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Informatics Strategy

Information & Communications Technology [ICT]

Information Management and Knowledge Services [IKS]

2013 - 2016

Date effective from: TBC

Review date: TBC

Version number: Version 1.1

See Document Summary Sheet for full details

CONTENTSSection Description Page

Document Summary Sheet 3Document Amendment sheet 4

1 Introduction 52 Summary 63 Vision 94 Business Drivers 9

4.1 Trust Strategy 94.2 NHS Information Strategy 104.3 Commissioning/Service Contracts 114.4 Regulatory and National Requirements 114.5 The Environment 12

5 Information and Knowledge Services 135.1 Business Intelligence 135.2 Information Quality Assurance 155.3 Information Governance (IG) 165.4 Knowledge Services 16

6 Business Systems 186.1 Clinical Support Systems 196.2 Corporate Systems 18

7 IT Infrastructure 197.1 Access Devices (PCs and printers) 197.2 Network 217.3 Videoconferencing 227.4 Voice Communications 237.5 IT Support (including Service Desk, Desktop and IT

infrastructure)24

8 Informatics Training and Development 259 Environmental Strategy 2710 Programme Management, Governance and Resources 2811 Glossary 2912 AppendicesA Trust Strategy Summary: Improving health, improving lives 32B Clinical and Corporate Systems Roadmap 33C IT Infrastructure Roadmap 34D Information and Knowledge Services Roadmap 35E LYPFT Informatics Governance Structure 36F Indicative Costs 37G Strategic Implementation Plan 38

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DOCUMENT SUMMARY SHEETALL sections of this form must be completed. Those marked with * will be used as search information on Staffnet.

Document title*:Informatics Strategy (ICT, Information Management and Knowledge Services) 2013 - 2016

Document Reference Number * TBC

Member of the Executive Team Responsible* (Title):

Chief Financial Officer

Document author* (Name and title): David Shelley, Head of ICTApproved by (group):

Date approved: TBC

Ratified by (group/Board): Board of Directors

Date ratified: TBC

Review date: TBC

Frequency of review: Every three years

Responsible for the review: Head of ICT

Target audience:(List, by title, the people this procedural document is essential for)

All staff and associated non –employed personnel, trust-wide

Responsible for dissemination: Head of ICT

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DOCUMENT AMENDMENT SHEET

Please record what changes you have made to the procedural document since the last version.

This is a summary of changes to the document and is designed to show people exactly what has changed. The version number recorded below should correspond to the ratified version number shown on the Document Summary Sheet.

Version Amendment Reason0.1 Initial Draft Produced Jan 20120.2 Minor changes First review on 30 March 20120.3 Changes to take account

of NHS Information Strategy ‘The Power of Information’

Following comments from ETTSSG on 23 May 2012

0.4 Implementation Plan (App 7) added

12 June 2012

0.5 Minor changes to reflect PbR dates and Trust HQ

20 August 2012

0.6 Re-formatted November 2012. To conform to Trust Template for Strategy Documents

0.7 Minor Updates Dec 2012 minor updates to reflect latest Trust HQ status and Clinical System Review

0.8 Section 5 revised and new sub-section added (Information Quality Assurance)

0.9 General updates 8 Feb 2013. Updated to reflect new Trust Strategy (2013-18) and Appendices updated.

0.10 Section 6.1 revised and minor updates added

10 Jun 2013. Updated to reflect Board decision to retain and develop Paris as strategic future clinical care system

1.0 Version for approval by ET – 18 June 20131.1 Minor amendments inc

reference to CCIO 6.1.10

Incorporation of comments/amendments requested by ET. Version to be submitted to Trust Board for ratification

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1 INTRODUCTION

1.1 The Information & Communications Technology (ICT) Strategy approved in April 2008 set out a Trust wide approach to the development, deployment and operation of ICT systems and services covering the period 2008-12. A separate but complimentary strategy covering Information and Knowledge Services (IKS) was also produced for the period 2006 to 2010.

1.2 The Strategies were based on the expectation that an integrated care record system (CRS) provided by Connecting for Health (CfH) would be deployed in 2012 to replace the ‘interim’ system (PARIS) implemented in 2008. However, continuing delays in the programme, especially regarding the delivery of mental health systems, resulted in the Trust deciding to extend the PARIS contract for a further three years (2011-2014).

1.3 This approach was endorsed by CfH and the Yorkshire and the Humber Strategic Health Authority (SHA) and resulted in the Trust effectively withdrawing from active involvement in the acute systems element of the National Programme for IT.

1.4 During the last two years there have also been significant initiatives, reports and strategies launched within the Trust, across the Leeds health economy and NHS-wide which have and will continue to have a major influence on the provision of Informatics services to the Trust. These include:

The requirement for the NHS to achieve up to £20bn of efficiency savings by 2015 as part of the Quality, Innovation, Productivity and Prevention (QIPP) programme of which the Trust has committed to saving £17m over the three years from 2010 to 2014, followed by a further programme of savings.

The publication of a national Mental Health Strategy ‘No health without mental health’ in 2011.

The consequences of the health and social care reforms published in 2011 and now underpinned by the Health and Social Care Act 2012 including:

o The creation of GP led clinical commissioning groups (CCGs) overseen by the NHS Commissioning Board Authority (NHS England) that have replaced Primary Care Trusts (PCTs) with effect from April 2013.

o The abolition of Strategic Health Authorities and the consequential reduction in scope of the National IT programme including devolving responsibility for the procurement and development of clinical care systems to Trusts

o Devolvement of all care provision responsibilities including community and mental health services under the Transforming Community Services (TCS) programme, from PCTs to NHS providers or Social Enterprise organisations.

The successful bid by the Trust, as part of the TCS programme to take on mental health and learning disability services covering the York and Selby

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area (and certain North Yorkshire wide services) with effect from February 2012.

The development of an integrated ‘Care Pathways’ based approach to delivering mental health and learning disability care as a result of a Trust wide service improvement programme (2011 to 2014). This programme will also support the QIPP agenda by achieving efficiency savings and modernising and standardising the provision of mental health and social care across Leeds.

The adoption in 2010 of a five year Trust strategy ‘Improving health, improving lives’ (subsequently refreshed to cover the period 2013-2018) which established three ‘End Goals’ and five strategic objectives setting out what the Trust needs to do to achieve these goals (see Appendix A).

The publication in May 2012 by the Department of Health (DH) of its Information Strategy ‘The Power of Information: putting all of us in control of the health and care information we need’ which focuses on using information to drive better health, care and support – to improve people’s experience, quality and health outcomes

Recommendations and lessons to be learnt regarding Information and patient information systems in the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (the ‘Francis Report’) published in Feb 2013.

1.5 The scope of this Strategy encompasses the provision of ICT, Information Reporting & Analysis, Information Governance and Knowledge Services.

1.6 A separate review of the organisational structure and effectiveness of the Trust’s Informatics function was undertaken in late 2012 by the Trusts internal Auditors (RSN Tenon). The report was issued in February 2013 and makes recommendations to ensure that the necessary skills, resources and capacity to deliver this strategy are in place. This work is currently being progressed but is not referred to in this document

2 SUMMARY

This Strategy outlines how the Trust aims to harness information and new technologies to support the achievement of higher quality care and the improvement of outcomes for service users. It aims to build on the progress achieved in the last 4 years in establishing Informatics as a key enabler in supporting the provision of care services throughout the Trust and the achievement of the Trust’s aim in ‘Improving health and improving lives’ of its service users.

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3 VISION

3.1 Our vision is for Informatics to support the Trust in achieving its business objectives by:

1. making health and care services more convenient, accessible and efficient by harnessing modern technology .

2. developing an information-led culture where all health and care professionals take responsibility for recording, sharing and using clinical information to improve care

3. becoming an ‘intelligent organisation’ which has access to accurate and timely information to support its business and is able to use that information effectively and appropriately.

4. developing innovative and integrated solutions within a framework of national standards that ensure information can be used and can flow between systems efficiently, safely and securely.

5. recognising and supporting the requirement to provide service users and carers with more control and easy access to their own care records and technology e.g. ‘virtual meetings’ and enabling a culture of ‘no decision about me without me’

3.2 The Strategy has the following main objectives:

1. Support the seamless operation of mental health and learning disability services covering Leeds, York, Selby and parts of North Yorkshire by providing a fully integrated Information and IT infrastructure (by end 2014)

2. Complete the move to a Trust-wide electronic patient record (EPR) used by all clinical services that fully supports the integrated care pathways approach being deployed as part of redesigning community and inpatient services (by end 2015 – to meet NHS England guidance on implementing EPRs)

3. Support the introduction of new technology and infrastructure in order to improve efficiency and reduce costs in the provision of clinical care and support services such as telecare and telehealth, mobile/agile working, centralised document management and web based services (2012-2015)

4. Improve the level of partnership working with Social Care and other care providers by aligning processes and systems wherever feasible (2013-16)

5. Undertake an incremental programme that supports the achievement of or progress towards the following NHS-wide objectives, set out in the NHS Information Strategy ‘the Power of Information’ :

a. Transferring electronically and in standard interoperable format all correspondence about service users between professionals and services.

b. Making wider use of alternatives to face-to-face consultations eg Telecare,Telehealth including virtual meetings where this improves value for money and patient experience.

