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JOINT MEETING OF NHS MANSFIELD AND ASHFIELD CCG ANDNHS NEWARK AND SHERWOOD CCG GOVERNING BODIESTITLE:Nottinghamshire CCGs’ Information Governance, Management andTechnology Strategy 2016/17.DATE OF MEETING:27 April 2017AUTHOR:Andy Evans, ProgrammeDirector, Rushcliffe CCGPAPER REF:PRESENTER:JGB/17/72Mrs Sarah BrayPURPOSE OF REPORT:To approve the Nottinghamshire CCGs’ Information Governance, Management andTechnology Strategy 2016/17.EXECUTIVE SUMMARY:This strategy is a further iteration of the IGM&T Strategy version 3.1 and sets out how, as ahealth and care economy, we will deliver technology over the next 3 years in order to supportthe ambitions of Nottinghamshire’s Sustainability and Transformation Plan (STP) and LocalDelivery Roadmap (LDR).Fully aligned to the Nottinghamshire Local Digital Roadmap, the ambitions of this strategydocuments how as a whole community we will achieve the vision of the STP by providing thetools to support Nottinghamshire in reducing the Health and Wellbeing, Care and Quality andFinance and Efficiency gaps.It describes how we will improve information sharing and systems in an increasinglychallenging financial environment to enable cost savings and efficiencies the whole health andcare economy. Whilst it is recognised that there is an increasing financial burden on healthand care organisations, by being innovative in how current and new technologies are utilised,efficiencies can be driven not only by commissioners but also in primary care and the widerhealth and care economy.Although Nottinghamshire has made significant progress across all health and care providersand commissioners in improving information sharing and infrastructure to supporttransformation in the last three years, further delivery of change must be performed at pace ifclinical benefits are to be realised, and, the improvement in quality and patient experience feltby members of the public. To operate at this pace the CCGs will need to act decisively andsupport their IT service provider and other Nottinghamshire health and care providers. There isa desire and willingness to work together across organisational boundaries with maturegovernance arrangements in place but it is recognised that some (change and benefitsmanagement) will need further development to cope with the change of scale and pacerequired to ensure the key deliverables and milestones identified within this strategy can bemet.RECOMMENDATION:To approve the draft strategy.KEY IMPLICATIONS:FINANCIALVALUE FOR MONEYRISKLEGALWORKFORCEPATIENT AND PUBLIC INVOLVEMENT

CLINICAL ENGAGEMENTCOMMITTEES CONSULTED PRIOR TOCOMMISSIONING COMMITTEEnAll the Terms of Reference in this paper have beenapproved by their respective CommitteesHOW DOES THIS CONTRIBUTE TO THE OUTCOMES AND OBJECTIVES OF THE CCG: Quality Health Financial Clinical Performance (tick as appropriate)CONFLICTS OF INTEREST:This is a recommended action to be agreed by the Chair at the beginning of the item. No conflict identifiedConflict noted, conflicted party can participate in discussion but not decision (see below)Conflict noted, conflicted party can remain but not participate (see below)Conflicted party is excluded from discussion (see below)CONFIDENTIALITY:Is the information in this paper confidential? NoANNEXES:Nottinghamshire CCGs’ Information Governance, Management and Technology Strategy2016/17.2

The Nottinghamshire Forward Viewinto ActionAn Information Governance Management andTechnology (IGM&T) Strategy for Nottinghamshireled by NHS Clinical Commissioning Groups

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Nottinghamshire CCGsIGM&T StrategyContentsVersion Control . 1Executive Summary. 4Introduction . 5Where Are We Now? . 61.Information sharing . 132.Infrastructure . 173.Improving Citizen Access to Information and Care Records . 204.Digital Maturity . 235.Assistive Technology . 25How will we deliver this strategy? . 29Appendix A: Nottinghamshire IM&T Road Map . 34Appendix B: Glossary 352015-2020Page iVersion 4.4

