MISSION 2:

The National Immunisation Framework (NIF) for Wales was published by Welsh Government in October 2022. The framework highlights the important role of digital technology in delivering high-quality health and social care services. We have been commissioned to review all vaccination systems and explore how to make these systems work better together. Challenges in the third quarter led to revised time frames for the National Immunisation Framework (NIF) discovery, but activity continues, and interim reports have been received.

The Welsh Immunisation System is at the heart of the COVID-19 vaccination programme in Wales. It also supports the administration of seasonal flu vaccinations alongside COVID-19 vaccinations, or at walk-in flu clinics. Patient GP records are automatically updated when information is added to WIS. The system is used across all health boards, with nearly 14,000 users in vaccination settings, 8,187 in general practice and 352 in pharmacies.

Since its launch in December 2020, the Welsh Immunisation System (WIS) has continually been improved, adding features such as booking and reminder SMS messages, and integration with the Vaccine Re-Booking Service.

At the start of the financial year, WIS was successfully separated from the Children and Young Persons Integrated System (CYPrIS). Operating the WIS as a standalone system has improved system stability, ease of maintenance and will enable further modernisation to meet users’ needs.

In August 2023, the WIS was deployed for the Autumn Booster campaign. Improvements in test automation and operating WIS as a standalone system supported improved data quality following a refresh of cohorts. Test automation has reduced the time taken to make changes to WIS. In February 2024 we made changes for the Spring Booster campaign in less than 4 weeks, almost two months faster when compared to previous spring campaigns.

Despite challenges in Quarter 4, such as resource constraints, recruitment challenges and delays in securing funding, significant milestones were achieved such as recording the 10 millionth COVID vaccination on WIS. New ways of working and automation have supported ongoing improvements and enabled us to respond to the needs of the National Immunisation Framework for Wales. Achievements include making changes to the HPV Immunisation Programme within the Children and Young Persons Integrated System (CYPrIS) and migrating our CYPrIS code to Git, enhancing development practices. There are 3,821 users in health boards and 360 users in general practice.

The Welsh Community Care Information System (WCCIS) provides digital tools for community nurses, mental health teams, social workers and therapists to work better together. It supports community care, helps reduce unnecessary hospital stays and improves record-keeping to avoid duplication. WCCIS also ensures appropriate access to sensitive data and supports integrated assessments between health and social care staff, improving multi-disciplinary team working. Since 2016, 19 organisations, including 15 local authorities and four health boards have implemented the system.

Throughout the year, significant progress has been made in advancing digital healthcare services within the Primary Care strategic programme, aimed at providing seamless access to services close to home.

Managed by DHCW, the programme focuses on building, procuring, and managing systems for healthcare professionals. This includes GPs, community pharmacists, dentists, and community health, mental health, and social care staff.

Key achievements include releasing mobile capabilities for the WCCIS system and multiple updates to the Care Director platform in the first quarter. Ministerial engagement-initiated discussions on the Outline Business Case for Phase 2, alongside the commencement of discovery work for mental health services and allied health professions.

Digital Maternity Cymru aims to provide a digital maternity solution across Wales that supports clinicians and empowers women and birthing people to take part in high-quality, safe care that supports improved outcomes and experiences.

The Digital Maternity Cymru (DMC) programme has made progress by setting up governance arrangements, recruiting staff and starting pre-procurement engagement. In the second quarter, DMC approved its strategy, vision, and target operating model. However, by the third quarter, the programme faced approval challenges and funding uncertainties, which led to resource constraints and delays. The programme produced a draft Outline Business Case in the fourth quarter and is now awaiting feedback from Welsh Government on the funding approach moving forward.

The National Digital Eye Care Programme aims to give hospital ophthalmologists and community optometrists access to shared clinical information. This helps to monitor eye health and provide shared care in both hospital and community settings such as high street opticians, as part of a single connected pathway.

The National Digital Eye Care Programme supports the following Welsh Government investment themes:

Transforming digital services for patients and public

Transforming digital services for professionals

Investing in data and intelligent information

This year, the National Digital Eye Care Programme transferred to DHCW from Cardiff and Vale University Health Board. At the request of Welsh Government, we undertook a ‘pause and review’ of the programme and started activities to support the migration which will need to be under a new supplier contract. We have been working with Cardiff and Vale University Health Board to find the best procurement method and with all health boards to determine what can be delivered under the current contract, which ends in January 2025.

