Rachel Dunscombe’s quality is clear. In 2016 Salford Royal, where she is CIO, was named by NHS England as the most digital organisation in the NHS (as measured by the digital maturity index) and won DigitalHealth’s Digital Trust of the Year award. As a result the trust has secured digital exemplar status, which will take it to a world-leading level of digitisation, equalling the best US sites in less than 24 months.

Job title
CIO Salford Royal Group

Company name
Salford Royal Group

How are you influencing the products, customer experience and services your organisation offers to its customers?
My role is both a leadership role for the organisations within Salford Royal NHS Group but also to the wider NHS system. This has been formalised by NHS England during 2016 in securing digital exemplar status – one of only 10 organisations to achieve this. As part of the exemplar we will be expected to provide professional development and leadership for other CIOs in the system.

The exemplar will take Salford Royal NHS Foundation Trust (one of the units I am CIO of) to a world-leading level of digitisation, equalling the best US sites in less than 24 months. It has also come with a funding pot of £10m from NHS England. I am the responsible officer for this programme and hold accountability for delivery.

The exemplar hosts a digital academy for NHS staff that includes CIO programme, clinical informatics officer programme, leadership for informatics programme, apprenticeships from school leaver to master’s degree and a range of professional development. I have achieved this in conjunction with Manchester University, Manchester Metropolitan University and the NHS Leadership Academy.

In my annual leave I work as an unpaid researcher and advisory board member for KLAS research. This work provides value to CIOs globally in the healthcare sector. The research compares and contrasts the digital health systems in all markets.

During 2016 I officially brokered a partnership between KLAS and NHS England/NHS Digital. Specific UK-centric reports will be provided to UK CIOs via this work. For me this has been one of my biggest achievements for the wider system – providing intelligence to the NHS without cost for the CIOs. It also has an effect on the market by driving product roadmaps and vendor/partner behaviour towards the anglicisation of systems needed for the NHS.

For the NHS clinicians who work in my local organisations I have led on a set of improvements in usability and portability. These include:

  • setup of a single Azure architecture between eight hospitals and various community settings
  • setup of a single trust domain across these organisations breaking down traditional barriers for clinicians
  • implementation of a seamless Wi-Fi network across this footprint
  • obtaining funding from our clinical systems vendor Allscripts for an experience centre and user experience lab
  • moving to software storage – reducing costs of storage by 70% and thus reducing the cost of entry for new clinical systems such as digital pathology.

A future roadmap and technical design authority for half of Greater Manchester is now in place with myself as sponsor. This has a roadmap for a single cloud-based virtual desktop for all NHS and social care staff.

Define the key business outcomes that you have delivered over the last 12 months and their impact on your organisation’s performance
In 2016 the Salford Royal NHS foundation trust was confirmed by NHS England as the most digital organisation in the NHS (as measured by the digital maturity index). In recognition of this the trust won DigitalHealth’s Digital Trust of the Year award. The achievement of these is in part due to the consistent investment in technology over the years, but also to the leadership framework and innovative technologies I have implemented. This is directly aligned with the board’s vision of being the most mature digital health enterprise in the NHS, operating at global standards.

This in turn has given us the £10m investment from NHS England to continue the work and move to fast-follower NHS organisations. In the due diligence work for this work I was granted a ‘green’ by NHS England as the responsible officer. This is directly aligned with the organisation’s aim of creating a group or chain of hospitals all operating to the same clinical model supported by digital technology.

During 2016 we were formally granted group status by NHS England, allowing us to onboard NHS organisations into our chain. We have safely onboarded the four hospitals in the Pennine region (Bury, Oldham, North Manchester and Rochdale). These units have a history of poor practice and infrastructure, and I have made solid progress in expediting the technology and leadership within informatics. I am creating a standardised and fully scalable model with partners in order to allow the rapid and safe expansion of the group. This model was a key part of the approval process with NHS England.

In terms of clinical outcomes 2016 has been an excellent year. I have put 100% of adult community services onto mobile devices and digital systems (a mix of devices based on the clinicians’ preference). The digital standardisation of our clinical pathways has commenced. Some amazing baselines have been taken for standardisation. Recent work showed we were saving one additional life in 10 after 90 days on our stroke pathway due to this work. We have powered clinical mobile apps such as Cloudy with a Chance of Pain, allowing patients to record real-time pain scores, which are integrated with their patient record. This work has proved a clear link between weather and pain (also proving that Manchester is not a good place to live with rheumatism). I have also implemented a blended team of clinical informaticians to support this work.

