The Welsh Risk Pool hosts the Once for Wales Concerns Management System (OfWCMS) which aims to provide consistency in the capture and analysis of data relating to staff and patient safety and service user feedback.
Procured on an all-Wales basis, the system is actually a collection of individual digital systems which are operated locally and designed, developed and maintained by a central team.
The Welsh Risk Pool continues to work with all health bodies and national groups to ensure that the information governance arrangements and cyber security requirements relating to the Datix Cymru and Civica Experience Wales are firmly in place. During 2023/24 the national Data Protection Impact Assessments have been reviewed and a key piece of work is the definition of roles and responsibilities for data sharing at a national level. There is an effective governance process which oversees OfWCMS.
Programme Board. Commissioned by the Welsh Risk Pool Committee, the OfWCMS is overseen by Programme Board, Chaired by Chief Executive of Velindre University NHS Trust Steve Ham. This provides strategic oversight to the programme and ensures organisations are able to demonstrate readiness for implementation of new functionality.
Programme Steering Group. Additionally, a Steering Group has been formed which oversees the operational elements of the system.
Content and Governance Group. A Content and Governance Group has also been established to monitor requested for system developments and changes in order to maintain the Once for Wales approach.
Workstreams. Each area of functionality is underpinned by a network of group which represents staff and practitioners related to the element of the system being served by the software. The number of workstreams required varies depending on the stage of implementation. Workstreams created to coordinate procurement, ICT integration and report form design have been stood down as the programme has been live since 2021. A number of the workstreams consist of the membership of the Safety and Learning Networks – which means that there is readily available access to expertise on topics when required. The power of collaboration across NHS Wales in developing the Datix Cymru and Civica Experience Wales systems through the OfWCMS workstreams is overwhelming successful. It has created a system for NHS Wales used by NHS Wales.
Datix Cymru
The Datix Cymru product is a cloud-based software tool with multiple modules that have been adapted, configured and implemented specifically for NHS Wales. In addition to replacing the legacy systems used throughout organisations for handling patient safety, health and safety and complaint records, the system has been configured to support specialist services such as the NHS Wales Medical Examiners service.
Fig.14 outlines the core functionality of the software.
Fig.14 Core Functionality of Datix Cymru
The power of the Datix Cymru system enables the creation and configuration of specific Investigation Workflows, which are made available across Wales – delivering consistency in not only data but processes used to determine learning and improvements. This incorporates the Yorkshire Framework of causal factors.
Datix Cymru provide large-scale interactive databases to report, capture, analyse and retain information relating to key parts of the Putting Things Right area. In 2023/2024, over 250,000 new records were opened. Table.13 outlines the breakdown of the records opened.
Datix Cymru Workstreams 2023/24
We have operated a number of dedicated workstreams with the aim of bringing consistency to the development and use of the Datix Cymru system used by all NHS Wales health bodies when handling concerns to investigate and improve quality and safety.
All organisations are represented at each of the workstreams and extensive collaboration, supported by a robust Governance process has led to significant development of the Datix Cymru system:
Mortality Workstream - reviewing the flow of the report form to align with the Medical Examiner report form. Focus on capturing learning consistently across all functionalities is a key agenda item going forward.
Incident Workstream – key pieces of work in 2023/24 include reflection and updating of the duty of candour section to support consistent reporting, user experience and management of the Duty of Candour process. In addition to significant changes to support the Information Governance reporter and management process. The Incident workstream has also commissioned a significant piece of work to develop a Restricted Practice reporting form that aligns to the National Framework.
Intelligent Monitoring Dashboard Data Analysis Workstream – have supported the Candour Network in developing National Candour dashboards, which have been used to support organisations in complying with their duty to report.
Coding Workstream – have reviewed and updated V15 of the national codes. Extensive work is being undertaken to ensure all codes have the appropriate combo linking to ensure accurate reporting across all levels. A key piece of work is to link with chairs of All Wales groups for specific areas such as, Tissue Viability, Infection Prevention Control, Health and Safety etc to gain assurance that the current codes and codes being requested in the future meet the needs of the services.
Safety Alerts Workstream – Two organisations are currently piloting the Safety Alerts system, which will be rolled out across NHS Wales once the pilot is completed. The workstream, which is made up of representatives from all organisations are monitoring and supporting the pilot process.
Risk Workstream – The functionality is current being piloted by one organisation. The workstream, which is made up of representatives from all organisations which are monitoring and supporting the pilot process.
Datix Cymru Developments 2023/24.
There have been a number of key developments for Datix Cymru in 2023/24
Active Directory. Datix Cymru was using ADFS system as the authentication tool for users to authenticate into the system – enabling users to log into the software and be allocated appropriate permissions. The migration from ADFS to Microsoft Entra was scheduled to be completed in December 2023 and was completed on time. This was a key programme deliverable for the Programme Board as ADFS will no longer be supported in 2024.
Safeguarding. The Safeguarding reporting and management forms have been developed and successfully piloted in Hywel Dda University Health Board. The Once for Wales Concerns Management Central team will continue to work with the NHS Executive, Public Health Wales and all organisations to standardise and implement this in 2024/2025, with an encrypted email system to support notifications to local authorities.