Cardiff and Vale University Health Board has implemented the Electronic Patient Record system for several sub-specialities at various sites. Cwm Taf Morgannwg University Health Board has implemented the system for glaucoma, all within a reduced funding envelope.

The Six Goals for Urgent and Emergency Care were co-designed by clinical and professional leads. They align with Welsh Government priorities in the Programme for Government 2021–2026, to provide effective, high quality and sustainable healthcare as close to home as possible, and to improve service access and integration. In 2023/24, significant progress was made in healthcare data management and service integration across Wales.

1. Co-ordination planning and support for populations at greater risk of needing urgent or emergency care

2. Signposting people with urgent care needs to the right place, first time

3. Clinically safe alternatives to admission to hospital

4. Rapid response in a physical or mental health crisis

5. Optimal hospital care and discharge practice from the point of admission

6. Home first approach and reduce the risk of readmission

The Six Goals for Urgent and Emergency Care Programme is a priority for Welsh Government, to understand ‘what good looks like’ for patients accessing care at an Emergency Department. A Welsh Emergency Care Data Set (WECDS) is needed, to agree care standards, create a uniform approach to measuring activity and develop a nationally agreed model of care for emergency departments. This will enable improvements in clinical outcomes, as well as patient and staff experience.

The Welsh Emergency Care Data Set supports the delivery of Goal 4 of the Six Goals. The draft data set and development proposal were presented at the Welsh Information Development Group on March 7th, 2024 and is due to be published in the first quarter of 2024/25. In future, the data set will be adopted by the ambulance service in their 999 and 111 services, leading to better service integration and more meaningful insights.

The Patient Care Record (ePCR) and Computer Aided Dispatch (CAD) support Goals 2 and 3 by creating a robust data set for sharing with health boards and trusts, linking with other data sets to enhance understanding of the service and patient pathways. Work is underway with the Welsh Ambulance Service NHS Trust (WAST) and Warwick University to establish the foundation data set that will be shared with health boards. This data will reside in the National Data Resource (NDR).

The Same Day Emergency Care (SDEC) service, supporting Goal 3, is still in the early stages of development across all health boards. The SDEC service is part of the Welsh Emergency Care Data Set phase one approach. We have worked with the Goal 3 and 4 leads to develop outline measures, and these are currently being collected across SDEC services across Wales. We continue to work on improving data quality to ensure that it is meaningful and useable.

The Urgent Primary Care Centres (UPCC), 111 and Out of Hours Services (OOH) have been working with the Data Standards team to update the existing Data Standards Change Notice (DSCN) from 2019, supporting Goal 2. A telephony DSCN, including UPCC work, is planned for publication in the first quarter of 2024/25.

We have been working with the Goal 6 director to develop an aggregate data set to measure Discharge to Recover then Assess (D2RA) activity across health boards.

We have produced two new Urgent and Emergency Care dashboards to replace the old Unscheduled Care Dashboard.

An operations dashboard with real-time or near-real-time metrics and demands across Urgent and Emergency care.

A management dashboard with metrics related to service performance.

The dashboards, managed and maintained by DHCW’s Information Services, went live in September 2023 and are being used across NHS Wales and Welsh Government. They are accessible without needing an NHS Wales Laptop or login, enabling significant progress in data access for Welsh Government.

DHCW has been supporting the development and testing of the Welsh Intensive Care Information System (WICIS). The WICIS will collect real-time information from monitoring devices, pumps, and respiratory equipment used in patient care. The system will provide frontline staff with easy access to vital data and insights, offering a quick and clear overview of patient and device statuses across the ward. The new digital solution aims to replace all paper charts and hand-written observations of vital signs. With over 10,000 patients admitted to critical care in Wales every year, this digital system will help reduce the burden on frontline staff. It will include medicines management and will be integrated into NHS Wales digital systems, ensuring information is available when and where it is needed.

Testing cycles for WICIS progressed as planned at the Grange Hospital, indicating readiness for go-live. However, challenges emerged in the third quarter following user acceptance testing (UAT) and validation testing, requiring re-planning with the health boards and the NHS Wales Executive. As a result, the first go-live has been postponed.

