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As the digital systems leader for NHS Wales, it is important that our partners, service users and the people of Wales have confidence in our work. Effective engagement helps translate stakeholder and user needs into our strategy, and the development of our products and services.
Working closely with our NHS Wales partners is vital. We engage regularly with all statutory health bodies in Wales and ensure strategic alignment through bi-annual executive meetings and the development of joint delivery plans. Through our attendance at the All-Wales Executive peer forums and the establishment and chairing of the Independent Members All Wales Digital Network, we support better understanding of digital across NHS Wales, as well as the future needs.
Establishing partnerships through formal Memoranda of Understanding or Partnership Agreements, we support delivery of our ambitions and ensure a coordinated and efficient approach to health and care across Wales and the UK. These include with NHS England, Social Care Wales, Centre for Digital Public Services, Digital Intensive Learning Academy and with academic partners via the WIDI.
Through partnerships with commercial organisations such as Kainos and Google, we bring the best knowledge and expertise to our products and services and help develop skills within NHS Wales.
We’ve involved over 850 people and 100 GP practices in user research undertaken through user testing of the NHS Wales App. We also established the Public and Patient Assurance Group to ensure that the patient voice is included in all of our work.
Regular events and activities have taken place to engage stakeholders around key themes, such as the Digital Services for Patient and Public Symposium and the National Data Resource Advanced Analytics and Big Data session. Alongside this we’ve undertaken a range of discovery sessions and individual programme and project Lessons Learnt workshops with stakeholders to support better understanding of needs, co-development and co-delivery of the digital systems and solutions needed for the people of Wales.
Co-sponsoring a first Digital Summit we explored the key issues of digital inclusion in health and care and we signed the Welsh National Digital Inclusion Charter to promote the agenda through six pledges.
With our engagement strategy and action plan we will listen, understand and respond to build trusted relationships with stakeholders to deliver the digital systems and solutions needed for the health and care of the future.
Communications play a key role in raising awareness of what we do and the impact of digital on the functional delivery of healthcare services and the well-being of patients.
In an ever-evolving landscape the Communications Team informs and interacts with external and internal audiences through social media, video, podcasts, events, award submissions, newsletters and media.
Highlights included the first Digital Summit connecting health, care and the voluntary sectors and the growing success of our social media channels, LinkedIn, Facebook, Twitter, Instagram and YouTube.
During the year, followers on social media increased by 15% to 18,296 and our average post engagement rate has increased 16% to 5.22%.
Throughout we have focused on creating a shared understanding of the value of digital in health and care.
With significant change in ways of working underpinned by new digital services, we have provided support to the NHS Wales staff who are new and existing users of digital services across the wider delivery programme, working shoulder to shoulder with service users to deliver a mix of support, technical advice on system changes, training, eLearning, videos and demonstrations.
Large scale training and support implementations have taken place this year for Cancer Informatics, the Welsh Patient Administration System, the Welsh Nursing Care Record and the urgent 111 interim solution which was part of our support of GPs during the cyber security incident which affected one of our suppliers. Through regular feedback, our Business Change team has been recognised as a significant contributing factor to the success of these key NHS Wales deployments.
Launched in 2021, our On Demand Training Centre is a website that hosts eLearning videos and reference guides for national digital systems and services . Offering 24- hour ‘on demand’ support, it is easily accessible to anyone with an NHS Wales email address. Since the launch of the ODTC there have been over 277,000 visits to the site.
Change ambassadors are needed at every level of an organisation to embed change in meaningful and sustainable ways.  As part of the strategy to support and embed digital change across NHS Wales, we created the Change Ambassador Programme. Accredited at Higher Education Level 6 and cited as an exemplar programme in behavioural change management by the University of Wales Trinity Saint David, the Change Ambassador Programme supports organisations by creating change ambassadors who promote a culture of embracing and supporting change.
Health professionals are dependent on the technology and services we provide and expect them to be as readily available as utility supplies such as gas and electricity. In response we work proactively to maximise reliability, availability and to prevent problems from occurring.
We are pleased to note that the delivery performance of our operational services during the year was good with an average availability of 99.977% including a total of 45 incidents which we categorise as major; we saw an improvement in overall availability as well as experiencing fewer major IT Incidents.
