2.1. CCG Board Paper Summary Sheet. DETAILS Part 1 (Open) Agenda Item. X Part 2 (Closed) Title of Paper Interoperability and Connecting Care Meeting

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1 CCG Board Paper Summary Sheet DETAILS Part 1 (Open) X Part 2 (Closed) Agenda Item Title of Paper Interoperability and Connecting Care Meeting CCG Board Date 3 rd December 2015 Executive Lead Sarah James Author Jason Young Appendices Appendix 1 : Finances Appendix 2 : Timelines & Local Resource Requirements Appendix 3 : Patient Flow & Diabetes Workshop Outputs 2.1 PURPOSE Approval X Discussion Information Assurance EXECUTIVE SUMMARY Summary of Key This paper outlines the costs and benefits to the CCG through joining the Points Connecting Care Partnership as detailed in the accompanying Business Case. Background The CCG is recommended to join the Partnership as an excellent fit with national and local strategy. The development of the Business Case has been at the request of the Transformation Group and overseen by the Interoperability Programme Board comprising clinical and IMT representation from across BaNES organisations. Ensuring the interoperability of IT systems across the health and care system is one of the six transformational projects outlined in the CCG 5 year strategy. Joining the Connecting Care partnership will enable access to, and influence the development of, a technical portal that enables relevant information to be shared around the individual. Risk High Medium X Low Risks exist with all large scale IMT implementation due to the complexity of the work involved. Joining an existing partnership mitigates this to a considerable extent due to the nature of the technical elements already being live. Risks to finances, engagement and individual consent are detailed with their mitigation below Impact on Quality Embedding the use of the information sharing portal in organisations has been evidenced to improve the quality of care Impact on Finance Recurrent funding over the period 2016/17 to 2021/22 is required as detailed below: 2016/ / / / / /2022 Total 200, ,000 Recommendation The Board is asked to: 125,000 90, ,000 Page 1 of 8

2 -Endorse joining the Connecting Care Partnership subject to key approvals and funding from other BaNES organisations -Approve the required funding for years 2016/17 to 2021/22 as detailed in 3.1 -Delegate the approach to implementing the portal to the community wide Interoperability Board and CCG IMT Steering group. Ensuring the implementation focuses on clinically or service lead identified benefits to individuals and organisations such as those identified in 2.3. OTHER INFORMATION Who has been Sarah James as SRO has enabled the development of the funding model involved/contributed with clinical leadership via Dr Shanil Mantri as CCIO. Cross Reference to Strategic Objectives National Policy / Legislation Review The CCG IMT Steering Group has overseen the CCG input to the Business Case with overall responsibility for the development of the case sitting with the Interoperability Programme Board, reporting to the Transformation Group. This links to all our strategic objectives: Improving quality, safety and individuals experience of care Improving consistency of care and reducing variation of outcomes Providing proactive care to help people with complex care needs Creating a sustainable health system within a wider health and social care partnership Empowering and encouraging people to take personal responsibility for their health and wellbeing Reducing inequalities and social exclusions and supporting our most vulnerable groups Improving the mental health and wellbeing of our population The aims of information sharing are in line with the national strategy for digital health and care as per National Information Board Publications. Information sharing contributes to all of the below 1. Preventing People from dying prematurely 2. Enhancing quality of life for people with long term conditions (LTCs) 3. Helping people to recover from episodes of ill health or injury 4. Ensuring people have a positive experience of care 5. Treating and caring for people in a safe environment and protecting them from avoidable harm Progress reports will be received quarterly at the IMT Steering Group and included in its report to JCC Equality & Diversity Applicable Not Applicable X An Equality Impact Assessment will be carried out on the approval of the Page 2 of 8

