https://digitalhealth.blog.gov.uk/2018/06/04/developing-a-portfolio-level-assurance-approach-across-health-and-social-care/

Developing a portfolio-level assurance approach across health and social care

Following the Cabinet Office’s recent update of its digital and technology spend controls to include the 'pipeline' assurance process, I thought it was worth describing the work we have started in the Department of Health and Social Care (DHSC) and across our arm's length bodies (ALBs) to explore how we would pilot and implement the pipeline approach.

Below is an abridged version of the discovery proposal that we have developed with 3 of our initial working group ALBs: Public Health England (PHE), Care Quality Commission (CQC) and NHS Business Services Authority (BSA).

We’ll be following up this post with regular updates as the working group moves from discovery into alpha and beyond.

– Ben Showers (Digital Assurance Lead)

Problem statement

The introduction of spend controls by Cabinet Office in 2010 has been successful in delivering significant savings across government, as well as providing a focus on delivering better services for citizens. Over the past 5 years, the Government Digital Service (GDS) has helped save over £1 billion by working with departments to identify better and cheaper ways to deliver IT and digital products and services.

However, spend controls have imposed a ‘one size fits all’ process over the wide variety of digital services and products being delivered. This is clear within the health and social care context, where engagement with our ALBs highlights the variety of different approaches being used to manage and support the spend controls across organisations.

We know there are a number of challenges that spend controls present to both the department and its ALBs, including:

  • business cases or projects are sometimes well underway prior to consideration of the digital standards that will need to be met
  • the interruption to delivery due to phased spend approvals
  • confusion between what is classed as digital or technology spend, and the multiple contact points in the department
  • potentially lengthy lead-in times for approvals from both DHSC and GDS, for both large and small projects
  • lack of transparency throughout the spend controls process as to where the request is in the process and the next steps
  • potential for duplication and missed opportunities for better collaboration due to a lack of visibility of what other teams are working on

Recognising that the current assurance and approvals processes could be improved, Cabinet Office has been working with a small number of departments to trial a pipeline approach to assurance and spend controls. GDS have recently published a blog post on the changes to the spend approvals and assurance process.

This approach requires departments to develop a list of projects and/or programmes to show all digital spend over £100,000 and technology spend over £5 million (novel or contentious spend must be included no matter the value). Each activity on the pipeline is then assessed against 7 criteria to determine what form of assurance those activities require.

See the full set of recently published guidance.

The challenge for health and care

For many government departments, for example the Department for Work and Pensions and the Ministry of Justice, the majority of digital activity is delivered or managed centrally, so a single pipeline can be coordinated within the organisation.

The Department of Health and Social Care is a relatively small department of state and the vast majority of digital delivery is done by our ALBs. Our larger ALBs, such as NHS Digital, PHE and NHS BSA, have large, mature digital teams. These teams have their own internal ‘pipelines’, which are subject to both internal and Cabinet Office controls and approvals processes.

Given the context within which we operate, and our understanding of the challenges and opportunities our ALBs have articulated around spend controls and the wider assurance process, we want to take some time to really understand how the pipeline approach could best be implemented across DHSC and our ALBs.

Proposal

We will run a 10-week project to understand the current approaches to pipelines used across different organisations and to develop a model for portfolio-level approvals that we can pilot with some of our ALBs.

Start date: April 2018

Complete: end of June 2018

Activities

In leading the development of a pipeline-approach to assurance for digital, technology and commercial across our health ALBs, we will work with PHE, CQC and BSA to undertake the following activities:

  1. review the current pipelines and understand the different approaches being adopted across the 3 organisations
  2. develop a minimum standard of pipeline across the 3 organisations. We’d look to explore what critical information is required and how it’s captured and presented
  3. understand ALB and DHSC internal assurance and approvals processes to share lessons and develop best practice/examples
  4. develop a better understanding of how best to implement the pipeline approach and the benefits for the ALB community
  5. explore the options for a governance model for any future implementation of the pipeline

Project team membership

For the duration of this discovery project, we propose the following working group:

DHSC Digital and Technology Strategy Team

  • Alice Ainsworth (Head of Strategy and Standards)
  • Hilary Hall (Portfolio Delivery Manager)
  • Ben Showers (Standards and Assurance Lead)
  • Isaac Smith (Technical Lead)

CQC

  • Andy Switzer (Head of Delivery)
  • Keith Wear (Digital Portfolio Manager)
  • Craig Whitfield (Digital Portfolio)

PHE

  • Simon Dixon (Head of Digital Strategy)
  • Liz Thomas (Digital Policy Lead)

NHS BSA

  • Darren Curry (Chief Digital Officer)

Outputs

The primary output of the discovery phase will be a report with an overview of the work undertaken and recommendations for next steps. We will also present this work to the wider health and social care ALB digital community and GDS.

The report will specifically include:

  • a list of prioritised user needs
  • a minimum standard for pipelines across the community, including any specific technologies/approaches to sharing pipelines
  • a proposal for the pipeline model(s) that will be tested during the alpha phase
  • analysis of options and recommendations for pipeline governance

Next steps

  • create project backlog (Trello board)
  • initial kick-off (virtual) meeting with the working group of 3 ALBs
  • share discovery plan with GDS and key stakeholders
  • ALBs to share details of internal governance processes
  • run face-to-face mock assessment of current pipelines against GDS criteria with each ALB
  • draft and agree minimum pipeline requirements for discovery and alpha phases
  • arrange mid-point check-in for working group
  • arrange end-of-discovery show-and-tell for ALBs