1. The Health Informatics Review and some workforce and professional development implications BCS HIF 7 October 2008 Luke Davie Health Informatics Review

2. Summary Background to the Health Informatics Review Health Informatics Review findings Building an “Informatics Literate NHS” Next steps

3. Background to the Health Informatics Review (HIR)

4. Background to HIR Commissioned by NHS Chief Executive & DH Permanent Secretary in September 2007 Originally led by Matthew Swindells Over 1400 stakeholders consulted:  1000+ frontline NHS staff  public opinion researched - deliberative event & surveys  voluntary organisations &professional bodies  SHA Chief Executive Officers and Chief Information Officers Findings published as part of NHS Next Stage Review on 10 July 2008 More detailed Implementation Report by the autumn, aimed at informatics specialists

5. HIR scope To outline an information and IT architecture capable of supporting the world-class NHS envisaged in the NHS Next Stage Review Health Informatics Review Programme Project 3 Creating an information system and management structure Project 1 Meeting the information needs of the DH and NHS “Information” “NHS CRS and SUS” “Governance” Project 2 Maximising the benefits from NHS CRS & SUS

6. NHS Next Stage Review

7. High quality care for all: NHS Next Stage Review Quality at the heart of the NHS High quality care for patients and the public Freedom to focus on quality High quality care for all Raising standards Stronger involvement of clinicians in decision making at every level of the NHS Fostering a pioneering NHS Empowering frontline staff to lead change that improves quality for patients Valuing the work of NHS staff Help to stay healthy Empowering patients Most effective treatments for all Keeping patients as safe as possible

8. Need for high quality information never greater… People want to:  understand choices about care, & how to stay healthy  be confident that health & social care staff have the information needed to provide care effectively & safely Care professionals need information & evidence when providing care, regardless of where the person was previously seen Commissioners need information to plan & redesign services Public expects that managers of health & social care services use information to:  monitor & assure quality  make decisions based on evidence & best practice  account for their actions Regulators need information to assure NHS & independent sector care providers

9. Delivering better, safer care Quality at the heart of the NHS Empowering staff to improve NHS performance Freedom to focus on quality Empowering patients and the public High quality care for patients and the public Information available at the point of care Health record securely accessible to clinicians and patients Personalised wellness support for patients & public Public access to service information Improving clinical quality and safety Improving performance management Improving information for staff Share information securely with partners Public access to health information

10. HIR strategic findings

11. Success is getting from:…to: Patients Patient records held on paper, hard for the patient to access or understand Choice poorly understood and limited information available to support patients I have access to my record I understand what is going to happen to me and my options I can make informed choices to receive the best possible care I can be involved in my own care Public Disparate sources of information to inform the public about health and wellbeing with little control of validity Perception that NHS is not delivering value for money I know where to find trusted answers on health and wellness I can see how my local health services are performing I can see information about the quality of services provided Staff Variable access to up to date, timely and accurate clinical information causing errors and cancellations Management decisions often based on inaccurate operational and performance data, or no data at all Few systems to provide staff with access to targeted information to help them do their jobs or personalised information on their development and learning Single source of patient & clinical information available at the point of care Electronic records will reduce the burden, help to join-up treatment along care pathways, & lead to improved patient care Clinical performance indicators available for individuals, managers & organisations to improve patient care Staff have access to relevant information & an employment, knowledge & learning support system

12. HIR key themes Delivering better, safer care: person-based information for clinical & care processes, shared across organisational boundaries Empowering staff to improve NHS performance: research, planning & management, improving quality of care & supporting regulatory activities Empowering patients and the public:  making information available about health, services, & patients’ own health & wellbeing  providing patients with secure access to their own electronic records & increasing their involvement in shaping the NHS Focusing on IT alone will not meet the needs of the NHS.

13. Strategic vision Patient information available at the point of need Strategic solutions making patient/client information available securely across care settings People will be able to:  access their own care record securely  have information to make informed choices about their own healthcare and wellbeing Additional services available to patients on-line Information should be:  collected once, as a by-product of care  used many times, only creating new data when absolutely necessary;  with an integrated programme to improve data quality

14. Conclusions Information and IT are central to:  improving health & social care services  empowering service users & staff New CIO for Health: reports to NHS CEO & on NHS Management Board - underlines importance of informatics & provides a model for the NHS Investment in IT gives the opportunity to make a leap forwards in the scope, availability & use of information Emphasis on information about the quality of care, for patients, the public & staff, with major new national systems Renewed focus on delivering systems now to meet clinical priorities Reinforces the importance of informatics skills & gives impetus to developing the informatics profession and workforce

15. An informatics literate NHS

16. Delivering better, safer care Quality at the heart of the NHS Empowering staff to improve NHS performance Freedom to focus on quality Empowering patients and the public High quality care for patients and the public Information available at the point of care Health record securely accessible to clinicians and patients Personalised wellness support for patients & public Public access to service information Improving clinical quality and safety Improving performance management Improving information for staff Share information securely with partners Public access to health information Needs an “Informatics Literate NHS”

17. Informatics Literate NHS Strong informatics governance Within DH & NHS Outside DH & NHS Investment assessment Standards governance Policy integration Informatics staff Other staff Sound leadership Good processes Skilled staff

18. Sound leadership New CIO for Health – Christine Connelly - Board level post reporting directly to the NHS CEO CIO has formal responsibility for providing professional leadership to the major informatics organisations inside and outside the Department of Health Expectation that SHA, trust and PCT boards include a CIO, following the model of the CIO for Health National informatics leadership to  develop the profession  co-ordinate the existing expertise  build the informatics capability of the general and management workforce

19. Informatics literate NHS Informatics-literate NHS Strong informatics governance Within DH & NHS Outside DH & NHS Investment assessment Standards governance Policy integration Informatics staff Other staff Sound leadership Good processes Skilled staff

20. Good processes Improved arrangements for :  early assessment of the informatics implications of new policy,  addressing national and local operational requirements Ensure that IM&T priority and funding is given to the most appropriate requirements Mainstream IM&T planning and Governance

22. Mainstreaming planning and governance IM&T planning part of mainstream NHS planning & service delivery, with Board-level ownership & support Increased dependency on the Secondary Uses Service (SUS) requires more robust processes & IT systems, by April 2009 Each local health community to have roadmap for achieving strategic vision, by end March 2009, as part of NHS IM&T Planning process & NHS Operating Framework. Governance arrangements:  to ensure robust & effective decision making  communicated effectively (local, SHA and national level) & with suppliers  ensure clarity on roles, responsibilities and accountabilities.