Major IT incidents are those that affect a large number of users and may include issues such as delays in processing test results, downtime for a service or partial disruption to a service. Some of these incidents were the result of problems with third party suppliers or problems with infrastructure running in health board premises. Of these major IT incidents 96% were fixed within their target fix-times.
Our award-winning IT Service Desk provides a single point of direct support for over 16,000 staff in GP Practices, the NHS Wales Shared Services Partnership, Digital Health and Care Wales, as well as some other national organisations. The team is also the point of escalation for all NHS Wales organisations’ local service desks, helping resolve issues and requests raised by health boards and trusts.
Following a successful audit in December 2022, the DHCW service desk retained its Service Desk Institute 3-star accreditation as a customer led service desk. In a year of adjustment the Service Desk refocused following a reduction in Test Trace Protect (Covid-19) support activity:
This year the Service Desk fulfilled over 220,000 support tickets from across NHS Wales
On average, the Service Desk succeeded in answering 94.3% of calls (i.e. abandoned call rate is average 5.7% across the year).
Our Service Desk collects feedback on quality of service and based on the responses received, has maintained a customer satisfaction rate of 95%+.
Cyber security continues to be a key focus. Widespread cyber-crime and cyber insecurity is a new entrant into the top 10 rankings of the most severe risks over the next decade, published in the World Economic Forum Global Risk Report. DHCW has developed a 3-year Cyber improvement plan which has been agreed by our Board and we also host a Cyber Resilience Unit, commissioned by the Welsh Government to review and assist each of the Operators of Essential Services (OES) across NHS Wales to evaluate their level of cyber security and resilience, based upon the requirements of the NIS (Network and Information Systems) Regulations.
In 2022-23 DHCW was recognised for the following awards and accolades.
Recognised by the British Computer Society as the best place to work for IT professionals in the UK.
Recognition for an outstanding contribution to research and innovation.
Marilyn Bryan-Jones, recently appointment as an Independent Board Member at DHCW, won an award at the Black History Wales National Community Awards for Wales 2022 for her contributions to race equality and inclusion.
The DHCW procurement team were highly commended at the Go Awards in the collaborative procurement category for their work on the All Wales Microsoft Enterprise Agreement.
A collaboration between NHS Wales Library and Knowledge Services (NHSWLKS) and the NHS Wales e-Library won the CILIP Cymru Wales ‘Welsh Library Team of the Year Award 2022’ for producing an innovative programme of live and pre-recorded library-user training delivered to NHS staff across Wales.
The impact of the Welsh Nursing Care Record (WNCR) for adult in-patients was recognised at the MediWales Awards 2022, winning the judges health and care award.
As a Special Health Authority, DHCW’s delivery role centres on digital programmes and operational IT services to support the care of patients and to populate patient data into the digital health care record. Therefore, the majority of the NHS Wales Delivery Framework measures do not apply to DHCW. Those applicable are detailed below:
Delivery measure 23 Agency Spend as a percentage of total pay bill.
Target: 12 month reduction trend. Monthly reporting via the Financial Monitoring Returns.
Outcome: Please see Finance Section
Please note the context of DHCW agency spend differs from that of wider NHS Wales hospitals which is primarily linked to bank staffing levels. Within our organisation it is reflective of the time limited nature of digital investment and development initiatives which are supplemented via flexible agency/3rd party staffing.
Delivery measure 26 Percentage compliance for all completed level 1 competencies for the Core skills and Training Framework
Target: 85%. Reported monthly via Electronic Staff Record (ESR).
Outcome: 91.8%
Delivery measure 27 Percentage of sickness rate of staff
Target: 12 month reduction trend. Reported monthly via ESR.
Outcome: Average percentage of sickness rate for staff is 3%
Delivery measure 28 Percentage headcount who have had a Personal Appraisal and Development Review (PADR) /medical appraisal in the previous 12 months.
Target: 85%. Reported monthly via Electronic Staff Record (ESR) /MARS.
Outcome: 84%
Delivery measure 32 Emissions reported in line with the Welsh Public Sector Net Zero Carbon Reporting Approach.
Target: 16% reduction in carbon emissions by 2025 against the 2018/19 NHS Wales baseline position. Annual reporting via Organisation Level Emission Return.
Outcome: Please see Our Carbon Footprint Section
Delivery measure 33 Qualitative report detailing the progress of NHS Wales’ contribution to decarbonisation outlined in the organisation’s plan.
