Amid the vast data landscape of the Central and North West London (CNWL) NHS Trust, with its tricky requirement to give accessibility but with confidentiality, Mark Large is fusing five separate clinical systems into one capable of providing mobile access to a single view of the patient record that is visible to all healthcare stakeholders when appropriate. Along with his determination to enable remote consultations by video and remote patient monitoring, it reveals a CIO pushing the boundaries.

When did you start your current role as CIO with Central and North West London NHS?
November 2013.

What is your reporting line?
Via CFO.

Do you meet with and discuss business strategy with the CEO every week?
No, but monthly with additional meetings around specific strategic topics.

Are you a member of the board of directors?
No.

What other executive boards do you sit on?
Executive board, operations board, informatics committee (chaired by NED), clinical systems programme board (chaired by pharmacy lead, attended by executive directors), infrastructure programme board (chaired by executive director and attended by other executive directors). Also chair of the London CIO Council, member of the steering group for Federation of Informatics Professionals.

Does your organisation have a CDO?
No.

What non-technology responsibilities do you have in the organisation? 
• Member of estates strategy board
• Member of procurement strategy group

How many employees does your organisation have? 
6,500.

What number of users does your department supply services to? 
6,500.

How do you ensure that you have a good understanding of your business and how your customers use your business's products?
Through thorough business engagement as follows:

• Infrastructure
I've outsourced all infrastructure to CGI using an outcome-based contract after a procurement process that involved engaging 200 end-users in generating the requirements for the contract. The contract consists of an ITIL-based service desk and complete infrastructure upgrade (links between buildings, wired and wireless networks in buildings, desktop, mobile and tablet technology) providing mobile access to a single view of the patient record wherever it is required.

• Clinical systems programme
Procurement process has just completed, with aim of replacing a range of clinical systems with a single system with app-based access to allow mobile view of the single patient record. Procurement process involved massive end-user engagement (400 end-users). Infrastructure plus clinical system equals a completely updated organisation with dramatically improved processes and thus efficiency. For example, there was a move from paper-heavy (requiring multiple visits to office base per day for community-based staff) to paper-light (visits to office base only as and when required – once a day or once a week, or even less).

• Organisation design
Complete redesign of ICT. ICT is no longer a tactical infrastructure break/fix department; it now needs to be a strategic partner that can understand the needs of business, converting them into service requests or projects/programmes that deliver value. The new team has 55 permanent posts, more than 50% of which are in the business engagement team, reflecting the importance of being customer- focused. As part of business engagement, we have posts specifically designed as named contacts for the business areas of CNWL so that all staff have a known and constant point of contact for ICT services. One of the key qualifications for being part of the business engagement team is the ability to talk in plain English to our customers. As well as business engagement, ICT consists of the strategic design authority team (a small but very senior architecture practice), the projects and programmes team, and the commercial contracts team.

• I also attend service director meetings, service lead meetings, and Super Tuesday (monthly meetings of all service leads).

Central and North West London NHS technology strategy and agenda

Is your organisation being disrupted by the internet, mobility or technology-oriented start-ups?
Yes.

Are you empowered by your organisation to disrupt from the inside?
Yes.

Describe a disruptive measure you’ve led or played a major part in
With mobility and videoconferencing, I pushed the boundaries to allow remote consultations by video and remote patient monitoring. Technology is on trial for videoconferencing as part of service and care pathway redesign programme led by the medical director.

As part of my chairmanship of the London CIO Council, I led the push to the practical delivery of interoperable systems.

I also selected the system for the clinical systems programme that will transform CNWL’s systems landscape. The five separate clinical systems have become one that is capable of providing mobile access to a single view of the patient record that is visible to all our healthcare partners, as appropriate.

What major transformation project has been recently completed or is under way at your organisation?
As well as the infrastructure, clinical systems programme and organisation design projects described above, as chairman of London CIO Council (regularly attended by CIOs and IT directors from all healthcare settings, with regular attendance from CSUs, representatives of the chief clinical information officer (CCIO) community, the Health and Social Care Information Centre and NHS England) I hope to persuade all organisations to send their CIO or IT director as well as getting CCIOs involved because the Council's agenda and objectives matter to all NHS organisations, not only in London, but nationally. We regularly invite guest speakers, provide networking opportunities, share experience and update each other on upcoming projects we can help each other with.

