1. Connecting Care Our story so far…… Ireland e-Health Festival May 2016

2. Andy Kinnear – 4 roles Connecting Care Programme Director – The BNSSG Digital Transformation programme Director of Digital Transformation – South, Central and West CSU Local Delivery Advisor – NHS Digital (formerly Health and Social Care Information Centre) Chair of BCS Health & Care Executive – British Computer Society Also: 25 years NHS experience Member of George Freeman MP’s Digital Cabinet CIO Network member Long suffering Crewe Alexandra fan ;-) Andy Kinnear

3. Background, History & Governance

4. BRISTOL

5. description what is BNSSG? Map The current footprint for Connecting Care is the Bristol, North Somerset and South Gloucestershire Health and Social Care community

6. Connecting Care is the Bristol, North Somerset and South Gloucestershire [BNSSG] programme, dedicated to using technology to support - Better information sharing between local health and social care organisations Joining up information to ensure care is focused around the individual and their needs Improving better, safer and more joined-up care Supporting increased efficiency in the delivery of health and social care services Ensuring that the people who are providing care have the information they need, when they need it what is Connecting Care? Our first focus has been the delivery of a shared ‘view only’ electronic patient record

7. local need “Adequate and timely information must be shared between services whenever there is a transfer of care between individuals or services.” “Services in all settings including health and social care need to improve their communication and handover ” “The information I have is limited and frequently is missing important elements…” “Better information would support better safeguarding” “I don’t have access to some important information electronically…” “If I had better information then it would help me evaluate risks when deciding whether to admit a patient…” “There are delays in getting hold of information that I need…and I spend a lot of time chasing it up…” * Summarised from feedback from local clinicians & practitioners during workshop events NOT having access to accurate, timely, shared information is a ‘blocker’ to providing high- quality, effective, efficient care… “There needs to be better communication between ‘in-hours’ and out of hours services.”

8. national drivers Royal College of Physicians’ “We must revolutionise the way we use information. We must create pathways in which information moves with patients across the system in real- time” Victoria Climbié (The Laming Report): “...systems were crude and information failed to be passed...information systems that depend on the random passing of slips of paper have no place in modern services” Caldicott 2 :“For the purposes of direct care, relevant personal confidential data should be shared among the registered and regulated health and social care professionals who have a legitimate relationship with the individual.” Caldicott 2: “people also expect professionals to share information with other members of the care team, who need to co-operate to provide a seamless, integrated service. …” DoH Winterbourne View Final Report: “All local authorities and their local safeguarding partners should ensure they have...information-sharing processes in place across health and social care to identify and deal with safeguarding...this requires a multi-agency approach including all partners”

9. strategic alignment 5 year forward view: “Most countries have been slow to recognise and capitalise on the opportunities presented by the information revolution……the NHS has oscillated between two opposite approaches to information technology adoption.....the result has been systems that don’t talk to each other and a failure to harness the shared benefits that come from interoperable systems…..In future we intend to take a different approach”

10. project approach 2011 Original Vision 2012 Procurement 2013 Staged approach – First stage (pilot) started in March 2013. Key deliverables: A working system for 500 users Evaluation of benefits Stage one themed on urgent & unplanned care 2014 A business case for the second stage started Dec 2014 (next 5-7 years) FYFV PUBLISHED 2015 & beyond = GROWTH Stage two will extend the breadth & depth (10,000 more users, more information sharing, more organisations, more functionality, more more more more….)

11. the partnership

12. Demographics Laboratory Radiology Encounters Allergies Diagnosis Clinical Data RepositoryRhapsody Integration Engine Pathology & radiology - tbc EMIS GPs and Community Health organisations Mental health (RiO) Authentication Patient Privacy & Consent Relationships Audit Logs Patient Search Patient Lists Patient Summary Timeline Presentation Integration Source Systems Security & PrivacyPatient Record Medications Problems Procedures Portal Connecting Care Clinical Portal Master Patient Index MiG PAS Systems (Weston Cerner, NBT Lorenzo, UHB Medway) Adult Social Care (Swift N Som & S Glos, Liquid Logic - Bristol) End Of Life ( Adastra) Children’s Social Care (Liquid Logic N Som & Bristol, Capita – S Glos) Out Of Hours ( Adastra)

13. Benefits

14. benefits Out of hours care Saves appointments and visits Saves admissions Safer prescribing Improved quality of consultation Pharmacy Safer prescribing – provides access to allergy and GP prescribing information Saves time – reduces the amount of time calling GP practices Safer communication - reduces errors Hospitals/ A&E Safer care – patient background, context and medications Saves times – reduces time trying to find out information Reduces risks – where patients unable to inform clinicians about relevant information/fax errors etc.

