B/18/53 CHI & Child Health Transformation Programme Health Board Chief Executives April 2018
Full Business Case Issues with Legacy Systems • Inflexibility: 30 – 35 year old legacy CHI and GPPRS and Child Health systems are poor at supporting changing business priorities and at meeting new requirements. Cannot support Health and Social Care Integration. • Poor Architecture: CHI processes are batch based and compete for a very limited batch window. Both CHI and Child Health have poor data quality. Legacy Technology: hosted on the Fujitsu VME, old mainframe technology and expensive to maintain. Cannot support access control, audit, legitimate relationships. • See Page 6 of FBC Executive Summary
Full Business Case New Systems Support and Enable Strategies • Digital Health and Social Care Strategy • eHealth Strategy – Declared legacy systems obsolete in 2014 • Children and Young People Strategies • Vaccination Transformation Programme • See Page 10 of FBC Executive Summary
Programme Progress • Tranche 1: December 2014 – February 2017 Procurement – CHI and GPPRS – Wipro – SCPHWS - Servelec • Tranche 2: February 2017 – 28 March 2018 Due Diligence, Proof of Concept and Full Business Case – Programme Board approved the FBC on 28 March (subject to funding). – FBC is now with SG for decision. – If approved the Programme Team will work with Health Board Lead Officers and suppliers to complete the implementation plan. • Tranches 3 and 4: Implementation (Partially funded with additional funding requested) • Tranches 5: Transformation (No funding requested as yet)
Tranches 3, 4 and 5 • Many Benefits delivered within Tranches 3 & 4 whilst Tranche 5 is transformational. • Tranches 3 & 4 Benefits ( Examples ): – Flexible modern solutions and increased automation – Single CHI record as source of the truth – Access control, legitimate relationships, improved security – One database across all Health Boards – Increased efficiency and fewer operators • Tranche 5 Benefits ( Examples ): – Real Time messaging instead of daily broadcasts – Introduction of the Record Locator Service (RLS) – Full audit capability on all transactions – Mobile working for Child Health – Integration with other national indices - English Patient Demographic Service (PDS), Welsh Demographic Service
Funding and Costs Position Funding 10 Year Total (£) eHealth Leads Reinvestment Fund 15.060 eHealth Leads/ SG Requested for past funding 7.410 ( * assuming that it will be approved) Additional Funding SG eHealth (total agreed to SG 12.206 eHealth Leads Feb 2017 letter to NSS £12.206m) Total 34.676 Funding Released after Switchover to New Systems Old CHI & Child Health System Savings 27.623 Total 62.30 Cost 10 Year Total Costs to Implement and operate new solutions 67.74 Funding shortfall over 10 years is £67.74 – 62.30 = 5.44 million (£3 million contingency is also being sought)
Legal Position Terminate after Tranche 2 • There is a specific right for NSS to terminate before issue of the Implementation Start Notice, subject to payment of the PoC and DD charges. • The contracts are in NSS’s favour proceeding to Implementation - there was no guarantee that the project would proceed to full implementation and roll out. • However, a case for compensation beyond the sums agreed for the PoC and DD charges is open to question, there may be advantages in reaching some sort of accommodation with a contractor with regard to reputational damage, avoid a formal legal dispute.
Implementation Who Does What? Health Board Local Programme Implementation Groups (LIGs)
Health Board Activities & Costs • Health Board Local Implementation activities, including local testing or activities needed to implement new working practices, are the responsibility of the respective NHS Health Boards. • As with the procurement, the programme funding does not cover payment to Health Boards to pay for Subject Matter Experts who support the Programme team – for example to support configuration decision making, or to carry out National User Acceptance Testing. • GGC worked with the programme team to estimate some Health Board Activities and costs which can be extrapolated for other Boards. Activity Cost (£) Child Health Testing 17,000 Child Health Migration 46,000 New CHI Testing(pre go live) 18,000 CHI Migration 11,000 Total 92,000
Commission • Scottish Government (as primary funders of this Programme) will commission a Board / multiple Boards / a consortia to lead on the implementation phase … • Key content of commissions – Introduction / Background – driven by FBC – Commissioned Organisation or Consortia – decision required … – Scope / Objectives / Deliverables – driven by FBC – Governance Arrangements – decision required … – Conditions, Constraints and Limits – decision required … • Response from Commissioned organisation – Recommendations / Risks / Assumptions – decision required … – Projected Costs – See FBC – Programme Plan / Timeline – See FBC – Confirmation of Acceptance through own Governance – when ready
Implementation Risk Factors • Large Scale • Multiple sub-projects • New technologies (systems and platforms / infrastructure) • Scope certainty / knowledge of existing systems • Mission critical systems / high cost of failure • Multi-supplier / overall design risk sits with client • High levels of dependency – supplier and client side • Dual running of environments / high cutover costs • High level of local collaboration / activity required
Mitigating the Risks - 1 • OWNERSHIP – Commissioned organisation – Joint ownership (NSS + territorial Board) ? – Board Chief Executive involvement / engagement / SRO ? – Scottish Government directorate involvement • MULTIPLE SUPPLIERS – How to best manage – Retain strong procurement / commercial / legal help – Ensure implementation phase CCNs are watertight – Create supplier sub-group within Programme Governance – Integrated plan with formal acceptance of all parties • COLLABORATION WITHIN NHSS – How to assure – Formal commitments through each Board Chief Executive – High visibility through Health Board governance structures – Board Lead Officers represented on governance groups
Mitigating the Risks - 2 • COST CONTROL – Risk mitigation – Clear delineation of programme costs ownership – Strong programme level financial tracking regime – Contingency arrangements/limits – Strong supplier contract management/billing oversight – Risk sharing across NHSS ? • QUALITY ASSURANCE – Oversight / Control – Continued high level of project/programme board scrutiny – External QA/Board assurance on regular basis – Adherence to MSP/PRINCE 2 methodology – Resilience/sustainability of team addressed/assured • OTHER KEY ISSUES FROM CHIEF EXECUTIVES?
Major Decisions Required - 1 • SG Oversight / Commissioning Directorate – SG eHealth department lead / GG ? • Joint Ownership Model – NSS (holds contracts) + AN Other ? • Governance Structure – As per current structure + linkage with CE Group ? – New SG Digital governance link tbd • Chief Executives involvement / engagement – Programme Board membership / leadership ? – Regular Review / Major Decision consultation ?
Major Decisions Required - 2 • Supplier Management Group – NSS, Servelec, Wipro, Atos, Health Board linkage ? • Resource Commitment / Risk Sharing – Chief Exec letter / MOU / written commitment ? – SG role / underwriting of risk ? • External Assurance – Programme Delivery - Ongoing / Gateway / Internal Audit ? – Clinical Assurance arrangements tbd ? • Conditions, Constraints & Limits – Tolerances and Contingencies / Escalation routes ? – External dependencies ?
Approval / Timeline • FBC / Commission Consultation / Approval / Governance – CHI / CHS Programme Board (FBC approval complete) – SG Funding & Sponsoring Directorates / DoF – eHealth Leads Group – SG Digital Assurance Board / Delivery Board – Chief Executives Group – Commissioned Health Boards Governance Groups – Local Health Boards Governance Groups • Timeline for Commission – Discussion with Programme Board: December 15 – Review with SG eHealth: January 12 – Discussion with Chief Executives: January 16 – Draft in correspondence for Programme Board: January 26 – FBC: February 23rd – Back to Chief Executives Now
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