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Modernising our delivery model

The objectives of Personalised Health and Care 2020 will only be achieved by all sectors of the health and care system working together. This means that different technology systems need to interoperate and data must be able to flow seamlessly under the appropriate controls.

The work being done to design and deliver local sustainability and transformation plans is already addressing ways of improving interoperability within a local health economy, so at a national level we must ensure that interoperability standards are in place and used to ensure that information can flow between organisations, or geographical groupings to provide consistent access to data and services, so that there is no 'postcode lottery' of variability in different parts of the country.

We must ensure that interoperability standards are in place and used to ensure that information can flow between organisations, so that there is no 'postcode lottery' of variability in different parts of the country.

Similarly, we need to ensure that the local services and systems that are being designed have access to the national services, under appropriate governance arrangements, to allow them to work effectively. The interface between national and local services will be critical to properly integrated care models.

Finally, we must ensure that existing and future national systems work together: that key functionality such as access permissions or personal records are only built once, but used many times by other systems.

This means we need to have a more detailed understanding of the architecture - the way technology is used and the way data flows around the health and care system. This is important not only to ensure consistency, completeness and interoperability, but also to ensure that robust investment decisions are made, and that there is no unnecessary duplication.

This work is underway and we have brought in external consultants to support us in designing a new service that works across the health and care system. This will be an important piece of the system-level governance arrangements, working through the Enterprise Architecture Board.

What we will do:

  • Implement an effective enterprise architecture function, supported by the necessary processes and tooling for the national health and care system.

The Personalised Health and Care 2020 portfolio contains many new programmes and developments of existing services. This is the focus of our new development work now and in the future. But many of the services we deliver today are still managed using 'programme management' governance arrangements although the delivery and implementation work has been largely completed and the services are now being used locally.

This is inefficient for a number of reasons and distracts us from the true objective for these programmes, which must be to encourage wider adoption in local settings, such as hospitals or pharmacy or other community settings. The Electronic Prescribing Service, the Summary Care Record and NHSMail2 are good examples of this, although it should be noted that Personalised Health and Care 2020 includes a big programme focus on new referrals capability.

Users of these services will not see any difference when we adopt these changes, although as well as being able to concentrate on faster and wider adoption, we will be able to respond more rapidly to requests for new functionality.

What we will do:

  • Establish a true Service Operations capability responsible for maintenance development and future roadmap for all NHS Digital technology services

  • Set out the criteria and due diligence for managing the transfer of programmes into service operations

  • Implement the transfer of programmes into Service Operations during 2017/18

NHS Digital inherited four major in-house software development and support teams, located over several NHS Digital sites (Leeds, London and Exeter), totalling in excess of 400 permanent and non-permanent staff. Each team has areas of specialist technical, system and business knowledge which has been developed over time through the work they have undertaken over the years:

IT-Teams-MapArtboard 1-800

  • The Systems and Service Delivery (SSD) team based in Exeter has considerable knowledge of screening and patient management systems having successfully delivered cervical, bowel and breast screening systems.
  • The NHS.UK team has considerable knowledge in citizen and patient facing systems through the delivery of the current Choices service and development of its replacement NHS.UK.
  • The Digital Delivery Centre based in Leeds carried out the work to bring many major national systems in-house, such as the Spine, PDS and SUS.
  • The IT Development team, also based in Leeds, run extensive data collection and processing functions
  • Additionally there are a few smaller development teams within NHS Digital, including the NHS 111 team based in Southampton.

There have been advantages to this historically, but if we are to be successful in the future, we believe we should operate these development centres under a single management structure. This will enable us to eliminate duplication of capability, encourage consistent development methods and give us more flexible access to local labour markets.

This single development capability will be used by the programme teams responsible for delivering the Personalised Health and Care 2020 portfolio when in-house software development is required.

What we will do:

  • Draw up a plan for merging the two Leeds-based digital delivery teams and establishing a single Leeds digital delivery centre which will also address the future direction of the smaller teams.

  • Introduce a single set of operating principles and streamlined processes including a single process for managing all new work requirements and the distribution of work to the Digital Delivery Centre teams.

Our teams are using different delivery methodologies to structure their work and we have reflected on the implications and consequences of this.

Our programme and software development teams are used to using what are known as 'waterfall' methods for traditional and complex work. We are also using a variety of 'agile' methods for more patient-facing and clinician-facing systems.

The delivery requirements that we are responsible for would be better served by the use of a small but defined number of delivery methodologies

We have concluded that it would be a mistake to adopt a single 'agile' method for the whole organisation. Rather, we believe that the different delivery requirements that we are responsible for would be better served by the use of a small but defined number of methodologies which are underpinned by consistent use of terminology, taxonomy, decision points and reporting requirements. We also wish to implement a consistent set of development tools across the enterprise.

This will enable consistent management and reporting within NHS Digital and with external stakeholders such as the Digital Delivery Board, and will also enable flexibility in transferring resources between programmes.

What we will do:

  • Define and publish details of the development and programme management methods we will use, along with the underpinning policies and procedures to ensure they are applied consistently across NHS Digital.

  • Develop and implement a plan for the use of a consistent enterprise-wide set of development and programme management tools.

Our programme teams examine whether to build a solution 'in-house', or buy externally today as part of the government's normal business case development process. Our review has highlighted that the detailed process for making these choices need to be modernised and put into the context of the new system governance arrangements.

