NHS England has published Who Does What, a framework designed to support NHS and integrated care system leaders on how to move forward together to maximise benefits of IT infrastructure, with the aim of ultimately enhancing provision of care and achieving optimal value for money.
“We will support ICSs in making digital and technology choices, that drive value, help to reduce health inequalities, and improve patient care, ensuring this happens within a coherent framework,” it reads.
The document specifies that ICS and health and care teams should know which business capabilities or activities will be provided once for the service nationally and which should be fulfilled regionally or locally; what technology platforms or services are available from the centre; the required standards and interoperability patterns; central support on offer; which best of breed application and services should be adopted; and how to prioritise and make investment decisions and how to avoid duplication with central offers.
In addition, national leaders will know which platforms and services will be provided centrally in a modern architecture; the maturity of national capabilities, any gaps and any areas of duplication; where to keep, rearchitect or retire systems; and how to make appropriate decisions for their target operating model.
Principles for where solutions are provided nationally
“Services and products will only be provided nationally where central provision meets strict principles and criteria,” the framework states.
NHSE is only to provide services and products where four aims are fulfilled; where national provision (as opposed to local or regional provision) will lead to better health and care outcomes; better patient and clinician experience; improved population health; and value for money and reduction in costs per capita.
NHSE will be the single central service provider where the need for scale and visibility is critical at national level, and where standardisation nationally is critical for patient care, safety, experience and cost optimisation.
Where NHSE is not the single central service provider, the framework notes that other support can be provided such as market management, national standards and delivery support, with further details to be provided.
Core enablers
There are five main enablers to the future state: EPR levelling up and What Good Looks Like; citizen-centred data and national digital channels; federated data hubs; APIs and record location; and secure data environments.
- EPR levelling up and What Good Looks Like: it is key to “ensure sustainable infrastructure with universal EPR coverage and simplified “source system” landscape within ICSs”, the framework says, along with providing real-time access to clinicians, social care staff and patients.
- Citizen-centred data and national digital channels: the enabler here is a consistent, structured NHS App ‘back end’ with a summary record, EPR record retrieval and access to ICS services, ultimately driving cross-organisational direct care and citizen empowerment, trust and involvement of citizens in data quality improvement.
- Federated data hubs: the framework highlights the need for “data hubs serving multiple use case categories managed at ICS-level but aggregated regionally based on consistent standards and a common, secure, data platform.”
- APIs and record location: EPRs, national and regional data sources must be able to interoperate with clinical and care services via secure APIs, or via record location where ‘high fidelity’ detail is needed.
- Secure data environments: the framework underlines the need for accredited controlled environments that store and analyse data securely. There must be access for authenticated users for an agreed purpose, activity must be auditable, and identifiable information should only be made available when authorised for an agreed purpose.
Support mechanisms
“We will provide a spectrum of support mechanisms spanning a high level of national accountability through to complete local autonomy,” NHSE states. “This will include nationally provided services, national commercial frameworks and buying support, national standards and where our role is to be community facilitators.”
Three options are listed:
- Single centrally provided service, where standardisation is critical or the scale is at a national level. This is a service or offering which should be used, such as the Patient Demographics Service.
- Central preferred service and other options, where the scale is at national level and standards are available to deploy equivalent solutions. This is a digital offering recommended for use, such as the Federated Data Platform.
- Other useful services, also known as Backstop, where there is no national level scale and the ICSs have no solution in place. These are offerings which could be used, such as the Summary Care Record Application.
Service catalogue purpose
The National Service Catalogue, providing technology resources for ICSs, aims to improve transparency on the support available from the central NHS.
The framework specifies that the catalogue will provide hands-on advice and updates will be made iteratively. It will:
- list services and products available from the centre to reduce duplication
- provide a single source of truth
- contain categorisations for each item
- specify the level of autonomy ICSs have in implementing the services or products
- highlight which of these services currently exist along with roadmaps for future services in the current funding cycle or beyond, where appropriate
- provide instructions on how to take advantage of a particular service along with how to onboard
National catalogue strategic alignment
“The national catalogue complements other activities that enable long-term digital transformation for the benefit of clinicians and patients,” the framework states.
It notes that digital transformation was set out as a top national priority in the plan for digital health and social care, and adds that the “National Service Catalogue should be seen in the context of a wider programme of work that aims to provide a more joined-up approach to technology and data solutions, as well as work by NHS England on the commercial side to make it cheaper and easier to buy technology and data applications through activity such as market management, framework consolidation, central volume guarantees and central price negotiations.”
The aim is to bring these elements together in order to enable ICSs to digitise and connect health and care; drive integration; and improve patient and staff experience.
The framework can be accessed in full here.
