Strategy and business plan

1. Strategy and business plan July 2019

2. Background and objectives • This strategy and business plan refreshes our five year strategy at year four in its delivery • We have developed the strategic objectives, business plan and priorities through widespread discussion and engagement with our members via the Advisory Board, the Board and PRSB clinical advisers • Our objectives and priorities for 2019/20 reflect the national drivers and priorities and strategic needs: • NHS England Long Term Plan • The future of healthcare: our vision for digital, data and technology • NHS Scotland Digital Health and Care Strategy, • NHS Wales Informed Health and Care, • NHS Northern Ireland eHealth and Care Strategy • The following sections provide: • A summary of key points captured from discussions with the Advisory Board, Board and clinical advisers. • The revised strategic objectives, deliverables and measurable outcomes • A new set of standards priorities for development – prioritised by clinical advisers and executive team (see criteria appended below) • The 2019/20 financial plan – developed and agreed by the finance committee.

3. What we heard from advisory board members – 17 October 2017 Key themes from our board and members’ • The five broad priorities of our strategic plan continue to hold true • 1. Our work on the core information standard (CIS) has clearly shown the importance of putting people at the centre of our work and we expect this to be a major feature in 2019/20 including people playing leading, influential roles in our projects, the pre-eminence of non-clinical ‘about me’ information, supporting people to take more responsibility and control of their own records and care management, increasing the numbers and diversity of people involved in our work.   • 2. Social care is further back in adopting standards and structured records than health and work undertaken as part of CIS and by SOCITM have illustrated the cultural, educational and technical work that is required.  We expect social care and in particular the integration of health and social care to remain a key theme and priority for PRSB in 2019/20.  We wish to proactively support the social care pathfinder projects that seek to introduce new standards in key and innovative areas of social care provision. • 3. There is a continuing strong demand for standards and a feeling that the focus has been overly on acute/medical pathways. Further work is needed in community based pathways, social care and other specialist areas of care.   • A summary of requirements identified by our members is included in slide 12. • 4. There is a strong appetite to see more support from PRSB to help achieve implementation of standards.  Key topics highlighted were: • working more closely with system vendors on clinical connectathons, best practice user interfaces (LHCR), accreditation of conformance with standards • clinical implementation tools, case studies, guidance related to specific standards • educational materials for onward sharing with the professions, CCIOs etc about digital generally, the importance of standards, e-learning, and how to integrate standards into practice .

4. What we heard from advisory board members – 17 October 2017 Key themes from our board and members’ 5. Our members have highlighted a need for more joined up and coherent messages from the centre and a focus on providing front-line implementers with clear, unambiguous guidance on what they need to do.  This includes disparity between different clinical and technical components of standards, misaligned datasets and standards for direct care, conflicting incentives (eg PRSB standard versus ISN).  PRSB need to unite with central bodies to create this consistent messaging.   6. Our unique multi-disciplinary membership and the powerful networks they give access to is our greatest strength.  Our members think the natural organic growth should continue and be encouraged.  The inclusion of regulators should be considered as part of this and new members should be welcomed wherever it will improve the quality of standards, spread and reinforce understanding of the need for standards and where it will encourage and enable adoption. (PRSB is reviewing its targets for new membership including faculties and regulators with an interest in health and care information sharing and standards.) 9 The core information standard driven out of the LHCR programme is recognised as a potential  game changer. It has delivered us a world class asset in terms of an overall detailed information model that will provide a reference point for all other standards which we must preserve and nurture.  Members recognise that implementation of the core information standard has profound implications for how clinical care is delivered, how patients engage with their own records and information and are enabled to manage their own health and care and how issues, information governance and security of patient data is handled in a world where information is highly integrated and centred around the person.  PRSB members expect this to be a major focus for the coming year and several thereafter.   10.  Continuing issues with funding have shown that whilst PRSB is highly valued, the business model and dependence on one or two main sources of funding is fragile and risks the future of the organisation.  We plan to actively seek alternative sources of recurrent income that are in line with/complement  our core purpose and mission.  We will also investigate opportunities to defray the cost of our infrastructure and reduce overheads.