Earlier in the year, a strategic review of the Welsh Emergency Department System (WEDS) project was completed and presented to the national project Board. Following this review, it was decided not to extend the rollout beyond the pilot site. As a result, commercial discussions have taken place with the supplier and the project is due to be closed.

Diagnostic services in Wales are facing challenges due to increasing demand, changes in clinical care, a lack of standardisation and scarce expertise. NHS Wales aims to improve service efficiency and effectiveness by reconfiguring services and providing diagnosis closer to the patient. Digital technology is being used to enhance service delivery, patient safety, communication, error rates, costs, and data usage.

We are working to integrate new laboratory and radiology informatics solutions, expand electronic requesting functionality, and enhance the national availability of diagnostic results and reports. This means better access to test results, improving patient care and clinical safety. Better information sharing across boundaries and improved storage and distribution of imaging are also key goals.

Modern diagnostic imaging is essential for diagnosis and treatment in modern patient care. Radiology services are being provided in a wide range of healthcare settings across all health boards and trusts in Wales. In future, regional diagnostic hubs will expand the range of services provided outside of typical hospital environments.

The Radiology Informatics System Procurement programme (RISP) aims to procure and implement a new system that integrates picture archive and communication, patient dose management, and radiology information management functionality. The integrated system will be rolled out across Wales by 2026.

The Laboratory Information Management System (LIMS2.0) Programme supports delivery of a modern, sustainable and safe pathology service as part of the Pathology Statement of Intent.

Both programmes transferred to DHCW from the NHS Wales Health Collaborative in January 2023.

In the first quarter, the full business case for the RISP project was approved, allowing for the contract to be awarded. Progress continued with the execution of the Master Service Agreement (MSA) in June and the endorsement of Local Deployment Orders by multiple health boards. However, setbacks were encountered due to changes in the supplier’s implementation plan and discussions are ongoing.

An agreement was reached with the supplier to terminate the contract for the replacement laboratory information system. As a result, the term was extended for the legacy laboratory information system to June 2030. Upgrades to the latest software version began in the second quarter and significant progress was made in LIMS2.0 by the third quarter, with the programme transitioning into the launch phase. The project continues to progress at pace despite tight timescales and is now in the set-up and build phase, whilst system integration testing has begun on the phase one interfaces.

Both programmes have faced resource constraints and concerns about ambitious build schedules and supplier delivery confidence. However, overall, substantial advancements have been made.

The ‘Pharmacy Delivering a Healthier Wales 2019’ plan outlines ‘A transformation which is required to maximise the health gain the citizens of Wales derive from their interactions with the pharmacy profession.’ This plan also focuses on providing greater value and finding cost-saving efficiencies.

Digital Medicines combines projects that will deliver the benefits of a fully digital prescribing approach in all care settings in Wales. Responding to an independent review, in September 2021 the Minister for Health and Social Services set out an ambition for a comprehensive digital medicines plan for Wales and asked Digital Health and Care Wales to establish the programme. The programme has four interconnected areas of work:

Primary Care Electronic Prescription Service (EPS)

Secondary Care electronic Prescribing and Medicines Administration (ePMA)

Shared Medicines Record (SMR)

Patient Access (NHS Wales App)

In November, the Proof of Concept (SPoC) of the EPS programme went live. EPS replaces paper prescription forms with a digital system that allows GPs to electronically send a prescription directly to a pharmacy of the patient’s choosing. The Minister for Health and Social Care, Eluned Morgan, visited the test sites to mark the occasion. The Patient Access Project completed the software development for the “prescription ready push notification” feature on the NHS Wales App. This feature notifies patients when their GP prescription is ready to collect from their community pharmacy. Development also began on a feature that allows patients to nominate a community pharmacy within the NHS Wales App to receive their GP prescription.

Since the Primary Care Electronic Prescription Service (EPS) Programme launched, 1,457 prescriptions and 3,196 prescription items have been sent so far. Two additional pharmacy systems have been approved to use EPS and the service has been rolled out to another GP practice. Although dependencies on the patient demographics have affected the Shared Medicines Record (SMR), testing with two suppliers on the ePMA framework is ongoing. The Patient Access Project prioritised migrating patients affected by issues with My Health Online.