System Upgrades. The Once for Wales Concerns Management Central team have supported five Datix Cymru system upgrades, in order to improve and enhance system functionality. A robust quality assurance process is followed by the Central Team prior to any new software release to ensure any operational issues are identified before this is signed off and implemented across all NHS Wales Datix Cymru systems.
Quarterly System Releases. Updates to the workflows and data fields within the system are implemented on a quarterly basis once the Content and Governance Group have approved the adjustments. The Central Team have continued to deliver the quarterly development workplan on time and on budget.
Supporting Primary Care Services. Bespoke Incident Reporting Forms for Primary Care Providers have been built in all Health Board systems to support the Duty of Candour Implementation and provide easy accessibility, with a dedicated webpage.
National Reporting Functionality. Interim solutions were established following the discontinuation of the UK National Reporting and Learning System and a new portal functionality to transmit data from health bodies to the NHS Wales Executive has been designed and successfully piloted in 2 of the Health Boards, with a plan to roll this out across Wales in July 2024.
All-Wales Coding and Categorisation. The Coding Workstream has continued to enhance the national codes to meet the needs of services and the codes are currently on edition 15. Additionally, work has been completed to combo-link the classification codes to ease selection by staff and improve data accuracy. Standardisation of terminology has also been a major focus to improve accuracy of reporting. A work programme has been developed to continue enhancements.
Business Continuity. A Datix Down process has been developed for NHS Wales, in the unlikely event the Datix Cymru Incident form was unavailable all organisations would still be able to report Incidents.
Civica Experience Wales
The National Health Service in Wales is a large and complex organisation and accurate and detailed service user feedback is crucial to designing and improving innovative health and care services. The Civica Experience Wales platform was introduced as part of the Once for Wales Concerns Management System programme and by the end of 2022 all Health Boards and Trusts in NHS Wales had implemented the Civica Experience Wales system and had invested in dedicated local system leads to support organisation’s commitment to collecting, analysing and learning from real-time feedback from users of its services and to manage system and data at a local level.
Civica Experience Wales provides a platform for real time feedback from service users to be collated and analysed quickly and effectively cross health and primary care. The system operates by developing and presenting surveys for completion by services users and utilises a range of contact methods, including SMS text messaging, QR code, Email, Interactive Voice Recognition, (IVR) web-based tools and a dedicated app which can be installed on devices within the organisation.
Sentiment analysis
The platform includes a powerful data sentiment analysis tool, which enables health service leaders to understand detailed information received from service users, adding the ability to recognise the sentiment behind a response. The sentiment analysis of responses enables very rich information to be drawn from the data input by service users and this enables me to provide our service leadership teams with valuable insight into the experiences of patients and relatives. The graphs and data tools are straight forward for managers to access with minimal training needed.
Quantitative data helps health bodies understand ‘what’ but only qualitative data helps you understand ‘why’. The sentiment analysis tool provides functionality to analyse emotion, thematically categorise information and show trends.
Example from the Civica Experience Wales system outlining the powerful sentiment analysis tool is shown in Fig.15 and Fig.16.
Presenting the National Experience Picture
Through the introduction of a common platform, health bodies now have a robust tool to gather feedback from patients, relatives and other users of health and care services across NHS Wales. With all health bodies using one platform, NHS Wales can better support service and quality reviews whilst ensuring a consistent national approach.
With the introduction of the NHS Executive in April 2023, the need for a national analytical platform to capture and visualise the feedback information being collected locally. Therefore, we reconfigured the Civica Experience Wales demonstration system to become a national analytical tool - to collect and analysis national survey feedback data.
In August 2023, working collaboratively with the NHS Wales Executive, organisations Civica Experience System Leads and members of the Service User Feedback Safety and Learning Network, the first national survey was launched. This collects feedback from Emergency Departments across NHS Wales and organisations use a variety of collection methodologies to gather feedback from service users who had accessed Emergency Departments in Wales, with the locally collected information being presented in the national analytical tool. Data collection included SMS text messages, Interactive Voice Recognition (IVR), QR codes and paper surveys. Between 1st August 2023 to 31st May 2024, 17,881 pieces of feedback were received. Analysis of this invaluable feedback via the national analytical platform from local Civica Experience Wales Systems is currently being undertaken.
Learning from the all-Wales feedback is shared with all health bodies and also via the Listening and Learning from Feedback Group, which oversees and coordinates this area of work. In addition, data from the national analytical platform is shared with the NHS Wales Executive to support triangulation of other sources of data through the Beacon dashboard.
An Editorial Board, coordinated by the Welsh Risk Pool has been established to manage the requests for national surveys and to support organisations in planning and implementing national survey information. 2023/24 saw the foundations being laid to support national collaboration, benchmarking and shared learning to improve service user experience by collecting, analysing, reporting on feedback. Going forward the focus will be on evidencing learning and improvement based on the feedback received.
The roadmap for national surveys currently and going forward include is shown in Fig.17.
Digital Stories
2023/24 saw the introduction of a key development in the functionality of the Civica Experience Wales system. This involved the development, led by NHS Wales, of a Digital Stories Library, which facilitates the uploading, categorisation by theme, consent management and an audit record for stories. With the appropriate level of consent, as defined by the NHS Executive Digital Stories Toolkit, level 4 consent allows for digital stories to be shared and become accessible across NHS Wales.