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c. Improving data quality, including universal use of the NHS Number.d. Using online technology to allow service users to access and

participate in their health care, including entering information into their care records.

e. Using secure electronic links to transfer information to users. f. Improving medicines management to support safer, more effective

care

6. Ensure that Informatics continues to provide ‘best value’ by evaluating alternative service delivery mechanisms including the rationalisation of IT Services (in particular Service Desk and data centre operations) and the provision of ‘Cloud’ based services i.e. services delivered by external organisations via the Web where appropriate

7 Continue the integration of the Trust’s voice and data services network and provide the necessary infrastructure to support the move towards agile and flexible working including the provision of wireless networks (WIFI), ‘hot desk’ facilities, mobile devices and a secure and resilient infrastructure to support remote and home working (2014/15)

8 Develop the organisation’s use of information as a resource to support clinical governance, improve efficiency and support service development and patient care

9 Develop the integration of information from different sources including activity, workforce, finance, outcomes and risk to enable a wider range of analyses to be undertaken

10 Ensure that all staff are trained to make effective use of information systems, email and the Web including the use of social media tools

11 Ensure that staff are adequately equipped with the appropriate IT technology to enable them to provide and utilise information in support of the business and to meet the Trust’s strategic objectives

12 Ensure adequate access and security controls are in place to manage access to the IT network, network systems and the information they hold

13 Minimise the risk of data loss or interruption of IT services by ensuring that appropriate security, environmental controls, system backup and disaster recovery procedures are in place

14 Ensure that ICT fully contributes to the Trust’s environmental (‘green’) Strategy by reducing energy costs and the overall carbon footprint that is generated by the use of IT across the Trust.

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3.3 In order to support the achievement of these objectives the following technology based initiatives will play a key role in enabling the efficient delivery of the strategy:

1. The replacement of paper medical records by electronic records (EPR)

2. The development of Health and Care Record systems (in conjunction with Suppliers) to support the requirement for patients/service users to access and manage their care records online.

3. Ensuring NHS and non-NHS healthcare systems can ‘talk’ to each other (interoperability) in order to support the new national strategy to “connect all” systems rather than “replace all” and to support the electronic exchange of information and documentation.

4. Provision of mobile technology (including notebooks, tablets/slates and smart phones) to enable staff to adopt more agile and flexible work practices resulting in improved quality and efficiency of care delivery.

5. Widespread deployment of modern IT infrastructure and systems such as collaboration tools, single sign-on technology, high capacity 3G/4G and WIFI networks and advanced document management tools (digital dictation, voice recognition) in order to reduce administration, improve productivity and support standardisation where appropriate.

6. The use of business intelligence software and data warehousing to deliver timely and integrated management and clinical information across the Trust to staff whenever they need to access it and to improve efficiency.

7. Implementation of improved methods of presentation and analysis including mapping, statistical analysis, dashboards and exception reporting to add value to information.

8. Adoption of telehealth and telecare based services and other innovative alternatives to face-to face patient consultations.

9. Rationalisation of IT services to improve efficiency and reduce costs.

10.Exploitation of ‘Cloud’ based services.

11.Use of Web based social media tools to improve communications to and from the workforce, service users and the public

3.4 The following Appendices provide supporting information including costs and timescales for delivering and supporting the strategy over the period 2013-16:

Appendix B – Roadmap - Clinical and Business Systems

Appendix C – Roadmap - IT Infrastructure

Appendix D - Roadmap - Information and Knowledge Services

Appendix F – Indicative Budget (2012-2016)

Appendix G – Summary Implementation Plan

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4 Business DriversThe following key business drivers both national and local underpin the principles and vision behind this Informatics Strategy:

1. Trust Strategy – Improving Health, improving lives

2. NHS Information Strategy – ‘The Power of Information: putting all of us in control of the health and care information we need’

3. New Commissioning arrangements – underpinned by the Health & Social Care Act 2012

4. Regulatory and national requirements

5. The Environment

4.1 Trust Strategy

During 2010 the Trust developed and agreed a five year strategic development programme which set out a commitment to provide ‘excellent quality mental health and learning disability services’. The Strategy was refreshed in early 2013 resulting in the establishment of five new strategic objectives to support the existing End Goals (see Appendix A).

A number of cross cutting operational requirements were identified that will enable Informatics to support the achievement of these objectives and in particular Objective 4 (‘efficiency and sustainability’) and Objective 1 (‘Quality and Outcomes - We provide excellent quality, evidence-based, safe care that involves people and promotes recovery and wellbeing’).

These include:

1. Providing and Using Information – provision of accurate, timely and complete clinical information to support the delivery of excellent clinical care and ‘real-time’ measurement of outcomes and performance.

2. Access and use of knowledge – the best relevant local and national knowledge is available to support all staff and service users.

3. Optimising the use of Information and Communication Technology (ICT) to improve productivity and enable our workforce to be flexible and adaptable.

4. The need to record appropriate clinical information including needs, goals, interventions and pathways.

5. The importance of providing the necessary capacity and capability to train staff to use new information systems and IT technology.

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4.2 NHS Information Strategy

4.2.1 The latest NHS Information Strategy1 ‘The power of information’ was published in May 2012. The Strategy is underpinned by the Health and Social care Act 2012 and is aimed at:

Supporting the delivery of the NHS Strategy ‘Equity and Excellence: Liberating the NHS’

Contributing to the delivery of the national QIPP initiative to release up to £20bn of efficiency savings and reduce management costs by more than 45% by 2014.

4.2.2 The main elements of the Paper that will influence the Trust’s Informatics Strategy are summarised below:

1. Enabling data provision – recognising the need to change the focus of collecting data to that driven by the needs of clinical decision-makers and provision/availability for patients/service users.

2. Providing information that supports the new commissioning environment that took full effect from April 2013. This information will also need to be connected across pathways, supporting clinical decision making and improving service user outcomes.

3. Integrating health and social care. This will include the need to standardise and integrate data (including a single service user identifier – NHS Number) in order to improve the working of care teams, improve efficiency and reduce costs.

4. Encouraging the use of the NHS Interoperability Toolkit (ITK) to enable joined-up systems and support the strategy to “connect all” rather than “replace all” and thereby facilitate the efficient electronic exchange of clinical documentation such as test orders / test results / medication information, between professionals and services.

5. Completion of the move to EPRs and paper-light document management strategies in order to improve productivity, efficiency and reduce costs.

6. Improving the patient and carer experience by:

a. Enabling information to be made accessible online to patients/service users to enhance engagement in their own care.

b. Utilising technology to reduce the need for healthcare attendances e.g. remote clinics and ‘virtual’ involvement in CPA meetings

7. Exploitation of new technology to improve efficiency and service delivery and reduce costs including the use of Telehealth and Telecare, collaboration and mobile (agile) working and new communication models such as Web 2.0, social networking and smart phones.

8. Rationalisation of IT services in recognition of the financial constraints within the NHS and the need to reduce costs and improve the quality and

1 NHS England have announced that they will be issuing a new Informatics Strategy in December 2013 called ‘unleashing the power of people’ which will include guidance in deploying EPR systems by end of 2015 and becoming ‘paperless’ by 2018

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reliability of service provision by moving to a model where IT services are delivered via shared services or specialised commercial providers.

4.3 New Commissioning arrangements

4.3.1 The recent NHS and Social Care reforms will result in Provider Trusts having to operate within a radically different commissioning environment. From April 2013 Clinical Commissioning Groups (CCGs) representing primary care practitioners (GPs, Pharmacists, Dentists etc) have assumed full responsibility from Primary Care Trusts for the commissioning of local care. These Groups are governed by NHS England who has also taken on direct responsibility for commissioning certain elements of specialist care.

4.3.2 The NHS Information Centre for Health and Social Care (ICHSC) has absorbed most of the operational elements of NHS Connecting for Health.