Target: Evidence of improvement. Six monthly Organisational Qualitative Monitoring Return
Outcome: We provide a six-monthly report to Welsh Government, which is included in their publication of NHS Wales Measures
Delivery measure 34 Qualitative report detailing evidence of NHS Wales advancing its understanding and role within the Foundational Economy via the delivery of the Foundational Economy in Health and Social Services Programme.
Target: delivery of Foundational Economy initiatives and/or evidence of improvements in decision making process. Six monthly Organisational Qualitative Monitoring Return
Outcome: We provide a six-monthly report to Welsh Government, which is included in their publication of NHS Wales Measures
Delivery measure 50 Qualitative report providing evidence of implementing actions to deliver the Welsh Language objectives as defined in More Than Just Words Action Plan.
Target: MThJW Monitoring Return
Outcome: Please see (Performance overview > How we do it > Welsh language) Welsh Language Section
Delivery measure 59 Percentage of complaints that have received a final reply (under regulation 24 or an interim reply (under regulation 26) up to and including 30 working days from the date the complaint was first received by the organisation.
Target: 75%
Outcome: Please see Complaints Section
Control measures are in place to ensure that all the organisation’s obligations under equality, diversity and human rights legislation are complied with.
As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with.
This includes ensuring that deductions from salary, employer’s contributions and payments in to the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations.
Data protection legislation requires that where personal data breaches meet a certain set criterion, they be notified to the Information Commissioner’s Office (ICO) as the statutory body for data protection in the UK. Information governance incidents are assessed against the threshold for notification by our Information Governance team. 
Incident reports which include data breaches are submitted to the Information Governance Group for scrutiny.For the year 2022-2023, there were no personal data breaches notified to the ICO.
As of the end of March 2023, staff compliance with the Information Governance training in the NHS Wales Core Skills Training Framework stood at 88.6% against a target of 85%.
The NHS in Wales needs to plan for and respond to a wide range of emergency incidences that could affect health or patient care. It has been confirmed that while NHS Wales Special Health Authorities are not currently covered by the provisions of the Civil Contingencies Act 2004, Welsh Government expects Digital Health Care Wales’ (DHCW) continued engagement and participation in emergency and contingency planning for Wales.
As such DHCW has been formally directed (under the powers of the NHS Wales Act 2006) to continue to:
Since operating in business continuity mode during the response to the Covid-19 pandemic, DHCW has continued its collaborative approach to business continuity and emergency planning through the active membership of a number of planning groups across Wales.
Our business continuity arrangements are working effectively and are continuing to improve with additional resource and focus on business continuity and emergency planning.
We will continue to develop our emergency preparedness through inclusion in multi-agency emergency preparedness response and recovery frameworks.
We seek the views of our people, potential staff, partners and community to make data driven decisions, and we partner with innovators to drive continuous improvement towards inclusion, diversity and equality, striving to become an exemplar in the sector.  We recognise that inclusion is everyone’s responsibility and through facilitation, training, support and performance management we will embed a culture that is inclusive and anti-discriminatory, demonstrating the core values and behaviours so that DHCW is known as a role model and a great place to work 
During the year, we developed our Strategic Equality Plan 2023-2027 and we were assessed by an external accreditation body which led to:
A systematic approach to Equality Impact Assessments helps us to place equality, diversity, cohesion and integration at the heart of everything we do and our strategies, policies, services and functions do what they are intended, for everybody.
DHCW’s Sustainability Strategy is the highest level of documented information which provides overall direction of the environmental aspects of the Integrated Management System (IMS).  
We established a Sustainability Strategy based on combining current DHCW processes with ISO 14001:2015 Environmental Management System requirements, as a structured and systematic tool to deliver our mandate to protect the environment and its natural resources. 
It is the guiding principle to establish, implement, maintain and continually improve our performance in managing environmental aspects and compliance obligations, in order to control the risk of threats and opportunities, and to satisfy the needs and expectations of interested parties.
At DHCW, we acknowledge the potential impact that we may have on the environment and we are fully committed to reducing this impact across the scope of our operations services.   By improving, increasing our communication and placing a greater focus on how we are disposing of our waste, we have become more environmentally aware. We are actively making efforts to measure and reduce our carbon footprint to boost sustainability.
