The North Cumbria Digital Strategy 2020-24 is a 30 page
document available digitally as a pdf file on the Trust intranet. It is
unclear if it is available publically. It is said to have been approved by
the Trust’s Executives. It does not feature in public Board minutes.
Published (launched) 21st March 2021, the timing
is curious. It is 15 months into the timespan the strategy covers.
The stated scope is the
Trust ‘..and care partners’ . Further into the document these are
identified (p.5) as 39 GP practices, CHOC
(Cumbria Health on Call), eight Primary Care Networks, eight Integrated Care
Communities, CNTW (Cumbria,
Northumberland, Tyne and Wear) who provide mental health and learning
disability services, Cumbria County Council, NWAS (North West Ambulance
Service), community pharmacies, the third sector, and NHS England and NHS Improvement.
The Foreward
(p.2) underlines the pivotal role of ‘Digital Health’. It states that
‘This strategy sets
out how in the next 4 years we will become recognised exemplar digital hospital
where people seek employment and where patients receive digitally enabled best
care’
The Forward ends with a quote from Darzi (2018)
‘Digital technology
has the potential to shift the balance of power between clinicians providing care
to patients receiving care’
The Introduction
(p.3) states that the strategy was created ‘through
a series of workshops, one-to-one interviews and surveys’. It does not
state who was involved in this. The Introduction then provides a description of
the contents of the main sections of the document
What Does Digital Mean? (p.4) confuses more than it illuminates. It starts
saying that ‘digital should be seen less as a thing and
more a way of doing things’. The explanation of what digital is then
ranges widely touching on many things that are not specifically digital at all.
A kind of half table, half
chart is used to summarise the digital vision:
The bottom of p.9 is padded out
with a meaningless, distracting semi-cartoon like graphic
Our future vision (p.10) indicates that at some point in the future
everything patient-related will be digital (or ‘digitised’) and that all partners will have
access to it
Benefits (p.10)
Digitise Patient
interactions and Apps Integrated
with Systems indicates that patients will have the ability to
interact remotely and add to their own records
Accessible Records Across
North Cumbria and Partners and Friction-Free Information Sharing and
Unifying Disparate
Information - indicates that our information will be available ‘across the region’
Our
Guiding Principles (p.11)
‘A digital mind-set provides the basis for cross-functional
collaboration, flattens hierarchies, and builds environments to encourage the
generation of new ideas’
Surely the basis for
collaboration is a collaboration mind-set? Flattening hierarchies would involve
the removal of layers of management. There is no evidence of any inherent will
to do this and consultation feedback along these lines in the most recent
Digital Restructure was ignored
In the middle of p.12 (‘Our
Request’) the voice changes from bring that of the Trust to being that of
the Digital Department.
Supporting the
Digital Strategy (p.13-4) lapses into a role based focus on the Digital
Department and heralds another reorganisation
Making Decisions (p.15) is a disjointed mixture of statements
about categorisation of initiatives, impact, prioritisation. This is the
prelude to more role based thinking indicating that all proposals will go
through the ‘Business Planning Group’ and outlining (p.16) a vague committee
structure
Delivering the
Digital Strategy (p.17) indicates that five programmes have been set up
within a four-year implementation period. It refers to a supporting
implementation plan
Five ‘highlights’ are set out, four of which are scheduled
for 2020, so presumably either have already happened or are already overdue
1. Enabling our
Workforce (p.18) sets out actions which seem either role focussed or vague
2. Strengthening our
Digital Infrastructure (p.19)
contains a lot a statements that are simply restating the need to
strengthen the Digital Infrastructure. There are almost no precise details. One
statement:
‘Converging to single Domain for North Cumbria
and Partners. All North Cumbria staff will be on a single modern domain
designed to be robust and resilient. This will allow the organisation to
introduce innovation and flexibility through the introduction of modern systems
and technology. It will remove the digital friction of our calendar and email
sharing.’
Could be read as implying that all North Cumbria partners (identified on p.5 as 39 GP practices,
CHOC
(Cumbria Health on Call), eight Primary Care Networks, eight Integrated Care Communities, CNTW (Cumbria, Northumberland, Tyne and Wear), Cumbria County Council, NWAS (North West
Ambulance Service), community
pharmacies, the third
sector, and NHS England and NHS Improvement)
would all move to a single domain. This would be a massive achievement. However
it is unlikely that this is what is meant. It seems likely that the main focus
is bringing the two parts of the existing Trust onto one domain – something
that was not tackled in the extensive period leading up to creation of the
Trust in October 2019. The inclusion of GPs in the section The move to cloud-based Office 365 is the only hint at anything
wider than the current Trust and this is not domain specific. It is hard to see
how the Trust will persuade CNTW, NWAS and NHS England to migrate to its own
North Cumbria domain. This is not referred to in the regional ICS digital
strategy. The ‘vibrant’ third sector may also have its own ideas.
