« Previous | Contents | Next »
Listen
8 Delivering the Strategy
This section covers the arrangements in place or to be developed which will contribute to delivering the strategy. Key principles and elements are described below, and follow-on documents will be prepared with more detail.
General principles to underpin delivery
The eHealth Programme will adopt a delivery strategy to ensure that different parts of the service understand their roles and what they are accountable for delivering:
a. eHealth projects are not IT projects. Which is a way of saying that people are at the heart of this strategy, so aspects such as organisational development and training needs must be addressed in any initiative.
b. There will be three categories of eHealth service or system:
- National - mandatory implementation across NHS Scotland
All NHS Boards will participate in a nationally defined and agreed roll-out programme - National - choice as required
NHS Boards will adopt the software application if and when functionality is required, or when existing alternative licence expires - Local - full choice.
c. While the particular circumstances of each programme and project need to be considered, the general principles are that responsibilities lie with:
- SGHD for strategy development and commissioning,
- NHSNSS for contributing specialist expertise, for example in procurement, and
- NHS Boards for implementation and benefits realisation, or if appropriate to lead procurement or development.
d. The assignment of a lead organisation to deliver projects and programmes will be critical to ensuring clear lines of accountability. Roles and responsibilities may change over the course of a programme or project, as it moves through initial concept and business case development to procurement/ development, roll-out and benefits realisation. But at each stage responsibilities should be clear and a commission defined.
e. Certain programmes may be organised at a regional level rather than national, where this makes sense from both a clinical/ business need and to achieve best value for money, but common standards will apply so that information can follow the patient through a journey that crosses regional boundaries, or requires expert input from outwith the region.
f. While there may be a lead board or consortium of boards on a project, they will be expected to act nationally on behalf of all boards. eHealth Programme implementation and governance approaches will be adopted.
Key governance mechanisms
The overall governance structure is summarised in the diagram below.
Key points are:
- each project and programme will have an appropriate governance board that is accountable for effective delivery of business benefits on time and within budget
- each board will include representation from key stakeholders and be chaired by a clinical or business lead from a delivery area
- terms of reference and membership of each project/programme board will be subject to approval by the eHealth Programme Board
- large programmes may also have local NHS Board project boards, which will link into the national eHealth Programme Board
- the eHealth Programme Board reports to the Strategy Board and through its chair, the Chief Executive of NHS Scotland, to the Cabinet Secretary for Health & Wellbeing
- each NHS Board will develop a local delivery plan aligned to implementation of the national strategy. This will be signed off by the NHS Board Chief Executive who will be accountable for delivery in each board area
- a (professional relationship) reporting line between the eHealth Leads and the SGHD eHealth Programme Director exists to encourage co-ordination between the national and NHS Board level.
Leadership and engagement
Core to this Strategy is the commitment that the eHealth programme will be patient focused, clinically led, and benefits driven. Leadership and engagement in eHealth will involve all clinical professionals - from identifying the need for eHealth investment to a focus on benefits and their realisation during specification and procurement - and subsequently when the system has been implemented and is in use by the service.
In acknowledgement that clinical time must be dedicated to taking eHealth forward, within the Scottish Government eHealth Directorate three clinical representatives will each provide circa 2-3 days input each per week to the eHealth Programme. This will comprise experienced medical input from both primary and secondary care, working closely with the existing NMAHP clinical lead for eHealth. Within NHS Boards, local clinical leadership for eHealth will continue to be provided by eHealth Clinical Leads and NMAHP leads.
There is a single national clinical representation group for the eHealth Programme, chaired by a Deputy Chief Medical Officer. This is known as the Clinical Change Leadership Group ( CCLG). Membership is drawn from the eHealth Clinical Leads and is supplemented by other clinicians as appropriate. The CCLG will link to the network of clinical leaders involved in national redesign programmes such as 18 weeks, managed clinical networks, long term conditions and mental health, as well as to other relevant national initiatives such as NHS Quality Improvement Scotland, and the Scottish Patient Safety Alliance.
The CCLG has a variety of functions. Firstly, it has a key role in presenting and consulting on the eHealth Programme with groups such as the Directors of Public Health and the Medical, Nursing and AHP Directors. Secondly, from the perspective of programme governance, it has an important role in commissioning new programmes of work. Thirdly, it will be an important forum to help steer developments in information governance. The group will also advise on the value of anticipated benefits, the capacity of the NHS to realise the benefits and how key challenges may be overcome. Consideration will also be given to the CCLG managing an innovation fund which could support the developmental stages of local initiatives arising from Scottish clinicians which have national potential.
Finally, in setting up eHealth leadership we must ensure that we do not create an eHealth-only 'silo' - links to existing 'mainstream' arrangements will be as important.
eHealth support for improvement collaboratives
Improvement collaboratives are a network approach to quality improvement. Within NHS Scotland, collaboratives have proved to be a successful model to support improvement in areas such as planned and unscheduled care, and diagnostics. Collaboratives provide support for delivery by pooling knowledge, experience and expertise; ensuring local work is undertaken within an effective guidance and evaluation framework.
We aim to contribute eHealth expertise to existing collaboratives, so that benefit gained from existing and new IT systems can help with the overall improvement objectives. Achieving full benefit from eHealth systems requires organisational development and redesign of processes and working practices. Whilst some change will occur organically as users adapt to a new system, significant change requires substantial effort and design on behalf of the service.
To support this, guidance and methods useful to the eHealth perspective will be developed and made available.
Local projects, national benefit
Local eHealth development projects will be supported from national funds where there is clear benefit to all of NHS Scotland. Examples of projects are procurements, development of new policies or promulgation of best practice. Collaborations between NHS Boards will be encouraged and support will be given for dissemination of outputs. Elements of what is known as a 'champion/challenger' process will be adopted where appropriate, for example when assessing the potential for a local innovation to be taken up nationally.
The eHealth workforce
An eHealth function has been established within the Scottish Government, the structure and staffing of which are intended to provide central governance, direction and support for the delivery of the eHealth Strategy.
A resourcing strategy has recently been completed which made recommendations on appropriate staffing to meet current and future eHealth Programme requirements, taking into account skills and competencies required and where best to find them. The recommendation is a mixed economy of Scottish Government, other Government organisations such as NSS and NHS Boards and some additional external contractual or consultancy resources where required.
In parallel with this, a separate working group led by NHS Ayrshire & Arran has been set up to consider the future skills requirements for the wider eHealth workforce in NHS Boards. This is at an early stage but the intention is to provide greater definition of the skills required, linked to existing industry standard frameworks and KSF (Knowledge and Skills Framework), and put in place a career development structure to support ongoing development and retention of eHealth staff across NHS Scotland.
« Previous | Contents | Next »