5. Strengths and weaknesses SWOT ANALYSIS • Weaknesses of the PRSB • Over-reliance on one to two sources of funding inhibits our independence and influence  • We are dependent on partners in NHS X and NHS D for successful deployment and implementation of standards • Scotland, Wales and NI are increasingly involved but not yet fully committed including funding and piloting/adopting standards  • Lack of strong evidence base and evaluation of impact of implemented (coded) standards • Our work and the potential of our members to play a supporting role in adoption of standards is not universally recognised by key stakeholders. Strengths of the PRSB • Engaging patients, public and carers in our work • Unique multi-disciplinary membership with common ethos and purpose for consultation and advice • Good social care coverage • Rapid and trusted access to extensive networks and frontline practitioners through membership • UK wide coverage • Excellent track record of delivery of standards based on extensive knowledge and expertise • Ability to work flexibly and agilely and apply our strengths to solve problems   • Robust infrastructure and governance • The LHCR core information standard has produced a considerable asset and high quality, robust reference framework for all future standards captured in a tool that enables professional management of the asset. • Alignment of NICE guidelines helps drive system behaviour towards standards.

6. Opportunities and threats SWOTANALYSIS • Threats to the PRSB • The tough financial climate could impact on any discretionary expenditure in health and social care and there is a concern about the transition to NHS X and hiatus as the new organisation establishes priorities. • The NHS Digital competitive tender of standards could damage the confidence of our members and destabilise the organisation as well as consume continuous effort in bidding activity. • The policy mandate for clinically led standards is not understood or enforced at programme level, hence adherence to standards is patchy and undermines the efforts of front line implementers. • Datasets and standards are developed separately and follow different enforcement mechanisms (ISN versus PRSB/NHS contract) causing misalignment and confusion on which to follow at the front line and this undermines standards in total. • Application of standards in the private sector – there is no policy guidance or incentives in place - which could undermine standards and principles of integrated care. • NHS England/NHS Digital develop standards using local professionals or other networks. • There is not an agreed end to end model for adoption of standards. Opportunities open to the PRSB • Create powerful patient presence and community who are highly influential regarding standards and use of digital technology. • Supporting local health and care systems to adopt the core information standard to create integrated care records by building upon our work with the Local Health and Care Record programme at a national and local level. • Build on our vendor engagement to work with individual vendors on use of the core information standard and accreditation. • Form strategic relationship and alignment with NHSX and exploit the opportunity to redefine our work; support implementation more and use our members to influence system-wide strategy and policy. • Converge data collected for secondary uses with standards for direct care (through DSAS process) • Gain ISN status for all PRSB standards. • Joint survey/consultation with the Academy gives us far stronger voice and opportunity to agree conclusive actions with govt and develop skills and approach of crowd sourcing. • Diversify our sources of income through new business lines (MHRA and accreditation). • Consider options to increase capability and reduce overheads of running an independent organisation. • Care provider support (CASPA) - great opportunity to engage with care home sector.

7. Opportunities and threats Key achievements 2018-19 Integrated care  • Delivering a comprehensive and well supported core information standard that will provide the reference model for future standards.  High quality delivery • With the demise of HIU we have successfully taken development in-house reducing our costs and improving the quality and consistency of our product. • We have continued to deliver high quality standards that have broad support across disciplines – the standards produced in 2018/19 include: • Maternity Care Record standard, • Digital Medicines Information Assurance, • Pharmacy Information Flows standard, • Document Naming standard, • Digital Clinical Referral Information standard • Ambulance Handover standard • Pathology Assurance • Structure and Content of Health and Care Records • We have delivered practical solutions for some of the problems that have been intractable and unresolved for many years eg interoperable medications and diagnoses recording  Patient engagement • We have significantly improved engagement with the addition of two patient representatives on our assurance committee and the launch of the Patients as Leaders programme as well as the recruitment of patient organisations including Patient Information Forum, Health and Social Care Alliance Scotland, Compassion in Dying. Our Patients as Leaders has driven far greater patient involvement and influence in projects eg Local Health and Care Records, tweetchats to drive diversity. 