While there are many activities that can reduce the total number of greenhouse gases that we emit as an organisation, we believe they must be undertaken as part of a coordinated and coherent programme to ensure a complete transformation. Crucially, our approach is underpinned by the belief that any steps taken must consider not only how to address generated CO2 emissions, but also how we can become carbon efficient. 
Examples of our progression during the year include:
Delivery against the 2022-23 decarbonisation action plan is 100% complete. Our environment annual trend is positive, with operational emissions currently showing a reduction of 39% (1090tCO2e) for 2022-23, compared to our baseline year of 2019-20.
We continue to measure emissions across several categories to ensure a comprehensive approach is in place to reduce CO2 levels.
The NHS Wales Decarbonisation Strategic Delivery Plan demonstrates how NHS Wales can contribute to recovery and the Wellbeing of Future Generations (Wales) Act 2015, which addresses long-term persistent challenges such as poverty, health inequity, and climate change.
We recognise the climate emergency and the need for all those in the public sector to contribute to the ambitious net zero carbon by 2050 goal for Wales set by Welsh Government.
In late 2021 we developed the DHCW Decarbonisation Strategic Delivery Plan and have made significant progress. However, there is more to do. This delivery plan takes a fresh look at our building and energy needs, as well as procurement, travel, and other emissions sources. Some of these emissions are beyond our direct control; highlighting the challenge we have in working collaboratively to influence the decisions of others.  
As a digital organisation, we are in a unique position to contribute towards reducing carbon emissions across the wider NHS by providing and improving digital solutions, such as those enabling for digital transfer and storing of information and solutions that enable remote consultation.
Carbon emissions are an important part of measuring environmental impact. Our carbon footprint is calculated as the total number of greenhouse gas (GHG) emissions produced as a result of our activities and services, expressed as carbon dioxide equivalent.
DHCW first measured emissions in 2019-20 (as its predecessor organisation the NHS Wales Informatics Service). This is known as our baseline year. Most of our operational carbon footprint during this year was attributed to electricity (80%) and gas (18%).  Operational emissions during 2019-20 totalled 2748 MtCO2e (Metric Tons of Carbon Dioxide equivalent).
Year 2 (2020-21) saw an overall decrease in emissions of 27% to 2011 MtCO2e which is very positive, electricity emissions saw a significant decrease due to a change to a renewable energy supplier.
Remote working also contributed to a decrease of building emissions but has been accounted for in a different manner to reflect home working emissions.
During Year 3 (2021-22), we saw a further decrease in our emissions (37% from our baseline year) to 1719 MtCO2e due to a range of measures including utility contract reviews and starting the move to an EV fleet. The majority of staff continued to work remotely throughout the year.
In Year 4, our current reporting year (2022-23) operational emissions have continued to decrease to 1658 MtCOO2e and we are now reporting a 39% decrease against our baseline year. A new reporting category has been introduced relating to F-Gas associated with air conditioning systems.
We anticipate that our operational carbon footprint will decrease further in 2023-24 with estate rationalisation (one site to be closed) taking place and the completion of a project to replace original lighting with LED lighting in two large sites at the end of 2022/23.
DHCW has completed its second full year of operation since transitioning from being a hosted body within Velindre NHS Trust to its own statutory Special Health Authority status.
We have continued to strengthen financial systems, controls, governance and reporting required to meet both statutory requirements and business need within the challenging context of NHS finances and implementation of new investments.
Digital solutions supporting the ongoing Covid-19 response (including Welsh Government’s Test Trace Protect and Mass Immunisation scheduling systems), resulted in an additional requirement of £9.128m revenue. Funding from Welsh Government was secured in order to ensure that there was no additional organisational financial impact upon our ability to break even. We also lead the delivery of a number of digital initiatives supported by Welsh Governments Digital Priorities Investment Fund.
For 2022-23 DHCW received £31.4m in revenue funding and £9.3 in capital. The future focus will remain on providing first class digital information and solutions to support effective patient care and citizen services. Some will require shifts in technology (such as transition to cloud first services) which will require adjustments to sustainable funding models in order for DHCW to meet financial targets.
The statutory financial duties of Special Health Authorities are set out in section 172 of the National Health Service (Wales) Act 2006.
