Commissioning for Integration – holding the ring on shared patient records Trevor Wright Head of Strategic Systems and Technology Midlands and East Region 3 rd December 2014

What has it got to do with the commissioner? Articulating a local vision Leadership Levers for change Market management Patient experience Commissioning for IDCR

Transformational Change – A 5year Plan 3 Changes in patients’ health needs and personal preferences. Long term health conditions - rather than illnesses susceptible to a one-off cure - now take 70% of the health service budget. At the same time many (but not all) people wish to be more informed and involved with their own care, challenging the traditional divide between patients and professionals, and offering opportunities for better health through increased prevention and supported self-care. Delivering on the transformational changes set out in this Forward View and the resulting annual efficiencies could - if matched by staged funding increases as the economy allows - close the £30billion gap by 2020/21. There have been three major economic transitions in human history – the agricultural revolution, the industrial revolution, and now the information revolution. But most countries’ health care systems have been slow to recognise and capitalise on the opportunities presented by the information revolution. A Link to the 5year Plan5year

What has it got to do with the commissioner? What do you need to achieve in your 2 year and 5 year plans? Can you afford to wait? How will you transform services if information doesn’t flow between providers? Needs to underpin a modern service with effective technology

What do you need to achieve in your 2 year and 5 year plans? Can you afford to wait? How will you transform services if information doesn’t flow between providers? Management of benefits – savings don’t always flow to the investing organisation Infrastructure ownership/brokering risk sharing What has it got to do with the commissioner?

The case for informatics commissioning Will our current ‘fragmented’ approach to investments in technology provide an adequate solution for those that are seeking to provide co-ordinated care? Are we confident that our current investments will empower our patients to receive services from a mix of providers? What could we do to secure better value from our collective investments? What could we do to ensure that we co-design systems that enable the patients to take a bigger role? How can we design a shared record that will survive re- organisations and decommissioning?

Personalised Healthcare Better use of data and technology has the power to improve health, transforming the quality and reducing the cost of health and care services. It can give patients and citizens more control over their health and wellbeing, empower carers, reduce the administrative burden for care professionals, and support the development of new medicines and treatments. Established by the Department of Health, the National Informatics Board (NIB) is a new body which brings together national health and care organisations from the NHS, public health, clinical science, social care and local government, together with appointed lay representatives. It is charged with developing the strategic priorities for data and technology in health and care to deliver the maximum benefit for all of us, as citizens and patients and to make appropriate recommendations for investment and action. ‘support care professionals to make the best use of data and technology’ – in future all members of the health, care and social care workforce must have the knowledge and skills to embrace the opportunities of information; A Link to Personalise Health and Care 2020Personalise Health and Care 2020

Articulating a local vision What are your local priorities? Better Care Fund or Prime Ministers Challenge Fund? Working with stakeholders to agree what services look like What are the enablers? What will the governance look like? What are the risks and opportunities ? Is there capability locally to deliver?

Collaboration & integration not segregation Organisations and the whole area working with their own informatics plans may fail to realise the benefits to be had from integrating their solutions and working practices with other organisations. Collaboration and integration help to benefit the patient more; promoted by seamless care and enabled by informatics.

The need to be an Informed Client Ensure NHS England IT Strategies are aligned with and embedded within (where appropriate) local business strategies and service redesign programmes Clearly specify local requirements in the form of a specification to ensure local delivery partners are clear on service needs Negotiate and contract for services ensuring value for money through effective use of national framework contract and procurement mechanisms in accordance with NHS England procurement rules. Establish effective governance and accountability arrangements which engage strategic partners and hold delivery partners to account for their services. Effectively manage risks and issues in accordance with system- wide procedures to help ensure the safe and successful delivery of outcomes associated with IT investment Take ownership of strategic IT direction relevant to their business

Vision - Driving Digital Transformation The Secretary of State vision is to achieve full integration of digital patient record across all care settings by We want local health and care services to use digital technology to ensure that vital, patient-related information is available at point of care, across all care settings. Better use of digital technologies will transform clinical effectiveness and outcomes and reduce the administrative burden on frontline staff; it will enable the integration of care around the person who is being treated; it will empower people to do more for themselves. “Not something we can achieve without effective leadership”

NHS Leadership – what’s needed?  Must have Board level commitment  Must have effective SROs  Must have Clinical (workforce) ownership  Must change the culture of the organisation(s)  Need to empower staff – leadership comes at all levels and is not necessarily hierarchical  Need to build capability and foster competence “Today’s leading organizations have shifted emphasis from the individual leader to collective leadership capabilities.”

Levers for change and delivery Programme management skills Change management skills Benefits management skills Risk and issue management CQUIN – Commissioning for Quality and Innovation Commissioning for outcomes Lead provider

Market Management Contracts need to specify that providers must participate Contracts need to be clear about information ownership and governance Think about providers with large geographies How will you manage decommissioning or provider change How will you empower small AQPs to join Strategic Partnerships?

Patient experience Patients expect that we already do this Consent questions, confidence versus barriers Is there a minimum level of integration that patients have a right to expect? Patient access and identity management Personal health budgets Apps!

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