Northern, Yorkshire & Humberside NHS Directors of Informatics Forum The NHS IC’s Operating Model / Responding to the

1. Northern, Yorkshire & Humberside NHS Directors of Informatics Forum The NHS IC’s Operating Model / Responding to the H&SC Bill 8th April 2011

2. Agenda • Introduction • Changing Business Context • Reshaping the NHS IC • Operating Model • Closing Remarks & Questions

3. NHS IC Established in 2005,The NHS Information Centre is the central authoritative source of health and social care information, acting as a ‘hub’ for high-quality, national and local comparative data to support policy, planning, assessment and effective service delivery • Based in the centre of Leeds • Was the NHS Information Authority • Merged with DoH Statistics Division • Merged with NHS Central Register

4. Busy Year…

5. Changing Emphasis…

6. Road to The Strategy…

7. Signals in the Strategy (i)

8. Signals in the Strategy (ii) “…stimulate a market for information providers who will develop new and innovative ways of presenting intelligible information to different audiences…” “…the market should innovate, and not stop at the minimum that the NHS expects. There should be a new culture, which promotes the creation of value through information, where patient choice and patient control of records becomes the driver for all stakeholders to raise their game…” “…Government, therefore, has its part to play in making more of data. Making data more readily available to the public, to information ‘intermediaries’ and to innovators, will support the development of a far more vibrant and open environment for the provision of information products and innovative ways of exploiting data for the benefit of health and social care services..”

9. ALB Review… • NHS IC Changes: • Firmer statutory footing • Centralising data collection • Assuring Quality of collected data • Creating a National Repository • Making data available to others

10. H&SC Bill… • NHS IC Responsibilities: • Systems for collection, analysis, publication / dissemination • Quality Assurance • Publish what is collected • Maintain an “Information Register” • Powers to require / request data • May be required: • Accreditation • Clinical Indicators

11. Trying to Work Things Out…

12. Change In a Complex System… • Very complex picture of organisations / data / flows • Has evolved over many years • Data demands are varied (performance, payment) • Little overall ‘system governance’ / ‘design’ …and we are about to ‘re-wire’ it…

14. Information Flows (ii)

15. Major National Systems • Secondary Uses Service (SUS) • Hospital Episode Statistics (HES) • Quality & Outcomes Framework (QMAS / QOF) • Central Collections (UNIFY) • Prescribing (ePACT) • Electronic Staff Records (ESR) • Central Finance (FIMS) • GP Registrations/Screening etc (OpenExeter) • etc..

16. Reshaping the NHS IC… ALB Review White Paper / H&SC Bill Other ALB functions (&relationships) New world of NHS / SC “landscape” NHS IC Statutory Functions Information Strategy Central Govt CIO Directives Consultations Shaping NHS IC “eg info delivery system’ New NHS IC “eg data.gov.uk’ Standards & Methods Customer Requm “eg outcomes’ Quality Assurance Market of Intermediaries Business Model (thin / fat) Commercial Service Providers Information Delivery systems National Repository

17. Our Basic Task is Simple… Collect Process Deliver

18. Customers Have Changed… < 2011 2011 > Deliver Deliver • Front-line NHS / Social Care • Comparators / Indicators • Analytical Views / Tools • Public / Accountability • Intermediaries ( b-2-b ) • Data centric delivery • Transparency / data.gov.uk

19. Collection Has Changed… • Centralised Collector • Powers to require data • Efficiencies needed across ALBs • New / different sources • Keeping watch on “burden” • Assuring quality • Effective systems Collect

20. Processing Must Change… • National Repository • Add more value (eg linkage) • Faster turnaround • Industrial Scale • Transparent Methods • Reliability / Consistency • Standards Process

21. Delivery Must Change… • Automated data.gov.uk surfacing • More open standards / interfaces • Faster access to data / content • Easier navigation / catalogues • Managed ‘accounts’ with NHS IC • Simpler access protocols • Better ‘user journey’ Deliver

22. “blueprint” New Operating Model for NHS IC… Expertise: • Domain / SME • Requirements • Design / Development Customers / Consumers • Intermediaries • National (eg NHS CB) • Official Stats / Public • Regulators • Researchers • Shared Services • + new customers Data Suppliers: • Datasets • Collections • Surveys • Registers • Warehouses / Systems • 3rd Party sources Production: • Technical capability • Operational capacity • NHS IC / 3rd party

23. Developing the Model… “As-Is” “Requirements” “To-Be” Communicating our approach Health Bill, ALB Review Commitments “blueprint” Customer / Stakeholder Requirements NHS IC Business Requirements / Constraints Commissioning delivery