8. Opportunities and threats Key achievements 2018-19 Engagement of professionals and profile - growth in membership includes 11 new members: • Faculty of Public Health, • Faculty of Clinical Informatics, • Intensive Care Society, • Health and Social Care Alliance Scotland, • E Health Ireland, • Compassion in Dying, • Royal College of Ophthalmologists,   • Patient Information Forum, • Community Practitioners and Health Visitors Association, • British Society of Orthodontists, • College of Optometrists • Our LHCR consultation attracted great interest with input from 1350 people and organisations  Methods and processes • Embedded Art Decor tool to support professional management of our core information models  • Endorsement of discharge summary by NICE with reinforcing link to NICE guidance - proving the principle of system alignment More effective endorsement policy introduced  • Developed a more agile, flexible approach to projects and solutions orientation to meet customers needs eg interoperable meds completed in 3 months, LHCR in 5 months, DWP project  UK and International reach  • Built far more active engagement of colleagues in Scotland including leadership of digital medicines information assurance project  • Stronger engagement with Wales, and potential for sharing work/piloting explored with Australia implementing child health record. 

9. prsb objectives Priorities Objectives Outcomes • Patient voice is dominant in our projects and influences our work • PRSB’s reputation for patient engagement is recognised as strength and emulated • People say they feel more empoweredt and their participation and diversity is measurably strengthened. We will prioritise patients, carers and citizens and ensure they are present and powerful in our work. Putting people at the heart of our work High quality, valued work for health and care system We will deliver high quality products in line with our principles and assurance criteria that promote the development and use of standards. . • Our reputation for high quality standards grows • More standards are implemented and lessons learned from their use are fed back in to improve and refine them. • Core infrastructure costs are covered by recurrent income from 2020/21 • 30% income from sources other than NHS X and NHS D • New product offers and service lines operational (accreditation, notifying authority). We will explore and implement a new business model to diversify and stabilise income and reduce costs to ensure sustainability. Creating a sustainablebusiness Income from new customers and products £150k • PRSB membership rises in line with our priorities; awareness and advocacy by members increases through participation by Advisory Board reps, CCIOs and frontline professionals. • Increased web traffic and social media stats (twitter strategy) • Increased number and diversity of patient/carer involvement in all areas of our work. • . We will raise awareness of PRSB and increase its influence by recruiting new members and identifying priorities across the four nations of the UK. Building influence and engagement • Business model operating that meets members’ and stakeholders’ needs, enabling staibility and growth • Flexible resources meet varying project demand • Clearly documented methods and processes guide our team • Advisory Board and members are active on our behalf. Developing the organisation We will develop PRSB to be fit for purpose and to deliver the new business model. .

10. Objectives and key actions • 1. Putting people at the heart of our work Strategic Objective 1: Key actions/timeframe/leadership We will prioritise patients, carers and citizens and ensure they are present and powerful in our work. Deliverables 2019-20 Patient community doubles and is more diverse. Policies and practice on patient records (eg LHCR ‘About Me’ infomration)and personalised care is being implemented. Patients as Leaders is embedded in assurance proceses. Outcomes and indicators of success 2019-20 Double the numbers of members of the patient community and diversity participants in PRSB programmes and leadership in developing standards by Dec 2019. All public-facing communications are judged by patients and citizens to be accessible and written in plain English. Clear proposals are agreed and decisions about commissions on LHCR ‘About Me’ and NHS X personalised care plans are decided by Autumn 2019.

11. Objectives and key actions • 2. Deliver high quality, valued work for the health and care system Strategic Objective 2: Key actions/timeframe/leadership Deliver high quality products in line with our principles and assurance criteria that promote the development and use of standards. Deliverables 2018-19 Work programme set by AB, Board, NHS X and NHS Digital. NICE endorsing PRSB standards; NICE guidelines and PRSB standards for maternity care aligned. CQC/NHS endorsement to support standards and conformance. DSAS plan for dataset alignment – MH dataset to start. Outcomes and indicators of success 2019-2020 Our reputation for consistently meeting contract requirements with customer satisfaction good/very good grows with delivery on schedule; System alignment resulting in conformance to standards viz NICE endorsement of standards progressed with child health standard endorsed and others to follow; alignment of NICE guidelines with PRSB standard for maternity care. MH dataset aligned to PRSB standard and ISN issued. Discussions with CQC and NHSI advanced on endorsing conformance to information standards as part of regulatory regime.

