Public Services > Healthcare

Walliker sets out Cheshire and Merseyside NHS trusts’ digital stall

David Bicknell Published 26 June 2017

Merseyside hospitals’ CIO discusses STPs, the global digital exemplars, NHS demand management, doctors’ fears over ‘paper free’ and tackling information governance and GDPR


David Walliker, chief information officer at Liverpool Women's Hospital Foundation Trust and Royal Liverpool and Broadgreen Hospitals Trust, has laid out some of the thinking that makes the Merseyside region one of the most strategically minded health areas in the country.

Speaking at the InterSystems ‘Joined-Up Health and Care 2017’ conference in Birmingham, and discussing the North Mersey area, Walliker painted a picture of how the region was working together on a series of key initiatives.

“We have the second biggest Sustainability and Transformation Partnership (STP) in the country. We’re not exactly sure how, but we ended up with Cheshire and Merseyside STP. So we broke it into three delivery areas," he said.

A unique perspective

Walliker described Liverpool as “somewhat unique”.  He said, “We have eight provider hospitals in that little footprint. They’re all specialists in their own right. We have Walton, probably one of the best neurocentres in Europe if not the world and certainly the UK. We have Alder Hey Children’s hospital, we have the women’s hospital. And yet we have a health economy that’s supposed to be  disjointed because we can’t flow patient information along the care pathway as we want to change the way we deliver care.”

Walliker said the Merseyside region offers a special perspective from Liverpool’s perspective of the global digital exemplar (GDE) programme, designed to put £100m of investment into 16 acute trusts to help them accelerate their digitisation progress. 

“On the Wirrall, there is Arrowe Park Hospital. They are one of the 16 GDEs. Within the North Mersey region, we have the Royal and Alder Hey a GDE. So out of the 16, three are in that footprint. And also our mental health trust is now a mental health GDE. So I think that demonstrates the significant investment we’ve made in digital over eight to ten years. If you tally it up, it’s about £82m that we’ve spent and that’s before we start talking about electronic patient record (EPR) projects.”

Demand management

Walliker said the Merseyside and Cheshire region’s priority is ‘demand management’, in other words, fewer people coming into hospital.

“That’s driven by the same challenges that everyone’s going to have with regards to blockages in the system,“ he said. “If there’s a breakdown in social care, there’s no way we can fund those patients, A&E stacks up, we end up in winter. And the cycle continues. So we need to look at the demand management. We’ve also got the hospital reconfiguration, some of which is driven around mergers. So Aintree Teaching Hospital and the Royal Liverpool are in quite advanced conversations at the moment about a potential merger.  But most of that is driven by single services across the city. Single service cardiology, for example.”

Walliker indicated that Liverpool is looking closely at population health. “Liverpool is the cancer capital of Europe. And I’m not entirely sure it’s a title we’re proud of.  We are looking at better use of our data and we need to get to the bottom of that. Liverpool is a population that doesn’t tend to move. It’s quite a static population."

Digital First

Walliker said the Merseyside region “has put digital first as one of the key drivers from both a Leadership Development Framework (LDF) and an STP perspective”, with both having their own work streams.  

“We have a digital roadmap for North Mersey that’s held up by NHS England as an exemplar. That’s quite a sorry state of affairs because the vanguards are very valuable and very good but it could be a lot better and we could achieve more. So it does create a pressure of where we measure good from….when it comes to the use of digital within healthcare.”

Another issue is culture. “We haven’t acted as one system culture. At the moment, for those of you working with money, it feels as if we are acting as if we are sharing a deficit.  But this is about breaking down the organisational barriers. We are not saying, ‘Well, we’re the Royal, so therefore you have to us.’ You have to act as one across the system. And we’re leading that really from a digital perspective because that can’t be defined by hospital walls.

“For Liverpool digital, the story is this, " he said. "The Royal has gone completely paper free, not pretend paper free. And that’s really quite transformative. We’ve also got a single Picture Archive and Communications System (PACS) across Cheshire and Merseyside because we have a single data share agreement between all the provider organisations that we can share the data between.”

