This document summarizes a presentation on new care models in the NHS. It discusses the integrated care pioneers program involving 25 sites integrating health and social care. It also discusses the 50 vanguards developing new models of care across 5 categories. Finally, it provides an overview of the technology support offered to vanguards and pioneers in 2016/17, focusing on 7 core themes like digital strategy and information sharing.

1. Our values: clinical engagement, patient involvement, local ownership, national support
New Care Models:
Pioneers and Vanguards
#futureNHS

2. 1. New Care Models Technology Support Offer 2016/17 –
Mark Golledge & Helen Arthur
2. Taking Forward Information Sharing – Indi Singh
3. Local Vision – An overview of the journey and learning to date from:
• Morecambe Bay – Paul Charnley, Interim CIO I3 Service
• Connected Nottinghamshire – Andy Evans, Programme Director
• Islington – Mark Futerman & Stephen Latimer, ICT Development and Support
• Tower Hamlets – Charles Gutteridge, CIO
4. Q&A with the Panel
Session Outline
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS

3. New Care Models:
The Context
Helen Arthur - Technology Lead
Vanguards Programme
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS

4. NHS Five Year Forward View
• Published in October 2014
• A shared vision across seven national bodies
• New care models programme key to delivery
• Focuses on both NHS and care services
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS

5. Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
National Information Board

6. Five Year Forward View
National Information Board
(digital strategy underpinning FYFV)
National Information New Care Models
Domain 1 Domain 2 Domain 3
Domain 4 Domain 5 Domain 6
Integrated
care pioneers
Integrated
personal
commissioning
Vanguards
Test beds
Healthy new
towns
Harnessing Technology
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
Strategic Context

7. Clinical
engagement
Patient
involvement
Local
ownership
National
support
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
Our Core Values

8. 1 Cornwall and Isles of Scilly
2 South Devon and Torbay
3 South Somerset
4 North West London
5 Islington
6 Camden
7 Waltham Forest, East London and City
8 Greenwich
9 Kent
10 Southend
11 West Norfolk
12 Stafford
13 Cheshire
14 Worcestershire
15 Nottingham City
16 Nottingham County
17 Greater Manchester
18 Sheffield
19 Blackpool and Fylde Coast
20 Wakefield
21 Airedale, Wharfedale and Craven
22 Leeds
23 Vale of York
24 South Tyneside
25 Barnsley
2
3
10
4
9
5 6
8 7
12
13
19
14 15
21
11
17 16
18
20
22
23
24
25
• The integrated care pioneers programme was launched in November 2013 and is focussed on the
integration of health and social care – with arm’s length bodies signed up to support pioneer sites to
develop their new integrated models of care
• The programme is supporting change and innovation at a local level, sharing learning across the pioneer
network – with support from national experts
• 25 sites have been announced –
some sites are also vanguards / IPC sites
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
Integrated Care Pioneers

9. 5 new models of care with a total of 50 vanguards:
Integrated primary and acute care systems
Multispecialty community providers
Enhanced health in care homes
Urgent and emergency care
Acute care collaboration
9
14
6
8
13
https://www.youtube.com/watch?v=BFJzCemX7AM&feature=youtu.be
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
50 Vanguards Developing their
Visions Locally

10. Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
50 Vanguards Developing their
Visions Locally

11. Our values: clinical engagement, patient involvement, local ownership, national support
New Care Models:
Information & Technology
Mark Golledge - Informatics Lead
Local Government Association
#futureNHS

12. Need for close alignment of activity and communications across the New Care Models
programmes, building on the work already delivered and responding to the feedback.
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
Developing a Streamlined Plan
Online
Learning
Environments
Information
and Guidance
Co-Design and
Learning Collaborative
Bespoke activity (and support where
required) to pilot / test new ways of
working or resolve challenges
Increasinglybespokeengagement
Activity which is shared with the wider
health and care system for wider use
/ deployment
Coordinated activity across the new
care models to capture learning
and produce common guidance /
case studies / evidence
Bespoke
Support /
Pilot Activity
Simplify
Standardise
Share