4.3.3 The immediate impact on the Trust will be an increasing emphasis that will being placed on datasets as the key data source for commissioners and other organisations to monitor performance, quality and outcomes. This will increase the importance of ensuring the accuracy of the Mental Health Minimum Dataset (MHMDS) which will be used to support Payment by Results in mental health and the existing NDTMS dataset for drugs and alcohol services. New datasets are also being introduced for IAPT and CAMHS services.

4.4 Regulatory and National Requirements

4.4.1 Significant information demands are placed on the Trust by regulatory bodies such as Monitor and the Care Quality Commission (CQC) in order to meet compliance standards. Consequently there needs to be a continuing focus on the timeliness, accuracy and completeness of the information that requires submission.

4.4.2 The acquisition of services in York and North Yorkshire which currently use different clinical support systems has resulted in additional complexity in collecting, analysing and reporting data.

4.4.3 The need to focus on improving the overall quality of care related information produced by Trusts has also been emphasised in the recently published NHS Constitution in which one of the values that Trust’s must meet is ‘commitment to quality of care’.

4.5 The Environment

4.5.1 The Trust has produced and implemented a Carbon Management Plan (‘green’ strategy) with the intention of reducing the environmental impact of

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the Trusts operations and reducing costs. Informatics can provide significant support in this area, particularly in the use of ‘smart’ technology to manage and reduce power consumption.

4.5.2 IT and Office equipment such as desktop PCs, monitors, printers and photocopiers currently account for about 15% (and rising) of a company’s energy consumption. A number of initiatives to reduce these levels are identified in this strategy.

4.5.3 The move towards more agile working practices including the capability of working remotely (including at home), the provision of improved audio and video communication infrastructure e.g. 3G/4G networks and videoconferencing will all provide the opportunity to reduce the Trust’s travel ‘footprint’ and carbon consumption.

5 Information and Knowledge Services The provision of information and the tools to support its analysis, interpretation and conversion into intelligence is a key business driver which has been identified in this Strategy.

In addition to directly supporting patient care there will be an increasing focus on the provision of data and information to support the new models of commissioning, improving the efficiency and effectiveness of clinical operations as well as supporting corporate requirements such as Performance, Workforce Planning and Risk management.

5.1 Business Intelligence

5.1.1 Cognos (now owned by IBM) business intelligence (BI) software was purchased in 2004 to improve the ability to analyse and access service user information. A server licence procured in 2010 now enables the product to be used throughout the Trust. (including York services). It is used in conjunction with a SQL server data warehouse which is updated nightly by feeds from the Trust’s clinical systems i.e. PARIS (Leeds) and CPD (York).

5.1.2 The following programme of development work will be undertaken over the next two years to further Cognos reporting services in order to enhance its ability to meet business requirements and improve efficiency and usability:

1. Redevelopment of the Trust data warehouse to improve report writing capabilities, and improve the performance of Cognos (2013)

2. Development of information ‘cubes’ to improve users ability to manipulate information and enable more analysis to be undertaken by local users (2014)

3. Development of ‘dashboards’ following completion of the Service Improvement Programme to provide key information to local and corporate service managers and clinicians in an easy to use and visual form ( 2014)

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4. Automated delivery of routine information requirements including event based reporting (2014)

5.1.3 New demands for information, analysis and reporting to support the following specific business areas will be met using Cognos:

1. Transformation and subsequent monitoring and evaluation, (2014).2. Outcomes and quality (2013).3. PbR and associated new service contracts (2014).4. Predictive use of information (2015).

5.1.4 Changes to dataset submissions will be made in response to new national requirements as these become mandated in order to support new commissioning arrangements from April 2013 and PbR. These include:

1. Mental Health Minimum Dataset (MHMDS)2. Improving Access to Psychological Therapies (IAPT) dataset3. Child and Adolescent Mental Health (CAMHS) dataset – mandatory

requirement from April 2013.4. National Drug Treatment Monitoring System (NDTMS)

5.1.5 In common with many organisations, the Trust continues to operate

performance and management processes based largely on separate ‘silos’ of information e.g. service user, workforce, finance and risk informationAn integrated approach to combine this information into a core structure with a common user interface would result in improved control, reduced workloads, in manipulating and use of intermediary processes, and improved quality and accuracy. The following initiatives will be undertaken to progress the development of this approach:

1.Implementation of Cognos based action tracking system (2013)

2. Automation of performance reporting based on Cognos metrics studio (Sep 2013 – Sep 2014)

3. Service line financial reporting and patient costing.4. Incorporation of workforce data from the Electronic Staff Record

(ESR) and e-Rostering systems into the Trust data warehouse with reporting via Cognos (2014),

5.1.6 The implementation of a fully EPR System by end 2015 will increase the demand from Clinicians for ‘real time’, efficient and easy to use reporting and analysis tools. The ability of Cognos to meet these requirements will be evaluated in 2015. The implications of any re-procurement of the SBS provided Finance system (which is also due for re-procurement in 2015) and the ESR system will be taken into account.

5.2 Information Quality Assurance

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5.2.1 Given the increasing dependence on information derived from the Trust’s PARIS system to support care services, performance, contractual and statutory obligations, there will need to be a continuing focus on improving the quality, completeness and timeliness of this data.

5.2.2 The following initiatives in how information is collected and recorded are planned to meet this requirement:

1. Where possible information required for management purposes such as contracting and performance to be extracted from PARIS, (2013)

2. All service / service user related data to be held on PARIS (or approved specialist systems) following Paris redevelopment and local systems eliminated (2014)

3. Recording of all service related information in ‘real time’ - a pre-requisite to achieving the final vision of full migration to electronic care records (2015)

5.2.3 The following additional work will be undertaken to consolidate the benefits from the Data Quality Improvement Project which was completed in 2011:

1. Review of administrative and clinical codes on both PARIS and CPD systems (2013).

2. Completion of the second phase of a data quality data warehouse to provide automated reporting of identifiable errors (2014).

3. Systematic approach to audits of data collection (2014).

4. Revised PARIS data collection procedures to incorporate transformation changes and PARIS re-design (2013).

5. Revision of the data quality policy following implementation of a Trust wide clinical information system including for York (2014)

6. Data quality assurance of York data collected on Paris following migration from CPD (2015)

5.2.4 Information Quality Assurance involves a culture change in the organisation where the use of computerised systems and maintaining those systems accurate and up to date is seen as an integral component of how we deliver our services. This will be fostered by an on-going programme of awareness raising.

5.2.5 Appropriate procedures including audits and change control will continue to ensure that the information used for management purposes reported from Cognos and the data warehouse is an accurate reflection of the source data held on operational systems.

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5.3 Information Governance (IG)

The Trust’s Information Governance Team is responsible for ensuring compliance with the CfH Information Governance (IG) Toolkit, overseeing the Trust Freedom of Information (FOI) procedures and provision of specialist support in the areas of Data Protection, Confidentiality and Caldicott.

The following initiatives will form the main tasks for the IG Team during the next 3 years.

5.3.1 Management and development of the Health Records and clinical coding functions under a common management framework within the Information Governance Team in order to provide a more unified and co-operative working structure.

5.3.2 The overall maintenance of at least Level 2 (‘satisfactory’) status against the IG Toolkit with achievement of Level 3 where appropriate.

5.3.3 Support for the Trust’s IG training programme which will be provided through provision of CfH Training Tool modules, Induction awareness sessions and the production of IG materials, briefings and Trust wide communications.

5.3.4 The Trust will continue to operate a mixed economy of paper and electronic records until deployment of a fully integrated EPR System is complete (2015). Until then there will be an increasing movement of patient records to off-site archive storage. The Trust is partnered with Magnum Services to provide this off-site service utilising their i-Track online record tracing and recovery service. A cost evaluation of ‘scan-on-demand’ recovery of archived records in place of paper record delivery will be undertaken in 2013.

5.3.5 The move towards a process of ‘scanning on receipt’ of all incoming clinical documentation into the patient/service user’s EPR is seen as an essential enabler to achieving the vision of a fully electronic record by 2015. This work will be included in conjunction with the deployment of document management services/systems (see 6.1.7)

5.4 Knowledge Services

This provision of information to enable staff to meet their clinical, developmental and personal needs and to improve communication across the organisation is an important element of this strategy. The wide geographic spread of the Trust and increasing move to mobile and agile working will increase the importance of providing efficient IT enabled Knowledge Services. Library Services and a Corporate Intranet (Staffnet) are seen as two of the key enablers in meeting this objective.

5.4.1 The main strategic objectives of the Library Service will be to:

1. Ensure compliance with the Library Quality Assurance Framework (LQAF) – part of the Learning and Development agreement.

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2. Continue to develop the Pan-Leeds Library Services and deliver the Pan-Leeds Business Plan.