The process needs to focus more on early market assessment (see the recommendations for the commercial function) and also on the resourcing decisions - whether to use NHS Digital resources entirely or whether to use alternative sources, possibly including off-shore resourcing. Finally, the decisions need to be formalised as part of our revised assurance processes.

What we will do:

  • Develop and adopt a single organisation-wide approach to the 'build/ buy' decision and ensure this becomes a major checkpoint in programme oversight.

During 2016/17 we have established the Cyber Security Programme (CSP) aimed at supporting local organisations manage cyber threats, and building the capability across the health and care system. This is a significant investment to manage cyber threats - in excess of £40m from FY16/17- 20/21. We work closely with the National Cyber Security Centre to ensure we are fully aligned with national and international efforts to  respond to the challenges posed by cyber threats.

Cyber threats continue to increase and we will continue to develop our capabilities to help counter them. A key element of this work will be knowledge transfer across the health and care system. For that reason we have a structured engagement campaign and a knowledge service which provides organisations access to a library of health related cyber security threats with mitigations to improve understanding and promote best practices, as well as a range of e-learning modules to prepare health and care professionals for managing threats to data confidentiality, integrity and availability.

What we will do:

  • Design and implement a single unified security operating model for NHS Digital based on ISO27001 robust industry standards.

  • Continue to enhance our security testing, tracking and reporting capabilities.

  • Establish a National Security Operations Centre with real-time intelligence on the threats facing health and care organisations.

  • Incorporate the new Data Security Standards and assurance function as recommended by the National Data Guardian.

  • Create a new commercial framework to make it easier for local health and care organisations to access support.

Data in general and better uses of data specifically are an important part of Personalised Health and Care 2020 (Domain H). Our Data Services were an explicit exclusion from the scope of the Capability Review because work was already underway to develop a data strategy when the review started - and we didn't want to slow that work down. The NHS Digital Data Strategy has now been completed, approved by the NHS Digital Board and published.

Our vision is for a health and care system that has all the data and information that it needs, provided in an accessible and timely way, to enable it to provide the best possible services and to achieve world class health outcomes. We want to empower the health and care system to be intelligent in the way it uses data and information to drive improvements in health and care, by delivering world class data and analytics services through the highest level of skills, expertise, tools, techniques and technology. We manage over 100 different data sets and collections and make the data available for wider use. There are three components of our current offer:

  • Data services: making data available to customers on health and care services to enable research and analysis by individuals and organisations (including commissioners, providers, arms-length bodies, researchers, the intermediary market etc.).
  • Analytical services: providing standard and bespoke analysis services to customers that either answer their question or provide them with the tools to answer their question.
  • Statistical services: developing and publishing national, official and other statistical publications that describe health and healthcare across the country.

What we will do:

  • Implement the new Business Intelligence tool-set immediately to enable a wide range of users to access the data we hold in a modern way, under appropriate controls.

  • Continue to reform our Data Access Release Service for data disseminations, including further development of the existing online facilities.

  • Continue to improve the quality of the data we hold and accelerate the time that this data is available.

  • Implement the Data Services Platform to further revolutionise the way our data is collected, stored and accessed. 

  • Use the capabilities of the Data Services Platform to transform and modernise or internal processes.

  • Extend the data we collect to respond to our stakeholders' needs, the governance of Personalised Health and Care 2020 Domain H and the National Data Guardian's oversight.

The Personalised Health and Care 2020 portfolio of programmes place a huge increase in demand on our commercial capabilities: many of the programmes require solutions from new and existing suppliers and we must understand emerging supplier offers more effectively.

Historically, it was left to individual programmes and services to determine their requirements and procurement strategies. As a consequence we have staff with good contract management skills spread across our organisation, especially for large-scale contracts that were in place for previous national programmes. However, the programme focus has resulted in a wide variation of processes and practices.

The nature of the contracts are themselves changing significantly, with a drive to greater use of smaller contracts, whose outputs vary considerably but require effective integration. This has a significant impact on the balancing of skills between procurement and contract management as well as reliance on a capability to understand and access new supply markets.

We have developed a new commercial strategy in response to this and are in the process of embedding it across NHS Digital. Its premise is that we will have a centralised function working across our organisation, so that expertise, policy and processes are applied consistently and skills are embedded within programme teams and across the organisation.

There are also some functional (and organisational) gaps that our strategy is now addressing. These include:

  • pro-active market engagement and development
  • supplier relationship management
  • category management and strategic sourcing
  • integrated technology platform and tools to support data management, procurement and supplier/contract management

By addressing these gaps, we will develop a better understanding of the market and what suppliers have to offer; we will have better insight to enable us to make the right decisions about what products and services we should buy, and what we need to build.

What we will do:

  • Ensure operating model and staff capabilities support the achievement of functional and organisational strategies and goals and ensure that the commercial strategy is implemented effectively across NHS Digital.

  • Implement standardised channels and tools, to deliver Commercial service and delivery optimisation.

  • Establish a system based capability to drive consistent and credible data and management information which will inform and drive engagement with the business partners and support effective resource management and strategy delivery.

  • Implement an organisation wide model for effectively managing and developing supplier relationships across their portfolio and defining roles and responsibilities across stakeholders.

Last edited: 12 September 2019 9:58 am