24. Developing an Operating Model...

25. Account Management Account Management Relationships… Expertise Partners Customer Relationships Supplier Relationships We have important relationships with: • Customers/consumers • Data & Content Suppliers • 3rd Party Capability (eg Northgate) • External Expertise (eg Academia) They are all relationships that need to be managed, and many will be on a contractual footing too Customers / Consumers Data & Content Suppliers Collection, Production & Delivery Partners

26. Collections… We gather data from many different places, and in many different forms: • Flat Files • Collection ‘instruments’ eg Omnibus • Some direct system extracts • Dedicated systems eg Clinical Audit We have to manage those collections effectively, and promote quality at source = “Goods Inward” Data Services Collection Acquisition Marshalling Validation & Collection Quality “collection instruments” Production Delivery Transformation & Processing Linkage Pseudonymisation Product Quality Catalogue Publication Web-platform Data self-service “delivery instruments” Collection, Production & Delivery Partners

27. Processing… • Data we deem of ‘acceptable quality’ can be processed into various ‘assets’ or ‘products’ • The common DME platform is pivotal here to ensure that we can increase processing speed and efficiency, and reduce our overall ‘per transaction cost’. Standardising on a platform also facilitates inter-team flexibility • Production processes have to be scheduled and managed effectively Data Services Production Data Transformation Data Processing Linkage Pseudonymisation Product Quality Collection Delivery Acquisition Marshalling Validation & Collection Quality “collection instruments” Catalogue Publication Web-platform Data self-service “delivery instruments” Collection, Production & Delivery Partners

28. Delivery… We make “assets” and “products” available to customers/consumers through our ‘e-platform’ which comprises: • Catalogue • Publication vehicles eg website • “delivery instruments” eg SEFT We want to increase the amount of customer self-service = more products in our catalogue, and easier access mechanisms Data Services Delivery Catalogue Publication Web-platform Data self-service “delivery instruments” Collection Production Acquisition Marshalling Validation & Collection Quality “collection instruments” Transformation & Processing Linkage Pseudonymisation Product Quality Collection, Production & Delivery Partners

29. Expertise… Expertise Partners Expertise Services Data / Domain Product Development Methods Information & Statistical Governance Analytical Commercial • We have specialist expertise which is essential to our business, and differentiates us from other organisations • We use this expertise to shape new solutions, develop new methods, to answer questions, and to provide appropriate levels of control • We must plan the appropriate use of such expertise as it is finite • Sustaining expertise is important

30. Order Management… By treating everything we do as an “order” we can provide a framework which will help us manage the processes associated with that order, including prioritising, scheduling, planning and delivery Order Management Order Planning / Scheduling: • Prioritisation • Scheduling / Orchestration • Alerting & Notification • Delivery planning End to End Order Management: • Order triage • Order Book • Order entry • Order tracking • Order fulfilment • Order problem management We can ‘order’ expertise in exactly the same way as we order an “asset” or “product”; its just the units and outputs that differ (eg 15 days of Azim Lakhani to produce an HSMR evaluation)

31. Closing Remarks & Questions • Important role in the new landscape • There are major delivery challenges • Landscape is ‘fluid’ • This is no money…we shall have to think… Thank you for your time today Andrew Frith Head of Informatics Strategy andrew.frith@ic.nhs.uk m: 07811 114206

32. { these materials are included for reference only }

33. Annexes (linked into the presentation) • Annexe 1 – Functional Decomposition • Annexe 2 – Customer Workflows • Annexe 3 – Design Principles • Annexe 4 – Systems Issues

34. Annexe 1 – Functional Decomposition

35. Stakeholder Liaison / Engage Customer Query Product / Service Develop. Manage Stakeholders Request / Query Handling Research / Development Liaison / Engagement Clarify Request / Query Scoping / Requirement Gather Views / Input Organise Answer / Response Justification / Costing Exploit / Act on Input Deliver Answer/work output Design / Specify Buy / Build / Modify Updates / Informing of Status Verification / Testing Closure of Request / Query Professional Input Deliver / Implement Manage Prof. Engagemnt. Manage Delivery (projects) Liaison / Engagement Transition to ‘operational’ Communications Acquire Input / Advice Message (define / manage) Communication with ….. Degree to which function is executed (ie within team): Review effectiveness Barely Partially Mostly Degree to which function is performed consistently (ie corporately across the NHS IC: Barely Partially Mostly Functional Decomposition (i) ‘Customer / Stakeholder Interface’ ‘Development’

