Yorkshire & Humber PSN “The Challenge & The Opportunity”

Yorkshire & Humber PSN “The Challenge & The Opportunity”
Jon Browne NYHDIF November 2014

YHPSN What is it?

PSN IA Conditions (CoCo)
What is the PSN? “A Network of Networks” PSN IA Conditions (CoCo) YHPSN Corp Network Corp Network GCN DNSP DNSP Corp Network Corp Network Corp Network NHS N3 DWP PSNSP WWW

The YH PSN There are four things I want you to notice, which makes our PSN somewhat unique It’s big It covers a population roughly the same size as Scotland It’s Holistic The Yorkshire and Humber PSN covers the majority of local public sector delivery. This opens the door to some interesting transformational change, while still providing a secured and highly available infrastructure. It’s complete It even includes the Regulated Area of Kingston upon Hull, so brings in Hull City Council, Humberside Police and the NHS bodies in the area. This has broken an age old monopoly It’s Supported Even the NHS agencies are moving their CoINs into the YHPSN, and this is very exciting, as you will see.

Principles Three Prime Principles Consolidate Standardise Simplify

Savings Estimated Regional Spend & Savings Spend Savings Connectivity >£42mill+ >£19mill+ Services >£19mill+ >£6mill+ And there’s still more to come! It’s been a real success, with an excellent take up and it is showing significant savings But up until recently it’s been looked at as a bit of a buying club, with the smaller agencies being able to buy at the same price as the big boys. Whilst there’s nothing wrong in that for us it’s completely missing the point of having a regional PSN like ours.

YHPSN & Health The Challenge

Health ‘As Is’ The following is a near verbatim account of the business case made by the Leeds Adult Social Care team for the sort of transformation needed in health. I’m basically reading this out as I’m really the mechanic, and if left to me I’d get it wrong. So Let me introduce you to Donald Click: Donald is 87 and has lived independently with his wife, been active and had a good quality of life. Click: He suffers a stroke and is taken into hospital. His wife cannot cope with his return home without some support. Click: A medically led discharge from hospital takes place. The hospital refers Donald to the Community Trust for community support – the hospital Administrator faxes a 12 page discharge document to Community Trust. Click: The Intermediate Care team do an initial referral and rehabilitation services are put in place to get Donald his independence back. Click: Intermediate Care team assess Donald at home using the critical discharge information for the basis of the assessment. (Donald had lots of information taken from him by many staff in this 2 week hospital stay but none of this is passed on – only the discharge document). Click: The care package is in place but Donald has ongoing needs and after the 6 weeks Intermediate Care/Reablement period, a referral is made from Intermediate Care to a Community Matron for further assessment. A further set of documentation is completed and stored in a file left in Donald’s home. Click: A referral is made by the Community Matron to Adult Social Care, who starts a Social Work assessment and financial assessment for Fair Access to Care eligibility. Another folder contains this paperwork in Donald’s home. The normal process is undertaken that establishes a care package for Donald. So all seems good BUT. Click: Donald falls and his wife finds him on the floor, Click: she is unsure who to contact as there are many folders of information, Click: so she rings 999 and he is admitted back into hospital.

