eHealth Strategy 2011-2017 (Revised July 2012 to include a Sixth Strategic Aim)

4. Technical, Governance And Financial Context

4.1 A New eHealth Finance Strategy

The eHealth Strategy 2008-11 had a strong focus on capital expenditure and renewal and growth of the capabilities and assets of NHSS. The building blocks for future IT enabled progress are now in place and eHealth has moved from an acquisition/development phase to exploiting the value of the new capabilities acquired during 2008-11. The programme will be a revenue based improvement programme leveraging the IT assets to support the quality improvements that NHSS has committed itself to. From 2011-12, the majority of eHealth funding will be distributed to Boards rather than allocated on a project by project basis or spent centrally by the Scottish Government. There will be allocations for:

• change programmes to deliver six strategic eHealth aims;
• applications/services enablers i.e. products and services already in use e.g. SCI Store and PACs; and
• infrastructure enablers e.g. Broadband and email.

These changes have been introduced to align with the key objectives of supporting change which is closer to the professionals providing care and to the people that rely on it. Experience with the strategy in 2008-11 has also demonstrated that these approaches produce significant value for money over more centralised control based approaches.

In September 2009, Robert Calderwood, CEO of NHS Greater Glasgow & Clyde, was asked to look at efficiencies and identify areas for savings in existing eHealth expenditure. The successful implementation of these findings will provide the funds to take forward the six Strategic eHealth aims. One recommendation was to develop a new eHealth finance strategy, replacing the one which has been in place since 2008. The new eHealth finance strategy, which was implemented on 1 April 2011, supports the delivery of the new eHealth Strategy. It has done this against the background of a radically different financial environment. It also builds on our experience of what has worked well and what has not over 2008-11. Actions to acknowledge the financial challenges faced by NHSS and health care providers include:

• allocating a larger proportion of the eHealth budget to NHS Boards against a smaller number of strategic headings (the six strategic aims), allowing Boards greater flexibility
• releasing funds for new investment from areas of existing expenditure through efficiencies
• further convergence around common eHealth systems, particularly where costs can be reduced
• building on the success of previous collaboration such as PMS to establish shared services
• making available funds to support eHealth enabled savings in NHSS
• not penalising where Boards have already invested; and
• not rewarding Boards with higher than average cost solutions

4.2 Our New delivery model: outcomes based approach

Our focus on six strategic eHealth aims as an enabler of quality improvements in healthcare services across Scotland, rather than discrete projects and programmes, and changes in the way in which eHealth will be funded have considerable implications for the way which eHealth will be delivered. It also changes the way in which performance is measured.

NHS Boards will progress the six strategic eHealth aims over the 6 years of the eHealth Strategy, with year 1 (2011-12) being a shadow year^[9]. It is envisaged that from 2012-13, the six strategic aims will, where possible, be incorporated into Local Delivery Plans (LDPs). These are the 'performance contract' between the Scottish Government and Boards. They run for three years, with the opportunity to review and adjust future years' plans. Boards develop LDPs in consultation with their stakeholders and for those that do not already include eHealth in their LDP process, they will have until the end of 2011-12 to revise their LDPs for 2012-13 and 2013-14. Our eHealth Strategy will cover two LDP cycles, providing a planning horizon that will allow time for the development of the value of aligning IT assets with Board improvement planning and for the development of convergence plans which make sense in financial terms. The Strategy will be re-visited and refreshed in 2014 to concur with the outputs of the next Scottish Spending Review, and a set of deliverables for 2017 will be developed in collaboration with NHS Boards.

Aligned to Boards' LDPs will be eHealth Plans, which will also run for three years, with the opportunity to review and adjust future plans each year. Plans should be locally signed off by a senior management board and progress reported annually to the Scottish Government. It is intended that eHealth will also become part of a Board's Annual Review. NHS Boards' eHealth Plans will contain:

• information and evidence on eHealth's contribution towards achieving the six strategic eHealth aims
• information assurance embedded into Boards' risk management procedures and systems
• anticipated budgets (both local and national)
• local priorities and activities
• benefits being maximised from assets that have been acquired during the previous strategy (2008-11)
• promotion and implementation of good practice and successful local initiatives more widely
• convergence of approaches to delivery in order to reduce duplication of effort and reduce cost
• adherence to national standards for architecture and design; and
• collaborative working between Boards and cross-border eHealth developments

The Scottish Government will report annually to the Scottish Parliament on progress towards achieving the six strategic eHealth aims. Our eHealth Report will draw on the material contained in Boards' LDPs and eHealth Plans.

We will promote and encourage the sharing of best practice through: our networks of technical and clinical eHealth leads; our people and website; conferences; newsletters; and the on-line publication of Boards' eHealth plans.

While the focus of the eHealth strategy and its funding is moving strongly to outcomes, how technology is organised and delivered remains important. eHealth is committed to encouraging value based convergence around common eHealth systems and approaches to the delivery of healthcare services across Scotland. Particularly where it makes collaboration between health providers easier and achieves greater value for money and efficiency. A national technical Design Authority has been established and a set of Architectural Principles to assist NHS Boards make informed choices has been published^[10]. A national standards development framework has also been established to develop and promote standards on a broad range of topics. Further information on these standards can be found at http://www.ehealth.scot.nhs.uk An application strategy and an infrastructure strategy, which will be agreed with boards, will be an important set of reference documents for the Design Authority.

The Efficiency and Productivity: Framework for SR10^[11] identifies priority areas to improve quality and efficiency across NHSS. It is a companion to the Quality Strategy and provides a baseline for the changes required that will be undertaken jointly between the Scottish Government, NHS Boards and other public sector organisations. The Framework sets out three overarching themes:

• support;
• enabler, which includes the effective use of technology in the delivery and redesign of healthcare; and
• cost reductions, which includes reducing variation, waste and harm.

4.3 Governance

Over the course of the previous strategy there have been substantial reforms and improvements around governance of eHealth, with new structures maturing and working increasingly well. These structures are depicted in the figure below:

With budgets held by Boards for nationally used systems, a key delivery mechanism is the Boards' eHealth Leads Group continuing to act collectively. To supplement this there are a number of Portfolio Management Groups (PMGs) which determine the roadmap for logical groupings of these systems. PMGs are accountable to both Boards through the eHealth Leads and to the national eHealth Programme Board for strategic directions. The Clinical Change Leadership Group (CCLG) is made up of senior clinical professionals with representation from all Health Boards. Its role is to ensure that eHealth strategy reflects the priorities of the clinical community across NHSS. CCLG will continue to act in advisory capacity to the eHealth Programme Board, the eHealth Leads and eHealth in the Scottish Government.