36. Functional Decomposition (ii) ‘Production Processes’ ‘Delivery Processes’ Production Processes Data Supply (to Customer) Prioritise Work Decide Delivery Route ‘Acquisition Processes’ Schedule Work Marshall Material(s) Resource Identification Data Supply to NHS IC Deliver via chosen route Data Manipulation Definition / Specification Analytical (data) Work Publication / Presentation Data Supplier Liaison Narrative / Analysis Create Publication Legal / Licensing etc Quality Control Manage Publication Scheduling IG Compliance / Records Schedule / Coordinate Acquisition / Collection Standards Compliance Package & Deploy Material Quality Control Storage / Holding Manage External Processing ‘Problem Management’ Contractual agreements Specify Work Issue Handling / Support Prioritise / Schedule Work Issue Identification Execute Work Package(s) Organise Fix / Resolution Receive / Accept Output Resolution Tracking

37. ‘Manage Resources / Services’ Functional Decomposition (iii) Manage Financial Resources Manage Staff / Teams Manage Service Financial / Resource envelope Work Schedules / Commitmts. Objectives / Roles Planning / Deployment Capacity / Capability Skills / Capability Review / Reporting Customer / Supplier Mgmt Work Packages / Plans Review / Performance ‘Commercial Capability’ ‘Compliance’ ‘Capability Development’ Procurement / Acquisition Specify requirement Information Governance Training / Staff Development Manage Process Assess compliance Identify Requirement Assess / Decide Manage NIGB / ICO relations Produce / Acquire Materials Acquire / Accept Establish IG / licence agrmnts Plan & Deliver Development Enforce compliance Review effectiveness Commercial Commercial negotiations Questions: ? Corporate governance / management ? Expertise-based responses (no data) Establish agreements Review / Performance

38. Annexe 1 – Functional Decomposition { back to presentation }

39. Annexe 2 – Customer Workflows

40. Actors / User Journeys (ii) • In recent web-strategy work we developed a number of user-journeys: • UJ001: Senior Business Manager (private sector software developer) – Wants to secure a one-off copy of 10 year HES data to develop software/reports to sell to local healthcare providers, local authorities and pharmaceutical companies • UJ002: Member of Public (diagnosed with a condition) - Looking for information on the prevalence and treatment of diabetes both nationally and in their area • UJ003: Head of Data Services (Commissioning Support for London) – A heavy data user requiring consistent monthly information feeds with an SLA and an agreed payment model • UJ004:Journalist (national press) – Writing an article about the cost of alcohol related treatment in A&E departments at a national and local level. Prepared to make an FOI request if data not readily available • UJ005: Information Analyst (PCT/GP Consortia) - Wants to find performance related information including comparisons, benchmarks and data for local use • UJ006:Academic Researcher (pharmaceutical sector) – Being funded by the Department of Health to do a study on the treatment of hypertension. Needs to find out what data/information is available, may need to link sensitive data

41. Actors / User Journeys (iii) • User Journeys continued…. • UJ007: Performance Manager (Provider Trust) – Wants to know how productive/effective their service/s are • UJ008:Member of Public (choosing a service provider) – wants to know how their local GP surgeries are performing in the provision of pregnancy services • UJ009: Regulator (CQC / Monitor) – Wants regular streaming of national and local data to inform risk profiling and quality judgements • UJ0010:Commissioning Manager (GP Consortia) – Would like to link GP event data with Office of National Statistics data on mortalities and understands that the resultant data file will need to be pseudonymised • UJ0011: Policy Maker (Department of Health) – Wants all available national data relating to lung cancer to help develop public health policy • UJ0012:Clinical Director (Provider Trust) – Wants to know how well their unit is performing against their peers • UJ0013: Information Manager (Local Authority) wants to deposit an MS-Excel dataset to the NHS IC

42. Actors / User Journeys (iii) • More complex journeys, derived from our ‘White Paper’ role: • UJ014: GPES request for national data from primary care to support QOF • UJ015: Requirement to land a new dataset (eg renal registries) and make it available for secondary use through the national repository • UJ016: Requirement to generate a new indicator and make it available for secondary use • UJ017: Requirement to receive and process a dataset from a 3rd party ‘data supplier’ eg ONS (assumes process has already been defined) • UJ018: Urgent requirement to collect a new dataset and make it available to front-line organisations to support of Operating Framework indicators eg Ambulance Performance • And from the recent NARS reworking: • Scenario D: Answer PQ, eg number of patients admitted for xxxx • Scenario H: Statistical Methodology Enhancement; eg change to readmissions rate query • Scenario J: SUS CDS change • Scenario M: Standard data download via www.data.gov.uk

43. UJ001: Senior Business Manager (private sector software developer) – Wants to secure a one-off copy of 10 year HES data to develop software/reports to sell to local healthcare providers, local authorities and pharmaceutical companies Multiple contact / negotiations with customer to resolve Information Governance and commercial agreements May need a commercial agreement in place for data supply Specification for work done by HES team at this point; assume a simple request 4 Commercial Mgmt 3 Who coordinates the supply from 3rd parties to the customer? 1 2 5 7 6 Depending upon how data is distributed to customer, may require logons?