Health ‘To Be’ Integrated Care Record
As Leeds is one of the 15 participants in the NHS ‘Pioneers’ programme, it is developing a city wide Integrated Care Record, Click, in which, assuming Donald has given his consent, or at least not refused permission, Click: are his medical records Click: He suffers a stroke and is taken into hospital. His wife cannot cope with his return home without some support. We’ve heard this all before. Click The hospital staff have access to Donald’s previous care needs and care plans and so can tailor his treatment specifically to his needs. Click: They can also inform Donald’s GP electronically that Donald is in hospital. Click :A medically led discharge from hospital takes place. An electronic discharge referral is sent to the Gateway team (Community referral). If the hospital staff need to talk they can ring the one number for the Gateway and talk to the team. Click The Gateway team complete an immediate assessment of Donald’s needs, building on the ‘record’ from the hospital collected during Donald’s stay, and which has now been passed to the Gateway (Community referral). A decision on services is taken by the Gateway to be delivered in the neighbourhood which includes Nursing and therapy. Click: Around Leeds there are 11 Neighbourhood teams covering geographic areas, and The Gateway team contact the relevant Neighbourhood team who are, of course, also able to view Donald’s record, Click: The Neighbourhood team assessing Donald’s care is able to access the information on their laptop in his home and are able to plan his care with him electronically. He can sign the plan on screen and the care plan can be printed and given to Donald. Click: The referral to the social worker is electronic and the record of Donald’s care is also accessible by the Social worker who adds to this growing record, and importantly can discuss the case with the Neighbourhood team as they share premises and bump into each other regularly. The Community care plans are goal focussed and the social work assessment is the personalisation approach. Click: Before the first visit to provide care for Donald the Neighbourhood team identify that Donald has complex needs and identify a Key Worker (One professional contact for continuity). When Donald falls his wife knows who the key worker is and contacts them to ask for support. Click: The Ambulance Service is engaged with this whole process, has access to Donald’s records should they be called in an emergency, are aware of the key worker and can make decisions to link back with the community care rather than taking Donald back to hospital. And what’s the glue that is holding this all together? Click: It’s the Yorkshire and Humber Public Services Network – the YHPSN Integrated Care Record

Requirements Integration of Health and Social Care
Support for Cross Team Working Provision of Collaboration Tools Simplification of Communications Channels Support for Multi-Agency Buildings Consistent Access to NHS Number = Ubiquitous Unified Network (fixed and mobile) Ubiquitous Access to Appropriate National Applications (e.g. PDS) So what appears is a shopping list of fairly simple requirements. I’m sure we can all add to these, but in essence if we could deliver these outcomes Health and Social Care would be improved. And to do it, we believe you need [Click] a unified network that gives people access to the information and applications they need.

Connecting to N3 Started in July 2013
HSCIC Led – Mark Reynolds Idea of a “Health Transition Layer” in PSN Developed by YHPSN TRT IA/IG Coalescence work undertaken Ralph McNally led IG Toolkit V12 PSN-H Board Representation Dylan Roberts So we tried. In fact the very original concept came from the HSCIC itself in the guise of Mark, who was very quickly replaced. We also understood that our IA/IG regimes were different, and that there would be unacceptable duplication and rework required to accredit to both, so Ralph McNally led a project to coalesce the two regimes, and make current accreditation cross-referenceable, hence IG Toolkit 12, with the Local Authority view having 40+ controls reduced to 28, of which 12 are directly equivalent to the PSN CoCo And finally Dylan Roberts, CIO at Leeds City Council and PSN lead for the LCIOC, joined the PSN-H Programme Board to represent Local Authorities. [Click]

Timeline 27 Aug 2013 6 Jan 2014 8 May 2014 14 Nov 2013 7 Aug 2014
So we started work, and have been on it ever since. This is this timeline which shows the amount of obfuscation and fudge we’ve been attracting from certain parts of Health Within the business case we’ve done some maths, which show that by using regional PSN programmes there could be a saving in excess of £250 million. [Click] 27 Aug 2013 6 Jan 2014 8 May 2014 14 Nov 2013 25 March 2014 7 Aug 2014

PSNH Budget 1,368,714 While at the same time the PSNH team were putting in a Business Case for their proposed N3 replacement. And it you can make out the bottom figure [Click] it’s nearly £1.4 BILLION Times is obviously hard in the NHS!