13. Digital strategy
Integrated systems
Information sharing
Digital citizens
Data for outcomes, research and commissioning
Remote assistive technology
Supplier engagement and procurement of digital services locally and at scale
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
Developing a Streamlined Plan:
7 Core Themes

14. Collaborate with others working on similar objectives to:
Ensure consistent
messaging
Maximise resources and
opportunities
Avoid overburdening
stakeholders
Align with national strategy/policy via the NIB and harness existing expertise
Look for opportunities to standardise and replicate (principles not systems)
Facilitate networking and sharing of problems, solutions, learning
Provide focussed support tailored to local vision
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
Principles of Working

15. • More intensive support / engagement with Vanguards and pioneers:
e.g. identifying front runners and fast followers to work with around the core themes
• Activity to capture learning / case studies / evidence across the New
Care Models:
e.g. as with work to produce blueprint for information sharing
• Activity to share and disseminate more widely with the rest of the health
and care system:
e.g. as with dissemination, webinars and regional workshops on information sharing
Our values: clinical engagement, patient involvement, local ownership, national support #futureNHS
What this Means in Practice

16. Building choice of high quality support for commissioners
Taking forward Information
Sharing
Indi Singh
Head of Enterprise Architecture

17. Building choice of high quality support for commissioners

18. Strategic context
Breaking down “interoperability”
What this means for professionals and citizens
Current priorities
Working in conjunction with localities and the market

19. End of life
cure
prompting key
preferences
Vaccinations and
immunisations
history
Visual
comparison
of medications
Prescribing
alerts
Encounter
timelines
Long term
conditions
(trending and
recall)
Pre-population
of pre-operative
assessment

20. The development of an open environment
for information sharing supporting
emerging models of care based on open
interfaces and open standards.
Open APIs
Open interfaces to enable information to flow
across a care pathway and to be accessed
across geographies
Local Integrated Digital Care
Records (IDCR) that link health
and social care as main
approach for delivering local
information sharing needs
Tight standards for key transfers of care
Local IDCRs Professional
Through my system I can
directly access and
contribute to summary and
detailed care information
Citizen
Using my PHR I can
access care information
about myself and
contribute information
PHR
Patient Record Index
Ability to locate patient record information that
can then be accessed through open APIs
Open interfaces from national
systems such as SCR to simplify
access and contribution.
Expansion of SCR for access by
additional care settings and
additional critical information.
Summary
Care Record

21. 97%Of localities using NHS Number as primary
identifier when sharing information
66%Of localities sharing discharge
summaries electronically
StandardsLevers Incentives Service change Technical Capability

22. Appointments
Manage appointments in order to
co-ordinate access to care
Access Record
Access a patient’s care record for the
purpose of direct care
Tasks
Manage tasks in order to work effectively
across care settings
eDischarge
Discharges from inpatient care back to
the general practitioner
A&E eDischarge
Information sent to the general
practitioner from an A&E attendance
Ambulance
Social Care
Referrals
Emerging needs

23. Creating a common and open set of APIs to support information sharing across health and care
Defining the key clinical information
sharing needs.
Prioritising the key APIs.
Group members e.g. CCIOs, CIOs,
Vanguard, Pioneers, PMCFs,
NHS England.
Outlining the accreditation approach
for APIs.
Group members e.g. TechUK, CIOs,
suppliers, HSCIC.
Defining the key underpinning components and
policies, e.g. security and authentication.
Group members e.g. HSCIC, suppliers, CIOs,
TechUK, NHS England.
Establishing and creating the required APIs
based on clinical information sharing needs.
Group members e.g. suppliers, innovators,
CCIOs, CIOs, NHS England, HSCIC.
Made up of the above organisations, the Project Board
is responsible for the assurance and governance process.
Links to existing
communities and
signposts tools and
products.

