Central and North West London NHS Foundation Trust, based in Hampstead, is one of the largest trusts in the UK caring for a wide range of physical and mental health needs. The trust covers a third of London, Milton Keynes and part of Kent, Surrey and Hampshire.

Director of ICT Mark Large began started at CNWL in November 2013 after performing the same job for five years at Great Ormond Street Hospital for Children. Mark also has been in the NHS for almost a decade, but also has experience working for global blue chip companies and charitable trusts.

What is your job title?
Diretor ICT

When did you start your current role?
18 November 2013 (moved from GOSH)

Have you completed an MBA?
No

Order the following sources of advice/information by value to you:
1. Peer group
2. Analyst
3. Consultant
4. In-house
5. Vendors

Technology strategy and spending

What is the major transformational IT project that has been recently completed, or is underway at your organisation?
CNWL is currently involved in a major seven year strategic plan to overhaul infrastructure and systems.  This wide ranging transformation consists of several strategic programmes:
• CNWL has just signed a £56m contract for the provision of infrastructure services (networks, server room, desktop, telephony and mobile devices).  
• CNWL has also just issued a prior information notice for the procurement of new clinical systems for community and metal health – a new electronic patient record that provides a single view of the patient record
• As part of the complete overhaul of IT at the Trust, a full organisational design for ICT to ensure that the IT capability matches the changing needs of the business going forward, can act as a full partner to a business moving at pace.
• Other strategic programmes include knowledge and information, integration and collaboration, service user access and corporate systems
Other systems continue to be updated or replaced as needed whilst the strategic programmes continue through to final delivery.

What impact will it/does it have on the organisation?
The organisation has grown over the last ten years from a turn-over of £128m to £430m and delivers care from Dover, to Winchester to Milton Keynes. Organisational growth can throw up a range of issues with multiple systems and processes being inherited as part of that growth.  Ensuring efficient systems and processes for our staff also ensures a better experience for our services users.  A more integrated and flexible IT, and IT that will be at the forefront of the organisation, helping to deliver future success is essential to CNWL’s continued growth.  IT must provide an agile platform, one which promotes the ability of the business to continue to move at an ever faster pace.
For the infrastructure CNWL needs to move beyond the traditional NHS backroom to one that is able to flex quickly and with precision if another organisation came into the Trust in the future as well as keeping existing services up to date.  
The contract with CGI will support the organisation as it grows and enters a more challenging environment in terms of finances and patient demand. The first step will be to ensure the trust network is stable and supported and to transfer major existing contracts to CGI to manage. Then it will look at making improvements, specifically around mobile working for the trust’s community staff.
The improved ICT infrastructure is expected to be in place by the end of May 2015.
Moving forwards:
• Access to a single view of the patient record is essential, regardless of location.
• Paperless is part of the agenda, but the key is how can we maximise face-to-face clinical time with patients and utilise IT to do that.  
• CNWL also plans to embrace telehealth and mobility to enable service delivery in the home or where ever the service is required.
• Employing a wide range of devices and techniques to capture data electronically at the time of service delivery, and entry of that data into systems is essential to aid the best possible data completeness and quality
• The ability to share that data as appropriate across all health care settings and with the service user is essential to efficient care delivery, ensuring that care pathways are able to operate smoothly and efficiently across organisation boundaries
• An IT capability that is designed to meet the needs of the business, and can help plan and deliver success for the future, ensuring that new contracts won can be incorprated into the above new world quickly and accurately.  This capability will ensure that the new contracts become a seamless part of the whole, a model that ensure that information, service quality measurement and assurance are able to be delivered quickly following contract wins.
• The new IT world will enable the speed and accuracy of transaction for the business which is critical to ongoing success
In summary – end users will have a more stable infrastructure, mobility backed by access to a range of devices to suit the need at the point of care, and access to a single view of the patient record that is updated in near real time.   These new capabilities will change service delivery on the ground, with more efficient use of time through scheduling (fewer trips back to base) and the speed of response in an emergency that comes when systems are designed to work well together and support the end user.  As a result, service users will have a consistently better experience.