Current Situation cPoP cPoP cPoP PSN N3 backbone
Govt. National Applications PSN Exchange Exchange Exchange Exchange Exchange Exchange Exchange Exchange Exchange Exchange Exchange Let us consider a simplification of the current situation. Hospitals need to communicate, and so have developed Community of Interest Networks, Or CoINs. Click These are typically connected using Point to Point connections flowing across all intermediate exchanges. Access to NHS National Applications is aggregated across an N3 link which is a point to point circuit to the nearest N3 Point of Presence, or PoP, of which there are about 60 across the UK. Some of these are Core Points of Presence, or cPOPs. These are ‘meshed together’ for resilience and referred to as the NHS N3 Spine Connected to the Spine are all the NHS national applications such as the Summary Care Record, Personal Demographics Service, eBooking etc. as is a national gateway for Internet Access. And this model is used to connect Trusts, CCGs, CSUs and of course GP Surgeries. Under the new health arrangements Local Authorities are now integral in health delivery. They are being encouraged to transition into a PSN environment as part of the Govt ICT Strategy Which is connected to the Government Conveyance Network (GCN, and hence to Govt Applications such as DWP. But to integrate with health and access services like the PDS for the NHS Number It either has to connect to the local NHS Trust Or buy its own N3 connection And We know that since N3 connections have been centrally funded they have proliferated. We know of one trust with 5 sites which currently has 10 N3 connection. Another has 22. It is sometimes claimed that nationally there are 48,000 such connections, which is a heck of an achievement, but it is very health-centric, and we believe isn’t best suited to the changes coming in the delivery of health locally. Exchange cPoP cPoP N3 backbone cPoP NHS National Applications

When all we want to do is get it across the road!
(For those that don’t know, the building in the foreground is Leeds Civic Hall, and the one across the road is the Leeds General Infirmary)

N3 Proposed Health Only VRF cPoP cPoP cPoP PSN PSN N3 backbone
Exchange Exchange Exchange Exchange Exchange Exchange Exchange Exchange Govt. National Applications Exchange Aggregator Exchange Exchange Our proposal has been simple and elegant Click The PSN already covers everyone in the region. [Click] If we introduce a PSN based ‘Health Layer’ within our PSN which was N3 compliant rather than PSN compliant to start with and connected directly to the N3 backbone, the IG and IA would not impact on the PSN CoCO as it’s for health use only. That solves the problem with integration and information sharing between health delivery partners And with everyone now connected to the health layer, all the dedicated point to point links can be ceased. [Click] And of course it then links everyone in the region reflecting the fact that 95% of all data traffic remains local. It covers GPs, the acutes, community and mental health, social care and children’s services, and allows for consolidation of data centres and other services such as end user computing across the region, and can easily be extended into care Homes, Hospices and so on. And it can be done now, doesn’t even require IP renumbering for Health, saves a significant amount of money (1000 circuits) , improves communications flows and of course, provides our health colleagues with a simple route to moving to PSN compliance. However, we’ve been blocked at every turn, and the PSNH Governance Board was dissolved in February and has yet to be reconvened! But…[Click] We have a master plan to use an aggregator. This is an existing construct and there is no reason why we can’t hook up with the recently formed Y&H CSU (YHCS) or even the Leeds Teaching Hospitals and use their connections. Exchange cPoP cPoP N3 backbone cPoP NHS National Applications

Objections Move your CoIN to PSN and lose your N3 CoIN Funding
Sheffield CoIN Move your CoIN to PSN and lose your N3 Uplink Funding LTHT Move your CoIN to PSN and lose your N3 IP Space BT N3SP issuing invoices for next 3 years on 21CN And if that isn’t enough PSN-H Board has not been convened since Feb 2014 Governance Transparency

YHPSN Strategy Use of an Aggregator Already Established Procedure
Regional (CSU) City (LTHT) Commercial Already Established Procedure Supported by Health Pioneers Supported by HSCIC Security Team Uses IG/IA convergence work already completed by YHPSN/HSCIC IG Toolkit V12 Move towards complete IA/IG convergence

City Perspective LCHT CCGs Health layer N3 2x100Mb LTHT LTHT L&YPFT
Click We could do it, with some political will, at the city level, where we have a number of agencies across the city delivering health All of which need access to N3 In Leeds we know that the LTHT has 2x100Mb bearers, and Everyone else currently also has it own connections We also know that we need to communicate to share information between ourselves Which, because we’re all in it we can do through the YHPSN, click So If we put a health layer into the YHPSN linked to each organisation, to allow for information sharing between us all, And all linked ourselves to it we could also use it to link to the LTHT and use their connection as an aggregated link. We could then remove the dedicated links, and the LTHT becomes the aggregator for the City. But only if only someone senior in Health says do it LCC