25. Informatics and Interoperability
Supports Better Care Together
Update from the IM&T workstream for Morecambe Bay Vanguard

26. Morecambe Bay
365,000 people
1000 square miles

28. Supporting the service redesign work
performed by the clinical workstreams
• Planned Care – working speciality by speciality
• Ophthalmology
• MSK
• Rheumatology
• Respiratory (etc.)
• Out of Hospital – Cumbria – Integrated Care Communities
• Out of Hospital – Lancashire - Integrated Care Communities
• Women’s and Children’s – Apps
• In Hospital

29. LPRES

30. QlikView

31. Integrated Analysis – Proof of Concept

32. Advice and Guidance/
Shared records
Real reductions in referrals
• up to 60% in some cases
• Direct access for imaging
Operational level
• Escalation and monitoring
• Tariff agreements
• Integration with EPRs

33. What is the National Replicability
Value Perspective
• Telehealth –the technology is standard but we have also developed standard operating
procedures and change management checklists for other organisations to follow.
• Shared Records –with LPRES and hospital access to SCR and MIG data form GPs we
are opening up new ways of working. This is underpinned with the Information Sharing
Gateway portal which is also used widely outside of the Bay
• Advice and guidance – as well as the technology we can provide a contracting model, a
change process and guidelines on how it could be implemented
• Dashboards and Data Warehouse – this work is probably being repeated around the
country but we can contribute by developing expertise in the handling of the disparate
data sets in realtime/neartime
• Community engagement – working with Millom to develop plans for the collaboration
between organisations and the community

34. Reflections/lessons learnt to date
• The Technology is the ‘easy bit’
• The technology exists and works ‘out of the box’
• Should we be?
• Clinically led and react/second guess emerging requirements; or
• Technology led and lead clinical and management thinking?
• There are many challenges in getting this technology implemented as follows:
• Knowing what is possible
• Sharing the vision between clinicians and managers and informatics people
• Not knowing exactly what is required and what will work – Think Big, Test Small, Scale Fast
• Dealing with multiple stakeholders and their agendas/IT plans whilst trying to work as a team
• Working against the “perverse incentives” such as being measured and funded on the basis of
activity you are actually trying to reduce.

35. Service Objectives 2016/17
• Close 2 inpatient wards (90 day process)
• Reduce consultant outpatient clinics by 25 clinics per week
• Save circa £5m in year - RoI on value proposition funding
• No impact on
• Trajectories
• Quality of care
• Challenge on funding for IM&T investment.

36. Connected Nottinghamshire
Programme established 2013
5 Vanguard Programmes (PACS, MCP, Care
Homes, U&EC and Acute Shared*)
3 Wave 1 Prime Ministers GP Access Projects
2 Better Care Fund Pioneers
1 Care Act Trailblazer
Population circa 1.2 million
Andy Evans, Programme Director

37. “Integrate /join up care using technology as an enabler”
The technology requirements are all the same
• Risk Stratification
– We use a local tool and the Devon Algorithm
• Information sharing
– IG sorted for direct care
– >80% of GP records available across health system
– Good Community Services sharing
– Mixed Secondary Care sharing
– Limited Mental Health sharing
– Some Social Care
• Electronic Workflow (tasks/actions/referral/notifications)
– eReferrals
– TPPs1 Tasks
– This is the hardest one
Workflow
Information
Sharing
Risk Strat
What are we really trying to do?

38. • The technical projects are easier than building the relationships
• If you don’t have good relationships you wont get where you need to
• Pretty much all new models of care need the same capabilities
• Its worth the time for the elicitation requirements work early –
because it will make life easier later and it will help the business
understand their issues
• Do not underestimate;
– The complexity of Data Quality and Records Management issues, these
will both create friction
– The time it takes to agree an IG framework for sharing
Lessons to share/we have learnt from others?

39. Mark Futerman & Stephen Latimer, ICT Development and Support
Local Vision – An overview of the
journey and learning to date

40. Up and running
• NHS Adapter: Ability to receive discharge notifications from hospitals and GP
referrals directly into Liquidlogic’s LAS using TDK Messaging.
Soon to be Completed
• Access to the PDS spine from LAS (our social care system)
Current
• The IDCR/IPHR: The Integrated Digital Care Record (for professionals) and
Integrated Personal Health Record (for residents).
Selected Health and Social Care Integration Projects

