Social Care Personal Demographics Service Early Adopter (SCPEA by tao16360

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									Social Care Personal Demographics Service
        Early Adopter (SCPEA) Programme




                   Lessons Learned



                                      April 2009




                In partnership with
                                            A Report by the Public Service Innovation Group
               of the Centre for Knowledge, Innovation, Technology and Enterprise (KITE)
                                              Newcastle University Business School (NUBS)
                                                                        http://www.ncl.ac.uk/ kite
                                                                            Newcastle University
                                                                                        NE1 7RU




The report is the result of survey work undertaken on behalf of the Department of Health by the
Public Service Innovation Group of the Centre for Knowledge, Innovation, Technology and
Enterprise (KITE) in the Newcastle University Business School.



The work was commissioned by the Department of Health Putting People First Team, in
partnership with Connecting for Health. It describes a set of lessons learned by the first group
of Local Authorities that have undertaken projects to connect their local record systems to the
NHS Personal Demographics Service. It provides material to support the DH, CFH and
subsequent projects undertaking similar work.



                                                                                          Authors
                                                                                       Mike Martin
                                                                                 Andrew Thompson
                                                                                        Rob Wilson
Contents

Executive Summary                                                           1


Survey Approach                                                             2


Local Authority Perspectives                                                3
  Not understanding the implications at the outset                          3
  Partnership and the importance of having the right people involved        4
  Information governance and consent                                        5
  Supplier capacity to cope with demands (Local Authority view)              6
  Relationship with CFH                                                     6
  The stage of technology development for partnership working               7
  Documentation and support materials                                       7
  Technology issues                                                         8


Supplier Perspectives                                                       9
  Support and Access                                                        9
  Documentation I                                                           9
  CFH relationships                                                         9
  Programme Issues                                                          10


Appendices (published separately)
  Workshop Notes                                                       Appendix 1
  Powerpoint materials                                                 Appendix 2
  The Newcastle University Business School                             Appendix 3
SCPEA Lessons Learned



Executive Summary
This report was commissioned by the Department of Heath Putting People First team
in partnership with NHS Connecting for Health. It presents material and analysis on
the lessons learned in the Social Care Personal Demographics Service Early
Adopters programme (SCPEA).

Five councils took part in SCPEA and four of them have agreed the format for
configuring their social care information systems to access the Personal
Demographics Service (PDS) on the NHS spine. They are confident that their
suppliers will provide the necessary developments. The exercise has proved more
complex and challenging than initial plans assumed and this has resulted in some
time slippage. These four early adopter sites and their suppliers all stated their
appreciation of the support and flexibility of the CFH team in managing these
challenges.

At the time of preparation of this report, (1st. quarter 2009) initial assurance
processes for connection to the PDS had been completed and plans are in place for
roll out to users in the 3rd quarter of the year (2009). Meanwhile, a further and a
possibly more challenging programme for the deployment of systems to support
Common Assessment Frameworks (CAF) has been initiated. This report is designed
to provide the detail of lessons learned by the SCPEA projects, as an input to
planning the support for subsequent projects in the CAF programme.

Prior to SCPEA, only NHS Trusts and systems suppliers who are engaged with the
National Programme for IT (NPfIT) had undertaken this accreditation exercise for
connecting with the PDS. The procedures and information resources that support it
had evolved in the specifically health care context. SCPEA has involved using, and
in some cases adapting, these processes and resources in the different contexts of
adult social care; and with some systems suppliers who had not been part of the
programme.

The material in this report is the result of semi-structured telephone interviews and
tele-conferences, site visits and face to face interviews and a series of workshops
and discussions. The main report (this document) presents the conclusions which
have resulted from these interactions, which have included representatives of the
CFH team, the PPF team as well as key members of the Local Authority, Care
Partnership and Supplier teams.

Supplementary material is supplied in the form of power point slides and
commentary.