3. Align services across Leeds and York areas (dependant on content of SLA with York Hospital FT and if agreed/continued) especially those services that cannot be provided remotely.

4. Develop financial contingency for sustainability of the service if external funding is terminated.

5. Continue to embed Library Services in Trust business including:

Improving awareness and access to remote services (via Staffnet)

Supporting the CPD needs of all Trust Staff

Supporting the dissemination, use and understanding of NICE guidelines

5.4.2 The Trust Intranet (Staffnet) currently uses Microsoft Office Sharepoint Server (MOSS 2007) software. It comprises approximately 200 micro-sites that are each managed by nominated staff from individual teams. These sites provide a variety of functionality, with varying degrees of success, such as:

Front page communications area

Committee meeting spaces (used to store meeting papers and agendas)

Policy & Procedure repository

Functional sites – sites operated to service Trust need (for example, e-Learning, Freedom of Information)

‘Shop window’ sites – sites created to give services a presence on the intranet.

Support for administrative processes such as form completion, staff directory maintenance, surveys etc.

Whilst Staffnet is well used and provides a range of useful facilities and information there are well recognised problems with much of the content and functionality, including a lack of consistency, out of date content, poor meta data (that hinders search facilities) and lack of interactive communication features. It is also recognised that there is insufficient capacity to effectively manage and further develop the service.

5.4.3 A project to re-develop the Site commenced in mid-2012 with the aim of providing an informed, people driven communications tool with easy access to information. It will be integrated with and complement the Trust’s internet website and will be capable of utilising different approaches to using information including Social media and provision of personalised content.

Deployment of the new Site, which will use the latest version of Sharepoint (MOSS 2013), is planned for Qtr 2/3 2013 and will be managed and supported by the Web Manager within the Communications Department.

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6. Business Systems

6.1 Clinical Support Systems

6.1.1 The clinical care and support systems currently in use across the Trust are summarised in the table below.

Location System (Supplier)

System Purpose Annual Support Costs (ex VAT)

Contract Expiry Date

Leeds Paris (Civica) Corporate Clinical Records system (Leeds based clinical services – see Note 1)

£276k July 2014

York & North Yorkshire

CPD (York FT) Clinical Records system including links to prescribing and Order Comms (York based services – see Note 2)

£200k March (annual SLA with York FT)

York & North Yorkshire

IAPTUS (Maden)

Clinical system supporting IAPTS (Improving access to psychological services)

£16k Mid 2015

Leeds & York

JAC (JAC) Pharmacy system for medicines stock control and prescribing

£25k March (annual SLA with Leeds THT)

Leeds Systm 1 (TPP) Clinical system supporting Leeds Addiction Unit (LAU) service

£10k In procurement stage Planned deployment Oct 2013 (see note 1)

Note 1: Leeds Addiction Unit (LAU) currently utilise an internally developed and supported system (Result) to support prescribing in conjunction with Paris

Note 2. Forensics, Eating Disorders and CAMHS make relatively little use of CPD and generally rely on local or manual systems to record activity and maintain patient records.

6.1.2 In order to achieve the objective of Trust wide EPRs by end 2015 (see 3.2.2) it will be necessary to standardise on a single fully integrated system to support the Trust’s core clinical services. A review of Clinical systems was undertaken in late 2012 and early 2013 resulting in a recommendation made to the Trust Board and subsequently accepted at the May 2013 Board Meeting to ‘endorse Paris as being retained and redeveloped as the Trust core clinical system’

6.1.3 The Board also agreed that where clinical services identify a requirement for specialist systems which cannot be fully met by Paris e.g. supporting Improving Access to Psychological Therapies (IAPT), then 3rd Party cloud based systems may be deployed. These systems will however need to demonstrate their ability and commitment to fully meeting NHS Interoperability standards

6.1.4 The following investment funding has been allocated to support the substantial redevelopment and implementation of Paris which it is estimated will take a minimum of two years:

Project support and implementation - £543k per annum Civica development costs - £208k 3rd party systems where required - £400k (see 6.1.6.4)

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Note: In May 2013 the DH announced the launch of a £260m Technology Fund to ‘facilitate the widespread adoption of modern, safe standards of electronic record-keeping’ for which provider Trusts will be invited to bid against. The fund will become operational in July 2013 and further information is awaited. It is expected that funding will be available to all Trusts who successfully apply

6.1.5 Current Configuration of Paris: In the short term (2013) the following work programme will be undertaken to achieve quick wins and reconfigure Paris to ensure it remains fit for purpose:

1. Upgrading to the latest available version (v4.5) of Paris (mid 2013)

2. Creation of advanced User Defined Forms (UDFs) and reconfiguration of the System to support the Service Redesign Programme and Payment by Results (PbR) requirements (mandatory from April 2014). This will be undertaken in conjunction with Civica who will provide consultancy support

3. Review of the provision of improved document scanning facilities pending the provision of a strategic document management system (see 6.1.6.3)

6.1.6 Redeveloped Paris: In the medium term (2013/15) and in order to support the strategic vision of full electronic care records by end 2015, the following work programme will be required:

1. Upgrading to Paris ‘Vision’ (early 2014) which will provide a new user interface with improved accessibility and usability

2. Redeveloping the System to meet the Trust’s new ways of working including supporting Integrated Care Pathways (ICPs)

3. Provision of a direct link to the NHS Spine to automate patient demographic checking and support the use of Smart Cards.

4. Corporate wide deployment of the following supporting systems either provided via integrated modules of Paris or via 3rd party systems linked to Paris and conforming to NHS Interoperability standards:

a. A corporate wide digital dictation and workflow management system including the capability of supporting speech recognition functionality to improve the efficiency of creating clinical letters/discharge notes.

Status - project commenced Qtr 2, 2012, supplier (Bighand) selected Dec 2012, Deployment commenced in Jun 2013. Phase 2 inc deployment of speech recognition and electronic distribution of letters to be evaluated in Qtr 3-4 2013

b. Provision of messaging services using ParisConnect to handle the electronic exchange of clinical documentation including letters, eDANs, referral requests and enable Lab tests (pathology, radiology, blood) etc to be ordered and results received

Status - project to commence Qtr 3 2013 in conjunction with Leeds Teaching Hospitals Trust (LTHT) using their existing ‘Integration Engine’ and Clinical Portal technology

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c. A document management system to improve the efficiency of storing, retrieving and searching for clinical documentation

d. A comprehensive medicines management system incorporating e-prescribing, dispensing (for Inpatients, outpatients and TTO ‘to take out’) and drug administration

e. Deployment of ParisMobile and/or development of specific applications (‘apps’) to support both ‘on-line’ and ‘offline’ working by staff requiring access to Paris away from their work base.

Note: The scope of the redevelopment of the clinical information system will include reviewing currently unused functionality/modules or un-purchased modules to assist with the redevelopment. The detail will be scoped as part of the redevelopment project which will be mapped into the Strategic Change Programme.

6.1.7 Pending the deployment of the redeveloped Paris in 2014 there will be a need to continue to operate CPD for York based services. The provision of short term developments including holistic assessments and care plans to ensure the system remains ‘fit for purpose’ will need to be considered.

6.1.8 Provision of training support for clinical systems is likely to move towards greater reliance on e-learning using on-line and Staffnet based documentation and guidance in recognition of the wide geographical extent of the Trust. A review of the feasibility of using centrally managed but locally delivered training, based on offering ‘train the trainer’ services and accreditation for local trainers was undertaken in 2012 but not progressed. This will be re-visited as part of any proposed changes resulting from the Informatics Services organisational review.

6.1.9 An important element of the Trust’s Strategy is to improve the level of partnership working with local organisations.

The Trust has committed to working with its health and social care partners in Leeds to create a ‘Leeds Care Record’ which will utilise web based portal technology to provide a shared ‘view’ of health and social care information across the City. This is being co-ordinated via a Leeds Informatics Board supported by a City-wide Programme Management Group, both of which have IT and clinical representation covering all the Leeds NHS Trusts, Clinical Care Groups (CCGs) and Social Services

An initial pilot phase is scheduled for deployment in mid 2013 based on patient data extracted from LTHT and GP systems (EMIS). If successful it is then planned to broaden the scope of the system to include data extraction from all Leeds NHS Trusts and GP Practices during 2014/15

6.1.10 The appointment of a Chief Clinical Information Office (CCIO) from within the Trust will be undertaken in mid 2013 to lead the development of clinical systems from a clinical perspective and ensure clinical requirements are met

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6.2 Corporate Systems

6.2.1 Most of the IT systems that support the Trust’s critical operations are now provided via remotely hosted managed service arrangements including:

Finance (Oracle – hosted by Shared Business Services)

Workforce & Payroll (ESR - Mckesson)

Care Services – Leeds (PARIS – Civica)

Care Services – York (CPD – York Hospital NHS FT)

Email (NHSmail – Cable & Wireless).