These many strands tie together to support Salford Royal in being one of only four outstanding NHS organisations as rated by CQC and also one operating within its financial control totals with average levels of IM&T investment.

What has been your involvement with innovation at your organisation – in particular, with products, business model and technology – over the last 12 months?

Product innovation

From the perspective of product innovation we have been pushing ahead with our digital and mobile offers sponsored by and conceptually designed by clinicians. We have continued to run the Mobilise the NHS programme that I designed with the Greater Manchester Academic Health science network to create these new digital products.

In terms of direct healthcare and research, we have designed and implemented a standards-based web API platform with Marand a Slovenian company. This platform is a first of type for the NHS and will allow patients to upload their lifestyle and medical data in real time in a standard, clinically safe and secure way. The design was a collaborative between Marand, my talented NHS team and me.

Business model innovation

The biggest business innovation I have enabled has been the move to a scalable group model enabled by digital processes (see above). This model is a cloud-based infrastructure to support all clinical systems and processes with fast provisioning. Without this centralised scalable technology, safe operation of a group could not be achieved.

This work will bring the NHS the first health economy-wide electronic patient record that can be scaled NHS-wide. Partners in the design and implementation of this include Allscripts, Microsoft and Imprivata. I have led on this work for the group and am the responsible officer for group technology scalability. This also forms part of the exemplar fast-follower work for which NHS England has granted a ‘green’ in due diligence.

During 2016 my team’s business model has changed from an internal NHS informatics function to a system-wide function. During 2016 we have taken on board a number of support services, including social care, drug company research, and support for additional NHS organisations, exemplar status with system-wide responsibilities and a host for NHS shared services. To underpin this sudden expansion and change in business model, I have invested heavily in supporting a healthy culture and managing relationships. In particular we have focused on SLAs and customer communication. As part of this work my service team were shortlisted at the ITSMF awards for their high customer satisfaction and first-time-fix rate. Coming in the top five nationally against other industries with much higher investment levels was a fantastic achievement.

Technology innovation

The clinician-facing technology stack we have created has become a case study for a number of our partners including Citrix and Imprivata. In 2016 the innovation has continued to optimise the technology, and we plan to standardise and unify this over the NHS providers in half of Greater Manchester. This technology saved six nursing hours per A&E nurse per 40-hour week in the first NHS site I implemented it in.

We also continue to do better cheaper with technology, implementing scalable software storage that will enable hybrid cloud. This technology is 70% cheaper than the industry standard vendors, and has previously won my CTO a national storage award.

How have you delivered cultural and behavioural change as a CIO within the IT department and/or more broadly across the organisation?
Within the informatics function 2016 has been a year of great change for our business model. We are now serving a much wider and diverse set of customers and increasing our direct support for the citizen. In order to be successful with this I have needed to work hard on the cultural elements of my teams.

This began with my leadership teams who have co-created with me the Navigator via several workshops. This is a 12-page document which looks at organisational objectives as agreed at board level, our departmental objectives and our environment. It details the values, behaviours, skills, assets, governance, culture and leadership we will use to navigate the dynamic environment. Taking inspiration from the viable systems model, which dictates that any viable system must be able to correct course, I decided that a Navigator was an appropriate metaphor for this work. The output has been validated with the business and board members.

In order to make us resilient through a period of intense change, I have invested heavily in support for staff. This has included coaching, mentoring, strengths finder and a local leadership programme. The local informatics leadership programme I commissioned from King Fisher coaching received rave reviews from staff. It has given them resilience, self-reflection and tools to deal with change.

I am very proud that my staff sickness remains under 1%, and that we have the best corporate services staff survey results in the organisation. In order to support the wider leadership we have been sharing our informatics journey to shared services and new operating models. This has supported HR, finance, procurement and other non-clinical staff.

In the wider system our exemplar will extend this leadership programme plus the clinical informatics programme to staff throughout the NHS.

How have you worked with your CEO and/or board to communicate whatever ‘digital’ and IT means to your organisation/sector and improve digital literacy at the highest levels of the organisation?
I have been very lucky with the board at Salford Royal – they already have a high level of digital literacy. During 2016 I managed to secure the board’s support for a full two-day digital workshop supported by our main systems supplier Allscripts. This allowed us all to talk strategically about scaling to group and how we can leverage opportunities that technology can enable. I took this time (and other shorter sessions at board throughout the year) to orientate the leadership in the environment. My job was to bring alive the trends internationally, describe the parallels with other international healthcare organisations, and describe the strategy of NHS England.