12. Objectives and key actions 3. Creating a sustainable business Strategic Objective 3: Key actions/timeframe/leadership Explore and implement a new business model to diversify and stabilize income and reduce costs to ensure sustainability Deliverables 2019-20 Options of alternative funding models fully developed including overhead reduction; plus implementation plan for preferred option. Work programme and costings fully costed and timetabled. Outcomes and indicators of success 2019-20 Core infrastructure costs covered by recurrent sources of income from 2020/21. 30% of income from other sources than NHS X and NHS D. New product offers and service lines in operation (accreditation, notifying authority).

13. Objectives and key actions • 4. Building influence and engagement Strategic Objective 4: Key actions/timeframe/leadership Raise awareness of PRSB and increase its influence by recruiting new members and identifying priorities across the four nations of the UK. Deliverables 2019-20 Findings of AoMRC/PRSB consultation with the medical profession and action plan to support f digital transformation. Digital Health - PRSB online workshops on standards; CCIO/CIO network engagement. Twitter strategy to increase our following by 50%. Outcomes and indicators of success 2019-20 Targets for membership growth are identified and met; increased involvement of member organisations in promoting standards adoption PRSB role in Digital Health online workshops raises profile with CCIO/CIO/CNIO networks 50% growth in Twitter following

14. Objectives and key actions • 5. Developing the organisation Strategic Objective 5: Key actions/timeframe/leadership Develop PRSB to be fit for purpose and to deliver the new business model Deliverables 2019-20 New business model in operation that enables stability and growth of PRSB. Resources have flex to meet range of project demands. Methods and processes fully documented to guide delivery Advisory Board and members active on PRSB’s behalf. Outcomes and indicators of success 2019-20 New business model delivers sustainability and growth and is recognised as meeting the needs of members and stakeholders. Each member organisation has agreed what activities it will undertake to support the work of the PRSB and has a clear programme to deliver those objectives. PRSB and its partners are able to flexibly resource work including growth.

15. Our standards and priorities add value to the health and care system Future priorities: Developing Completed • Transfer of Care standards • E-discharge (NICE endorsed) • Mental health discharge • Emergency care discharge • Outpatient letters • Clinical referral information • Digital Medicines Information • Pharmacy Information Flows • Integrated care standards • Healthy Child Record • Maternity Care Record • Digital Care and support plan • Cross-government • Employment status– DWP • Other • Document naming standard • Alcohol and tobacco use recording • Diagnosis recording • Integrated care standards • Core information standard • Pharmacogenomics (alerts) • End of Life standards consolidation and implementation (EPaCCs) • Social care pathfinders assurance • Standard for pathology coding- (phase 1) • Ambulance to ED handover and UEC datasets • Other • Sports medicine • Mouth health • Integrated care standards • LHCR further releases • Pathways and specialist care plans • Radiology imaging standards • Decision support/SNOMED (NICE) • Prevention/wider determinants of health • NHS secure mail to care homes • Sutton red bag • Social care standards for domiciliary care, care homes, and disabilities • Patient-centred care • Standards for apps • Shared decision making • Hospital and care passports • Functional assessments • Other • Safeguarding • Anaesthetics • Safety incident reporting • Standard for genotype+phenotype data

16. Financial plan for 19/20 • Working with NHS X to create an alternative funding model for PRSB as sponsorship shifted from NHS Digital to NHS X in June 2019-20. Options include developing new recurrent business streams outwith NHS X as well as agreeing a forward work programme with NHS X/D/E. New project income is delayed due to NHS X reviewing its programmes and funding; PRSB is working with NHS X/D/E to develop the forward work programme. • £140k of income is 'projected' for the second half of the year. • Support and maintenance funding from NHS Digital – planned to continue through March 2020. • PRSB will continue to focus on internal project delivery and enhancing its skills and expertise, allowing greater control over costs and margin. • Costs are being continually scrutinised to ensure tight controls on spending and to maximise financial sustainability.