Supplies Management (NHS Logistics)

Clinical Spine Application - providing a patient tracing facility, and Secondary Uses System for care activity analysis (hosted by BT)

JAC - Pharmacy Stock Control System (LTHT)

Electronic Test Results – Pathology, Radiology etc (LTHT)

6.2.2 These SLAs/contracts will require active management to ensure that they continue to deliver the best value, remain fit for purpose and support the Trust’s vision and Strategy.

6.2.3 A technical standard has been established (based on a Microsoft SQLserver platform) with the aim of standardising, as far as possible, on the support infrastructure for Trust systems supported internally by IT Services. These include the following main systems:

QSM – Service Desk system (supplier – Datawatch), to be replaced in mid/late2013

Risk Management System (Datix)

Catering Management System (Manna)

E-Rostering and Bank Nurse System (Allocate)

Corporate Data Warehouse (MS SQLserver/IBM Cognos)

Patient Affairs System (Trojan)

Trust Intranet (Staffnet - based on MS Sharepoint)

Digital Dictation and Workflow Management System (Bighand) – from June 2013

Service User Debit card System (internally developed)

6.2.4 A policy for interim or tactical departmental system developments has been developed to ensure that the appropriate governance processes are followed for any new developments e.g. business case justification, data and security

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standards, documentation etc. An audit process has also been deployed to enable all MS Access based databases to be approved and accredited to meet Data Protection Act (DPA) requirements for maintaining and reporting on personal information.

The move to a fully integrated Clinical System by 2015 should enable most of the remaining local systems and databases to be phased out

7 IT Infrastructure

The primary purpose of the IT infrastructure strategy will be to ensure the continued provision of cost effective, modern, reliable and responsive IT services and systems that are capable of supporting the Trust’s business operations and strategy.

The following key components make up the strategy and are described in this section (see also Appendix B for summary roadmaps):

Access Devices i.e. PCs and printers

IT Network including remote access and security

Video communications

Voice Communications

IT Support including Service Desk and PC/Server support

7.1 Access Devices (PCs and printers)

7.1.1 Access to a reliable networked device that is ‘fit for purpose’ and will support the use of email, internet browsing and access to corporate information systems such as PARIS, Email, ESR and Staffnet will be a key enabler in delivering the Strategy. An increasing demand for mobile and agile access to support new ways of working will require a corresponding diverse range of access devices to be adopted including:

1. Desktop PCs – for staff who are mainly office based and require a ‘thick client’ based service due to the specialist nature of their work e.g. some Finance, Information and Performance staff.

2. Desktop terminals (converted PCs and/or new ‘dumb’ terminals) – for standard users and shared devices, mainly in Wards, with services delivered by thin client/VDI infrastructure (see 7.1.3)

3. Notebook/Laptops – for staff who regularly work away from their base location utilising agile working principles and for which services will be delivered via a ‘thin-client’ architecture as above.

4. Tablet devices – for staff who require high portability and ease of use for accessing and browsing for information e.g. Community Mental Health Teams (CMHTs) and Directors.

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5. Smartphones – where use of Notebook/tablet is not appropriate and where it may be possible to deliver specialised applications for staff to use as well as providing access to Email.

In the case of ‘mobile’ devices it is recognised that some staff may prefer to use their own devices because they fit their personal requirements and ways of working. Adopting a ‘bring your own device’ (BYOD) approach could also provide an opportunity to reduce IT support costs. This concept will be evaluated during 2013 in conjunction with work to deploy appropriate controls and monitoring systems to permit the above range of devices to be safely connected to the Trust’s network.

7.1.2 The number of networked PCs in use across the Trust stood at circa 2200 (plus 280 Laptops/Notebooks/Tablets) at the end of 2012. The number of desktop devices is expected to decline over the next four years as many Staff, especially Clinicians adopt more agile ways of working and migrate to ‘mobile’ devices such as laptops, notebooks and tablet devices. The provision of docking stations and ‘hot desk’ facilities will enable IT support and license costs to be contained by reducing the need for staff to require both a mobile and a desktop device

7.1.3 In order to reduce the costs for supporting desktop PCs and improve control over these devices, a programme to introduce ‘virtual desktop’ technology will commence in 2013. This will enable many of the desktop PCs to be replaced by simple terminals which will be cheaper, more resilient, easier to manage, more efficient (utilise less power and easier to control remotely) and more secure as all data and software will reside on central servers. It is envisaged that most of the desktop PCs in wards and public areas e.g receptions will migrate to using this technology over the next 2-3 years as existing PCs require replacing. This work will be undertaken as part of the IT support for the Service Improvement Programme to redesign adult inpatient services across Leeds and York.

7.1.4 Whilst the move away from desktop PCs to terminals may reduce support overheads the strategic shift towards using a more diverse range of mobile devices will have a correspondingly opposite effect as mobile devices tend to be less reliable, more easily damaged and/or lost and subject to software faults due to increased technical complexity. Therefore it is likely that overall IT support capacity will need to be strengthened to ensure satisfactory levels of service are maintained.

7.1.5 The following principles regarding printing adopted by the previous strategy will continue to be applied together with the evaluation of additional approaches that could further reduce print costs including corporate outsourcing of print management, centralised print management and software applications to increase the efficient use of print cartridges:

Stand-alone laser and inkjet printers (and fax machines) will be replaced wherever practicable with multi-function devices (MFDs) or shared networked laser printers capable of duplex i.e. double sided printing. This

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will be undertaken as printers require replacement and in all cases where new sites are established or existing services re-located. A limited range of approved printers are available via the IT Services catalogue.

MFDs which provide combined printing, copying, scanning and fax services will be deployed wherever the business case can be made to support such a device.

7.2 Network

7.2.1 A five year contract was signed in September 2008 between Virgin Media and BTN3 (the National Application Systems provider responsible for the provision of IT networks across the NHS) in order to provide a secure and resilient IT network to all the main Trust sites. The network provides a resilient ring of 1 GB lines connecting the 6 core Trust sites (Becklin, The Mount, Newsam, Trust HQ, St Mary’s House and St Mary’s Hospital) and 100 Mbps (capped at 10Mbps) links for the remaining 20 spur sites. The contract also provides the following benefits:

The provision of two high bandwidth links (100Mbs) into N3 and onwards to the Internet to provide resilient access to remotely hosted applications such as ESR, Finance, PARIS and NHSmail.

Provision of N3 backup circuits to spur sites to provide full resilience.

Matched funding of £958k provided by CfH towards the total contract cost of £1.8m

7.2.2 Renegotiation and retendering for this contract will be undertaken in conjunction with the project to migrate the York sites, currently linked to and supported by YHT, to the Leeds Network. This work will commence in Qtr1 2013 with the aim of achieving a single integrated network infrastructure during 2014.

7.2.3 In order to improve the capabilities of the Trust to support mobile and agile working the following developments have been undertaken, are in progress or planned:

1. Deployment of a new remote management service (using Citrix Zen Apps) that enables both Trust owned and personal PCs to connect to the Trust network via home/public broadband 3G or 4G. (completed in Sep 2012)

2. Migration from the use of token based security cards to a token less system (Pinsafe) to improve and simplify secure remote connection (complete by Qtr 2 2013).

3. Deployment of Single Sign on technology to simplify and speed up access to Trust IT systems and services (by Apr 2014)

4. Deployment of Wireless Network technology (WIFI) across all main Trust sites (Trust HQ, Airecourt and St Mary’s House, North Wing already installed) focussing initially on the Leeds Locality Hubs and satellite sites by mid 2013 followed by the remaining PFI sites (Becklin, Newsam, The Mount, Parkside and Millside) in Leeds by March 2014.

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Provision of ‘guest’ access for visitors, non-Trust Staff e.g Social Care Staff and service users will be incorporated in the technology design

Plans to provide similar facilities at York based sites will be developed in 2014 once these sites have been integrated into the LYPFT network (see 7.2.2 above).

This work will need to be undertaken in conjunction with the Trust’s Estates Strategy and plans for rationalisation of the Estate

7.2.4 In order to enable Trust staff based in York and Selby (who currently utilise YHT’s network for most services) to have full access to Trust services and systems, a fixed link has been installed between LYPFT and YHT (Jul 2012). This has enabled York based staff to have access to systems on the Trust’s network and will provide a continuing link to YHT’s systems when the York sites migrate to LYPFT’s network

7.3 Video Communications

7.3.1 An extensive Videoconferencing (VC) infrastructure was implemented in 2009/10 across the Trust including 11 fixed units (Becklin, Newsam, The Mount, Trust HQ, St Mary’s Hospital, St Mary’s House, NSCAP and the 4 Pharmacy Offices), 8 x Videophones (mainly installed in Executive Directors’ Offices) and circa 40 webcams for desktop and/or mobile access.