These sessions without doubt have built further trust between the board and myself. Indeed, two non-exec members have also been having one-to-one sessions with me to develop thinking and strategy.

Digital at the end of the day is just a word. We all use it but it can mean many things to many people. For the board and myself I have chosen to define what the digital health enterprise means for us in terms of clinical outcomes – quality and productivity measures. I’ve related it to their reference points – A&E, community nursing or podiatry.

In the wider environment, digital literacy of the clinical workforce has become an essential skill. We had realised that nurses and therapists were not in some cases fully digitally literate, and doctors were unwilling to use some technology. In order to deal with this at source, I have provided a sandpit technology system to the local university who will be using it as part of the training for their doctors, nurses and therapists. My teams are also contributing to the e-nurse programme with essential skills for nurses using electronic patient records.

How have you worked with the technology and IT vendor market to achieve your business goals? How have you been able to influence IT suppliers and successfully manage your partnerships/relationships with large IT companies, SMEs and startups?
In order to achieve our goals for health care we have truly partnered with a number of vendors big and small. From Allscripts creating an anglicised patient record with us to Marand (an SME from Slovenia) co-creating an efficient web API platform for health. What has been important regardless of size or geography is an understanding of each other’s business, mutual respect, a building of trust and creating something new together that benefits both partners. My job has been to carefully choose partners based on their values and behaviours, and to find ways to safely mitigate the risk (often perceived rather than actual) of working with the small or emerging player.

Much of the digital work I have done has focused on startups around Manchester. Part of the success has been in working with partners like Manchester Digital and the Landing in order to start dialogue with these companies in our ecosystem. I’ve personally been out to meet them and taken technical architects to ensure they have a 101 of what the NHS technically looks like to ensure they don’t waste time and effort.

In summary it is about choosing the right partners and building respect and credibility. Co-location and sharing of working practices and knowledge also create something unique.

How have you tried to develop the diversity of your team?
My informatics leadership team is over 50% female and with LGBT representation. I also have two openly HIV-positive senior managers. This year I have further increased the diversity including appointing a deputy CIO from an ethnic minority.

Supporting and nurturing the best talent in the system has achieved this – there has not been a need for positive discrimination. I must say I am fortunate to have had a diverse talent pool to pull from. The NHS is by nature more diverse than most industries and I am thankful for that.

For the wider system I have become a supporter, speaker, funding source and coach for HealthTech Women UK. I assist in arranging the events in Manchester and arrange the funding from vendors and partners. This is a really important network. With only one in five taking computer science GCSE being a female, we need to provide support to ladies who choose to take this career path.

Diversity in my teams is being increased through work with the Prince’s Trust and local educational establishments.

Describe how you organise and operate IT and how this aligns effectively with business strategy and operations
My teams are very much in a transitional phase as we move from a large NHS organisation into a group of many NHS organisations. This as detailed above is about staff being led well, buying in and supporting change.

2016 has seen my information, BI and data science team move from disparate departments in different NHS organisations to a single shared service. The human side of the change was managed amazingly well by Emma Birchall, one of my deputies and director of the shared service. There were no objections or issues with the HR process and full staff-side buy-in. Emma and the team keep close to the operational management and directors of the organisations to ensure we have the correct service specifications for our work.

Within the technology and innovation domain, parts of our work have already been unified, such as some infrastructure and service delivery. This will complete over the coming year and a half as we remove the variance in the technology sets and integrate teams further. The local and group technical design authorities, which meet weekly, ensure we are converging on technology, standards and procurements. Any exceptions are raised to me.

In terms of operational management I hold stand-up meetings on Mondays and Fridays with senior staff to discuss issues and project exceptions as well as mandates. I also have an open door and txt any time policy for staff. My aim is to enable my teams and never unduly hold them up or waste their time.

What strategic technology deals have you made in the last year and who are your main suppliers and IT partners?

  • Allscripts – UK reference site, strategic partner and exemplar partner
  • Microsoft – group cloud scalability partner
  • Softcat – VAR partner with large investment in Manchester – also partnering on apprenticeship rotations with Salford Royal
  • Marand – Web API partner for digital, wearables, IOT and medical devices
  • Sectra – Digital pathology and imaging
  • Imprivata – Single sign-in security and user experience
  • NCC – Cybersecurity and major incident planning
  • HCI Group – Business change services
  • CSC – Patient online booking

For others we are under NDAs, but they are very exciting!