15. benefits… Community Care Saves time in triage and assessment Saves time – reduces the amount of calls to GPs Saves unnecessary home visits Supporting risk management and safeguarding Social Care Supporting referral management Saves time in triage and assessment Informs assessments & care planning Saves installation and equipment costs Supports risk management and safeguarding General Practice Reduces burden on practice administrators Supports risk management and safeguarding Increased confidence in better care being provided outside of the practice Immediate access to GP records (new registrations)

16. benefits… “ Massive difference in time spent accessing information. On average [I can] access the GP record within 30 seconds compared with 15-20 minutes taken via telephone or via fax” Critical Care Pharmacist Manager UHB “3 cases identified on Connecting Care today that were already allocated to a health practitioner (BCH OT or IMCS OT) so did not require referrals to BCC OT”. Occupational Therapist Bristol City Council “I now use Connecting Care on almost every case I deal with it (approx. 25 cases per shift). It always makes a difference and adds value. Every shift, acute admissions are avoided.” Doctor (out of hours) “Have been able to identify trends which have then resulted in swifter [safeguarding] interventions…one case where concerns would not have increased without Connecting Care…” Social Worker Safeguarding team “Connecting Care is brilliant…I use it to triangulate information from service users, to find out about other services involved so that I can contact them to inform my assessments” Bristol social worker “it has enabled us to commence discharge planning earlier in the patients stay to help prevent delays later on.” Discharge Nurse “Unable to obtain a medication history or allergy status from the patient….accurately confirmed through Connecting Care …” Pharmacist, NBT ““Information about the patient’s diagnoses has helped our team decide which type of therapy to offer the patient” UHB

17. benefits… “ On Monday I managed to obtain details for 22 patients on Connecting Care, I saved a huge amount of time as I didn’t need to phone the GPs and wait for the faxes to arrive” Acute Pharmacist “I used Connecting Care to find vital information for the diabetes nurses. The information logged by district nurses is a goldmine of information. We saved 20 minutes on the telephone and managed to find the reason for patients insulin being discontinued” Discharge Nurse “In cases where we are dealing with a person who is being supported by Rapid Response and the district nurses, Connecting Care comes in to its own. All the notes from visits are documented and it can save at least 30-40 minutes on duty cases of this nature” Social Worker “The extra patient detail is useful when deciding to stop drugs such as anti-platelets and it helps to identify risk factors” Doctor Having access to accurate, timely, shared information is no longer a ‘blocker’ to providing high- quality, effective, efficient care… “Without Connecting Care today I couldn’t have done my job.” Pharmacist “Connecting Care has been really helpful tonight. Could not do without it. Particularly in the case of an old lady with XX who I could not reach on the phone. Without Connecting Care this would have resulted in a visit and probably her door being broken down. But with CC I was able to work out that all that should of been done, had been done.” OOH Doctor

18. potential financial benefits Prevented Admissions 10,000 users could see annual saving of £1,036,288 from inappropriate admissions prevented, by using information in Connecting Care Based on a Department of Health reference cost 2012/13 of £1,436 for a unplanned admission and only the same rate of stated admissions prevented in the pilot Reducing duplicate assessment Reducing duplicate assessments 10,000 users could see a annual saving of £179,520 on stopping the duplication of assessments as a result of using information in Connecting Care Based on cost savings if the same rate of stated admissions prevented during the pilot continues – based on £60 for an average cost of a face to face assessment by a community nurse - Department of Health reference cost 2012/13

19. potential financial benefits Time saving 10,000 users could see an annual saving of £155,278 of ‘people time’ as Connecting Care users spend much less time calling other organisations for information Based on salary cost savings if only one call per week per user is saved where the medium salary between NHS bands 7 to 8 is used. Reducing wasted home visits 10,000 users could see a annual saving of £68,000 on stopping unnecessary home visits as a result of using information in Connecting Care Based on cost savings if the same rate of stated home visits prevented during the pilot continues – based on £60 for an average cost of a face to face assessment by a community nurse - Department of Health reference cost 2012/13

20. Our Vision

21. vision - platform With thanks to Leeds City Council

22. 5 reasons we have been successful so far….. 1. Line of business systems that ‘share’ You cannot share paper data easily Good electronic ‘line of business’ systems that share data are critical 2. Integration Partner Integration is tricky. Find a software partner who ‘gets it’ 3. Money…locally owned money! Invest locally….seek national money too, but make your local organisations put skin in the game 4. People….local talented people Hire really talented project people….we did, we do, we always will 5. SPIRIT Overrides everything else Stamp on ‘organisationally centric’ thinking at every single opportunity. Command the morale high ground that the patients/citizens best interest occupies

23. Reasons to be cheerful…….or “Why England is finally getting its e-Health strategy right”

24. The Digital Transformation ‘engines’ THEORY…. NHS England - Vision & Strategy - Money - Leadership ‘ ‘Locals’ - Design - Delivery - Timetable HSCIC - Standards - National systems - Delivery Suppliers - Products - Innovation - Repeatability Our Patients Our Public

25. The Digital Transformation ‘engines’ THEORY…. NHS England - Vision & Strategy - Money - Leadership ‘ ‘Locals’ - Design - Delivery - Timetable HSCIC - Standards - National systems - Delivery Suppliers - Products - Innovation - Repeatability Our Patients Our Public Requires people to lead, act, think and behave DIFFERENTLY