Pharmacy services utilise the technology extensively to undertake remote prescribing and Team meetings but take up elsewhere across the Trust has been low. However, the potential for using VC to support the new Integrated Care Pathways including Team Assessments and continuing cost pressures may result in a resurgance in demand to use the technology. Provision of a VC link to Bootham Park Hospital in York is planned to be installed in 2013.

7.3.2 The adoption of Telecare and Telehealth technologies is seen by the Government and the DH as one of the key enablers to improving the quality and scope of health and social care whilst also reducing costs. The Trust’s existing VC network has the potential for being utilised to support Telehealth and Telecare e.g. to support Multi-Disciplinary Team (MDT) meetings, remote consultations and remote monitoring. Exploitation of this technology will be progressed together with the provision of additional wall mounted screens to support use by Clinical Staff and the use of web based video conferencing (eg Webex) evaluated in 2013.

7.3.3 The use of VC technology in place of hospital and other healthcare attendances eg to enable carers and relatives to ‘virtually’ attend CPA meetings will also be explored.

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7.4 Voice Communications

7.4.1 The majority of the Trust’s analogue voice lines are provided under the Leeds Health Network (LHN) contract with Virgin Media (previously NTL Telewest) which covers all Leeds NHS organisations. The contract is renewed on an annual basis with all NHS Trusts in Leeds continuing to benefit from free calls between NHS sites across the City.

7.4.2 The migration of the minority of Trust sites that are not connected to the LHN to an internally managed ‘Voice over IP’ (VoIP) system was completed in 2012. This has resulted in savings of circa £30k pa in telephone rental and call charges.

7.4.3 A phased programme to upgrade the remainder of the Trust’s telephony network to VoIP will commence in 2013, with the aim to complete this work by 2015/16 when support for the existing analogue Siemens PBX equipment will cease. This will require the internal exchange systems (PBXs) located at the main PFI sites i.e. Newsam, Mount, Becklin and Asket House to be replaced.

7.4.4 All sites in the York & Selby area supported by YHT are already served by VoIP. This will enable free ‘on-net’ calls between York and Leeds sites (which have VOIP installed) to be available when the York sites migrate to the LYPFT network (see 7.2.2) in 2014.

7.4.5 A Voice Activated Directory system has been in use for internal calls since 2010. This will be extended to include incoming external calls from early 2013 in order to ease congestion on the Switchboard and provide an improvement in response times and a reduction in abandoned calls. This is being undertaken in conjunction with a new on-line facility that will prompt staff to regularly review and update their ‘directory’ details.

7.4.6 The Trust currently has circa 1400 mobile phones and 290 pagers. A review of the need to continue using pagers, given improvements in mobile coverage and the problems experienced in managing pagers (more costly than mobile phones, prone to being lost and damaged, expensive to repair or replace, rental costs of circa £8500 pa compared to £0 for Mobile phones), will be undertaken in 2013/14.

7.4.7 In conjunction with the upgrade to VoIP (see 7.4.3) work will be undertaken in 2013/14 to introduce ‘Session Internet Protocol’ (SIP) technology. This technology is already in use for Videoconferencing and its extension to include external voice calls will result in significant line rental cost savings (ceasing of analogue voice lines) and will provide improved data network and business continuity options. This will complete the migration to a fully integrated data and voice network infrastructure and also facilitate the use of the latest call features e.g. providing extension number functionality via mobile phones.

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7.5 IT Support including Service Desk, Desktop and IT infrastructure

7.5.1 IT support for Leeds based services is currently provided by an internal IT Service Desk (4 wte) providing ‘1st line’ support and an IT support team (5 wte) providing ‘2nd line and out of hours ‘on call’ support’.

There has been no increase in overall establishment in IT Services since 2007 despite the number of servers supported having doubled (from 30 to 65) and the PC estate increased by 50% from 1200 to 1800.

IT support for sites in York/Selby and North Yorkshire has been provided by York Hospital Trust and NHS North Yorkshire since acquiring these services in February 2012.

The move towards provision of a single integrated Clinical System in conjunction with the integration of York and NYY sites with the existing Leeds network (see 7.2.2) will require the expansion of the Trust’s IT Support capability including the establishment of a physical presence in York.

Subsequent to the take on of support for York and North Yorkshire (2014/15) a review will be undertaken to evaluate the feasibility of continuing to provide an internally resourced service or outsourcing these services

The following issues will need to be considered when undertaking the review:

o continuing pressures to achieve cost savingso demand to increase quality standards o meeting increasing demands for IT support - inc 24/7 cover to

support fully electronic care record systems o Recommendations included in the NHS Information Strategy that all

NHS IT Service Desks should be accredited to NHS and Industry Standards.

7.5.2 The Trust has, since 2003, operated and supported an internal data centre based in North Wing, St Marys House, with a separate site at Becklin providing contingency and disaster recovery capabilities. Whilst most of the Trusts critical applications are now hosted remotely (see 6.2.1) a number of key business applications (including e-Rostering and Digital Dictation) and technical applications eg Active Directory are still hosted internally. Significant investment has been made over the past six years to improve the back up and resilience of these sites, but they lack the facilities, security and features expected of modern purpose-built data centres.

Recent work undertaken as part of the QIPP initiatives in West Yorkshire identified significant opportunities to improve service levels and reduce costs by rationalising the number of data centres across the local health economy. The feasibility of outsourcing the provision of data centre services will be considered as part of the review identified in 7.5.1 above.

7.5.3 Deployment of National systems which use ‘Smart Cards’ to control access including ESR and NHS Spine has required the Trust to set up and operate a

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Registration Authority (RA) function to issue and administer the cards. Since its inception in 2007 this has been managed by IT Services and over 2600 cards covering Leeds based staff have been issued. The issuing of circa 1000 Smart Cards to York based staff is being undertaken by YHT under the IT Services SLA and is scheduled to be completed by the end of 2013.

Management of the process for starters and leavers is now undertaken by HR whilst an RA Manager (reporting to the Information and Knowledge Services Manager) co-ordinates Trust wide RA operations. This will be reviewed in 2013 as part of the project to deploy single sign on technology (see 7.2.3)

8. Informatics Training and Development

8.1 Training of staff to use corporate systems is currently delivered by Directorates or Departments that are responsible for managing the system. Dedicated training resources are currently in place for the following applications:

1. PARIS (Leeds) – A team of three trainers with Administration support (part of Informatics Department) delivering training predominantly at St Mary’s House, North Wing (see also 8.4)

2. CPD (York) – Training provided by York Hospital Trust staff on their premises under an SLA.

3. E-rostering – A dedicated trainer delivers training at St Marys House, South Wing, supplemented by additional trainers and temporary local rooms when deploying the system.

4. Other Corporate Systems (Finance, ESR, Cognos, Datix) – Mainly delivered via the provision of paper and on-line guides/manuals and individual one-to-one training on demand.

8.2 In addition to the provision of training for specific applications, the following general IT courses are available for staff, consisting of a mixture of external training organisations, Pan Leeds trainers and internal resources:

1. Basic PC Skills – mainly for newly recruited staff where the need for additional basic skills to enable then to use email, Staffnet and the Web has been identified.

2. E-Learning via the e-Learning Management System (LMS) on ESR and accessed via Staffnet. The catalogue of courses covers a variety of topics including PARIS training modules, Registration Authority processes, NHS Spine applications and the NHS’s own internally developed basic skills training programme (NHS Elite).

3. Basic MS Office training covering Outlook, Word, Excel, Infopath etc. These are classroom based courses and are organised dependant on demand, with costs charged to Directorates. This training will be delivered using the NHS funded MOST (Microsoft Office Training) programme

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8.3 The Trust uses the Learning Management System (LMS) to organise and provide access to a wide range of external and internally developed courses. The site is managed by an externally funded resource who have developed a number of specific courses for use across the Trust. The LMS links to ESR which enables details of courses successfully undertaken to be recorded on each members Development record.

8.4 The Trust currently has two dedicated IT training rooms at St. Marys House (16 PCs) and one at the Mount Annex (10 PCs) of which the Rooms at St Mary’s House are principally used to deliver PARIS training. Currently there are no dedicated IT training rooms at Bootham Park Hospital (training on CPD is currently undertaken on the York Hospital site as part of the IT Services SLA with York).