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Nottinghamshire CCGsIGM&T StrategyVersion ControlReferenceCCG IGMT Strategy v4.4.docxDocument PurposeThis document lays out the strategic intent of the sixNottinghamshire CCGs in respect to developments ininformation governance, information management, andinformation technology and associated servicesVersionStatusTitleAuthors4.4FINALIGM&T Strategy 2015 – 2020Andy Evans, Connected NottinghamshireSavi Cartwright, Connected NottinghamshireAlexis Farrow, Connected NottinghamshireDan Wood, NHS Nottingham City CCGIan Trimble, Connected NottinghamshireContributorsPaul Gardner, NHS Nottingham City CCGAndy Peers, NHS Mansfield and Ashfield and NHS Newark andSherwood CCGThilan Bartholomeuz, NHS Newark and Sherwood CCGAndy Hall, NHS Rushcliffe CCGJeremy Lewis, Nottingham University HospitalsCaron Swinscoe, Nottingham University HospitalsMark Simmonds, Nottingham University HospitalsTracy Tyrrell, Nottingham City Care PartnershipAnna Simpson, Nottingham City Care PartnershipChris Packham, Nottinghamshire Healthcare NHS FoundationTrustSusan Clarke, Nottingham University HospitalsGavin Lunn, GPDebbie Pallant, Nottinghamshire Health Informatics ServiceApproval Date[To be inserted once approved by CCG internal process]Approving BodiesCCG IGM&T/ICT Committees for all publishing CCGsReview DateApril 2018Target audienceAll Nottinghamshire Health and Care providersPublic domainAll Nottinghamshire Health and Care providersPublic domainClinical Commissioning Groups strategy documents;Operating Framework 2016/17;The Caldicott 2 Review: To Share or Not To Share 2013;National Data Guardian for Health and Care Review of DataSecurity,Consent and Opt-Outs 2016;Circulation listAssociated documents2015-20Page 1Version 4.4

Nottinghamshire CCGsSuperseded documents2015-20IGM&T StrategyCCG vision for 2020NIB Personalised Health and Care 2020Using Data and Technology to Transform Outcomes forPatients and Citizens: A Framework for ActionThe Forward view into actionNottinghamshire Local Digital Roadmap (LDR)Nottinghamshire Sustainability and Transformation Plan (STP)CCG Data Management StrategyCCG IGM&T Strategy version 3.1CCG IGM&T Strategy version 2.1CCG IGM&T Strategy version 2.0CCG IGM&T Strategy version 1.0Page 2Version 4.4

Nottinghamshire CCGs2015-20IGM&T StrategyPage 3Version 4.4

Nottinghamshire CCGsIGM&T StrategyExecutive SummaryWith an increasingly challenging financial environment, cost savings and efficiencies that areaffecting the whole health and care economy. The NHS has been tasked by NHS England to changethe way that it delivers care in order to reduce cost whilst still improving the quality of care. Whilst itis recognised that there is an increasing financial burden on health and care organisations, by beinginnovative in how current and new technologies are utilised, efficiencies can be driven not only bycommissioners but also in primary care and the wider health and care economy.Information and technology can bring enormous benefits by making the delivery of care moreseamless and efficient. It is vital in supporting improvements in health and wellbeing, organisationalefficiencies and is pivotal to good quality care. By utilising technology the CCG can help patients tounderstand how to improve their own health, to know what their care and treatment choices areand to assess for themselves the quality of services available to them.This Information Governance Management and Technology (IGM&T) strategy sets out the keydeliverables and the Governance required supporting the delivery of these: and modernising health and care IT systemsImproving Communication across the health and social care communityImprove patients’ access to informationIntegrating primary care systems with other health and care systemsSupporting patients care through e-consultation, tele-care, tele-health and tele-medicineUse of data analysis to inform clinical behaviour and commissioning decisionsGovernance and accountability requirementsThe delivery of this strategy directly supports the ambitions of the Nottinghamshire Sustainabilityand Transformation Plan (hereafter STP) by providing the tools to support Nottinghamshire inreducing the Health and Wellbeing, Care and Quality and Finance and Efficiency gaps. This strategysets out how Information and Technology will support NHS Nottinghamshire Clinical CommissioningGroup’s future vision for a digitally mature health and care profile over the next five years, theimportance of Information, Management and Technology (IM&T) within the health and social carecommunity and how IM&T will best support the links between health and social care providers andcommissioners, which will be essential in delivering a comprehensive service.In order to deliver the ambitions of this strategy a true system-wide approach is required in order tomeet both the clinical and operational demands across the health and care economy. To achievethis, a close multi-professional collaboration between all system partners, both across theprimary/secondary care divide and into the Mental Health and Social Care sectors is required. Thesepartnerships should be clinically led and help steer the direction of travel for system wideInformation Governance Management and Technology developments. Working in this way willensure that joint ambitions are aligned to the collective requirements of each organisation, andimportantly linked to clinically meaningful changes and outcomes.This document is an enabling strategy to support Health and care transformation and should be readalongside other key strategic documents identified later in this strategy. It supersedes the CCGIGM&T Strategy version 3.1 for 2016/17 and sets the strategic direction over the next five years.Driven by the National Information Boards (NIB) paper in support of the NHS Five Year Forward Viewand clarity on the digital maturity framework, this strategy informs not just the local requirementsbut also takes into consideration the organisational attributes expected from external providers.2015-20Page 4Version 4.4

