Taran Sohal from Cloud2

Author: Taran Sohal
Taran is a founding director at Cloud2

The Carter challenge and the dog on a nail

The Carter report “Review of operational productivity in NHS providers” - Interim Report (June 2015) has been cropping up regularly in our conversations with senior NHS management. And for good reason too.

The Carter challenge and the dog on a nail

In this blog, I’ll look to expand on a few areas where we see significant opportunities for improvement that were also highlighted in the report by Lord Carter of Coles. In particular, the use of existing and/or inexpensive technology and standardisation to manage business processes e.g. HR for staff leave, sickness and training.

The latest efficiency targets for the NHS are to save £22bn by 2020, whilst introducing seven-day working. These targets are of course very ambitious and fundamentally challenging.

A part of the solution will inevitably be to replace manual paper based processes with automated e-processes. However, NHS trusts struggle to derive value from previous technology investments, such as the earlier NHS EWA (Enterprise Wide Agreement) with Microsoft raise a question over their ability to achieve different results this time around.

The key reasons for this were:

  • the maturity of and integration issues with the available technology at the time
  • poor business cases not aligned to strategic objectives
  • Little or no investment in training/knowledge transfer and ongoing support/development costs
  • weak project management

Carter worked closely with 22 NHS trusts, at least a couple of which are our customers, and believes that savings of £5billion per annum can be made by 2019/20; split £2bn workflow and workforce costs (annual leave, sickness and training), £1bn hospital pharmacy/medicines optimisation, £1bn estates and £1bn procurement management.

The real opportunity and need here is to transform the way these services are delivered; not just take existing manual processes and introduce technology to automate them “as is”. Every process should be reviewed and assessed for their alignment with strategic objectives, to seek out new ways of working that deliver more efficient processes, as well as a better user experience for staff and patients. Any transformation programme will necessitate an element of change management in order to realise the benefits and deliver the strategy. One of the key areas we focus on at Cloud2 is to ensure all our product innovation is UI (User Interface) and design led to ensure an intuitive and engaging user experience which accelerates adoption.

Common mistakes we see here are organisations that still think they can just code applications from the ground up (based on a waterfall approach to project management) with all the requirements magically captured upfront in a document. The reality is that this approach will fail most of the time as most customers don’t actually know what they want. What I mean by that is that although they’ll have a broad understanding of their requirements, it’s usually pretty high level i.e. a one pager of bullet points at best. To get from a high level set of requirements to a final technology solution successfully requires a more agile approach and working closely with the key stakeholders as features and functionality are developed. It’s also critical that these applications are implemented quickly; as requirements change rapidly, so do the project stakeholders within an organisation. We recommend an ideal project time of 8-12 weeks maximum for most projects, delivered in phases rather than a `big bang’ approach.

As Microsoft’s leading UK partner in healthcare, we’re surprised how often customers are unsure of their organisation’s existing Microsoft technology investments. To be fair, Microsoft’s software licencing can appear to look like it’s been designed to deliberately obfuscate customers. Nevertheless, should these technologies already have the broad functionality needed and support agile delivery, this information could be used to accelerate decision making and strategic business cases.

From our perspective, despite the challenges, the NHS is now in a far better position to deliver on the stretching efficiency targets than in the past due to the following reasons:

  1. The Carter report has provided a clear steer for NHS boards on some key focus areas. These will now provide more top down support for key areas such as process automation that have long since been advocated by departmental and IT leaders but haven’t necessarily engaged senior board stakeholders
  2. Technology has now matured sufficiently to provide an effective end-to-end foundation for delivering a transformation programme around core business processes e.g. HR with ESR integration, Clinical, Finance and IT. This can now rapidly deliver a mobile friendly portal with interactive visualisations of processes, eForms for data capture as well as real time analytics for team/departmental managers to drive the really fun bit - insights and actions
  3. Many NHS trusts have already made the core Microsoft infrastructure investments needed with £100,000’s+ of Microsoft SharePoint user licences (ranging from £34 - £130 per user depending on SharePoint version), that can be used to underpin much of the process automation, especially when combined with inexpensive business process automation tools.

Will the NHS get it done this time?

When I think about this, I’m often reminded of a chap I met when I lived out in Mumbai, India in 1999. I was walking down the road one early morning and he was standing with his dog sat down next to him. The dog was letting out a sad, whining sound that was really rather loud so I stopped and asked him if his dog was OK. He replied; “Not really, he’s sat on a nail”. After pausing to digest what he’d said, this of course prompted me to ask the next question “So why doesn’t he get off then?”. He said, “Because it doesn’t hurt enough yet”.

C’mon NHS, maybe it’s time to get off that nail

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