8.5 In order to ensure the successful deployment of this Strategy and enable to Trust to become an ‘intelligent Organisation’ all clinical and care professionals will need to have the capability to efficiently use the supporting technologies described in this Strategy.

This will require a significant increase in the provision of IT training and support capacity, both resources and premises, as the currently available IT training resources are fully committed to supporting existing operational systems (predominantly PARIS). In order to ensure the sustainability of these skills, the use of information and systems will also need to be incorporated into the routine development planning for all clinical staff.

9. Environmental Strategy

The following Informatics led initiatives and projects will contribute to the Trust’s Environmental Strategy over the next 3 years:

9.1 Procurement and deployment of software that will assist in enforcing the Trust Policy of switching off PCs (base units and monitors) when not in use for significant periods of time and overnight/weekends where appropriate.

9.2 Continuing rationalisation and standardisation of the Trust’s printer estate by replacing ‘personal’ printers with Multi-Function Devices (MFDs), combining printing, copying, scanning and faxing in one device, where feasible or ‘shared’ printers. The use of duplex print settings and long life cartridges will further reduce print costs.

9.3 Evaluation of options to phase out any remaining dedicated fax machines (during 2013/14) which are costly to maintain - given that most MFDs and printers now have fax/scan capability and reduce overall fax usage.

9.4 Remote access infrastructure which supports the widespread use of mobile access devices (including Smart Phones, Tablets etc) and move to ‘agile’ working for Staff where appropriate. Significant savings in staff travel, space costs and carbon usage can be realised in adopting agile working principles.

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9.5 The Trust’s investment in corporate-wide Videoconferencing facilities in 2009/10 has provided the capability to greatly reduce the ‘travel footprint’ of the Staff’s workforce. The infrastructure also has the potential to support the delivery of remote care services including Tele care and Tele health including supporting access for service users and carers.

10. Programme Management, Governance and Resources

10.1 The Enabling Tools & Technologies Standing Support Group (ETTSSG) which reports to the Strategic Objective 4 Group (Efficiency & Sustainability) has overall responsibility for co-ordinating and directing the Trust’s Informatics Strategy. The Group which has broad representation from all Services will act as the Programme Board for managing and supporting the implementation of the Informatics Strategy.

10.2 The approach will be to develop and agree a detailed and fully costed annual plan and an outline plan for the following two years. Capital funding for the detailed plan will require discussion with, and agreement from, the Capital and Estates Standing Support Group (CESSG). The plans will be reviewed and updated on an annual basis. Changes to priorities, in year, will be considered by the Programme Board.

10.3 In addition to managing the Informatics Strategy, the ETTSSG will co-ordinate and direct the work of the ETTSSG Operational Support Group and any Project Boards established to manage information led projects.

10.4 The delivery of this strategy will require the undertaking of a number of business change projects enabled by IT and Information, and some technically driven projects which will be led by Informatics. The business change projects, whilst having a technical component and requiring support from informatics specialists, will need to be Business led to ensure success. (see Appendix G for summary list of projects)

10.5 Projects must be benefits driven, sponsored by Service Directors and governed in line with best practise including Managing Successful Programmes (MSP) and PRINCE2 methodologies. This approach will maximise the chance of the new systems becoming properly embedded and sustained, and the benefits from being realised.

10.6 A Corporate programme management office (PMO) function has recently been established which will support and co-ordinate the Trust’s strategic projects (12 projects as at June 2013 including re-development of Paris – see also 6.1). Most of these projects will require Informatics support and will therefore be monitored via the PMO

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11 GLOSSARY OF DEFINITIONS

Term DefinitionNHS Interoperability Toolkit (ITK) collection of specifications, guides and related

documents, to bring consistency to system integration within the NHS.

Connecting for Health(CfH)

part of the Department of Health Informatics Directorate who’s role is to maintain and develop the NHS national IT infrastructure. Duties have since April 2013 been devolved to NHS England and the Health and Social Care Information Centre

PARIS The electronic patient information system used primarily by Leeds services.

CPD The electronic patient information system used primarily by York services and hosted by York Hospitals Trust.

End Goals See Appendix A

Strategic Objectives See Appendix A

Health Informatics The way in which information is acquired, stored, retrieved and safely shared in the delivery of healthcare, as well as the information and communication technologies that are used to support this

NHS Number A unique identifier used by the NHS and other health organisations to aide service user identification.

Telehealth and Telecare Telehealth is the delivery of health-related services and information via telecommunications technologies, which could be as simple as two health professionals discussing a case over the telephone or as sophisticated as doing robotic surgery between facilities at different ends of the globe.

Telecare refers to the idea of enabling people to remain independent in their own homes by providing person-centred technologies to support the individual by offering remote care i.e. the use of sensors as part of a package to mitigate against harm by reacting to untoward events and raising a help response quickly.

Session Internet Protocol (SIP) A de facto standard for controlling communications sessions such as video and voice traffic over the Internet

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QIPP initiatives in West Yorkshire A Strategic Outline Case (SOC) for the rationalisation of data centres across the West Yorkshire NHS health economy produced in March 2012 by external consultants (Channel 3) for Optimising IT Services. The document’s main recommendation which was agreed by the Board in May 2012 states;

procurement be undertaken for a collective data centre service to determine the most economically advantageous solution and put in place a call-off framework for organisations to take advantage of the opportunities identified in this SOC

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12 Appendices

Appendix A – Trust Strategy Summary: Improving health, improving lives

Purpose: Improving health, improving lives

Values: Improving lives

Commitment to quality of care

Respect and dignity

Everyone counts

Compassion

Working together

Ambition: Working in partnerships, we aspire to provide excellent mental health and learning disability care that supports people to achieve their goals for improving health and improving lives.

End Goals: End Goal 1: People achieve their agreed goals for improving health and improving lives

End Goal 2: People experience safe care

End Goal 3: People have a positive experience of their care and support

Strategic Objectives and Priorities:

Strategic Objective 1: Quality and Outcomes - We provide excellent quality, evidence-based, safe care that involves people and promotes recovery and wellbeing

Strategic Objective 2: Partnerships - We work with partners and local communities to improve health and lives

Strategic Objective 3: Workforce - We value and develop our workforce and those supporting us

Strategic Objective 4: Efficiency and sustainability - We provide efficient and sustainable services

includes a key priority of ‘Making best use of modern technology’

Strategic Objective 5: Governance and compliance - We govern our Trust effectively and meet our regulatory requirements

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Appendix B - Clinical & Corporate Systems Roadmap

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Appendix C - IT Infrastructure Roadmap

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Appendix D – Information & Knowledge Services Roadmap

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Trust Board

Means Group 6(Strategic Priority 4 – efficiency

and sustainability

Enabling Tools & Technologies Standing Support Group

(ETTSSG)

Informatics led Project Boards

ETTSSG Operational Sub-Group

Appendix E – Informatics Governance Structure

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Appendix F – Indicative Costs

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Indicative Costs for delivering the Informatics Strategy - 2013-2016 Appendix F

2012/13 2013/14 2014/15 2015/16 Notes£k £k £k £k

Pay CostsInformatics Management & Strategy 184 168 168 88

IT Infrastructure Development (inc York IT migration) 0 99 0 0 4IT Services - IT Infrastructure, Service Desk, RAIT Services - voice & data Network managementSystems Management (inc Paris)Systems Support (inc Analysis,Training, Prog Mgt)Paris Redevelopment 333 333 0 4

Information Management 700 619 619 605

Information Development - Action Tracking + Cognos Dev 97 40 0 4

Information Governance & Records Management 80 80 80 80Library & Information Services 105 105 105 105

Total Pay £2,153 £2,660 £2,604 £1,977

Non PayParis Redevelopment - Civica Consultancy Costs 150 58 4

IT Services SLAs (York Hospitals & NHS NY&Y) 304 300 100 50 5IT Services SLAs (Service Desk & Data Centre Ops) 160

Data Network - BTN3 COIN + York and NYYline rentals 270 320 320 320

IT Infrastructure Inc in IT Services SLA

Voice and data Network Infrastructure see IT capital programme

Support & Maintenance/Software Licences/ 380 440 484 534IT Training - inc IT basic skills and Office Apps 20 20 20 20ICT Department - Admin inc Training, expenses 15 10 10 10Systems Operations - Admin inc Training, expenses 352 352 352 352Information Department - Admin inc training, expenses 35 35 35 35Information Governance & Library 62 62 62 62

Total Non Pay £1,438 £1,539 £1,627 £1,627

Total Informatics Budget - Revenue £3,591 £4,199 £4,231 £3,604

PC Replacement programme (Leeds) 177 190PC Replacement programme (York) 60 275Mobile Device deployment 183 161 50 50Deployment of WIFI (PFI sites & CMHT Offices) 158 143 100 6

