Tracey Watson, CIO at the Northern Care Alliance NHS Group, is focused on building the infrastructural foundations for digital transformation at a healthcare organisation that faces the dual pressures of constrained financial resources and complicated governance processes.
Watson, who spoke at the recent HETT conference in London, explains to diginomica how she is refreshing the network and data centre across a complex organisation that faces reorganisation in the next 12 months. This split will lead to system disaggregation, but in the meantime Watson must ensure she continues to build a strong IT infrastructure to help support the work of healthcare professionals across her group.
The Northern Care Alliance comprises of two NHS trusts, Salford Royal NHS Foundation Trust and the Pennine Acute Hospitals NHS Trust. Watson, who was previously director of innovation at NHS Digital, joined the organisation in March. Having also working for NHS England, she is keen to have an impact on healthcare at a local level:
I just thought I've worked in the centre for a long time and I've never walked the walk. I’ve set all these policies, I've delivered massive infrastructure programmes, but I've not actually really understood what some of the barriers are around the local digital delivery of transformation. So this is me in in learning mode and wanting to get a proper perspective on how to deliver some of the policy that the centre pushes out.
Watson’s initial priority at Northern Care Alliance was to understand the exact risks and issues at the organisation. She spent the first three months in situ pulling together an internal diagnostic of internal technology demands and financial pressures.
What Watson faces is a complicated governance situation, where two legal processes – known as transactions – are underway to reorganise care services associated to the Pennine Acute Trust. The plan is for The Royal Oldham, Fairfield General in Bury and Rochdale Infirmary to formally become part of Salford Royal and the Northern Care Alliance, while North Manchester General Hospital will become part of a new city-wide Manchester University NHS Foundation Trust. Watson says this transaction has an impact on her plans:
My ambition is very much kind of played out in terms of when that transformation can be supported financially. Everything's predicated on money. We're still in conversation about what the funding might look like. And as you can appreciate, that's kind of sensitive at the moment in terms of where we're at with some of those conversations. Transaction is something that will come with a budget envelope, but it's all about when that will happen – and I have no control over that.
The transaction could take place early next year but the exact nature of the switchover is still up for debate. And regardless of when the transaction takes place, Watson says she still needs to ensure that technology helps boost local healthcare:
So there is a lot of talk at the moment about the transaction. But if the timing of the transaction moves down the road, and therefore the money that comes with a transaction moves down the road too, then there are risks that we need to deal with here and now.
Getting the basics right
Watson says many of those concerns are connected to legacy IT systems. Much of her first six months in charge has been about forming a consensus around the key technological challenges in the trust and how her team can solve them, once the funding is available:
It's all about getting the basics right and making sure that we get to first base because they haven't been able to do that in in a long time. Pennine is ridiculously challenging because you have a situation where you don't have an electronic patient record (EPR) – you’re sitting on a very old infrastructure. The entire network needs replacing and the landscape is complicated.
Further complication comes through the governance situation. Watson says the transaction – when it happens – will lead to the disaggregation of systems. She says her role is to de-risk that whole process from an IT perspective:
We're talking hundreds of systems, sat on a very old infrastructure. What I'm trying to do is look at refreshing the data centre and the network to provide a completely stable environment. So whatever we do in terms of disaggregation in the future to support transaction can be done safely and securely.
The network programme, which is being developed with Virgin Media, involves the implementation of a new wide area network and local area network. Watson is about to start the procurement process around a data centre refresh. That project will involve the replacement of existing on-premise servers and platforms. When it comes to further IT projects, Watson is waiting to discover what additional funds might be available. She recognises that decisions here could be affected by things beyond her control, from local decision-making, to national policy and onto Brexit:
What happens elsewhere is going to have an effect on whether or not there's going to be a funding envelope to support whatever happens. So I have no control over that; it could be March or it could be September. We're still waiting to hear. I think the point I'm trying to make is that we're trying to do as much as we can do with what we've got to play with. And if we can do more, then we'll have dialogue with those people to try and get more done.
Watson says she hopes the updated infrastructure environment will be stabilised within the next 12 months. The network programme covers four different care organisations and is due to complete in 2021. It’s a significant project and Watson says that the programme covers some older, complex sites. She hope to complete the data-centre refresh in a shorter time span and mentions a six-to-eight month timeframe. Once infrastructure stabilisation is complete, Watson will focus on software:
I think the next ambition would be to move up to the application layer. At the moment, Pennine doesn't have any EPR – what it does have is hundreds and hundreds of different clinical systems. What I'd like to be able to do is to rethink the whole application strategy and move towards a single shared record across the Northern Care Alliance.