Nottinghamshire CCGsIGM&T StrategyIntroductionRapidly advancing technologies have revolutionised the way we interact with each other in everydaylife. Industry and the commercial sector have changed profoundly and technology now has theability to enable a similar change in health and care services, shifting the relationships betweenpatient and clinician towards one of shared decision-making. These changes are also influencing thebehaviours between commissioner and provider towards one that is commercially beneficial andfocused on working in partnership or alliance.A critical element of the National Information Board’s national vision is local design and deliveryagainst the identified national objectives. Clinical Commissioning Groups (CCGs) became accountableon 1st April 2016 for the production of local digital roadmaps working with local authorities, localproviders, and other local stakeholders to set the direction for fully interoperable digital records.This is the fourth version of the Information, Governance, Management and Technology (IGM&T)Strategy for CCGs across Nottinghamshire, and sets the scene for the organisational attributesexpected from providers.Achieving interoperability and the integration of systems within Nottinghamshire is critical to enablesuccessful communication and information sharing between clinical teams and the wider health andcare economy including; primary, community, secondary, mental health, social and third sectorservices. Information should be recorded once, at first contact and shared securely with thoseprofessionals with a ‘legitimate’ patient relationship in providing care. Information is a service in itsown right, and local digital maturity will be closely monitored by the CCGs following nationalguidance, tools and standards set out within the NHS England Interoperability Handbook.The Five Year Forward View made a commitment that, by 2020, there would be “fully interoperableelectronic health records so that patient’s records are paperless”. This was supported by aGovernment commitment in Personalised Health and Care 2020 that ‘all patient and care recordswill be digital, interoperable and real-time by 2020’. Radically new care delivery models supportedby new payment arrangements which are value and outcome based are driving the need for change.This requires information to flow more effectively across health and care to support the delivery ofdirect care to the patients/citizens.Nottinghamshire’s STP identifies Technology Enabled Care as one of its themes in order to deliverthe ambition set out in national policy, the vision is to gain a number of ‘quick wins’ where digitalenablement has already made progress whilst continuing to develop strategic information systemsand make improvements in the system wide infrastructure.Nottinghamshire’s vision for supporting the STP, the five year forward plan and 2020 objectives is toprovide the capability for paper free at the point of care through the digital provision of; The Right InformationTo be available at the Right PlaceFor the Right PersonTo make the Right DecisionsAt the Right Time AlwaysNottinghamshire’s focus on existing and planned transformation programmes/projects such as:Vanguards, Prime Ministers Challenge Fund, GP Access Projects, Care Act Trailblazer and IntegratedCare Pioneers, supports the vision that Nottinghamshire should always be one step ahead inproviding the digital enablers so that transformation can happen without waiting for technology.2015-20Page 5Version 4.4

