Hospital IT director Anthony Brewer leading efficiency drive

Few good things came out of the 2001 foot-and-mouth outbreak in the UK, but one positive by-product of the year-long crisis that decimated livestock and is estimated to have cost the economy £8 billion, is that it led Anthony Brewer taking the IT director's role at Kingston Hospital NHS Trust.

Brewer was a strategy development manager at rural affairs department Defra when the first cases of the disease were reported early in 2001, and he recalls how the transformation from doing banal departmental work to leading a fire-fighting project, in which strategies changed by the hour and the response had to be immediate, inspired him.

"I was leading a project to establish testing facilities across the UK, involving everything from having valid tests, recruiting staff, putting up buildings and adding computer networks and computer systems," Brewer recalls.

"It was really exciting times because you had to get stuff operational fast, turning strategy into reality over a week. The army took over a floor of our building - we were fighting a war against the disease. I said once we couldn't do something and I was threatened with having to report to [Cabinet emergency committee] Cobra.

"All that made me think I needed a job where I could turn strategy into reality."

Brewer arrived at the hospital in the London-Surrey border town later the same year, and while the pace of change at the trust is somewhat less dramatic than that required by the foot-and-mouth crisis, as a proven change manager he has spent the last 12 years successfully using technology to improve patient care and, in the process, saving money for the trust.

Like all public services in this age of austerity, healthcare is in the grip of an efficiency drive, with the NHS working to meet the 'Nicholson challenge' laid down by its chief executive Sir David Nicholson to save £20 billion by 2015. For the trusts themselves that means annual efficiency savings of 5%, a target Brewer is helping to meet with what he calls an "IT-enabled productivity programme" which includes the digitisation of everything from patient records and X-Rays to staff rostering and procurement.

Outsourcing has been seen as a silver bullet when it comes to cost-cutting, and within the public sector, local authorities are also starting to identify overlapping areas where they can procuring and manage shared services. As part of a cost and performance benchmarking study conducted by ImprovIT, Brewer and his counterpart at St George's Hospital in Tooting, John-Jo Campbell, asked the business technology specialists to explore the feasibility of the two trusts sharing services and to investigate whether or not it would be cost-efficient for either to outsource some or all IT services. Brewer says the findings around outsourcing confirmed his suspicions, but the investigations into shared services - for which ImprovIT modelled the services of the trusts' IT teams as if they were a single body - threw up surprising conclusions.

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"I thought outsourcing was more expensive and the study proved that it was far more expensive," Brewer explains.

Kingston Hospital NHS Trust IT director Anthony Brewer

"It also showed that shared services wouldn't deliver much more than we could internally in terms of efficiency gains. If you compare the benefit of sharing services with the cost of setting up a shared-services arrangement - not to mention the governance issues and the disruption - then it wasn't worth doing. It would also require a large upfront investment to reconfigure our infrastructures and methodologies, which in the short term isn't worth it."

The benchmarking, which Brewer calls "very forensic" and based on "solidly grounded facts, not facile suppositions", did confirm that both Kingston and St George's were running "lean and mean", and 15% more efficiently than similarly benchmarked peers.

Brewer and Campbell may have decided not to share services for now, but that doesn't mean they, and other IT directors across London's hospital trusts, don't share ideas, experiences and learnings on a regular basis.

"Our default strategy is convergence and collaboration - if we're both procuring a rostering system, let's get the same one unless there are good reasons to do otherwise. We might make it one project with one project manager," says Brewer.

"We've got a long-standing IT directors' forum that meets every couple of months," he adds. "We all do things at different times, but the London Procurement Partnership will ask people what their plans are and get hospitals together to support procurement, while the London Programme for IT is part of the strategic health authority - they've been much more collaborative with us rather than trying to telling us what to do."