One Person, One Digital Record Our Local Digital Roadmap Janet Fitzgerald Director of Corporate Governance

Context National context: By 2020 – all patient and care records will be interoperable and real time Between April 2016 and March 2018 – 10 universal priorities to make significant progress on Scope is to include paper-free at the point of care, digitally enabled self care, real-time data analytics at the point of care, whole systems intelligence to support population health management and commissioning informed by local priorities Local context: STP and Success Regime – how do we deploy technology to accelerate change? Model of care – person, past middle age, 3 long term conditions The local digital roadmap needs to describe how we achieve all this.

Local Vision – options for care & support through hubs House bound Care plan, telehealth Prevent an exacerbation Support Manage an exacerbation Prevention Supported by a care coordinator STP models of care 3 Long term conditions

Progress Peninsula approach 3 CCGs working together 19 other stakeholders - Local Authorities and providers Agreed set of principles Used the “I” statements to develop a series of outcomes relating to Identified 12 Peninsula wide projects Key points: Have achieved agreement (at CIO level) to work at Peninsula level. Sign off of Roadmap document will provide endorsement from each organisation for this way of working Large number of stakeholders TCS engagement started in 2013/14 Principles that underpinned I statements were developed by a system wide stakeholder group - taking into account views of public - then finalised following further engagement and consultation   Then jointly with local authorities developed into 'I' statements which have again been supported through the TCS engagement widespread patient and public engagement across Devon and people told us that this was how they wished to experience their care. This has been used as the foundation, informing the work of the roadmap.

Our Principles o Optimise and make best use of any funding sources to ensure that we maximise income within this programme of work o Work collaboratively and apply our “Do It Once” methodology across the Peninsula o Make the best use of national systems o Ensure that all our work meets common standards, both technical and information standards o Make best use of our combined procurement power to ensure financial sustainability

Four areas of focus in our roadmap (1) Health and care organisations need to reach digital maturity (Build the foundations) - ensure plans are in place for all the health and social care organisations across the patch to reach digital maturity at the earliest possible point in time Secondary care digital maturity returns indicate varying levels of maturity with none of the secondary care providers expecting to achieve full paper free at the point of care by 2020 Social care and primary are currently being gathered (at a national level) and once published will be used to inform the roadmap. Connect all the digitally mature organisations (Leverage the capability) – develop and buy the infrastructure which enables information exchange between organisations to assimilate and create a single view of the records held for a person Peninsula wide project *Text in blue is our current position* Providers have identified the levels of funding they would need to move their current systems to become paper free and interoperable. They have identified £150m over 5 years (2021) required to achieve this and currently advise that this is additional funding over and above their capital programmes. It may be possible to bring some of this work forward with additional funding to achieve the requirements by 2020 HOWEVER it is important that further diligence takes place over the summer to clearly identify: What is deliverable within their capital programme and by when (i.e. with no additional funding) What additional funding would deliver the paper free at the point of delivery by 2020 What additional funding would achieve a pragmatic outcome somewhere between 2020 and any projections set out in their capital programmes. (For example - RDE have spent the last 18 months hoping to get funding for their Electronic Patient Record via national sources or via a loan – they have still not secured this so will have built the full cost of this into their capital requirements. Unless they secure the funding in some way at the moment they are at a stand still or will need to move to a plan “B”)

Four areas of focus in our roadmap (2) Enable citizen access (Exploit the opportunities) – create the ability for citizens to access and upload information to their integrated digital record. There are pilots and pockets of work underway across the Peninsula however the real opportunity will come when the records from all the digitally mature organisations are connected together. Peninsula wide project Identify what can be achieved ahead of the 2020 deadline (Leverage existing capabilities) – what information can we share and by when? These include the nationally mandated “universal capabilities” by 2018 and a range of other locally identified projects. Includes the 10 Universal Priorities – significant progress required by 2018 We have identified a number of projects that will enable us to share information at a partial level ahead of 2020. To be scoped, estimated and prioritised in Summer 2016

What can we do already? 10 Universal Priorities: Professionals across care settings can access GP held information (medications etc.) Partial Clinicians in urgent & emergency care settings can access key GP held information Partial Patients can access their GP record Partial GPs can refer electronically to secondary care Complete GPs receive timely discharge summaries from secondary care Partial Social care receive timely electronic assessment, discharge and withdrawal notices from acute care Being scoped Clinicians in unscheduled care settings can access child protection information with social care professionals notified Being scoped Professionals across care settings made aware of end of life preference information Partial GPs and Comm Pharmacists can utilise electronic prescriptions Partial Patients can book appointments and order repeat prescriptions from their GP practice using online services Complete Our progress is red, amber or green infrastructure for ‘2’ will enable this rolling out – 85% GP practices committed, North Devon Hosp ED, Devon Docs. SWAST keen to pilot across Devon and Torbay, RDE now exploring, PHNT yet to commit Available via Patient Online for over 90% of Practices use of DRSS 1st phase complete in all other than PHNT – now moving to more structured information set Being Scoped infrastructure for ‘2’ will enable this, further scoping required awaiting update it has been enabled however key issue is uptake and use

A summary roadmap showing the key steps and projects Pink boxes are the foundation work that needs to take place – Peninsula wide Green boxes relate to the 7 capabilities described in the guidance and against which digital maturity is measured Purple boxes relate to specific Peninsula wide projects that require further scoping The roadmap will be updated once the work is completed after the summer – so we will have a firmer view on where the boxes should sit in the timeline.

Costs and sources of funding Overall capital programme: At least £150m, across the 22 organisations, and across 5 years With ongoing revenue consequences of £15m But unclear what the intended source of funds are 12 Peninsula wide projects Would cost between £12m and £22m depending on clarifying a number of issues Patient Safety Initiatives (such as cyber security, data quality) At least £5.9m Sources of funding are unclear and further diligence is needed as part of the work programme over the summer

Governance Initial governance arrangements are set out with the aim of convergence for the Devon Groups over a period of time The plan is to use the SR/STP programme office The steering group will then report to both the Cornwall and Devon programme exec delivery group (part of the STP governance arrangements and developed with Laura)

Risks Greater clinical involvement and capacity – CCIO capacity We will need to consider how we engage patients and public as we scope each project Investment – not all of this has funding identified across the system Scale and pace Approvals process very tight

Next steps Stakeholder organisations sign off Local Digital Roadmap 25th May – mid June 2016 CCG Executive Committee 15th June 2016 Final Scrutiny – Chief Officer and Chief Finance Officer Finance Committee 23rd June 2016 Submission to NHS England 30th June 2016 By supporting this document organisations are signing up to the following commitments:   Our vision for ‘One Person, One Digital Record’ That all organisations within the Peninsula work to common standards for data structures, technology and information sharing That we commence a period of scoping to produce project mandates for the programme of work identified and complete the diligence work on the financial information That an updated and more detailed roadmap is produced in September 2016. Optimise and make best use of any funding sources to ensure that we maximise income within this programme of work Work collaboratively and apply our “Do it Once” methodology across the Peninsula Make the best use of national systems Make best use of our combined procurement power to ensure financial sustainability