23. Roles & responsibilities NHS CFH:  include social care, voluntary & independent sector  lead on national elements of all approved IT programmes NHS IC:  independent experts overseeing data capture, coding, grouping and analytical access, on behalf of the NHS & Social Care DH Information Services:  supply internal IT to the DH, standardising where appropriate with the NHS & driving DH knowledge infrastructure NHS CFH & IC further to empower frontline, by clarity about their programmes & flexibility in implementation.

24. Informatics Literate NHS Strong informatics governance Within DH & NHS Outside DH & NHS Investment assessment Standards governance Policy integration Informatics staff Other staff Sound leadership Good processes Skilled staff

25. Skilled staff – general workforce & informatics specialists Creation of a health informatics career framework, to guide the development of staff who wish to progress Health Service leadership to:  address the skills needed in the NHS needed to deliver large scale IT-enabled change  develop the Informatics Profession Informatics content in core training & professional development programmes for NHS clinicians and managers SHAs and NHS CFH to work with suppliers on supplier capability to help ensure that planned milestones are met & products are fit for purpose.

26. Developing the informatics workforce – key elements Workforce development and planning Career pathways Attraction, motivation and retention Performance management Leadership

27. Leadership – HIR commitments CIO for Health, reporting to NHS CEO and on the NHS Board as a model for NHS bodies CIO for Health formal responsibility for professional leadership to informatics organisations inside and outside the Department of Health Leadership required at national level to address skills shortages and develop the profession; co-ordinate exiting expertise to achieve most impact Develop effective professional leadership at local levels Establishment of new Leadership Council with focus on standards; will commission programmes

28. Leadership - actions (so far)  CIO – Christine Connelly – started 22 Sept  CEO NHS CFH – Martin Bellamy – started 22 Sept  Research into leadership development needs of aspiring Heads and Directors of informatics  Accessing & influencing the new Leadership Council

29. Attraction & Motivation – HIR commitments Form a pool of informatics specialists Strengthen long term planning of informatics workforce requirements and expand recruitment sources Generate excitement around a rewarding career in informatics in health and social care Ensure recognition of success Ensure management commitment to supporting informatics staff Strengthen the competitive position of critical informatics roles relative to other opportunities, in IT, IM and analysis Consider local Recruitment & Retention premia consistent with Agenda for Change Attract and develop more individuals through the existing graduate training/fast track scheme

30. Attraction & Motivation - actions  New NHS careers materials; promotional videos (eSkills); promotions  National HI Graduate Training Scheme pilot (20 trainees in 2007 & 2008); integration with other national schemes from 2009 (20 trainees a year)  Developing informatics apprenticeship and talent management schemes

31. Career Pathways – HIR commitments Embed HI in the NHS Career Framework Create options for different paths to support different individual skills and aspirations Clearly define standardised pathways with criteria for advancement Develop informatics apprenticeship and talent management schemes

32. Career Pathways -actions  Career Framework launched Spring 2008  Phase 2 development with Informing Healthcare in Wales underway  Early adopters being identified  Support for Apprenticeships

33. Workforce development & planning - HIR commitments Provide skills and training modules linked to each career level Encourage the development of a skilled talent pool with relevant qualifications through partnership with educational establishments Knowledge sharing supported by technology; benefits and change support should be available

34.  ASSIST workforce surveys 2007 and 2008; exploring options for central collection of workforce data  Health Informatics Quality Scheme for Learning and Development (HIQS)  eSpace; Health Informatics Community and NHS Faculty of Health Informatics Workforce development & planning - actions

35. Performance Management – HIR commitments Reinforce expectations and accountability for individual performance Introduce strong performance feedback systems to promote personal growth Develop mechanisms for providing assurance about services, processes and people

36. Performance Management - actions Actions  Support for certification of individual practitioners (UKCHIP)  Health Informatics Quality Scheme for Learning and Development (HIQS)  Health Informatics Services Benchmarking and Accreditation

37. Developing informatics skills in the general workforce: care professionals, managers and administration staff

38. General workforce – HIR commitments Informatics specialist curriculum for medical staff in training Work with Royal Colleges to incorporate information and IT training into the basic training for doctors, nurses and other clinical staff Standard packages for graduate and postgraduate management and other courses Linked informatics training schemes for staff from Ward Clerk to Board Member Further develop CFH’s eLearning toolset

39.  Revising curriculum framework “Learning to Manage Health Information”  Planning conference for clinical educators  Establishment of informatics clinical educators special interest group on eSpace  Ensuring HI embedded in CPD for nurses  Input into AHP career modernisation activity  Analysis of current informatics education and training for health staff, and links to NHS Career Framework General workforce - actions

40. Next steps and conclusions

41. HIR next steps Collating detailed implementation plans Produce more detailed report by the autumn, aimed at informatics specialists, with implementation update & plans Continue stakeholder engagement – SHA road shows Embed as “business as usual”

42. Questions?