What are your key strategic aims for next year?

  • Complete the scalable infrastructure for group that can scale NHS-wide (board objective)
  • Deliver the key milestones for the NHS England exemplar programme
  • Deliver 10 further standardised pathways (board objective)
  • Complete the integration of the technical teams (board objective)
  • Reduce operational budgets by 20% like for like without a reduction in quality or service (board objective)
  • Provide the first standard scalable health web API platform to multiple NHS organisations for NHS England
  • Launch joint ventures with our partners (again NDA) (board objective)
  • Onboard further NHS and non-NHS business into our shared services
  • Maintain 100% uptime for another year
  • Maintain or better our customer satisfaction and first-time-fix rates
  • Change the skill mix of teams and upskill teams for emerging needs such as cloud and data science
  • Maintain staff survey results and low sickness rates

How are you preparing for any impacts Brexit might have on your organisation?
Brexit is a very hard issue. We are likely to lose a number of useful partnerships and networks that are paid for by the EU (eg ECH Alliance). We also have a number of EU workers – which is even truer of the wider NHS workforce. There will also be the loss of EU innovation funding – we will need to look for funds elsewhere, eg from our partners with IP share.

As budgets are so tight (we have 2% of revenue and 600k per annum capital at Salford for informatics), the biggest effect will be changing exchange rates. Locking in where possible today and agreeing to longer contracts is sometimes an option. This may well work, say, for buying an electronic patient record, but not for those aspects of our work which are more dynamic. This leaves us to risk manage as best we can and draw attention to the financial risks of Brexit. The issue is, however, on the board’s agenda as many medicines and medical devices we used will be affected in a similar way.

Overall our best defence is to make ourselves the digital health nation and sell our knowledge globally. The US and Europe have their own issues with digitisation, and I do believe the UK needs to find ways of reinforcing the economy. Working with others in Manchester we are encouraging big companies to create jobs and a digital health hub that will give us intellectual capital. Providing services we can sell and powering research will provide subsidy to the NHS that will help to offset the effects of Brexit.

When did you start your current role?
April 2016 – group CIO (previously Salford Royal NHS Foundation Trust CIO)

What is your reporting line?
Group strategic director

Are you a member of the executive leadership?
Yes

Are you a member of the board of directors?
No

What other emerging roles does your organisation have and what is their relationship to you?
None

How often do you meet with your organisation’s CEO or equivalent?
Monthly

How many people at your organisation does your function supply services to?
18,000 staff plus citizens and shared services

What is your annual IT budget, or your spend as a proportion of the organisation’s revenue?
2% of revenue – £28m

What percentage of your budget is operational spend (ie keeping the lights on) and how much new development (ie innovation, R&D, exploratory IT)?
95% keeping lights on, 5% R&D (so we have to get partners to subsidise).

Rank the following sources of advice/information in order of importance:

  1. CIO peers
  2. Industry bodies
  3. Media
  4. Analyst houses
  5. Consultants

IT security

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

Are you expecting an increase in budget specific to security in order to tackle the cyber threat?
No

Does your organisation have a designated security professional – CISO or otherwise – and what is their relationship to you?
Yes – report to my deputy CIO (infrastructure) but have authority to work directly with me. Has been sponsored through a master’s in IT security.

Salford Royal Group IT department

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

Does your IT organisation operate an apprenticeship scheme?
Yes

How many employees are there in your IT team?
280 (including clinical coding, medical records, medical legal).

Are you increasing your headcount or planning to bring skills and the ability to react to needs in-house?
No

Which technologies or areas are you expecting to be investing in over the next year?

  • cloud
  • data analytics/business intelligence
  • IoT
  • security
  • machine learning/artificial intelligence
  • wearables
  • 3D printing.

Which technologies or areas are you expecting to be investing in over the next one to three years?

  • cloud
  • IoT
  • security
  • machine learning/artificial intelligence
  • social
  • devices (mobile)
  • wearables
  • 3D printing
  • metworking/communications.

What emerging technologies are you investigating or expect to have a big impact on your sector or organisation?
We are already working on AI and deep learning for research this will emerge further.

The EU

Does your organisation do a significant amount of trade with the EU?
No

Does your department include technology staff from the EU?
Yes

Are you or have you been looking to the EU to recruit key skills?
No