Journey's End: Overcoming Challenges, Transforming IT Infrastructure, and Enabling Unified Communications

1. Journeys’s End?Dr Ian HulmeGoverning Body meeting held in public27 February 2019

3. 2013 • Multiple clinical systems • Multiple email systems • Limited access to patient records • End of life legacy systems with no support • Diverse network hardware and software • Incompatible systems • Limited options for remote working

4. 2013 Challenges • Multiple domains, complicated infrastructure, difficult to support • Servers in practices need on-site support, maintenance and back up • Unsupported legacy systems caused significant issues • Systems were not patched consistently, leading to security breaches • System wide management was not achievable – IT support had to be on site. • Flexible working across practices was not available

5. 2014 > Caring Together • Caring Together IT Group Formed • Agreed with partners to deploy a flexible working environment across a wide foot print, including health and social care • Agreed with partners to support the development of the Cheshire Care Record a replacement for the Cheshire Health Record • Agreed with partners to raise the level of Digital Maturity.

6. 2018 Summary • EMIS across all practices across Cheshire • NHS Mail used consistently across all practices • Cheshire Care Record deployed • Major 4 year programme to upgrade infrastructure completed • Flexible working enabled across the Cheshire footprint for Health Workers. • Systems managed centrally at CSU level • Hardware and software now fully supported • New security processes and systems in place

7. 2014 – 2018 Network • Eastern Cheshire CCG instigated the new community of interest network (COIN) and brought in partner CCGs South, and West Cheshire and Vale Royal • This now connects all the practices across the Cheshire footprint. • This also resulted in an upgrade to all the systems on the network including local switches. These now have full hardware, software and security support • We can now deploy management systems and software updates centrally and reduce the amount of hardware required to support services. (For example we can now deploy a single Wi-Fi controller supporting multiple sites, instead of installing one for each site)

8. 2018 - NWSIS • The Cheshire CCGs agreed to set a common set of security and network standards by joining the North West Shared Infrastructure Service (NWSIS) • Systems and individual PCs can now be deployed to a common standard and any issues in common resolved centrally • Ensures all locations are at the same level of anti- virus software and any intrusions are picked up immediately. • (At the time of writing the CSU picked up an intrusion that identified the compromised PC and re imaged it within an hour)

9. 2018/19 Removal of Local Servers • The removal of servers in practices, will be completed in 2019. • During 2018, where possible local services were moved to the cloud • Cloud services include Docman 10, and Lexacom Digital Dictation • All remaining data will be moved to the ECT data centre • Users will have remote access to systems and data from any location using Horizon VM Ware. (available to all staff) • Systems will now be maintained, secured and backed up by the CSU • Cloud systems – will be maintained directly by the service providers • Local practice staff will no longer maintain and back up these systems.

10. UNIFIED COMMUNICATIONS • The new network has enabled access to the Cheshire Unified Communications system, including phone exchanges • These exchanges are replicated in Crewe and Chester and have sufficient capacity to support all Cheshire practices and trusts. • Eastern Cheshire have so far installed Cisco phones in 9 practices, with a further 6+ scheduled for 2019. • The system provides considerable savings in call costs as well as providing business resilience. • The unified communications system has the potential to support video, telephone and web conferencing, as well as presence and instant messaging facilities. • The long term ambition is for all health and social care staff to be connected on this one technical platform.

11. Current Programmes • The CCG has invested in the generation of electronic correspondence from local trusts. The rewards in terms of financial saving, reduction in clinical risk and efficiency savings are significant, easily running into 7 figures. This is an ongoing programme conducted with our Cheshire CCG partners. • The increase in cloud based services has put pressure on local MPLS network connections. The CCG now has funds to expand current practice links to full fibre 100mb links. The new links will be rolled out towards the end of the financial year 2019/20. • The new security mandates introduced by NHS Digital now mean we have to keep licences and software patching up to date. They have mandated that the NHS estate move to Windows 10. The CCG has made significant in roads into moving the estate to Windows 10, including the replacement of hardware that is not compatible. • In addition to Windows 10 we are required to update server licences, productivity software licences and review and replace any services that are not compatible with the new security measures or operating systems. • Govroam – Eastern Cheshire CCG on behalf of all the Cheshire CCGs are investing in Govroam a product approved by the STP , which will be used to bring organisation together

12. Personal Care record NHS England funding has been awarded to develop an electronic “patient passport” in the Cheshire East region. This development initiative will enable local people to unlock care information held about them, and have direct control over how the information is utilised to manage their own health needs: • Citizen needs come first through open and transparent information exchange, with ability to self manage conditions or care interests. • Provide citizens with control over information about them - their ability to view it on their own device, and decide who to share it with, and when. • Provide citizens with the option where possible, to view correspondence, health information, and appointments electronically rather than through the post. • Provide citizens with the ability where possible, to upload health and wellbeing measures for monitoring and potentially management of health goals. • Provide citizens with the ability where possible, to interact with professionals in real time. • The solution components should be integrated such that the user has one gateway interface as far as possible. • The solution should have a single registration, with single sign on to other Council citizen services where possible (for example, Live Well Cheshire East, online self assessments, social care billing/payments, council tax payment, etc.).

13. Future Risks • The centralising and standardisation of the system will ensure a more secure and efficient system overall, but also changes the nature of risk. • Isolated systems meant isolated issues, centralised systems can result in a single point of failure. • This has been mitigated by the deployment of systems that can be accessed in multiple ways: • Practice staff can move to other NWSIS sites • Information can be accessed from any internet connection • Single points of failure such as the ECT site have been mitigated by moving most of the critical data into the cloud and by replicating the network management services such as active directory across the network.

14. Future Strategy • The CCG is in a good place to respond to change, in that the new services, embrace flexible working both from an organisation and location point of view. • We will continue to work with our partner organisation on joint strategies, procurement and programmes. • We will continue to improve services and after a time of unprecedented change, will look to consolidate those changes and ensure that legacy issues are resolved before moving on. • Locally we will ensure that we maintain a good level of Digital Maturity and continue to work on improving business resilience.

15. The NHS’s milestones for digital technology, as set out in the NHS Long Term Plan: • During 2019 we will introduce controls to ensure new systems purchased by the NHS comply with agreed standards, including those set out in The Future of Healthcare [the preliminary policy paper published last October, which set out Matt Hancock’s digital vision for the NHS]. • By 2020, five geographies will deliver a longitudinal health and care record platform linking NHS and local authority organisations, three additional areas will follow in 2021. • In 2020/21, people will have access to their care plan and communications from their care professionals via the NHS App; the care plan will move to the individual’s LHCR [Local Health Care Record] across the country over the next five years. • By summer 2021, we will have 100% compliance with mandated cyber security standards across all NHS organisations in the health and care system. • In 2021/22, we will have systems that support population health management in every Integrated Care System across England, with a Chief Clinical Information Officer or Chief Information Officer on the board of every local NHS organisation. • By 2022/23, the Child Protection Information system will be extended to cover all healthcare settings, including general practices. • By 2023/24 every patient in England will be able to access a digital first primary care offer. • By 2024, secondary care providers in England, including acute, community and mental health care settings, will be fully digitised, including clinical and operational processes across all settings, locations and departments. Data will be captured, stored and transmitted electronically, supported by robust IT infrastructure and cyber security, and LHCRs [Local Health Care Records] will cover the whole country.