3 programme Interoperability and Connecting Care 1. Executive Summary The attached Business Case details the costs and benefits of joining the Connecting Care Partnership. This existing group of 17 Health and Care organisations have come together around a vision of sharing information to make a positive contribution to the health, well-being and opportunity of the population. Joining the Connecting Care Partnership represents an excellent fit with both local and national strategic direction. It is in line with the vision for increased digital health and care services laid out in the Five Year Forward View and with the response to the Your Care Your Way consultation on community Services. This partnership will enable access to, and influence the development of, a technical portal that enables relevant information to be shared around the individual. Joining an existing programme represents good value in comparison to procuring or developing a solution in isolation, with the costs to the CCG over seven years detailed below. 2016/ / / / / /2022 Total 200, , ,000 90, ,000 The Board is asked to: -Endorse joining the Connecting Care Partnership subject to key approvals and funding from other BaNES organisations -Approve the required funding for years 2016/17 to 2021/22 as detailed in 3.1 -Delegate the approach to implementing the portal to the community wide Interoperability Board and CCG IMT Steering group. Ensuring the implementation focuses on clinically or service lead identified benefits to individuals and organisations such as those identified in Interoperability of IMT Systems in BaNES 2.1 Background Page 3 of 8

4 Achieving the interoperability of IMT systems across health and care is one of the transformational projects set out in the CCG 5-year strategic plan. The overarching aim of IMT systems talking to each other is to ensure that data relevant to the care of an individual that is captured in one organisation s IT system is available to support the required care regardless of setting. Clinical and IT engagement work across the health and care community led to the formation of the Interoperability Programme Board and confirmation of the local appetite to share data across organisations. In February 2015 the BaNES Transformation Group were presented with an Option Appraisal indicating that the most appropriate technical solution to the information sharing priorities identified was to join the Connecting Care Partnership. The Group requested a Full Business Case (FBC) be developed to identify the costs and benefits of that option. The FBC accompanies this paper. 2.2 Strategic Context The 5-Year Forward view has set out a vision for a more digitally enabled NHS. Part of this vision includes the aim for primary, urgent & emergency settings to be paper free at the point of care by This extends to whole of health and care by A number of actions across organisations will be required to meet this aim with the Connecting Care Partnership the strategic vehicle that enables the change required for information sharing. 2.3 Local Context Excellent progress has been made in using IT to share information around the health and care community in BaNES, an example being electronic discharge summaries being the norm from the RUH for some years. The FBC references the local starting point but identifies benefits through improved sharing that could be developed through use of the Connecting Care portal. The CCG and Council, via the Your Care Your Way programme, recently received the response to Making Plans, a consultation document detailing proposals to improve the delivery of integrated community health and care services to the people and communities of Bath and North East Somerset. This identified a priority of a technical solution that enables everyone to work from a single care plan. Connecting Care can provide the foundation for this development. In developing the FBC workshops were held with local clinicians that identified specific areas that would benefit from the increased information sharing offered by the Connecting Care partnership. These include: -Discharge planning and support via the community cluster MDTs. Page 4 of 8

5 -Treatment planning for complex diabetes patients via the community diabetes MDTs. -Information to support ED attendance/admission avoidance in emergency and urgent care settings. 2.4 The Connecting Care Partnership The Connecting Care Partnership currently comprises 17 organisations serving the Bristol, North Somerset and South Glos CCG regions (BNSSG). Approval of this FBC would see BaNES CCG join the partnership as an equal member to the existing partners. The RUH, B&NES Council, BaNES Doctors Urgent Care (BDUC), Dorothy House Hospice Care and Banes Enhanced Medical Services (BEMS+) are also considering this FBC to join the partnership. Sirona and Avon and Wiltshire Mental Health Partnership (AWP) are already members of Connecting Care but are considering the case in terms of the financial implications of extending the membership to the BaNES area. Membership of the Partnership will provide BaNES organisations with access to a web based portal that enables a view of person-centric information sourced from the multiple providers across the BaNES and BNSSG region. A simple example would include providing a community team or GP with access to a real-time list of their patients currently in a bed within RUH, Weston and Bristol hospitals. The benefits section of the FBC (7.1) includes detailed descriptions of the kinds of benefits being realised by the programme in BNSSG. These primarily focus on improvements in quality and experience of service users. It also includes an estimated financial value of the productivity improvements released into the respective organisations through using the tool. 2.4 The BaNES Interoperability Programme Board The BaNES Interoperability Programme Board reports to the Transformation Group with clinical and IMT representation from across BaNES organisations. A sub-group including membership from the RUH, Sirona, B&NES Council and the CCG oversaw the development of the Business Case of which the full Board received a copy at its November meeting. The Board recommended that BaNES organisations join the Connecting Care partnership subject to each individual organisation s governance requirements. Page 5 of 8