Data & Voice Network (inc BTN3 replacement & VOIP) 40 415 177 211IT Infrastructure Upgrades/replacement 31 82 30 274Information management - Data warehouse/Cognos 50 10 22Single Sign-On System 80Corporate Document Mgt (Digital Dictation/Voice Recognition) 85 35 50 6

Clinical System enhancements (Paris) 200 200 100Leeds/York IT Network Integration 300 100CAS Call Centre Upgrade 26Medical Devices Management System 25Wall Mounted Display and VC Screens (Leeds and York) 43PC Power and patch management system 30Other Projects 25 6 5

VC replacement (14/15 - Pharmacy, 15/16 - Corporate) 26 225

E-Rostering System replacement 170

Total Informatics Budget - Capital £734 £2,080 £1,012 £1,299

Notes2012/13 - Approved Budget, 2013 to 2016 - Indicative costs

No cost indexing applied

Support and lIcence costs for following systems excluded (in Directorate budgets) - ESR (payroll & HR), SBS (procurement & Finance), E-Rostering/Bank

1 Decrease in budgets over period 2012-16 due to non replacment of retiring staff and rationalisation as result of creation of Informatics function

2 Decrease in 2015/16 as a result of potential outsourcing of IT Service Desk

3 Library Services and Medical Records pay costs excluded

4 Non-recurrent funding agreed by ET and Trust Board - May 2013

5 Assumes reduction in scope of SLA w ith YHT from 2014/15 w ith move of Inftrastructure to LYPFT and migration off CPD

6 Figures in italics signify estimated capital requirements but not currently in capital programme (mainly York related costs)

IT Capital Programme

Information & Knowledge Services

509 509Clinical Systems Development & Support

ICT

263 242 6

1

575 650 750 590 2

3509 509

inc in IT Capital programme

of 41

Appendix G STRATEGIC IMPLEMENTATION PLAN (2013-2016)

Ref Start Finish Business Lead Project LeadCapital (13/14)

Capital (14/15)

Capital (15/16)

Revenue (13/14 Notes

5.1/5.2 Information Management and Information QA

5.1.2 BI Enhancements inc Cube & dashboard developments 2013 2014 DoF Informatics Mgr

5.1.3 Support for new business areas inc Outcomes, PbR, Predictive analysis 2013 2015 DoF Informatics Mgr

5.1.5 Develop integrated performance and reporting approach 2013 2014 DoF Informatics Mgr inc Action Tracking, automated reports, service line costing, inclusion of ESR and e-rostering info

5.1.4 Dataset Changes 2013 2013 DoF/Care Services Informatics Mgr includes CAMHS, IAPTs,MHMDS and NDTMS datasets

5.1.6 Review of Reporting Strategy and reprocurement 2015 2015 DoF Informatics Mgr

5.2.3 Data Quality improvement initiatives 2013 2015 Clinical ServicesData Quality Improvement PM

5.3 Information Governance

5.3.2 IG Toolkit conformance 2013 2016 DoF I&K Manager refreshed annually

5.3.4 Archived Medical Records management 2013 2014 Clinical Services I&K Manager feasiblity study to be carried out re scanning on demand facility.

5.3.5 Evaluate 'scanning on receipt' of incoming clinical documentation 2014 2015 Clinical Services I&K Manager

5.4 Knowledge Services

5.4.1 Compliance to LQAF 2013 2016 DoF L&K Manager refreshed annually

5.4.1 Alignment & continung development of Library services across Leeds and York 2013 2015 DoF L&K Manager Full integration expected by 2015

5.4.3 Re-development of Trust Intranet (Staffnet) 2012 2013 Dep Dir Strategy Head of Comms 50 32 62 Includes upgrade to MOSS 2013 and purchase of MS client access licences (CALS) - £62k pa

6.1 Clinical Support Systems

6.1.5.1 Paris Release v4.5 Qtr 2 2013 Qtr 2 2013 DoF Upgrade to latest available version of Paris

6.1.5.2/3 Paris redevelopment (current configuration) Qtr 1 2013 Qtr 4 2013 DoF Quick wins' to support service re-design inc configuration changes and new adavanced UDFs

6.1.6 Paris redevelopment (new configuration inc support for ICPs) Qtr 2 2013 Qtr 2 2015will also include deployment of ParisConnect (interoperability) and ParisMobile and 3rd party systems to support document management and medicines management

6.1.6 Paris v5.0 (Vision) Qtr 1 2014 Qtr 2 2015 DoF Upgrade to Vision providing new user interface

Paris Future Releases 2015 2016 DoF vrs 6.0 inc Choose & Book compliance (2014/15), vrs 6.1 (2015/16)

6.1.7 Support for CPD (York Services) 2013 Qtr 4 2014 Continuing support via SLA to ensure CPD remains fit for purpose until all services on Paris

6.1.7 Migration from CPD (York Services) to Paris Qtr 2 2013 Qtr 2 2015 Phase migration to Paris

6.1.1 Systm1 procurement and deployment in LAU Qtr 1 2013 Qtr 3 2013 D.Raistrick ICT 35 12

6.1.6.1 Corporate Digital Dictation and Speech Recognition System Qtr 1 2013 Qtr 4 2013 Ass Dir SSD CSU 120Being deployed Qtr 1/2 2013, Phase 2 to involve mobile dictation, e-distribution of Letters and speech recognition to be progressed in Qtr 3/4 2013

6.1.6.2 Link to Leeds Care Record and LTHT 'Clinical Portal' Qtr 4 2013 Qtr 1 2014 DoF

6.1.6 Integrated Order Communications and Results Reporting System (LTHT) DoF

7.3 Upgrading and provision of new Video communications infrastructure 2013 2014 DoF Head N/W Ser 43 26 220 Includes provision of VC screen at BPH and refresh of Pharmacy and corportate VC infrastructure

7 ICT Infrastructure

York Community Hub & satellite reprovsion 2013 2013

Womens Low Secure Unit - York 2013 Apr-14

Yorksire Centre for Psychological Medicine (YCPM) 2014 2015

Trust HQ (SM House/Asket Croft) 2013 Feb-14

7.1.1 Upgrading of York IT & N/W Infrastructure 2013 2014 DoF IT Manager 264 80 + £72k (13/14), £65k linked to Paris implementation plan

7.2.3 Deployment of WIFI to main Trust sites (Leeds) 2012 Dec-13 DoF Head N/W Ser 143

7.2.2 Migration of York sites to LYPFT Network - Phase 1 (9 sites), 2013 2014 DoF Head N/W Ser 300

7.2.2 Migration of York sites to LYPFT Network - Phase 2 (remaining sites) 2014 2014 DoF Head N/W Ser 100

7.2.3 Deployment of WIFI to main York sites (9) 2014 2015 DoF Head N/W Ser funding dependant on site suveys still to be undertaken

7.2.3 Single Sign-On System 2013 2014 DoF IT Manager 80 will include a review of RA processes (smart cards) across the Trust

7.1.1 Provision of Mobile devices to Locality Based Staff (Leeds) Jan 2013 Aug-13 DoF IT Manager 143 £60k Project commenced in 2012/13 - projected total deployment costs - £320k

7.1.1 Provision of Mobile devices to Locality Based Staff (York) 2014 2014 DoF IT Manager 120 £20k

7.1.1 PC Replacement Programme DoF IT Manager 314 212 182

7.1.3 Deploy Thin Client/VDI technology DoF IT Manager 48

7.4 Migration of Voice services to VOIP DoF Head N/W Ser 112 131

7.2.2 Reprocure BTN3 Network COIN 2013 2014 DoF Head N/W Ser 250

7.5.2 IT Services Review - evaluate feasibility to migrate to external managed services 2015 2016 DoF Head of IKS review options for future provision (inc leeds and York services) - 14/15 on

8 Informatics Training & Development

8.5 Strategy for provision of basic and general IT training 2013 2013 DWD

8.4 Provision of IT Training for York based Staff 2014 2014 COO Currently included in SLA with YHT (expires Mar 2014)

9 Environmental Strategy

9.2/3 Printer and Fax rationalisation (inc centralised print management) 2013 2014 DoFHead of Procurement

9.1 PC Power & patch management System 2013 2014 DoF IT Manager 30 Existing Microsoft systems (SCCOM) to be used

10 Strategy and Programme Management

10.6 Establishment of Corporate PMO 2013 2013 COO PMO Mgr

Estates reprovision projects (IT support)

Development Costs (£k)

200

50 10 22 97

533200

Informatics Development Service

funded from Estates capital schemesHead of Estates IT & N/W Mgrs