First Financial Duty
Section 172(1) sets out what is referred to as the ‘First Financial Duty’ - a duty to secure that DHCW expenditure does not exceed the aggregate of the funding allotted to it for a financial year. The powers of direction in the National Health Service (Wales) Act section 172(6) WHC/2019/004 clarified that the annual statutory financial duty is set separately for Revenue and Capital resource allocations. Revenue and Capital resource allocations were issued to DHCW for the period 1st April 2022 to 31st March 2023 and will form the basis of assessment of the First Financial Duty in the statutory accounts.
Second Financial Duty
The ‘Second Financial Duty’ for NHS bodies in Wales is the duty to prepare a plan and for that plan to be submitted to and approved by the Welsh Ministers.
DHCW responded to the Welsh Government’s published NHS Wales Planning Framework 2022-2025 with a three-year Integrated Medium Term Plan (IMTP), which was submitted to Welsh Government in March 2022. This was not a statutory requirement for Special Health Authorities, and under the NHS Finance (Wales) Act 2014 the plan did not require Ministerial approval; however, it was accepted and noted by the Minister for Health and Social Services in July 2022.
DHCW is reporting the achievement all financial targets set
Fees paid to the Audit Wales for their statutory audit and performance audit work were £197,039
Our Handling Concerns and Complaints policy focuses on swift resolution, outlining target timeframes for responses, as well as having an emphasis on organisational learning to inform service improvement.
A total of three complaints and no concerns were received during 2022-23. All were resolved within the times outlined in our policy.
Special Health Authorities do not currently sit within legislation relating to the NHS complaints policy ‘Putting Things Right’, which is aimed at patient facing organisations.
As an organisation in our second year, we continued to set ambitious targets, whilst adapting to new challenges and stepping into the system leadership role to be NHS Wales’ digital organisation. Our Incident Review and Learning Group have implemented several improvements as a result of lessons learnt throughout the period, key aspects of which are:
Improvement of the Service Desk Communications process, documentation and tools. The review resulted in more consistency in communications from the Service Desk, with simplified language for end users, and better flow of information across teams.
Improvement of Major IT Service Incident Management process, documentation, resourcing and training. A working group reviewed all aspects of Major incident management and carried out a series of improvements to make the previously complex process easier to navigate for those involved.
Improvements to the incident review process using the Yorkshire Contributory Factors Framework to develop a more sophisticated understanding of the factors that cause incidents.
Improvement to the technical Change Management process to ensure increased consistency of approach by change managers and change advisory boards. Implemented changes have deeper scrutiny by change advisory boards, and better linkages to post-change incidents exist, providing learning which feeds back into the process for further refinement.
Workforce and culture lessons resulting from staff surveys and other records. The lessons learned have influenced the new Vision and Values, as well as workforce policies, and processes for starters and leavers.
Improved promotion and communication of Lessons Learned to promote IT Service Management best practice and shared learning with colleagues across the sector.
In our second year we saw significant growth, challenge and change, as we embedded the organisation within the NHS Wales family. What we deliver matters to health professionals and to the people of Wales, and the higher the quality of our delivery, the better chance of a positive outcome.
Our IT Services are the bedrock of NHS Wales’ digital capability, and maintenance of service availability at 99.977% has ensured that technological disruptions have been kept to a minimum, underpinned by additional refinement and management of systems, including our cyber security approach, going forward.
We are proud to support our NHS Wales colleagues, providing the digital services now so essential for efficient and effective patient care, and we are looking forward to meeting the challenges and embracing the opportunities of the coming year.
Flexibility in the delivery of our plan is essential to ensure that we are delivering the right things at the right time; we will continue to build on this approach, taking account of stakeholder needs and the clearly stated ministerial priorities which inform what we do.
Looking ahead we will continue to support NHS Wales staff with modern systems and data solutions to provide insights and to deliver the App which will enable the citizens of Wales to better manage their own health.
Key areas include moving forward with new systems for critical care and emergency care and further development of citizen-facing services to transform care pathways, as well as maintaining the strong focus on developing our organisation through growth in skills, capacity and culture.
As a forward-thinking organisation, we will continue to work with our stakeholders and partners to ensure that our digital solutions make life easier for all, make a real impact, and place health data and quality at the core of all we do. 
Our stretching objectives are set out in our latest Integrated Medium Term Plan 2023 –2026