The objectives of the London Health and Social Care CIO Council are to:
• Create a forum for CCIOs, CIOs and leads from all healthcare settings, including CSUs, CSGs, local council and social care partners to drive forward the digital healthcare agenda.
• Influence policy government directly as well as through NHS England and HSCIC.
• Establish thought leadership and tangible progress on interoperability, the appropriate sharing of electronic patient data across all care settings, patient access to their electronic records, and mobile working and access to patient records with near-paperless operation, and raise professional standards and improve the competency of informatics staff by promoting professional registration with the Federation of Informatics Professionals and collaborative working and knowledge sharing to achieving economies of scale and cost reduction. 
• Work closely with the London Procurement Partnership IT Category Board to drive their strategy and work plans to achieve the best possible procurement environment.

What impact will the above transformation have on your organisation?
• CNWL will give access to a single patient record wherever and whenever required, one that can be shared with all healthcare settings involved in the care of the patient.
• The London CIO Council will build an ever stronger membership consisting of CIOs, CCIOs, CCGs and CSUs, with regular attendance from NHS England, HSCIC and real influence on issues of policy at a local and national level.

How has your leadership style contributed to the outcomes of the transformation project
Collaborative, honest and open approach with a strong management team that I have built with a wealth of experience that has rapidly built a reputation for having a can-do approach and one focused on delivery.

What key technologies do you consider enable transformation?
Mobility, video, unified communications and modern systems with app front-ends to promote easy access on the move.

Are you increasing the number of cloud applications or infrastructure in use at your organisation?
No.

What is your information and data analytics vision for the organisation?
The information and knowledge strategic programme – one of seven in the organisation – will look at all aspects of information, ranging from predictive modelling, what-if analysis, performance management, reporting, compliance, quality research, media (social, internet and intranet), content management classification and sharing. It will be a single source of the truth for the organisation and promote agility.

How is mobile and social networking impacting operations and customer experience?
CNWL has a very active communications team that promotes the use of Twitter and social networking to communicate widely.

Describe your strategic vision towards shadow IT and BYOD. How do you influence and engage executives and employees around choice?
CNWL intends to work with its infrastructure supplier CGI and chosen clinical systems suppliers (procurement is completing now) to understand the opportunities BYOD presents given the aim of mobile and secure access to a single view of the patient record wherever required.

What strategic technology deals have been struck and with whom?
• CGI for outsourcing of service desk and all infrastructure. The service desk went live in April 2014, and the infrastructure roll-out plan in progress (networks, desktops, mobility etc).
• We are in the process of signing a contract with clinical systems suppliers to replace the community, mental health and pharmacy clinical systems.

Who are your main suppliers?
CGI for all infrastructure, Ascribe for Pharmacy and Jade patient record, BT for four instances of national programme Rio. Major clinical systems procurement about to complete to replace Jade and the four instances of Rio and Pharmacy.

Central and North West London NHS IT security and budget

Has your organisation detected a cyber intrusion in the last 12 months?
No.

Has cyber-security risen up your management agenda?
Yes.

Does your organisation understand the potential cyber-security threats it faces?
Yes.

Has this led to an increase in your security budget?
No.

What is the IT budget?
£22m.

How much is the IT operational spend compared to the revenue as a percentage?
3%.

What is the strategic aim of the CIO and IT operations for the next financial year?
The 24- month horizon is to deliver mobile access to a single patient record for 6,500 staff as well as interoperability allowing the sharing of patient data with our partners across primary, secondary and tertiary healthcare settings.

Are you finding it difficult to recruit the talent you need to drive transformation?
No.

Has recruitment and retention risen up your agenda as a CIO?
Yes.

Are you looking for recruits in the EU to fill the skills shortage you have?
No.

Does your IT organisation operate an apprenticeship scheme?
No.

Central and North West London NHS technology department

How would you describe your leadership style?
Driven, open and inclusive, but challenging and decisive – never afraid to take responsibility for decisions or actions.

Explain how you’ve supported and developed your senior leadership team to support your overall objectives and vision
When creating the new organisation design for ICT, all the key stakeholders were consulted to ensure that a relevant target operation model was created, from which the new organisation flowed. A full competency map/framework has been created for staff at all levels in ICT to map existing skills and skill levels versus desired skills and skill levels. The competency framework is being used to determine the development required. While I have been lucky enough to have a new ICT organisation design approved and have been recruiting to it, there will always be a need for development as no one is an absolutely perfect match. This approach has been welcomed by CNWL HR. 

As part of my chairmanship of the London CIO council, I am keen to support and assist the work of Fed-IP to drive professional membership and registration, thus improving the standing and recognised quality of informatics professionals.

How many employees are in your IT team?
Currently 60 to 70, but in the middle of recruiting a 55-strong permanent team.

What is the split between in-house/outsourced staff?
Moving from 90/10 contractor/perm to 90/10 perm/contractor, plus outsourced CGI infrastructure contract (the numbers for which fluctuate according to need at the time).

Does your team include key skilled workers from the EU?
No.