Nottinghamshire CCGsIGM&T StrategyThis work will ensure that Nottinghamshire is able to achieve the 2018 and 2020 NationalInformatics Board milestones.This five-year strategy shows how Information Management and Technology will support the aimsand ambitions of Nottinghamshire Clinical Commissioning Groups, and, the health and social carecommunity in the delivery of the ambitions of the STP. The objectives within this document dependon all stakeholders having an up-to-date and robust IT infrastructure combined with modernoptimised systems which provide good quality and relevant information. For this reason the DigitalMaturity of all providers across Nottinghamshire will be monitored through the Digital MaturityFramework – a national requirement for providers to submit details of their digital readiness.Technology enables the use of information when and where required for the best clinical,operationally effective delivery of care. The key elements to IM&T investment are: Infrastructure (the physical hardware used to interconnect computers, users and services);Systems (the clinical applications that provide staff, managers and clinicians with the toolsand information to perform their tasks safely and efficiently and developing systems to allowpatients to have improved access to services)Accessibility (improving patient/citizen and clinician access to information)Support (needed for all organisations involved including CCGs; Primary care; communitycare, acute and mental health secondary care; and Social Care);Change Management (the management of change and development needed within Healthand Care organisations);Transitional Management (necessary in managing an institutional investment and enable themerging of funds and pooled resources).Where Are We Now?The CCGs were given delegated responsibility for GP IT Systems and infrastructure, clinical systems,IT support and maintenance, networking, information governance support for primary care,software licences and hardware management which allows the direct influence of the Primary Caresystems.The CCGs hold a Service Level Agreement (SLA) between their informatics service provider and theGP Practices. This SLA identifies and details all the elements necessary to maintain IT services. Itprovides a framework for the provision of specified services including operational support, desktopsupport, network support, application support, programme management and business change,training and telecommunications, where locally agreed and funded.Nottinghamshire CCGs, through Connected Nottinghamshire, have supported the digital agenda bybringing together outcomes from both the STP and Local Digital Roadmap (LDR) to inform theirstrategic direction. Across Nottinghamshire health and social care organisations including thirdsector partners have helped deliver an exemplar LDR document, in which our joint ambitions toachieve the 2020 vision have been documented.Nottinghamshire has identified five key work stream areas (information sharing, infrastructure,patient access to their records, digital maturity and assistive technology), each of these workstreams have an executive lead and will have oversight of key projects identified to enable deliveryagainst the objectives of the LDR. Further work including a gap analysis with STP teams will beundertaken in order to ensure that delivery is aligned to the priorities of the STP. Some key projects2015-20Page 6Version 4.4

Nottinghamshire CCGsIGM&T Strategyare already well into the delivery phase such as Medical Interoperability Gateway (MIG),Nottinghamshire Health and Care Portal and GP Repository for Clinical Care (GPRCC).Nottingham IT Managers (NITMAN) is a well-established core infrastructure group whose membersspan across health, social care, provider organisations and third sector partners. The objectives ofthis group is to, where possible, align organisations strategically across areas such as unifiedcommunications, system authentication, Wi-Fi and mobile working at all sites acrossNottinghamshire.The CCGs have formalised their transformation strategies for the next 5 years, with a number ofvanguard projects being delivered across Nottinghamshire. These transformational programmesrecognise there is a shift from secondary care to primary and community care delivery and a need tokeep more citizens, supported and healthy in their own home. IT is crucial in providing the tools toassist in the delivery of effective health and care services and enable the delivery of seamless,accessible care, improved outcomes, reduce inequalities and improve quality and capacity in thelocal health and care economy.As part of the integrated care models transformation work Greater Nottingham organisations havebeen working together to develop a new system of care. This work has helped emphasise theimportance of high quality data relating to both operational processes and events, and the clinicaloutcomes which ben

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