26. NHS England….

27. £4.2bn will be spent on NHS technology over the next 5 years £1.8bn to create a paper-free NHS and interoperability for clinicians £1bn on infrastructure, cyber security and data consent. £750m on transforming out of hospital care, including digital primary care, medicines, social care digitalisation and digital urgent & emergency care £400m to enable the NHS to become digital, including a new nhs.uk website, apps, free Wi-Fi and telehealth £250m for data for outcomes and research

29. Suppliers 5 principles of the Interoperability Charter: We will make available to other suppliers, the NHS and Local Authorities, the technical specifications of our interfaces without charge Where there is customer demand we agree to co-operate without charge with other suppliers in developing interfaces We will not reinvent the wheel and will use internationally recognised standards where relevant We will only charge reasonable and proportionate fees to the end user organisation for Licencing, Implementation and Support services required for the interfaces. Where new interfaces and enhancement to existing enhancements to existing interfaces are required, we will not charge twice for the same software development

30. Locals - 2014 Oxfordshire Shared Record Hampshire Shared Record Connecting Care

31. Locals - 2016 Oxfordshire Shared Record Hampshire Shared Record Connecting Care SIDER Dorset Care Record JUYI Single view of the citizen Berkshire West – Connected Care Berkshire East – Share my care

32. Creating a common and open set of APIs to support information sharing across health and care Defining the key clinical information sharing needs. Prioritising the key APIs. Group members e.g. CCIOs, CIOs, Vanguard, Pioneers, PMCFs, NHS England. Outlining the accreditation approach for APIs. Group members e.g. TechUK, CIOs, suppliers, HSCIC. Defining the key underpinning components and policies, e.g. security and authentication. Group members e.g. HSCIC, suppliers, CIOs, TechUK, NHS England. Establishing and creating the required APIs based on clinical information sharing needs. Group members e.g. suppliers, innovators, CCIOs, CIOs, NHS England, HSCIC. Made up of the above organisations, the Project Board is responsible for the assurance and governance process. Links to existing communities and signposts tools and products.

33. On top of that…..

34. Domain Descriptions A. Self-Care and Prevention: We will deliver the online services that patients need to take control of their own care, which will reduce the pressure on front line services. B. Urgent and Emergency Care: We will help to deliver the national urgent and emergency care strategy by providing the digital infrastructure, algorithms and pathways we require. C. Transforming General Practice: We will use technology to free GPs from time consuming administrative tasks and provide patients with online services. D. Integrated Care: We will better inform clinical decision making across all health and care settings by enabling and enhancing the flow of patient information. E. Digital Medicines: We will enable and improve pharmacy decision making and outcomes by providing patients and prescribers with streamlined digital services. F. Elective Care: We will improve referral management and provide an improved treatment choice for patients by automating referrals across the NHS. 34 G. Paper free at the point of care: We will create an NHS “paper free at the point of care” by driving up levels of digital maturity and by enabling the NHS workforce to better utilise the benefits of digital technology. H. Data Outcomes for Research and Oversight: We will deliver the health and care information and insight which is fundamental to informed policy making, commissioning and regulation by improving information collections, analysis and reporting. I. Infrastructure: We will enable information to move safely and securely across all health and care settings by providing robust and future-proofed national systems and networks. J. Public Trust and Security: We will provide the means for citizens to set their consent preferences. We will provide confidence that clinical and citizen information is held safely and securely and protect health and care systems from external threats.

35. Linking Programmes to Outcomes Citizen Identity NHS.UK Health Apps Assessment & Uptake (inc wearables) Widening Digital Participation Digital Referrals 5 Integrated Care – Business Change Integrated Care – Interoperability and Architecture Social Care Integration Personal Health Record Digitising Community Pharmacy Pharmacy Supply Chain and Secondary Uses Integrating Pharmacy Across Care Settings 19 18 17 20 Driving Digital Maturity Digital Child Health Digital Diagnostics Workforce and Professional Capabilities 21 General Practice Operational Systems and Services Adopting Existing Technologies in General Practice Technology for General Practice Transformation GP Data for Secondary Uses 10 9 6 12 4 29 3 2 1 Clinical Triage Platform Patient Relationship Management Access to Service Information Out of Hospital Care National Data Services Development Data Content (inc. GP data, PLICS and PCOMS) Innovative uses of Data 25 26 Self Care and Prevention Integrated Care Elective Care Infrastructure Digital Medicines Paper Free at Point of Care Data Outcomes for Research and Oversight Urgent and Emergency Care Transforming General Practice C B H G A I D E F Cyber-Security National Opt-Out Model Public Trust and Security Digital Interoperability Platform and Spine NHSmail2 HSCN WiFi 11 13 14 15 16 22 23 24 27 30 31 32 33 7 8 28 J 35

36. The Digital Transformation ‘engines’ emerging reality…. SOME people ARE leading, acting, thinking and behaving DIFFERENTLY….. …..Its time for the rest to do the same

37. Thank you Andy Kinnear - Programme Director T: 0117 900 2552 M: 07967 005871 andy.kinnear@swcsu.nhs.uk Andy_Kinnear