44. UJ002: Member of Public (diagnosed with a condition) - Looking for information on the prevalence and treatment of diabetes both nationally and in their area Some information directly available on IC website, or may route to other 3rd party from signposting portal Cant find what they need from the website, so may make contact with IC 2 Contact Centre might have to refer to a topic specialist to locate right information? 4 Specialist 5 1 6 3 Signposted from NHS IC to diabetes.uk, or other 3rd party source 2a

45. UJ003: Head of Data Services (Commissioning Support for London) – A heavy data user requiring consistent monthly information feeds with an SLA and an agreed payment model Collection of material from NHS IC sources eg via Data Depot Scheduled production run set up for query / request to generate the data / output NHS IC Managed Account / Login to get access to data-files Who manages the SLA with the customer and ensures scheduled delivery of product? 8a 11a 7a IG / commercial Agreements established 4 3 5 Commercial Mgmt 6 2 Who coordinates the supply from 3rd parties to the customer? 9 1 10 7b Request may require data from more than one source to satisfy, so how is this coordinated with 3rd parties? 7c Informs customer of login details 8b 11b 3rd Party Managed Account / Login to get access to data-files Collection of material from 3rd party source eg SUS-EM

46. UJ004:Journalist (national press) – Writing an article about the cost of alcohol related treatment in A&E departments at a national and local level. Prepared to make an FOI request if data not readily available Information might be available from website 4a Information might have to be collated from internal sources (eg FOI) NHS IC Analyst Prepares Answer 4b 5 3 6 1 2

47. UJ005: Information Analyst (PCT/GP Consortia) - Wants to find performance related information including comparisons, benchmarks and data for local use Some information directly available on IC website Similar journey to UJ002, but may provide more detailed data access as a result, therefore may require access to tools via a managed account Cant find what they need from the website, so may make contact with IC 2 Some indicators available in IC tool eg NHS Comparators (needs login) Contact Centre might have to refer to a specialist to locate right information? 3a 7 Specialist 4 5a Signposted to other 3rd party source 8 1 6 9 5b 3b

48. UJ006:Academic Researcher (pharmaceutical sector) – Being funded by the Department of Health to do a study on the treatment of hypertension. Needs to find out what data/information is available, may need to link sensitive data. Produce output for delivery Multiple IC specialists may have to get involved to determine what is needed Cant find what they need from the website, so have to make contact with IC 2 If linkage required then TDLS service does the link / pseudonymise task 4a Specialist 8a 4b 9 7 Specialist TDLS Service 8b 10 4c TDLS Service may require specialists to pull together discrete data extracts, or 3rd parties to produce outputs – may need specs / quotes, commercial agreements to supply Specialist 8c 5a 5b Commercial Mgmt 3 1 6 8d 8e May require complex approvals for access to certain data for research purpose. Might need NIGB approval, and/or commercial agreement to be in place If linkage required then TDLS service does the link / pseudonymise task

49. UJ007: Performance Manager (Provider Trust) – Wants to know how productive/effective their service/s are Some information directly available on IC website, or routed to 3rd party via signposting Same journey as UJ005. If the information does not exist, then another type of journey might need to be initiated (see UJ015 for details) Cant find what they need from the website, so may make contact with IC 2 Some indicators available in IC tool eg NHS Comparators (needs login) Contact Centre might have to refer to a specialist to locate right information? 3a 7 Specialist 5 Signposted to other 3rd party source 4 8 1 9 6 3b

50. UJ008:Member of Public (choosing a service provider) – wants to know how their local GP surgeries are performing in the provision of pregnancy services Some information directly available on IC website eg QOF, others routed to 3rd party via signposting 2a Similar journey to UJ007. If the information does not exist, then generally would signpost to other source where information might be available eg NHS Choices Cant find what they need from the website, so may make contact with IC Contact Centre might have to refer to a specialist to locate right information? 4 Specialist 6 5 1 3 Signposted to other 3rd party source eg NHS Choices 2b