Who Does What

A plan for digital health and social care published on 29 June 2022 includes the commitment to publish more information on Who Does What. This publication fulfils that commitment.

This document is intended to assist NHS England (NHSE) and Integrated Care System (ICS) IT leaders on how they should move forward together – maximising the benefits of their IT infrastructure to enhance the provision of care and at the same time achieving optimal value for money for taxpayers.

This publication provides an overview of the Who Does What programme including frameworks, standards, and key messages. This includes the Who Does What programme goals and challenges; principles for where solutions are provided nationally; defining the five core enablers of the future state aligned to delivery areas; and description of the national support mechanisms.

Who Does What has been developed through engagement and partnership. It is not an end state, but a framework that we will build on to enable the system.

The target audience for the publication includes ICSs and national health and care leaders.

ICS challenges that we are seeking to support

The Wade-Gery review and the plan for digital health and social care identified opportunities for the centre to clarify the respective roles of the centre and local systems in digitally enabled care pathway transformation.

In addition, we have had feedback from ICSs that has identified the following challenges that Who Does What seeks to support:

• Clarity on what the centre is working on, so everyone is aware of what capabilities are available or being developed.
• Support regional investment decisions so that ICSs/ICBs/Trusts have the information they need to make best use of their investment spend.
• Build trust with the centre: by providing a clear view of roadmaps and timelines, opportunities and to influence the roadmap, with effective management of production life cycles.
• Support for the local innovations and research and the path for scaling exemplars to become national services.
• Reduce waste and inefficiency by identifying and reducing redundant systems driving up total cost of ownership.

The goal of Who Does What

We will support ICSs in making digital and technology choices, that drive value, help to reduce health inequalities, and improve patient care, ensuring this happens within a coherent framework.

ICS and health and care organisation teams know:

• what business capabilities or activities will be provided once for the service nationally, and those which must be fulfilled regionally or locally
• what technology platforms or services are available from the centre
• required standards and interoperability patterns to join it all up
• what support the central team will provide and where it will look to reduce variation
• which best of breed application and services should be adopted
• how to appropriately prioritise and make investment decisions and avoid duplication with central offers

National health and care leaders know:

• what technology platforms and services will be provided centrally in a modern health and care target architecture
• what is the maturity of national capabilities, where are there gaps and areas of duplication
• where to keep, rearchitect or retire systems
• how to make appropriate decisions for their target operating model

Who Does What outcomes

1. Improved decision-making and increased speed and agility in delivering business outcomes and pathway transformation (including patient safety, productivity/freeing up staff time, burden reduction, patient experience and reduced health inequality)
2. Reduction of duplication across the system to reduce cost, reduce technical debt, improve consistency and traceability of patient data and release capacity
3. Reduction in total cost of ownership and cost per transaction of core platforms
4. Improved security and reduction of cyber risk and reduction in tech debt
5. Improved engagement with key stakeholders and better management of suppliers

Principles for where solutions are provided nationally

Services and products will only be provided nationally where central provision meets strict principles and criteria.

NHSE will only provide services and products where the following quadruple aims are fulfilled, namely that national provision, as opposed to local or regional provision, leads to:

• better health and care outcomes
• better patient and clinician experience
• improved population health
• value for money and reduction in costs per capita

Therefore, NHSE will be the Single Central Service Provider where the following criteria apply:

• Where the need for scale and visibility is critical at a national level.
• Where standardisation nationally is critical for patient care, safety, experience, and cost optimisation.

Where NHSE is not the Single Central Service Provider, we can provide other support such as (details of which will be set out elsewhere):

• Market management.
• National standards.
• Delivery support and regional/local coordination.

Support mechanisms

We will provide a spectrum of support mechanisms spanning a high level of national accountability through to complete local autonomy. This will include nationally provided services, national commercial frameworks and buying support, national standards and where our role is to be community facilitators.

The options below show descriptions of nationally provided services within the spectrum of accountability:

Service catalogue purpose

The National Service Catalogue will improve transparency on support available from the Centre.

The catalogue will:

• list services and products that are available from the centre so that you don’t duplicate at ICS level
• be a single source of truth
• contain categorisations for each item (e.g., single centrally provided service, framework, standards, guidance etc.)
• specify the level of autonomy ICSs have in implementing them (e.g., is it a must-do versus discretion in how they apply a national standard)
• highlight which of these services currently exist and roadmaps for future services and products in the current funding cycle (two to three years) or beyond, where appropriate
• provide instructions on how to take advantage of a particular service and how to onboard, as well as the contact details to get further information

The catalogue won’t:

• be final - it will be updated iteratively
• provide hands on advice. But it will aim to list all the things we are building and prioritising nationally, with an initial list to accompany the first iteration
• offer funding

National catalogue strategic alignment

The national catalogue complements other activities that enable long-term digital transformation for the benefit of clinicians and patients.

As set out in the plan for digital health and social care digital transformation is a top national priority for health and social care. The National Service Catalogue should be seen in the context of a wider programme of work that aims to provide a more joined-up approach to technology and data solutions, as well as work by NHS England on the commercial side to make it cheaper and easier to buy technology and data applications through activity such as market management, framework consolidation, central volume guarantees and central price negotiations. Taken together, this will enable ICSs to digitise and connect health and care, drive integration and improve patient and staff experience.

What Good Looks Like

Drawing on Local Learning

Building on established good practice to provide clear guidance for health and care leaders to digitise, connect and transform services safely and securely.

Standards and Interoperability

National Open Standards for Data and Interoperability

Maintaining and developing open standards through a collaborative and consensus-driven approach, and joining up systems so that information to support a person’s care is available for those that need it at the right place and right time.

Digitising Health and Social Care Records

Improving Core Digital Capabilities

Fully realising the benefits of digital technology by increasing coverage of Electronic Patient Records and Digital Social Care Records, so frontline health and care staff can spend less time on administrative tasks and more time delivering personalised care.

Next steps

The Who Does What programme will iterate work on the National Service Catalogue and Target State Architecture using work already done on business capabilities and services. We welcome any feedback on this publication or linked content, please email us on who.doeswhat@nhs.net.

We make regular updates on our FutureNHS page and host show and share calls which we invite colleagues to join. To get involved please reach out on the above email.

Who Does What information will be updated on a regular basis.

Resources

National Service Catalogue

Example Service Catalogue pages:

• National Record Locater
• Cohorting as a Service (CaaS)
• National Care Records Service (NCRS)