for continuous patient care in conjunction with their GP Practice
Chronic Conditions Service:
This will provide chronic conditions support to patients in their local community pharmacy in conjunction with care from their GP Practice
CANISC This is a summary electronic record which is available at all times, providing clinical information on cancer patients across Wales. The information may also be used for monitoring national standards, cancer research and clinical audit.
Diabetes The aim of the National Diabetes Project is to deliver a single diabetes Informatics system for Wales. This will provide a clinical, multidisciplinary record, outpatient workflow, and share information across primary, secondary and community healthcare settings.
GP Links With the introduction of the new single, national All Wales Pathology Laboratory information Management System (LIMS), there is a requirement to consolidate the messaging solution to the General Practices. This will also include the transmission of Radiology reports and other ad hoc information.
GP Test Requesting (GPTR) GPTR is an Electronic Pathology Test requesting service for General Practice so users can request tests and review results.
Hospital e-Referrals (HERS 1) – Medical To electronically administrate the registration
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NWIS Main Projects Description Records of patients from WCCG to Hospital PAS. Individual Health Record (IHR) Enables health staff in Out of Hours to see
the important part of the GP record in an emergency
Laboratory Information Management System (LIMS)
This project is a collaboration between the Pathology Service, the Pathology Modernisation Agenda for Wales & NWIS, to procure and implement a replacement Laboratory Information Management System
Wales Pathology Handbook Will provide national and local catalogues of requestable tests, rules and guidance for electronic requesting
Point of Care (POCT) The aim of this project would be to provide software and infrastructure to link all appropriate POCT devices (e.g. Glucose testing) in any suitable setting (primary or secondary care, pharmacy etc) to capture all the information and store it in the patient records held on the Heath Board repositories. This could then be accessed by both Welsh Clinical Portal users and GP’s
Master Patient Index (eMPI) Links patient identity records across a range of IT systems. The result is a single “gold standard” identity record which will help minimise the number of duplicate records and support LHB mergers
National Intelligent Integrated Audit Service (NIIAS)
Addresses the need to monitor access to patient records across NHS Wales in order to address known and suspected breaches of privacy
Medicines Management Hospital Pharmacy and ePrescribing
My Health Online (MHOL) A secure NHS Wales website which enables patients to book appointments, order GP repeat prescriptions and change their contact details online
Patient Administration System (Myrddin) This is the NHS Wales Patient Administration System (PAS). Modules include PAS, A&E, Maternity, Theatre and Clinical Letter Creation. Some LHBs have taken all modules whereas others have taken one, usually the PAS.
Picture Archiving and Communications
System (PACS):
Implementation is being planned for a National PACS system (Picture Archiving and Communications System). The procurement has been run by BCU Health Board and NWIS
Radiology Management System (RADIS2) The RADIS2 system is a second generation Radiology system developed by NWIS used across Wales. This project consolidates the number of operational instances of RadIS down to one per Health Board
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NWIS Main Projects Description Systems Integration Tools Replacement Procurement to replace the existing JCAPS
messaging solution. Welsh Care Records Service A national procurement of a document
repository to hold scanned medical records plus other documents and records.
Welsh Clinical Communications Gateway (WCCG)
Gives GPs the ability to electronically refer patients to other healthcare settings. The current roll out focuses on referrals from GPs to medical record departments
Welsh Clinical Portal (WCP) A secure health space, uniting key patient information from the different NHS Wales computer systems. Current functionality includes patient lists, electronic pathology test requesting and results viewing, graphing and tabulation, radiology reporting and PACS Viewing.
IHR View in WCP Will provide access to the IHR from within the Welsh Clinical Portal for clinicians in unscheduled care settings across secondary care
Hospital e-Referrals (HERS 2) – clinical prioritisation of eReferrals
To facilitate electronic consultant prioritisation of electronic referrals
WCP Medicines Transcribing and e-Discharges (MTeD)
This project allows clinical staff to manage patient medication administered in secondary care and send an electronic copy in a Discharge Advice Letter, back to the patient’s GP Practice.