What new strategic technology deals has your organisation struck and with whom?
Central and North West London NHS Foundation Trust has awarded a seven-year £56m infrastructure contract to CGI and is commencing an OJEU procurement to replace its key clinical systems.

Name your strategic technology suppliers?
Logica CGI, Cisco, Microsoft, Dell, HP, Canon

What is the IT budget?
Revenue - £10m, Capital £11m

How much is the IT operational spend compared to the revenue or company turnover as a percentage?
Circa 5% of turnover

What is the strategic aim of the CIO and IT operations for the next financial year?
To complete the transformation of the ICT organisational design, complete the transfer of ICT operations and infrastructure to CGI as detailed above, to complete the OJEU for clinical systems and commence delivery of systems that continue to transform the end user experience.

Transformation achievements

Would you describe the CIO role as a transformation leader in your organisation?
Yes – this role is key to the transformation of CNWL. It reports to the CFO, but also is a standing member of the Executive Board meeting, Informatics Committee and is responsible for the strategic programmes delivering the transformation.

Describe the transformations you have led / been involved in, how did they transform operations, customer experience or the organisation?
I have just moved from Great Ormond Street Hospital where I transformed the IT capability there, am now in charge of moving towards paper light operation and mobility on a much bigger scale (circa 7,000 staff, over 100 locations stretching from Dover to Milton Keynes compared to 3,500 staff at GOSH all in one location).

Beyond technology, can you describe a business transformation programme that you own or contribute to?
Clinical systems, organisational design of ICT, Corporate systems, service user access, knowledge and information

What key technologies are being considered to enable transformation?
Mobility (choice of devices to match the circumstance), Tele-Health, Video Conferencing, Presence, Unified communications, BYOD, digital dictation/voice recognition, digital paper, electronic process management, electronic patient record, outsourced infrastructure

What percentage of your applications / infrastructure is run from the Cloud?
None (but we have centrally hosted Electronic Staff Record as part of the wider NHS setup)

How is the use by employees of their own technology, use of mobiles and social networking impacting operations, customer experiences or the organisation at present?
Social media is increasingly being used across the organisation, from service delivery to the Executive team use of Twitter for example.  This trend will gain pace over time as we seek to communicate with service users using a range of media that they use as second nature.

Do you have a plan in place for how to deal with shadow IT and BYOD. How do you influence and engage executives, place the right controls around employee choice and engage with the organisation on this issue?
BYOD is part of the infrastructure plan being considered in the CGI contract. I am responsible for the transformation programmes and have regular 1:2:1 meetings with the CEO to discuss progress and strategy moving forwards, as well as attending Executive Board, Informatics Committee and Operations Board.

Where do you seek transformational inspiration from?
In addition to my peer group, the people I serve - be they staff or service users. Improving the experience of that audience is very inspiring.

The CIO role in the business

Who do you report to?
CFO, but dotted line to executive board and Informatics Committee which is chaired by a non-executive director.

Do you have a seat on the board?
No

How often do you meet with the CEO?
Monthly as part of Exec Board and then regular 1:2:1s

Does your organisation have a digital leader and what is the difference in their responsibilities to yours?
Not outside of ICT

What percentage of IT budget do you control and what percentage of IT budget does your digital peer hold?
100% controlled by me

The IT department

How many staff make up the IT team?(What is the split between in-house/outsourced staff)
Circa 100 in house

Describe the CIO’s management team, do you have direct reports that develop the relationship and services between the business and IT?
Currently structure:  Head of ICT Service, Head of Delivery, Head of Assurance, Head of Business Engagement (responsible for developing the relationship an services between the business and IT – the eyes and ears on the ground), Head of Infrastructure and Architecture, ICT Resources Manager

New structure currently being planned: Director of Strategic Design Authority, Head of Business Engagement (responsible for developing the relationship an services between the business and IT – the eyes and ears on the ground), Head of Programme & Project Delivery, Head of ICT Operations, Performance Reporting Manager

And how many log-in accounts do you issue across you organisation?
Circa 7000

What is the primary technology platform? ( for example ERP, Website, trading system)
Rio, SystemOne and Jade Clinical Information Systems