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SCPEA Lessons Learned


Survey approach
The data collection process started with attendance at and observation of a
facilitated Lessons Learned workshop in late December 2008. This was attended by
all the suppliers in SCPEA and by representatives of four of the Local Authorities.
The principles and objectives of this review were presented briefly at that workshop
and appointments for telephone interviews with key Local Authority informants were
made.

Structured telephone interviews were undertaken in January and early February.
These lasted about an hour and were based on a project time line which had been
discussed following the December workshop. In February, site visits to three of the
Early Adopters were undertaken and these included face to face interviews and
demonstrations of social care systems.

Two workshops were conducted. The first was aimed primarily at the SCPEA
participants and explored several issues and questions that had arisen in the data
collection. The material of this workshop and a commentary are presented in the
appendices to this report. The second workshop in early March was attended by the
CFH and PPF teams and was concerned with the clarification and analysis of the
SCPEA material and the discussion of its relevance and application to the CAF early
adopters programme. This workshop was also informed by a tele-conference with
representatives of two of the CAF sites.

An initial draft of this report was circulated to the CFH and PPF teams in mid March
and extensive comments and questions have been addressed and incorporated in
the final version.

The report takes the form of two sets of comments and observations, the first
represent the Local Authority perspective and the second that of the systems’
suppliers.




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SCPEA Lessons Learned


Local Authority perspectives


1. Not understanding the implications at the outset
   1.1. In the start up stage of the projects, Local Authorities faced a steep learning
        curve. Although it was rapidly understood that a code of connection to N3
        was a pre-requisite, it was a surprise, in some instances, that this was a
        Local Authority responsibility, rather than that of the supplier of network and
        facilities management (given that some suppliers had already deployed
        connections to N3 from their own installations). This sort of
        misunderstanding occurred in spite of the effort which was put into the
        explanation of the programme. It may, in part, be accounted for by the
        significant degree of variation, between Local Authorities, in the distribution
        of responsibilities for infrastructure, network and application services in
        comparison to the situation in health where all the actors are embedded in
        the National Programme for IT (NPfIT). Projects seemed to have had some
        difficulty in applying the presented information to their own specific
        configurations of agencies and resources. This variation will be typical of
        the significant number of Local Authorities and care communities who will
        eventually need to connect. It emphasises the need for more effective
        profiling and segmentation of audience and targeting of information to adult
        social care partnerships.

   1.2. This variation has consequences for end to end testing. Whilst the
        Connecting for Health (CFH) sandpit process supports the verification of
        the safety of the application, it does not test the product in the mix of
        environments that will be encountered in the field and, as a consequence,
        field testing and verification is likely to be demanding. See also paragraph
        8.1

   1.3. Achieving Information Governance Statement of Compliance (IGSoC) for
        SCPEA has been limited to Adult Social Services. In discussions with Local
        Authority representatives, uncertainty was expressed about whether, in the
        future, all partners accessing the system will be required to achieve
        compliance. If this is going to be the case, then worries were expressed
        about the resource implications (skills and capacity) for some agencies (e.g.
        the fire service, voluntary sector) which might not have the necessary
        experience in information governance. This discussion arose because the
        definition of the SCPEA exercise was focussed on the link between adult
        social care and clinical care. In contexts where care partnerships are
        maturing, the issues of consent for information sharing outside of these
        professional contexts were already under consideration before SCPEA.


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SCPEA Lessons Learned


   1.4. At the outset of the projects, Local Authorities needed assurance that the
        project was a good fit to their wider priorities. Since connection to the
        Personal Demographics Service (PDS) is an obvious place to start for
        linkage to NHS systems, this was regarded, on the face of it, as a relatively
        well contained, technical issue. However when taken in conjunction with
        Department of Children, Schools and Families (DCSF) and DH demands
        across the wider Local Authority (for example Contactpoint deadlines, and
        the personalisation agenda), the value of the additional effort associated
        with SCPEA was open to question as a strategic priority for the Local
        Authority. Progress was permitted as the impact could be contained within
        the technical arena, and within that, largely within the remit of the social
        care application system supplier. This might not be the case in CAF and
        establishing and maintaining the strategic priority of CAF developments
        within the Local Authority represents a significant factor in the success of
        projects.

