Stephen Dobson on NHS IT resilience

The chief digital officer for the Greater Manchester Health and Social Care Partnership outlines his vision for infrastructure, IT systems and information across the city, explains how they will support the ambitious aims of DevoManc, and why it all matters to his mum.

“It has been a potentially momentous week for the NHS and regional government in England,” the BBC’s Hugh Pym commented in February 2015, as the government unveiled its Devo Manc proposals.

Although the details were sketchy, it was clear that the entire health and care budget for Greater Manchester, some £6 billion, was going to be handed over to local control in a bid to deliver integrated care on a bigger scale than had been tried anywhere else in the country.

Three years on, new structures have emerged to deliver devolution and are starting to bed in. The Greater Manchester Combined Authority holds the health and care budget and has set up a series of programme and commissioning boards to plan and deliver services for the city.

A five-year plan, drawn-up shortly after the devolution agreement was signed, acts as the city’s sustainability and transformation plan; with the goal of closing a £2 billion funding gap by reshaping hospital services, creating local care organisations, and, critically, focusing on prevention and health inequalities.

To support Taking Control of our Health and Social Care, an IM&T strategy was agreed in June 2016; and in January the following year, Stephen Dobson was appointed to implement it.

Many challenges: one big question  

“When I arrived, the principles were in place,” says Dobson, who arrived from Wrightington, Wigan and Leigh NHS Foundation Trust, where he had overseen a successful ‘big bang’ implementation of an Allscripts electronic patient record.

“I developed an implementation plan, working with people from across the system, and we published that in June 2017. We knew we would get some money from the £412 million tech fund that [health and social care secretary Matt] Hancock confirmed recently, so the big question was how to spend that.”

The implementation plan identified eleven key challenges, ranging from mapping and consolidating systems and applications to joining up data and implementing a population health management programme, and from using the city’s collective market power to drive better deals to improving staff and patient access to data.

At the end of the day, though, Dobson suggests that all these challenges can be expressed as one big question: “How can we give health and social care staff the information they need, on the devices they need it, as fast and reliably as they need it?”

The information challenge  

The information part of this challenge will be addressed by Manchester’s recent, successful bid to become a local health and care record exemplar.

Parts of Central Manchester already use the Graphnet CareCentric shared care record and this, together with developing LHCRE technology, will be rolled out across the city, to integrate information from 472 practices, 10 acute trusts, 10 councils, and six community providers.

But Dobson says Manchester will need more than just information sharing. “The LHCRE is all about creating a longitudinal care record, wrapped around with APIs, so an ecosystem of apps can contribute to and use information,” he told the UK Health Show.

“So, Allscripts, or EMIS [the system used by city GPs] can access these APIs, and contribute to or consume information from across Greater Manchester.”

The mechanism for doing this is the Greater Manchester interoperability hub, which is being developed alongside the city’s innovation hub. Running separate but linked projects should enable the release of valuable data for planning, medical and pharma research; while maintaining the necessary privacy and consent controls.

LHCRE status, which Dobson describes as “the thing I am most proud of” to date, comes with £7.5 million of central funding.

This will not fund everything the city wants to do, so it has prioritised work on frailty and dementia, and is working on risk models to reduce hospital admissions and other adverse outcomes, on standardised care plans, and on patient input.

At the UK Health Show, Dobson showed a page that is being created for frail, elderly people going into care homes.

“My mum is 85, and at the moment she is very fit, but in a few years she might be going into a care home,” he said. “If she does, I want her to have something like this, that tells people how she wants to be cared for and what matters to her.”

The infrastructure challenge

The infrastructure part of the challenge comes in many parts that include making sure health and social care staff have robust applications to use, that they have appropriate devices, and that they run over fast and resilient networks.

An early priority has been to get to grips with “the huge array” of systems in use across the city’s ten localities. “Each area can easily have 1,000 systems when you look across the acute sector, community services, GPs…” Dobson says, “and that’s just systems, not instances of them.

“They are all depreciating, they are all managed by over-stretched IT departments, and they are all potential sources of malware, or data corruption. We need to consolidate.”

Dobson didn’t want to consolidate by launching massive procurements for new products that could be deployed across multiple sites.

Instead, he ran a search for a company to do an asset analysis and develop an infrastructure policy that would be cloud-first, supported by central storage and management, and with access handled by a single Active Directory.

The company doing this work is Manchester-based Shaping Cloud. Dobson stresses that this is not about replacing people, but about “freeing people up to do other, higher value things” – although there will be “a huge workforce piece attached” because some staff will need new skills.

Another priority is to shift off the old N3 network, and onto the new Health and Social Care Network, so hospitals can send and receive larger quantities of data; not least the huge files generating by new technologies, such as digital pathology.

Yet another is to roll out the govroam network, so health and social care staff could walk into any public building and connect not just to wi-fi, but to their desktop as if they were in their home office.

DevoManc makes change possible – and also vital

All this sounds very ambitious; but Dobson is confident the pieces are in place to make it achievable. On the technology front, cloud-computing is creating new opportunities, while the LHCRE has ten or even 15-years of interoperability developments to build on.

Just as critically, he says DevoManc means the governance is in place. “We have a single health and care digital board, chaired by Jon Rouse [who also chairs the Greater Manchester Health and Social Care Partnership] and Rowena Burns [chair of Health Innovation Manchester]. All the key chief executives sit on it, so if they agree something should be done, it will be done.”

Plus, of course, there is an imperative to deliver in order to support the vision that led to DevoManc in the first place: that of integrated health and care services that are both sustainable and more effective for patients.

Dobson points out that if the LHCRE has the impact on frailty and dementia that it hopes “the wins we get will be fantastic.”

“If you have a fall when you are under 35, the chances are that you will be picked up by ambulance and taken to hospital and fixed up. If you have a fall over the age of 75, the chances are that you will still get the ambulance, but you could probably be better managed at home.

“If we can make contingency plans available over the next year and a half, then that should happen more often, and that will have a big impact on services. We will also get more information from patients about what matters to them. Like my mum. If I become a carer for her, I want to make sure she is cared for in the right way.”

The £7.5 million LHCRE money will not solve every problem across Greater Manchester, Dobson reiterates, but if it enables the city to solve some problems with frailty and dementia it will also give it ‘Lego blocks’ with which to build out and solve problems for other conditions.

Hive of excitement   

Finally, Dobson says, there is something about size that should enable the city and towns of Greater Manchester to make progress. “Manchester is exciting,” he says. “It’s big enough to make a difference, but it’s quite contained, so it feels like we can all move forward together and do great things.”