The ambition to Move
towards hybrid cloud infrastructure by 2024 (p.20) is one of those vague
statements which could mean anything or nothing. A move towards something could
be said to have been achieved simply by taking the very first step.
Most of the Strengthening
our Digital Infrastructure section could be paraphrased to say ‘we
recognise that we have neglected this for several years and are way behind most
peer organisations – and we did not even complete the recent merger properly - so we will bring ourselves up to where we
should already be’
3. Digital Systems
(p.22) This critical section is full of vague statements, most of which are
restatements of the question, not the answer, for example
From Divergence to Convergence of Clinical Applications
‘In order to move from
our current silo-based system architecture, we intend to pursue and agree a robust plan for EPR
development that will meet our patient, staff and collaborative needs.’
‘We will ensure that
all our future clinical applications are set on the pathway to converge and interoperability
will be at its core’.
4. Data Analytics (p.24)
This section is a ramshackle collection of vague, grandiose statements and
buzzwords padded out by two spurious graphics. The tangible action seems to
focus on producing a new Data Warehouse and introducing unspecified Business
intelligence tools. How these platforms will be used to create Business
Intelligence is not specified. It is unclear how all the data from all the
various North Cumbria partners gets into this Datawarehouse – or even if it does – or how all this data – much
of which is sensitive – can be safely used
5. Data Protection by
Design (p.26)
This section seems to be little more than stating that we
will do the things that we are, or should, already be doing
What and When? (p.28)
This section includes a bizarre graphic in which a
concentric timescale with six radial sectors is overlaid with a series non
radial arrows
As a data visualisation this is incompetent, not least
because the lengths of the arrows do not accurately reflect the timespans. It
also suggest that several of the planned actions are already overdue
Our Digital Maturity
(p.29) This section contains the rather
chilling admission
‘Our Trust currently
has one of the lowest digital maturity levels in the NHS of its size and is
heavily reliant on the movement of paper to facilitate the provision of care’.
Rather than look to why this is - so we can avoid repeating the same
behaviours – this section simply states the obvious – that we must do something
about it . It then describes the HIMSS Benchmarking framework and leaps to the
conclusion that
‘As a digitally mature
organisation we will be able to shorten our diagnosis and treatment times
whilst simultaneously creating a more efficient and cost effective organisation
due to a large scale reduction in repetitive, manual and resource intensive
activities. Our digital solutions will increase safety whilst simultaneously
reducing resource intensive activities.’
Strategic Risks And
Financial Plans (p.30) This section sketches out some general categories of
risk
Not taking the workforce with
us
Not implementing well
Not achieving high value
benefits
Resources being insufficient
Inertia
& too slow pace of delivery
The first
listed risk is said to be ‘Mitigated by
our clinically led, technically enabled approach…’ . It could be argued
that one of the main factors in the current highly fragmented, inefficient
tangle of overlapping, competing half solutions this that under-informed
technical people have been led by a small number of highly influential, but not
necessarily representative, clinicians
The risks,
apart from the obvious lack of funding,
could be re-stated as lack of clear vision, lack of strategic analysis,
lack of understanding of scope, lack of recognition of the potential for
disruptive innovation from competitors, lack of self-scrutiny and
self-awareness.
In short the
people who presided for several years over the slide into ‘one of the lowest digital maturity levels in
the NHS ‘ are shamelessly putting themselves forward as those who will
transform us into a ‘recognised exemplar digital hospital’
|
Conclusion |
|
There is a lot
of big talk, simply echoing nationally defined themes, with a lot of vague generalities. Bold
claims are made about where we are going but the document demonstrates very
little understanding of what is needed to get there. A lot of the focus is
simply to catch up with where we should already be. There is too
much fixation with the roles, responsibilities and processes of the Digital
Department. The document is
particularly lacking in detail about how our extensive list of partners will
share and access data Overall I am
left feeling short-changed and very disappointed by it. I have no confidence
that the authors have the capability to lead us to the destinations they
sketch out My conclusion
is that the Trust has been required to produce a Digital Strategy which means
that somebody needed to create a document. Some of the obvious national
themes have been echoed. But in place of strategic analysis we have boasting.
And in place of a clear direction we have glib, vague statements. The implication
is that if we proceed with a rag bag approach
of committees and projects, somehow
we will arrive magically at our destination. Overall it
feels more like a sales brochure than strategy. But the fact it now exists as
a document labelled ‘Digital Strategy’ makes it even harder to produce an
actual digital strategy I think we are
in trouble |
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