   1.5. Despite best efforts of the DH and CFH, many of the Local Authorities and
        suppliers took time to appreciate that the project was more than just a pilot
        to prove feasibility through the development of a disposable prototype.
        Early adoption was being called for, requiring full blown design,
        development, testing and implementation regimes. Once operational in the
        field, further effort in deployment and training is implied.

2. Partnership and the importance of having the right people involved
   2.1. Pilot sites have different degrees of maturity in terms of partnership
        arrangements. Where partnerships between health and social care were
        well established, mechanisms already existed to ensure high level buy in
        and sponsorship (although structures and relationships were nonetheless
        complicated). Where the Local Authority was operating largely on its own in
        relation to SCPEA, the technical emphasis of the project meant that
        partnership issues were not a major risk and progress has been
        demonstrated. It was also reported that the specific technical focus of
        SCPEA meant that, in some cases, once underway, SCPEA developments
        had relatively low visibility for senior management1. This is unlikely to be
        the case with CAF.

   2.2. Projects have made best progress where they have had the benefit of the
        skills of particular individuals in key roles. For example one project was led
        by the Caldicott Guardian for both Adult and Children’s Services. Another
        benefited from the support of a particular individual who had already had

   1We were not able to investigate the case of the project that did not start in any detail but the
   difficulties appear to have arisen early in the project process and indicate that initial internal
   approvals and commitments could not be made.
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SCPEA Lessons Learned


        extensive experience in developing detailed policies and protocols for
        information sharing across agencies. These circumstances could be
        characterised as fortuitous rather than the norm and there is a clear
        indication that professional capacity building and staff development are
        important supporting priorities for the delivery of programmes. Particular
        reference was made in interviews to the need for access to skills and
        experience in information governance and to the practical adaptation and
        introduction of information sharing protocols in partnerships.

3. Information governance and consent
   3.1. To implement the SCPEA projects, Local Authorities have required
        Registration Authority services to authenticate users and issue smartcards.
        PCT partners have by and large been happy to provide this function to the
        Local Authority partners in the limited context of the early adopters. A
        number of the interviewees expressed the view that this approach is not
        sustainable in the long term and that ultimately, Local Authorities will have
        to absorb these functions into their corporate responsibilities for identity
        management. Current practice in implementing RA services is to provide
        them in an integrated, enterprise oriented way where all the responsibilities
        of registration, card management, provisioning and authentication
        management are undertaken within a trust. The issues of how distinct RAs
        can federate identity management and trust, and the extent to which they
        can share functions and services with other areas of service and operation,
        remain largely unexplored but are likely to become more pressing as early
        adoption moves to general rollout.

   3.2. This is an area where tools and frameworks are required to help exploration
        and planning of organisational configurations. An example of such a
        framework, which was used in the February workshop is provided in an
        appendix to this report.

   3.3. In general, in the Local Authority context, Adult Social Services have the
        most experience in the problems of addressing information governance and
        consent. They will be expected to play a leading role in supporting other
        departments to raise their game in these regards.

   3.4. Reorganisation and changes in senior management have impacted on
        more than one pilot, less in terms of introducing actual complexity but more
        in terms of disabling decision making processes during transition. Change
        of personnel and in organisational structures and relationships in response
        to policy, which necessarily shifts in emphasis and priority, is a factor which
        will remain characteristic of the public sector. Coping with this and at the
        same time creating infrastructure which is flexible enough to be reshaped in

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SCPEA Lessons Learned


        response to change is one of the major management challenges of the
        development programmes being considered here.