WCP Clinical ADTs Functionality to allow WCP users to Admit, Discharge or Transfer patients without logging in to PAS
Welsh Demographic Service (WDS):
Enabling the retrieval throughout Wales of NHS numbers for babies from the PDS, via the WDS, ahead of the closure in England of NN4B in June 2014.
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Appendix 4 – Quality Improvement
NWIS has established an Integrated Management System based on its current
certifications against ISO 9001:2008 and ISO 27001:2005. Over the coming years,
this overarching management system will be enhanced to include the requirements
of ISO 14001:2004 (Environmental Management), ISO 20000-1: 2011 (Service
Management) and ISO 22301 2012 (Business Continuity Management). An
overview of each of these standards is provided below:
ISO 9001:2008 ISO 9001:2008 sets out the criteria for a Quality Management System. The standard
is based on a number of quality management principles including a strong customer
focus, the motivation and implication of top management, the process approach and
continual improvement.
NWIS has established an Integrated Management System (IMS) to report on its
performance and improvement, promoting awareness of customer requirements
throughout the organisation
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Figure 1: Quality Management System
ISO 14001:2004
ISO 14001:2004 specifies requirements for an Environmental Management System
(EMS) and applies to those environmental aspects that the organisation can control
and influence. It is applicable to any organisation that wishes to establish,
implement, maintain and improve an environmental management system and to
assure itself of conformity with its stated environmental policy.
During 2012/13, NWIS commenced development of an EMS with a view to achieving
ISO 14001 across main sites by the end of 2013 and across the whole organisation
by March 2014.
NWIS environmental targets and objectives include the promotion of:
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Efficient use of energy and resources in an economical and environmentally
sound manner through conservation, promotion and where economically
viable invest energy/resource saving technology and management
Waste management and minimisation and encouragingmeasures for the
recycling of materials
ISO 27001:2005
The standard requires the establishment and maintenance of an effective information
security management system, using a continual improvement approach governing
the security of information and network systems covering Multimedia Services, Data
Centre Services, Data Services, Network Services and Service Desk. The standard
has recently been updated to ISO 27001:2013 and there will be a transition project
taking place over the next few years to achieve compliance with all requirements of
the 2013 standard.
ISO 20000-1:2011
ISO 20000-1:2011 refers to a Service Management System (SMS) and specifies
requirements for the design, transition, delivery and improvement of services to fulfil
agreed service requirements.
The IT Infrastructure Library® (ITIL) adopted by NWIS is the most widely accepted
approach to IT service management in the world. ITIL is a cohesive best practice
framework, drawn from the public and private sectors internationally. It describes the
organisation of IT resources to deliver business value, and documents processes,
functions and roles in IT Service Management (ITSM). ITIL is supported by a
comprehensive qualifications scheme, accredited training organisations and
implementation and assessment tools.
ISO 22301:2012
NWIS has developed a Business Continuity Plan that enables key operational
services to continue to be provided where circumstances prevent normal day to day
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operations. This will be tested on a regular basis to ensure it remains fit for purpose.
The organisation is working towards securing ISO certification for Business
Continuity in 2014/15.
The following activities/arrangements are also integral to the establishment of a
quality organisation, providing safe services of a high quality, to our service users:
Medicines and Healthcare products Regulatory Agency Inspection
Some NWIS products (systems and services) are classed as Medical Devices and
as such, will be subject to Medicines and Healthcare products Regulatory Agency
(MHRA) inspection.
During 2013/14, NWIS will continue to liaise with MHRA to ensure compliance with
regulations.
Improving Quality Together
Improving Quality Together was launched in March 2013. It aims to ensure that
NHS Wales provides the highest quality and safest care for the people in Wales.