YHPSN & Health The Opportunity

Leeds City Survey Workstations Printing Connectivity Mobility
Applications File & Data Sharing / IM / Social Identity Management Service Desk We recently received back an independent report commissioned by the Leeds CCGs in support of the Smarter Working Initiative, and I thought it might be interesting to share the observations It identified the following areas where significant work needed to be undertaken [Click] Workstations - Multiple devices, Usernames and Passwords, software version incompatibility, difficulties with WiFi, speed of boot. [Click] Printing - Difficult to connect to printers (USB), in own org, between orgs, at home = work arounds, 3 x new managed print service contracts in Leeds alone! [Click] Connectivity – No site details re services, wifi connection difficult, no tethering knowledge, VPN token confusion, appetite for video. [Click] Mobility – Costs too high, Meeting tools not used, want iPads (!), management reluctant to provide smart devices [Click] Applications – ID management complex. Different apps for the same tasks, multiple apps needed to do job = need for integration [Click] File & Data Sharing – Mapped drives still best understood. used as file store, no x-organisational file stores, little access from mobiles, IG issues, ‘Cloud’ scares IT people. [Click] – Quota size limits, file store for many, no central GAL, 2 s (org + Secure) confusing [Click] ID Mgmt – Multiple logons, permissions often based on previous people not roles and innaccurate, self service pwd reset [Click] Service Desk – differences across desks, uncertainty as to which to call, firefighting not proactive, smartphone support low. They obviously had some recommendations, which aligned with strategy we’d already started, which validates the approach.

“PSN Connected” YHPSN equivalent of “PSN Roam/Edu Roam”
Utilises current partner wireless Light Touch, Low Cost Consistent SSID Connection to Corporate Concentrator only No Access to Internet Ad-Hoc connection Visitors Attendees The concept is to use existing partner infrastructure but add a consistent PSN SSID common across the region which links the user to a separate network layer from which they can get to their corporate VPN concentrator and get connected. This does away with captive portals and time limited access and having to know the Guest SSID of every partner and makes connection simple. It’s low cost, using existing provision and will make working on cross agency projects simpler and more effective [Click], and we hope will also drive adoption, as users will see the signage at Reception and know that they can connect, so will both recognise building where the service exists, but more importantly, feed back where the service is not available and where it would be useful, allowing the organisations to target scare resources at the most beneficial areas. Now to our N3 Connectivity tale [Click]

High Level Design

End User Computing Microsoft Azure / Amazon LCHT CCGs End User layer
GPs LTHT L&YPFT Shared Data Centre Services So let’s hold that thought and extend the same idea to the end user Look familiar? We could create an end user layer linked with bi-directional links to each corporate network across the city. Click The end user would connect to this layer, rather than the individual corporate network, and Using core services located in a shared data centre, could be authenticated, and be granted printing services. We can then link the end user layer with the office services we all need to work together and collaborate, such as Microsoft Office 365 and Azure, including telephony, instant messaging, etc. And gateway back to the corporate LANs for access to the organisational localised applications But logically, what if All the organisations relocated their corporate applications into the same shared data centre? As you can see, there is then nothing really left at the corporate level, and so The network can be flattened, and every site becomes a shared site, wireless is ubiquitous, printing is common, and the free flow of users is encouraged. click Microsoft Office 365 / Google Apps LCC

Estate Rationalisation
We know that we have a mix of public sector in the region Click (Slide builds) A mix of GP Surgeries, Police, Health Centres, Local Authority offices, even libraries. But many of these are legacy, and some will not be located ideally for engagement with the community. Click (Ex Libris) There is a lovely old library building in Holbeck in Leeds, but the community it served has completely disappeared, and there are no houses anywhere close. So it had to be closed down, and is now offices. How many other buildings are no longer in ideal positions Click (Ex Libris disappears) Click So what if we chose buildings that were in the right place for the community, and then looked to see what services we could offer through them to the citizen, and to the public sector as a whole. We could locate a library along side a police station and merge a health centre with a GP surgery to bring together health services under one roof. That could include a pharmacy so prescriptions could be filled just after a consultation. All these services sharing a single PSN connection to get to the services they need. And although we’re not going to be able to relocate City Hall, we can locate other services, such as social care, housing and benefits etc. in the same building so the citizen has one place to go to for a range of services. And of course the vacated buildings can be repurposed, disposed, or redeveloped. It is interesting to note that the graphic I’ve used for the multi-purpose building is from a Visio stencil, and was originally a Shopping Centre. We need to start thinking about where people go and want to be, and where best we can support them, and Shopping Centres might just be an idea! So let’s summarise the benefits click