“From a primary care perspective, primary care is better at digital than secondary care. I would like to challenge that because it’s a little bit easier. But in reality, it’s because they have a system that works, that they agreed on. A consensus where they deployed it. Whereas in secondary care, if you take the eight providers in Liverpool currently, we’ve got eight EPRs. That’s eight EPRs. Eight sets of interoperability, that’s eight things to go wrong.”

Into the 'Valley of Death'

Discussing the region’s ‘paper-free’ programme, Walliker said, “If you’re going to get rid of paper, you’ve got to put electronic forms in. We developed our own suite of electronic forms as an enabler to ultimately rip and replace and go about the EPR but we thought we’ll go for that cultural change headache now, and I’m not going to lie, it was quite horrific.

“My favourite quote from a doctor is that I was marching them into the Valley of Death by making them go paper free. I took that on the chin and we still went live. And what I thought was really interesting was that A&E was the last to go paper free around the middle of April. It was really hard on A&E. To be fair to A&E they wanted it. We went live in the end, on the 15th April, and then on the 12th May we had the cyber attack.”

Walliker said the region was not affected by the attack itself, but had to take precautions. “We didn’t get the virus in any of our hospitals but we did do the safe thing and shut the N3 connection down, which meant that we knocked off connection to our PAS system which meant that it wasn’t feeding the paper free system. I actually had the A&E consultant in my office within an hour or two saying that I was slowing flow down in A&E and making them go back to paper!

“We have 18000 electronic forms at the moment which sounds ridiculous and is ridiculous. I think we have to be careful when we talk about digital disruption. But taking a paper form and making it digital isn’t digital disruption. We have tried to rationalise as much as possible and we went from 7000 forms to 1800. I would still say that’s round about 1700 too many. So we have a lot of work to do there, but it’s being done.

One area that Walliker is clearly proud of is early warning systems. “We had an electronic whiteboard solution that’s still more than patient tracking. In this we’ve developed the sepsis early warning algorithm and we’re predicting about 200 lives a year can be saved using the e-sepsis warning system. And we’ve done it for cardiac arrests and reduced them by 46% in the hospital. That’s been done by moving to digital technology and alerting earlier. The Care Quality Commission cited our whiteboard solution as outstanding. We also had palliative care and IT cited as outstanding.”

EPR ambition

Earlier this year, it emerged that the Royal Liverpool and Broadgreen, Liverpool Women’s and Aintree University Hospital NHS Foundation Trust had picked InterSystems’ TrakCare for their joint EPR project.

Discussing EPR deployment progress, Walliker indicated there was an ambition in Liverpool’s local digital roadmap for one adult electronic patient record within the city by 2023.

“That’s one adult system plus one children’s system. We have now started the deployment of InterSystems across Aintree, the Royal and the women’s hospital which is about 75% of the adult activity in the city. But we need the others now to come and join that party.  We can’t enforce it. They’ve got their suppliers, they’ve got their systems and they work. But I think the idea that you can plug in together clinical systems and expect it to be a good outcome is fraught with difficulty.”

He added, “We’ve got to maximise technology. In fact I would say anybody that calls their IT department 'IT' needs to refresh that and call it digital. It used to be called 'back office' which is equally patronising. IT is no longer back office, it’s clinical service delivery models. You can’t have effective clinical delivery without effective technology.”

Information Governance and GDPR

Another key area is information governance, notably in light of the recent cyber attack.

“Information governance in the NHS gets a bit of a bad press,” said Walliker. “IG isn't there to make everyone’s lives miserable.  IG is there to protect the organisation from big fines. Sometimes we tie ourselves in hoops and sometimes miss the point. So we have one single overarching clinical data sharing agreement for Liverpool. That has made life so much easier. Three years ago we decided to put EMIS into A&E. I had to get permission from all 76 GP practices in Liverpool because they were 76 individual data controllers.  If one of them said no, then it wasn’t going to happen. We share by default and that’s started to reap the benefit.”

Taking questions at the end of his conference talk, Walliker discussed which officer within an NHS trust should be responsible for tackling the organisation’s readiness for General Data Protection Regulation (GDPR)

“On current job description that would be me,” he said. “I think it is far too big and complex a subject matter to be a sort of ex-officio role on someone’s job description. It has to be someone who’s dedicated to it full time.”

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