Overall, significant progress has been made in advancing electronic prescription and medication management initiatives. These efforts demonstrate an ongoing commitment to overcoming challenges and ensuring successful implementation for the benefit of patients and healthcare providers across Wales.

Healthcare professionals rely on the technology and services we provide We work proactively to ensure maximum reliability and availability.

We are pleased to note that our operational services performed well over the past year, achieving an average availability of 99.984%. During this period, we experienced a total of 44 major incidents.

Major IT incidents affect a large number of users and include issues such as delays in processing test results, service downtime or partial service disruption. Some of these incidents were due to issues with third party suppliers or infrastructure problems at health board premises. Of these major IT incidents 98% were resolved within their target fix-times.

We received 20 Subject Access Requests, with one response falling outside of the statutory timescales.

We also received two other Individual Rights requests, one Environmental information Regulation request and three requests made by the police and other agencies under Schedule 2 of the Data Protection Act. All of these requests were responded to within the statutory timescales.

Computer systems are at the heart of primary care and manage millions of patient records each year. We provide primary care with a growing range of digital tools to help GPs manage records, organise daily tasks and care for patients.

Further to the establishment of the Primary Community and Mental Health Directorate at the end of last year, we have developed our Primary Care Strategy. Published in quarter two, the strategy aims to provide DHCW a platform from which we can deliver digital products and services with improved value and benefits.

The GP Systems Framework Contract mini competition process was undertaken this year, this is the process by which all GP practices choose their next clinical system. Following the conclusion of this process, one of the GP systems suppliers confirmed their withdrawal from Wales. This has required planning to move 198 GP Practices to another clinical system, highlighting resource allocation challenges.

Choose Pharmacy helps community pharmacies provide services for patients and the public, freeing up GP appointments for people with more complex needs. It supports pharmacists in clinical decision-making and improves patient safety by offering:

Accessible advice and support at a time and place convenient to local communities.

Digital templates which help to guide pharmacists through a patient consultation.

Of those surveyed, 77% (344,371) said they would have made an appointment with their GP if Choose Pharmacy was not available. This year, we also introduced a Urinary Tract Infection (UTI) service across Wales to aid pharmacists in providing person-centred care closer to home.

The Welsh Patient Administration System (WPAS) holds patient identification details, outpatient appointments, admin letters, notes, and patient pathway referral to treatment (RTT) data. We are working towards a single view of this data, promoting seamless links with the Welsh Clinical Portal and standardising reference data and ways of working. WPAS is used in six health boards in Wales and Velindre Cancer Centre.

The year began with the successful launch of a consolidated instance of the Welsh Patient Administration System across the Betsi Cadwaladr University Health Board, making patient information and interactions easily accessible across the whole health board. This saves time, increases patient safety, and improves the patient experience.

Work is continuing to address the implications of the boundary change between Swansea Bay University Health Board and Cwm Taf Morgannwg University Health Board on WPAS and related systems.

Additionally, functionality was implemented to enable multi-disciplinary teams to collaborate effectively.

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Registered WPAS Users and Transactions (Millions)

WLIMS is a clinical IT system used by pathology staff across Wales to store, record, and exchange information such as blood test results. The system also links to the machines that perform tests and analyze the samples. In the past year, the system managed 40 million tests. WLIMS links to the Welsh Clinical Portal, allowing health professionals to see all previous tests conducted for a patient and request new ones, no matter where they are in Wales.

This year, the blood transfusion part of the service went live in Swansea Bay University Health Board. This means blood transfusion data is now available across Wales for both laboratory and clinical staff, enabling a more joined-up approach.

WHPSMS is a digital hospital pharmacy system used nationally in 28 sites across seven health boards and one trust in Wales. Implemented in 2022, it improves the accuracy of computerised dispensing and medicines stock management, replacing 30-year-old software. It offers better performance, reliability, and efficient medicines management. The improved data clarity ensures compliance with national governance, meaning safer and more consistent patient care.

In 2023/24, we introduced the National Pathology Exchange. This system allows users such as nurses to track the status of prescriptions without calling the pharmacy for updates. This saves time and provides patients with up-to-date information.