Desktop Physical OS Connectivity Browser Office Productivity Messaging
Collaboration Printing Anti Virus IA/IG Security Storage LoB And what is a ‘Desktop’? It’s merely a set of ‘stuff’ that we give to our users as a whole package, and this is currently a costly exercise But can we abstract elements over time and replace them with functional equivalents as a cloud service? Well yes [Click] we can abstract the office, and collaboration tools using Office 365 or Goggle Apps so we have a single unified address list and contact points. Click We can provide cloud storage which is easy, [CLICK] and cloud printing services so users can print anywhere they need to. And if we virtualise the Line of Business applications [Click] this allows us to collapse the security and IA/IG back into the cloud and shared data centres to protect the core, [Click] which means we’re less concerned about the posture of the device.[click] Which then begs the question, what’s left on the device that we actually need? Basically all that is then necessary is connectivity and a compatible browser [click] And if that’s all then we don’t need to provide the device, [click] allowing the user to choose devices that suit their way of working And we can extend this then into the support structure [click]

Roadmap National Apps YHPSN YHPSN National Apps National Apps
SIAM Corp Network Corp Network Corp Network Corp Network Common LoB Applications LoB Apps LoB Apps LoB Apps LoB Apps Core Common Applications Common Apps Common Apps Common Apps Common Apps We all build support stacks with service desks, 2nd and 3rd line, to support common apps such as Office, and Line of Business apps for health or housing, care plans or community charge. We have a corporate network team which also links us to the national backbones [Click] And then we replicate this for every organisation in the region. This cannot be sensible. [Click] We’ve already made a start by using the PSN to connect us to the national Apps, and an N3 link would complete this. [Click] and most of us have moved our corporate networks into the same managed service So if we agreed on a common set of cloud based apps for office productivity and collaboration [click] and used them instead; [click] We could then merge the service desks and provide one number to call, and [click] and then if we merged line of business apps, more of which are becoming integrated such as Integrated Health Care records available across agencies, or made them cloud based, [click] we could consolidate the tech support, retaining localised specialist knowledge. And finally, with most things provided as a service, we can consolidate the corporate networks, and [Click] develop the co-ordination of the components and suppliers through Services Management and Integration, or SIAM, using a [Click] Consolidated Technical Support Tech Support Tech Support Tech Support Tech Support Service Desk Unified Service Desk (One Number to Call) Service Desk Service Desk Service Desk

One Vision Organisationally Agnostic End User
Organisationally Agnostic Buildings Unified End User Computing Platform Shared Communications and Collaboration Services Virtualised Line of Business Applications Regional Strategy, Architecture and Commissioning (SAC) function Services Integration and Management (SIAM) Consolidated IT Support Functions Unified Service Desk (One number to call) Single Virtual Support Team.

“Alto Gnaritas”

Regional TDA Regional Technical Design Authority Consolidate
Standardise Simplify Support Application Component Orchestration Supplier Management A Regional Technical Design Authority It’s role will be to work with the partners to develop common utility services for the partners based in the YHPSN, or delivered though it, with a simplified, common and appropriate Information Assurance and Governance which is sector agnostic. It will also be responsible for aligning the partner support needs and functions, and working with vendors to ensure good service and value for the taxpayer pound.

Thank you So you can see how central the YHPSN is to our plans, and how we can exploit it to rationalise and develop integrated, standardised and collaborative services across partners, allowing for simplified delivery of services; doing more with less. We’re very excited about the future of our PSN, I hope you are as well. Thank you all for listening.

Yorkshire & Humber PSN “The Challenge & The Opportunity”

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Yorkshire & Humber PSN “The Challenge & The Opportunity”

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