   3.5. Processes for operationalisation and management of explicit consent in
        social care are well established compared to the implied consent in the
        health setting. Although SCPEA has required the introduction of a new or
        modified consent process, the general consensus amongst projects is that
        these will not present difficulties for social care practitioners.

   3.6. Accessing demography data in SCPEA is a relatively easy case for consent
        compared with CAF. The data involved is of lower sensitivity compared with
        record or assessment content and, for most of the population is relatively
        stable and well structured. It is further the case that, in general, the
        universality of the list – everyone has an NHS number – means that there
        are few inferences that can be drawn from demographic data alone. This
        having been said, the data is personal and subject to the associated legal
        and regulatory strictures. We expect further lessons will be learned from
        embedding the use of PDS in practice when the systems are rolled out in
        the field.

4. Supplier capacity to cope with demands (Local Authority view)
   4.1. Local Authorities are accustomed to a one to one relationship with their
        application suppliers. In some cases they are reliant on the supplier for
        particular technical competencies that they do not possess in house. The
        SCPEA projects introduce a third relationship, namely between the supplier
        and CFH. This was a cause of some initial concern among the Local
        Authorities but there is evidence that this issue has been handled with
        sensitivity in the SCPEA projects and that supplier relationships are good.

   4.2. The need for Local Authority project managers to remain clearly engaged
        with the dialogue between CFH and the suppliers has been stressed by
        more than one of the projects.

5. Relationship with CFH
   5.1. All sites have reported a constructive and supportive relationship with CFH
        and DH colleagues.

   5.2. This support has been particularly important in navigating through the CFH
        organisational space, finding the right person to talk to in relation to a
        specific issue was frequently problematic. This may be due to the
        organisation of the CFH team in terms of the assurance process whilst
        some of the issues that arise are associated with structures and
        responsibilities.


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SCPEA Lessons Learned


   5.3. Some sites had an expectation that the centre would be more directive, in
        terms of prescribing the detailed content of project plans, and also be more
        in the driving seat for delivery of the plan.

   5.4. CFH set parameters for their turn-round of documents sent to them for
        review and approval. In practice these timescales were a challenge for
        CFH. This, together with the pace of supplier development and the serial
        nature of the testing regime contributed to the ongoing slippage.

   5.5. SCPEA developments and the demands they place on capacity in Local
        Authorities cannot be isolated from other policies and initiatives.
        Interactions between programmes have created stresses that could be
        avoided if central departments achieved better coordination. (See 12.2)

6. The stage of technology development for partnership working
   6.1. Multi-agency working is seldom paperless, scanning and images are often
        required. Some of the SCPEA projects reported a tension between the
        technical efficiency of an entirely electronic design and the need to cope
        with these realities of practice. Although this is felt to be manageable for
        establishing links with PDS, it prompted the projects to look ahead with
        some concern towards the interoperability requirements for CAF. There is
        clearly a wide range of states of development; from the universal adoption
        of mobile working technologies to relatively manual and non-electronic
        information handling. This is another important aspect of the need for
        profiling and flexibility of approach for subsequent CAF projects.

7. Documentation and support materials
   7.1. Local Authorities and suppliers have found the high volume of complex
        documentation extremely difficult from the outset. Significant resource was
        expended ensuring that the right version of the right document was being
        used. Interviewees reported an absence of signposting for users with
        different roles and responsibilities to the content relevant to them. Changes
        to documentation were, inevitably, made in flight during the project but not
        necessarily notified to document users. It also added to the burden of local
        configuration management. There are a number of observations and
        suggestions in this area of document management and change control
        which are already being addressed by CFH.

   7.2. The main structuring principle in the organisation of the assurance
        documentation is that of a project process. While this process is an
        important aspect of an initiative such as SCPEA, there are other aspects
        such as organisational structure and relationships. The relatively uniform
        situation in Health has meant that these aspects could remain implicit and
        assumed to be understood. The diversity of social care contexts means
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SCPEA Lessons Learned


        that the SCPEA exercise has exposed the need for more explicit tools and
        materials to help projects position themselves and to understand how the
        different responsibilities and associated project activities and materials
        apply to them.

