A new wave of government business technology leader is actively creating streamlined public sector services. To date each individual county, NHS Trust, emergency service or borough has an individual IT service. With government debt at an all time high, a stagnant world economy and the banking crisis continuing it’s the collaborative nature of CIOs that is driving public sector organisations to share and approach their business models differently.
Richard Gifford is Managing Director of Kent and Medway Health Informatics Service, a shared services organisation in Kent that has up to 280 IT professionals delivering technology services to 15 health providers, four acute hospitals at three NHS Primary Care Trusts (PCT) and one local mental health trust.
Maidstone and Tunbridge Wells NHS Trust is the legal entity that hosts the Health Informatics Service (HIS), including the provision of accommodation for the organisation.
Gifford explains that three years ago the HIS was a managed service for Maidstone and Tunbridge Wells NHS Trust and not a healthy organisation.
“I came three years ago with the customer’s eyes and it was basically a failed organisation with weak governance,” Gifford says. “There was a need for transformation and I came here as an interim to begin that turnaround.” Gifford has remained with the organisation that was set up in 2003 and today it is breaking even and has its eyes on making a profit.
The HIS has a budget of £12 million, the bulk of which goes on the payroll. Computacentre, Dell, HP, BT, IBM Cognos are the primary technology suppliers to the HIS.
Since the coalition government came into power the NHS has been at the centre of policy and operational reform as the Conservatives seek to put GPs at the centre of decision making.
“There is a huge amount going on with the change to Commissioning Groups coming into force in 2013 and the end of the PCTs. The fragmentation of the PCT into Commissioning Groups means we have to forge relationships with the GPs,” he says. Gifford has no choice but to embrace the change.
“It is a brilliant opportunity to help these new services. It is all about the stakeholder management piece and how you manage it,” he says of his organisation’s role. “We are meeting with the GPs and Commissioning Groups as much as we can, so we are not waiting for things to happen. We are in a really good position because we are in the NHS.
Before the coalition Commissioning Group policy disrupted the NHS, the previous government spearheaded its NHS reform agenda around the National Programme for IT that sought to create a central single IT platform for the entire NHS. The controversial strategy provided NHS trusts across the country with benefits and obstacles in equal measure. Gifford explains that Kent as a county was not a big adopter of the National Programme for IT, the mail and imaging platforms were adopted, but the Cerner and major administration systems were not adopted.
“The problem with the National Programme for IT was integration; there was never a real plan to bring it all together. So that means that Kent has not had the pain that other NHS regions have.
“Our long term strategy is to be more independent as a service provider, where we compete with the private sector, so we have to be financially viable. If we are selling software, then we can make a profit. We have just won a couple of contracts from outside of Kent providing helpdesk services. I am also looking at offering data warehousing and business intelligence that provides trusts with patient risk strategy information.
“Looking at our back catalogue of developments there is a lot we can offer, so it is an exciting time as it is the commercialisation of what we do,” he says.
“We provide a full range of managed services from a catalogue,” Gifford says of the desktop infrastructure, information management, training, project management, service desk, development, telecoms and web development on offer to NHS Trusts.
By design the HIS has focused on working with health providers in Kent as well as nearby Surrey. “We are local and we know the people of the local market,” Gifford says of the difference between his organisation and a global service provider bidding for NHS work. “When we get all the stake holders to agree and to move together, then we can move with some speed.” Analyst house Gartner were brought in to benchmark the HIS against other providers and reported that the HIS is more cost effective than a profit oriented private sector provider.
The future challenge for the HIS is whether to become a profit orientated company itself or a social enterprise, Gifford says.
The HIC works with each of its client trusts to put governance in on technology and drive down costs.
“The big wins come from consolidating the applications and datacentres,” he says.
“To have a common approach and common and a common architecture would be the thing to do,” Gifford says of the transformation possibilities for all the Trusts the HIS provides. “The networking, infrastructure and datacentres are possibilities. But on many things they [the trusts] want to things themselves. For example , some trusts are very interested in the brand of PC they use.
“We treat each customer as a separate entity on these issues, rather than try and bring them together. I try to be realistic with them and engage them.”
That process and the challenge of GPs and organisations wanting to control their technology will not change with the move to GP Commissioning Groups.
“These doctors are bright people,” he says of his future client base.
As a technology organisation the HIS is challenging its clients to transform themselves using technology. Gifford says tablet devices with Citrix secure access to mental health records have been provided to mental health nurses and iPads are being deployed into some hospitals using the VitalPAC patient information system.
“Mobility is absolutely key, the NHS is facing huge issues, people and buildings are its biggest costs, not the patient admin, so mobility and cloud computing could be very important to us in healthcare. But there are a lot of concerns and the NHS is rightly very risk averse. So for us it’s about taking simple steps with bits of private cloud,” he says.
“My predominant role is the MD with the CIO knowledge that helps me work with the trusts to help them set their visions and achievements with technology, so my role requires two hats.
“In my career I have transitioned across different industries. The transition to health was a big learning curve, but in terms of driving the HIS forward it the same challenge as other organisations. So I am getting people to start to think about how much time we spend and how we create benefits to be part of the HIS culture,” he says.
Gifford had been IT Director at building services firm ROK up to 2008 when he joined Kent and Medway NHS.
“I decided to leave ROK as I was looking for a transformation opportunity and came across this health role and it looked fascinating with the complexity of it.” The challenge and complexity will remain for the foreseeable future in the NHS.