Improving Quality Together is a standardised framework of core improvement skills
for all NHS Wales’ staff and contractors, which builds upon recognised local, national
and international expertise. All staff will be given the opportunity to develop their
skills and gain accreditation in quality improvement methodology.
Quality Objectives and Review
Through the annual business planning process, NWIS ensures that objectives
needed to meet requirements for services and products are established at relevant
functions and levels within the organisation. The objectives are measurable,
consistent with the Management System’s policies and continually reviewed in
accordance with the requirements of the standards, covering the full range of IT
systems and associated support services.
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Appendix 5 – Financial Controls, Reporting and Audit Arrangements
Financial Controls
Welsh Government
On an annual basis, Welsh Government notifies NWIS of its revenue and capital allocations. These may be subject to review and change during the course of the year depending upon NHS Wales’ priorities and demands. NWIS is required to prepare monthly financial Monitoring Returns for submission to the Welsh Government in accordance with the reporting timetable notified at the start of each year. These Returns disclose actual performance to date and forecast year end outturn and are supported by a commentary by the Director of Finance. Meetings are held between WG and NWIS as and when required throughout the year. NWIS is required to breakeven on its revenue funding allocation and to meet the CRL capital target.
Velindre
As a hosted organisation, NWIS is required to comply with the SFIs, SOs and FCPs of Velindre NHS Trust. All financial control requirements of Velindre are adhered to and this ensures that the financial activity of NWIS is accurately reflected in the Trust’s financial ledgers. NWIS is a user of Velindre’s Oracle ledger system and all the financial controls and limits are applicable to NWIS. The control and availability of the ledger is managed by the Trust.
NWIS
Financial control within NWIS is based upon the requirements of both the Welsh Government and Velindre. In addition, NWIS enhances and supplements these controls by having its own internal procedures and reporting arrangements where applicable, for example the Balanced Scorecard, the Organisational Scorecard and Internal Audits.
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Financial Reporting Arrangements
Welsh Government
As a hosted NHS organisation, NWIS is subject to Welsh Government reporting requirements both independently and via Velindre Trust. NWIS responds to reporting requirements from Welsh Government during the course of the year. Financial reporting requirements are primarily managed through the monthly Monitoring Returns and supporting Director of Finance commentary.
Velindre
As a hosted organisation, NWIS is required to comply with the reporting requirements of Velindre NHS Trust. All financial reporting requirements of Velindre are adhered to and this ensures that the financial activity of NWIS is accurately reflected in the Trust’s financial ledgers for Audit purposes. The financial activity of NWIS is included within the consolidated Monitoring Returns of the Trust. Submission of monthly reports, budget plans and ad hoc reports are made to the Trust in accordance with reporting deadlines.
NWIS
In addition to meeting the above reporting requirements of Welsh Government and Velindre, NWIS produces its own internal reports to Directors, budget holders and others on a regular basis. The aim of these is to enhance the financial controls operating within NWIS. Reports are produced on a regular basis detailing actual performance, budgeted performance and forecast outturn performance.
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Auditing
Welsh Government
NWIS is subject to Welsh Government audit requirements both internal and external and Gateway Reviews where applicable.
Velindre
As a hosted organisation, NWIS is required to comply with the audit requirements of Velindre NHS Trust. All financial control requirements of Velindre are adhered to and this ensures that the financial activity of NWIS is accurately reflected in the Trust’s financial ledgers for Audit purposes. NWIS attends the Trust’s Audit Committee, Audit planning and post Audit de-brief meetings.
NWIS
In addition to meeting the above auditing requirements of Welsh Government and Velindre, NWIS performs its own Internal Audits on an ad hoc basis to supplement statutory audits. The aim of these is to enhance the financial controls operating within NWIS.
Other relationships
NWIS has developed supplementary auditing relationships for specific advice and support with external advisers, for example, to determine accounting treatment of particular developments and schemes, and used to provide assurance to Externals Auditors at the end of the financial year.