   7.3. The power point materials annexed to this report present some initial
        attempts to address this issue. They include the representation of care
        partnership support environments in terms of platforms, applications and
        networks. A mapping of the ownership and relationships is overlaid on this
        in order to delineate the technical and organisational interfaces and the end
        to end paths from the demographic service over in-sourced and/or out-
        sourced networks and platforms to applications and clients. The situation
        between the NHS and CFH has been relatively uniform in these matters
        and the documentation reflects this. As presented, this might seem rather
        generic. However, it becomes very specific when a particular partnership
        context is mapped against it, and allows the partners to start exploring the
        consequent distribution of responsibilities in relation to their information
        sharing processes and infrastructure.

8. Technology issues
   8.1. As mentioned previously there is a high degree of variability in the way in
        which the Local Authority technical environments are configured and
        managed. Even after the Information Governance Statement of
        Compliance (IGSoC) has been achieved and the physical infrastructure to
        connect to N3 has been installed, there were some significant problems to
        solve before applications could successfully run across N3. Many of these
        were in the firewall and server domain and as such created an unexpected
        workload in those projects where these were locally owned and managed,
        where technical resources are in short supply and already challenged by
        the need to meet operational pressures.

   8.2. Taken in combination, addressing these issues demands a high degree of
        capability and professionalism from those responsible for facilities and user
        management.




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SCPEA Lessons Learned


Supplier perspectives

9. Support and access
   9.1. Many of the suppliers stressed that a single and effective point of contact
        for technical information is important.

10. Documentation
   10.1. There was much comment about documentation from the suppliers who
         observed that it was not considered to be complete or stable particularly
         regarding the social care integration aspects. This reflects the fact that the
         material had been originally developed for the assurance of health systems
         in particular.

   10.2. Key assurance processes involve mapping of issues between CFH
         documentation and supplier documentation. This also implies a division of
         labour and responsibility. Suppliers felt that their documentation was in
         general adequate and, while there was some resentment at the workload
         involved in achieving assurance, the process was undertaken and managed
         successfully. The investment in this area will be of direct benefit to
         subsequent roll out to other partnerships using the same products.

   10.3. The volume of material is high and it is hard to get an overview of the big
         picture or to know which bits are relevant to different responsibilities.

   10.4. The access and maintenance tools have not been adequate and have been
         the source of much frustration. There is a clear call for a better document
         management system with effective versioning and also for more “librarian”
         support.


11. CFH relationships
   11.1. The assurance project plan is well defined but the details of what will be
         examined, i.e. the precise subjects and content of the assurance have been
         less well defined. This has resulted in “worst case” assumptions that have
         led to overestimating of time required and unnecessary extensions to
         project plans.

   11.2. The assurance plan is not flexible enough to allow activities to be
         undertaken in parallel.

   11.3. The signoff of documents in the assurance process caused many delays;
         timescales should be defined more realistically.


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SCPEA Lessons Learned


   11.4. More direct engagement with project boards or face to face reviews are
         required in “first generation” connection contexts.

   11.5. More direct and rigorous auditing would help to focus project attention and
         maintain priority.

12. Programme issues
   12.1. More could be done to promote the exchange of learning between projects
         and this would be a worthwhile investment.

   12.2. Better coordination is required between central government departments
         and initiatives, for example the Department of Children, Schools and
         Families Integrated Children’s Services (ICS /eCAF) and Contactpoint.
         Local Authorities require significant resource to deal with these and further
         initiatives from other central departments including the Department for
         Communities and Local Government, the Department of Work and
         Pensions, and the Criminal Justice System. Their suppliers need to fit the
         resulting development requirements into a manageable release cycle.




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