6 3. Financial Impact 3.1 Costs The overall cost to BaNES organisations over the seven years of the contract equate to 3.1m. The CCG revenue contribution to this is detailed below: 2016/ / / / / /2022 Total 200, , ,000 90, ,000 In addition to the sum above is CCG funding from existing budgets in 2015/16, an annual contribution from the existing GP IT budget, a contribution from the Academic Health Sciences Network, NHS England capital and partner contributions from the BaNES organisations listed above. The values indicated above relate to the additional expenditure required to join the Connecting Care Partnership. In comparison to the procurement and development costs that would be required to purchase an alternative approach to delivering the paperless vision described above, these represent excellent value to the CCG. 3.2 Financial value of benefits Benefits to the BaNES members who would join Connecting Care have been calculated by extrapolating the benefits identified by the existing partnership through interviews and surveys of c300 users. The financial value of these benefits to the whole health and care community has been estimated as below: 2016/ / / / / /2022 Total 1,130,200 1,130,200 1,695,300 2,260,500 2,825,600 2,825,600 11,867, Local project team costs There is a need for any contributing organisation to source appropriate technical and specialist resource to support the local delivery. These teams will work closely with the programme team. These additional local resources will be required across BaNES partner organisations and have been estimated at circa 252k p.a. This is the notional value of the resource required as will come from within existing establishments. 3.4 Additional costs and funding sources The costs in 3.1 deliver a specific programme of work to bring BaNES organisations on line and includes an annual amount for development across the partnership. Work required in addition to this programme, or at a faster pace, would incur additional cost. Page 6 of 8

7 There are likely to be national funding streams that are available that could be bid against to fund this work or contribute to the existing costs. 4. Risks and Mitigating Actions 4.1 IMT implementation risk There are risks associated with any large IMT implementation. The consequences of when these occur have been well documented across the NHS. Risks include technical issues such as software not working or costs escalating as implementation timetables drift out. Mitigation: The Connecting Care Portal is already live and in use across BNSSG that has experience of working with all the relevant software with the exception of TPP. An extended implementation time has been given for the TPP element as a more realistic expectation of the work involved. 4.2 Engagement risk Software doesn t deliver benefits on its own and needs change management within organisations to deliver improved ways of working. The risk exists that due to conflicting resource demands organisations won t fully engage in the programme. Mitigation: The CCG is considering the use of CQUIN to incentivise engagement with the use of the Connecting Care Programme in its early phase 4.3 Financial risk The CCG will be joining a partnership that includes a contract with a number of suppliers. Should one of the funding streams be reduced or removed, the partners will need to fund the gap. Mitigation: All partners will sign a partnership agreement detailing the required costs. National funding streams will be pursued where appropriate. 4.4 Consent There is a risk that the population will not consent to their information being shared to support their care in this way. Mitigation: Funding has been allocated to ensure a clear communication and engagement programme is included in the project. Page 7 of 8

8 5. Conclusion and Next Steps Joining Connecting Care represents an opportunity to BaNES organisations to increase the quality of care offered to the population we serve through increased sharing of information. It further provides the technical foundation to build on that will be required to deliver the vision for more digital care outlined as part of the national strategy. Joining an existing partnership is a logical step based on the geographic flows of our population and offers value on the investment required. Subject to the approval of the FBC by the CCG and key BaNES partners our membership request will be considered by the existing Connecting Care Partnership Board in January 16. On receiving approval from the existing partnership the contractual and ground work will begin with the development of a project plan detailing the necessary steps to be live with EMIS and TPP GP systems, RUH data, AWP, Sirona and Dorothy House data in 16/17 with local authority data flowing shortly after. 6. Recommendations The Board is asked to: -Endorse joining the Connecting Care Partnership subject to key approvals and funding from other BaNES organisations -Approve the required funding for years 2016/17 to 2021/22 as detailed in 3.1 -Delegate the approach to implementing the portal to the community wide Interoperability Board and CCG IMT Steering group. Ensuring the implementation focuses on clinically or service lead identified benefits to individuals and organisations such as those identified in 2.3 Page 8 of 8