# Programme definition **Proposed direction — 20 October 2026.** COPPER TIGER is the evolving programme, problem statement and architecture definition that may drive Care Hub. **Care Hub is a potential rebranding of Programme Cortisone**, not a confirmed rename. This is owner-directed definition, not an approved Defence programme or delivered capability. [SRC-211](https://copper-tiger.pages.dev/sources/index.md#src-211) ## Problem statement Defence needs a coherent way to sustain care and accountable work across its population, clinical services, operational settings and external partners. Records, responsibilities, access rules and service processes must support that continuity together. Technology alone cannot establish who acts, who accepts responsibility or which information may be used for each purpose. COPPER TIGER will examine how fragmented information, uncertain handovers, duplicated work, restricted access, changing responsibilities and unreliable connectivity can affect care, readiness and service performance. These are candidate problems to investigate, not a measured Defence-wide finding. Public evidence of specific workflows and limitations is retained in the [Defence mechanism map](https://copper-tiger.pages.dev/defence-mechanisms/index.md). The problem set remains open. Known and unknown risks can emerge, change, be addressed, recur or be introduced by change. Programme definition must keep the case for change, assumptions, dependencies and outcomes under review. ## Scope and initial emphasis **Terminology in this proposal.** Defence healthcare is the wider scope, including Armed Forces and civilian patients. The owner’s “occupational health-led” description qualifies military medicine, not every Defence healthcare service or activity. The architecture supports both the wider care needs and the specific needs of military medicine, with purpose-specific access. [SRC-221](https://copper-tiger.pages.dev/sources/index.md#src-221) | Dimension | Proposed scope | |---|---| | Population | Armed Forces and civilian patients within Defence healthcare scope. Recruitment, service, deployment and transition are relevant journeys, not conditions that every patient must meet. Inclusive scope does not imply identical care entitlements. [SRC-219](https://copper-tiger.pages.dev/sources/index.md#src-219) | | Settings and partners | All Defence healthcare settings across Firmbase, Overseas and Operational (MARITIME, LAND and AIR) environments, including primary, dental, mental health, rehabilitation, specialist and hospital care; NHS, devolved, overseas, allied and contracted provision. Interfaces and responsibilities are in scope. | | Operating model | Clinical workflows, responsibilities, service governance, workforce, policy, organisational arrangements and ways of working, alongside information and technology. | | Purposes | Care, coordination, occupational health, readiness, command support, planning, population health, surveillance, research and operational analysis, with distinct governance for each purpose. | | Priorities | Clinical service coordination and occupational health/readiness have a marginal initial emphasis. All purposes are interconnected; priorities and measures remain to be evidenced. | | Conditions | Connected, degraded and disconnected operation from the outset. Capabilities and safe limits depend on the setting and pathway. | | Reference contexts | England is an initial reference. Devolved, overseas and allied requirements inform the design from the outset. | Policy and responsibilities are open to change alongside technology. Existing commitments, contracted systems and national services inform the baseline; none fixes the future architecture. Other projects remain independent sources of questions and challenge. They may later become workstreams, but that is not assumed. ## Leading architectural principle Maintain patients’ **continuing primary records of care in line with applicable NHS conventions and standards**, supporting continuity and record transfer from and to NHS general practice when Defence care arrangements begin and end. Develop a complementary, appropriately governed **Defence Shared Care Record (DShCR)** alongside them. This proposed direction includes Armed Forces and civilian patients within Defence healthcare scope. [SRC-219](https://copper-tiger.pages.dev/sources/index.md#src-219) [SRC-220](https://copper-tiger.pages.dev/sources/index.md#src-220) Position Defence to integrate with future national shared care records, including England's Single Patient Record and corresponding devolved initiatives, and companion national and regional services. This is the leading hypothesis to support, test and develop. The proposed DShCR provides a comprehensive, primarily read-only overview across multiple clinical source systems and relevant supporting tools. It brings information into a **contiguous, longitudinal view**: connected across sources and extending over time. Authorised users could access complete contributing clinical source records through that view, subject to actual coverage, currency and permissions. Source systems retain their originating accounts and corrections. [SRC-212](https://copper-tiger.pages.dev/sources/index.md#src-212) [SRC-220](https://copper-tiger.pages.dev/sources/index.md#src-220) An associated **Integration Platform (IntP)** coordinates two-way information exchange and publish–subscribe notifications, including flows back to independent specialist source systems. Sharing conditions, medications, vaccinations and allergies should support **clinical decision support systems (CDSS)** within those systems. Source authority, provenance, currency and reconciliation rules remain to be defined; delivery does not authorise automatic overwrite. Workflow processing remains distinct from message brokering. [SRC-220](https://copper-tiger.pages.dev/sources/index.md#src-220) The wider architecture includes an Enterprise Master Patient Index (EMPI) for matching and shared demographics, and a Healthcare Provider Directory (HPD) for provider profiles and relationships. These support access and routing; they are distinct from clinical source records. Business continuity options include retained information, consultation capture and later reconciliation. Their scope and implementation remain to be explored. Patient-facing services are also options to develop. No product, storage topology or universal access model is selected. See the [internal architecture](https://copper-tiger.pages.dev/architecture/index.md) and [national interfaces](https://copper-tiger.pages.dev/national-regional-integration/index.md). ## Decision sought and evidence boundaries The initial decision is agreement on the problem and strategic direction, providing a basis for discovery and eventual programme investment. A coalition across Defence clinical leadership, operational commands, digital leadership, governance and delivery should develop its respective roles during definition. This wiki does not assign those roles to particular organisations. The draft [programme decision brief](https://copper-tiger.pages.dev/programme-decision-brief/index.md) brings together the wider case for change, public evidence, desired outcomes and strategic decisions sought. No coalition decision is recorded by preparing the brief. **Public evidence** describes what a dated accessible source supports. **Proposed direction** describes owner intent and architectural inference. **Discovery questions** identify decisions or missing evidence. An owner's statement is not public proof of rollout, authority or capability. This remains an open/internet-source definition; internal project material supplies leads rather than factual substantiation. ## Outcomes and discovery Assess safety, continuity, readiness, patient experience, staff workload, access, resilience, value and other outcomes identified during definition. Baselines, measures, trade-offs and relative priorities remain open. Candidate measures include unowned overdue tasks, repeat history-taking, time to referral acceptance, reconciliation errors and recovery of pending work after disruption. They are proposed measures, not measured benefits or targets. Develop the [operating model](https://copper-tiger.pages.dev/operating-model/index.md), [architecture](https://copper-tiger.pages.dev/architecture/index.md) and [discovery register](https://copper-tiger.pages.dev/validation-queue/index.md) together. The scope is deliberately capable of evolution. ## Related lines of inquiry Independent projects can inform and challenge this definition through public sources: strategic healthcare delivery; shared-record design; legacy interoperability and terminology; patient access; data governance; safety inquiries; medicines and diagnostic exchange; risk methods; and population or geographic analysis. None is automatically a constituent workstream. Local notes, internal datasets and supplier-oriented project names do not establish public facts, preferred products or programme dependencies.