41. • Allows us to receive notices of Admission, Discharge and Discharge Cancellation from a
partner hospital (the Whittington, Royal Free goes live soon) via Quicksilva’s adapter service.
• A template is completed by ward staff within the hospital’s PAS system and sent via nhs.net
to an email address hosted by Quicksilva.
• The adapter converts it into XML and sends onto our LAS via GCSx.
• This appears as a task in LAS and is automatically placed into the group worktray of the
appropriate team (e.g. GP referrals are received by the Access team).
• We are a pioneer authority. HSCIC have confirmed that it is likely that this will be taken up
nationally.
NHS Adapter

42. • Enables nominated LAS users to verify LAS demographic data against data
held about people on the NHS Spine.
• The PDS does not hold any clinical or sensitive data items such as ethnicity
or religion. The PDS is a component part of the Spine.
• The Spine is the name given to the national databases of key information
about service users’ health and care.
• Users need smart keyboards and a Smart card; and to be registered with the
NHS registration authority at the Whittington.
PDS
(Personal Demographics Service)

43. • The IDCR will allow health and social care professionals in Islington to view
records containing collected data from multiple data sources for individuals
they help.
• The IPHR will allow individuals within the borough to view their own records
and will include some elements which they will be able to modify.
• Phase 1 go-live date provisionally set for September 2016.
• Phase 1 partners include the Whittington, the Out of Hours Service, Camden
and Islington Mental Health Trust, University College Hospital and the London
Borough of Islington (Adults and Childrens services).
• The consent model likely to be adopted will be explicit.
The IDCR and the IPHR

44. Portal Services
Electronic
Master
Patient
Index
Integration Engine
BT Developed Adaptors to Clinical and Social Care Systems
Clinician
Context
Management
Patient
Summary
Charts Detailed
Care
Record
Secure
Messaging
Clinical
Document
Editor
Appointments Secure
Messaging
Charts Health
Links
Clinical Provider Portal Patient Portal
UCLH
Interface
Whittington
Health Interface
EMIS Web
GP
C&IFT
Interface
OOH/
Adastra
BT Data
Centre
Health
Platform
Audit
Logs
Analytics
and
Reporting
Products
Clinical
Data
Repository
Social Care Worker Patient / Carer
Social
Services
Spine Smartcards / Soft-Token Two Factor
Authentication
N3 and internet
Royal Free
Interface
Homerton
Interface
London
Ambulance
EOL/
CareUK
NMUH
Interface
Moorfields
Interface
CNWLFT
Interface
IDCR/IPHR
Logical Architecture Overview

45. Possible View of IPHR

46. Charles Gutteridge
Creating value:
The Tower Hamlets Vanguard

49. What is an MCP – Key Characteristics

50. 3 Core Elements for Transformation
• A people health data movement
• Empowering clinicians with point of care information and
outcomes data
• Developing data for population health

54. Riskstratification
Co-ordinatedcare
Reduce
emergency
attendances
Reduce
emergency
admissions
Improve
outcomes
QAdmission®
algorithm
(Consent)
(Enrol)High
Moderate
Low
Very low
Very high
East London Integrated Care Programme

55. Background
• Provision of care
Multiple teams across local health economy
• Current metrics
SUS data - not actionable in real time
• Suggestion
Focussed datasets using live information, used by teams

56. Patient at
home
Social
Care
Mental
Health
Primary
Care
Barts Health
Community
Teams
Condition
specific
ArCaRe (COPD)
Heart Failure
Diabetes
Palliative Care
Learning disabilities
Integrated Care
TH: Care navigators
WF: IC Co-ordinators
NH: Rapid Response
DISCHARGED
Inpatient Teams involved with
discharge planning
DISCHARGED
DISCHARGEDDISCHARGEDEmergency
Department
DISCHARGED

57. NHS numbers of patients enrolled on IC
(List supplied by CSU)
NHS numbers of subgroup: co-morbidity = x
(Based on Read code for ‘x’ in GP record)
Interrogate Barts Health datawarehouse
(ED attendance, IP admissions)
Deriving Actionable Datasets Using
Existing Metrics
Focussed, actionable data used by clinical
teams

58. Output: e.g. Patients with COPD

59. Clinical Analytics Service
• Training and learning
– Data science seminars
– Mentoring and 1:1
• Desktop data extraction
• Advisory service
– SNOMED expertise
– Data visualisation
• Data linkage