Recent board papers from Isle of Wight NHS Trust, Solent NHS Trust and Southern Health NHS Foundation Trust revolve around ‘Project Fusion’, which will see a number of their services brought together under a new trust; as part of their meeting, the boards discussed the new trust’s developing digital strategy and digital transition requirements, including plans to develop an EPR roadmap and priority areas of focus for digital.
Through Project Fusion, all services from Solent and Southern Health will be brought together under a new NHS trust along with community, mental health and learning disability services provided from the Isle of Wight and child and adolescent mental health services (CAMHS) from Sussex Partnership NHS Trust.
The papers share that a clinical strategy has been developed for the new trust with ten initial priorities, largely focusing around mental health and learning disabilities along with community care; an enabling digital strategy is undergoing development in addition to strategies for workforce and estates. This digital strategy is to focus on joined up networks; cyber-security; interoperability and access to records; robust foundations supported by effective governance; and supporting the digital workforce to be competent and confident.
Electronic patient records
The paper highlights that at present each of the four trusts operates a number of different EPR systems, including RiO, Iaptus, SystmOne, eCAMIS, R4 and INFORM. In terms of ongoing plans, the Isle of Wight is in the process of migrating community and mental health services to SystmOne by March 2024, and £1.3 million has been secured to transfer CAMHS at Sussex Partnership from Carenotes to RiO by March next year, also by next March.
For the new trust, an options assessment to develop a convergence or rationalisation roadmap for the EPR systems is to be undertaken. The papers also acknowledge that work will need to be undertaken ahead of the new trust’s ‘Day 1’ “to ensure access to appropriate software and systems, alignment of networks and infrastructure and consolidation of corporate systems where essential.”
With each of the trusts having its own strategy, IT functions and systems, the boards discussed existing arrangements and how they are to be brought together.
Firstly, the papers focus on Hampshire and the Isle of Wight ICB’s overarching digital strategy, which places focuses on empowering citizens to use digital solutions; the boards highlight that this aim is “particularly relevant to the services provided by the new trust as the associated benefits will particularly support patients and carers that are based in the community”. They also commented on how supporting digital literacy and confidence in the workforce is expected to benefit staff at the new trust as they work across different sites and communities.
Regarding the digital function of the new trust, the papers state that this has been “designed to deliver the emerging digital strategy whilst providing direct support to clinical and corporate services” whilst building on each trust’s existing arrangements. It will take into account technical design; information technology infrastructure library service management; clinical systems and application support; programme and project management; information and communication technology and clinical systems training; business intelligence, data and insights; digital security; and digital clinical leadership, including chief nursing information officer and chief clinical information officer.
The new trust is to retain the the existing digital teams and processes for Day 1 with the aim of minimising risk to service delivery. Emphasising the importance of clinical input to digital functions to “ensure that the digital strategy remains relevant and aligned to service needs”, the paper states that each digital team will include representation for clinical leadership wherever relevant. These teams are to “embrace an approach of continual service improvement”, with service engagement and communications functions gathering feedback to help update and iterate the digital strategy as user requirements change over time and the trust matures.
Also on the topic of people, the board papers note workforce change management measures that are being planned for the new trust, including an integrated people function designed to support the increased scale of the new trust by removing duplication in processes and improving digital automation once systems have been integrated, with the aim of improving efficiency.
A single governance model is to be implemented across the new trust, providing a “robust framework to manage activity” which will map governance to functional outputs, rather than an organisational structure, to allow for flexibility during the trust’s integration. The trust is to adopt “a collaborative approach to digital transformation with its workforce,” the papers add, “with service users being represented at all stages to enable co-design, transparency and challenge where appropriate.”
“The current objective for Day 1 is to allow colleagues to work seamlessly side by side from all legacy organisations and sites, wherever possible, allowing the right access for the right staff from any place,” the paper states. As such, this should “result in very little changing for Day 1”.
At present, the intention is that a digital roadmap will be developed with two main phases. Phase one will see the introduction of greater interoperability and collaborative working between legacy organisations for Day 1 by providing access to appropriate software and systems across legacy organisations, including Microsoft Tenancies, EPR, shared data and corporate systems. In addition, this phase includes ensuring that networks and infrastructure are aligned to allow legacy staff to connect from any site, and consolidating corporate systems where required in preparation for Day 1.
Phase two will see the development of options regarding consolidation for remaining software and systems, to be considered by the new trust, which should result in the development of a plan for convergence or rationalisation of systems where required. “The considerations for options will need to be a blend of patient and user impact, capability and cost” and may “mean that convergence of systems may not result in a cost effective solution and interoperability is a more viable solution.”
Where possible, the plan is for the new trust to avoid dual run licenses in order to minimise costs.
For the Isle of Wight’s digital services, a service level agreement is being planned for an initial period of two years, which will allow the Isle of Wight to continue to provide a full digital service for their staff within the new trust, “ensuring continuity of access to clinical information in support of the IoW place-based care approach. Community and mental health staff will retain easy access to systems, thereby mitigating the potential risk to patient safety.” The boards state that this helps to avoid the need for immediate capital funding for changes to infrastructure of digital services, and retains existing specialist digital capibility and capacity working across services.
The papers can be accessed in full here.
Earlier in the year, we explored what’s happening in digital and data across ICS regions; check out our coverage of the South East region here.
In related news around digital strategies, you can find out more about the plans from Humber and North Yorkshire ICB here; Bedfordshire, Luton and Milton Keynes ICS here; and Hertfordshire and West Essex ICS here.