Technology, digital and data have, for some time now, been at the heart of transformation within the NHS. However, since the appointment of Matt Hancock as Secretary of State for Health and Social Care in the summer of 2018, this technology-focused drive has been stronger than ever, prompted by the publication of a new digital vision.
That vision is all about using the latest technology and digital tools to improve service delivery, enhance care and drive efficiencies across the healthcare system. One organisation driving this transformation is the NHS Business Services Authority (NHSBSA), the Special Health Authority and an Arm’s Length Body of the Department of Health and Social Care that provides a range of critical central services to NHS organisations, NHS contractors, patients and the public.
“Our big vision is around using technology to deliver better health outcomes by developing the right systems and solutions,” says Nick O’Reilly, Chief Technology Officer, NHSBSA: “Two years ago, we established a digital insight and technology approach. An integral part of that is how we make good use of our big data sets to deliver better health. Alongside that new approach, we adopted a cloud-first approach, which underpins the digital elements and our ability to harness insights.”
That digital insight and technology approach is already paying dividend according to Darren Curry, Chief Digital Officer, NHSBSA: “Technology provides us with a huge opportunity to deliver more services to many more people in ways that meet user requirements. That’s a huge advance from the past when we’ve been driven by business requirements.
“One of the areas we’re seeing really good results in is the use of AI-enabled voice technology in our contact centre. By automating responses to customer queries via Alexa we’ve seen a positive reduction in the number of calls made to our operators. It’s worth noting that this isn’t about reducing headcount; it’s about freeing up those operators to be able to better deal with those users who need support, guidance and human interaction, rather than being bogged down by simple queries. It’s a case of adding value to the service we deliver and the feedback from staff is that they feel empowered as a result, because they’re making more meaningful interventions.”
While delivering better health outcomes will always be at the heart of the work being undertaken by the NHSBSA, cost savings and efficiency clearly also important. When asked how the organisation is delivering cost savings, Nick responds by saying: “Our primary focus is on delivering better health outcomes, but of course we do need to keep an eye on our operating costs and technology can clearly help with this. Moving to the cloud straight away helps us avoid unnecessary spare capacity costs and allows us to scale up and down more quickly, avoiding costs of underused capacity for example.
“Also, by focusing on how the wider NHS works and where processes can be streamlined, which we’ve been doing for a number of years now, we’re on target to achieve a target of saving £1bn. Some of those savings link to data analytics and machine learning. For example, our tools have helped us to identify simple savings that have been overlooked, such as the fact gluten free bread is cheaper in the supermarkets than on prescription. It’s about identifying patterns in our data to find savings that are much bigger than when you focus on operational costs.”
The activities of the NHSBSA clearly involve plenty of largescale data sharing from across the NHS, a topic that has gained plenty of column inches in the media over the last few years. This has not gone unnoticed by the NHSBSA Leadership team who are very clear this is about ethical use of big data and not individual patient records.
“When we talk about data sharing, we must concentrate on ethical data sharing,” he says. “The majority of the data we have is anonymised and when we do data analytics on data sets, we’re looking at patterns that, for example, link drug prescribing with specific outcomes. We’re not dealing with individual patient sensitive data. Likewise, when we’re working on workplace data, for example, we’re using the big data set, not an individuals. We take cyber security and responsibilities very seriously too. We have to because data is at the heart of our work – unless we treat data well, use it ethically and protect it, we’ll lose a great asset or lose trust.
“Given the size and age of the NHS, the reality is that we come across legacy data and we have to contend with mixed data quality and data inconsistency issues. This is where new technology can really help us – using the tools at our disposal we can improve data quality and therefore exploit data to better effect. It’s how you use new data management tools to bring big data sets together that really counts.”
As mentioned earlier, the NHSBSA has adopted a cloud-first policy that is transforming the way the organisation can deliver new solutions and services.
“Our cloud-first policy, and the fact most of our new digital solutions are in an Amazon Cloud environment, allows us to be more agile and enables us to introduce and implement new systems and new technologies faster,” explains Nick. “There’s a constant stream of new solutions coming through now, which is a game changer compared to the old days when you introduced something every 12 months! This isn’t particularly new to the tech sector but is not as common across the public sector.”
Darren adds: “It’s that flexibility that we’re able to leverage. Vastly reducing the time it takes to get services up and running, tested and rolled out is liberating. Rather than investing vast amounts to acquire hardware, which took time, we can now acquire large amounts of computing power in minutes. Succeeding quickly or failing fast is what it’s all about.
“We’re fortunate in that we’ve got a strong ethos that allows us to learn the lessons of the past. Some of our deployments haven’t be as successful as we had planned. But, as long as we learn from them and move forward it’s no problem, because we have a culture that appreciates you have to try something new if you are to be innovative. Thanks to technology it’s a lot easier to try things safely now than it used to be. As long as it’s safe to try out new ideas – there are times when you can’t let a solution fail – you need to have the freedom to do so.”
Nick points out that underpinning this freedom is an organisational culture that enables creativity and empowers people to innovate.
“The organisational culture has changed in line with technology,” Nick points out. “It’s about rebalancing risk. You’ll naturally be more risk averse if the investment is large, as it used to be when you had to buy servers, software and so on. Projects were often too big to be allowed to fail as a result. By moving to agile development, doing discovery work followed by alphas and betas you have better opportunities to manage your risk profile and exploit experimentation. Empowering people to take risks drives innovation. Technology has to be supported by culture, which starts with the leadership team.”
The adoption of the cloud-first policy and the subsequent ability to take more risks and deliver transformation more rapidly mirrors trends being seen across the public sector. Sean Grimes, Managing Director of Cloud & IT at Agilisys – the cloud and digital transformation specialist to the public sector and the cloud, IT and digital transformation partner to the NHSBSA – comments: “In our experience, cloud adoption rates across the public sector have risen dramatically in the last few years, indicating that any previous fears and uncertainties have been dispelled. It’s really encouraging to see organisations, such as the NHSBSA, understanding that cloud is critical to driving service transformation and they’re leading the way by moving faster than ever to capitalise on new cloud capabilities.
“Our recent report on cloud adoption in the public sector revealed that cloud is seen as key to unlocking innovation across the public sector. In fact, many respondents see it as an essential platform to leverage emerging technologies such as IoT, data & analytics, AI and robotics, which will revolutionise services for the future. And while cost reduction is an increasingly important driver, it’s the cloud’s ability to improve capabilities that’s now the deciding factor, which is really encouraging.”
Taking everything said above into account, what can we expect to see from the NHSBSA over the coming months and beyond?
“The leadership team has set out its vision for 2019 and we already have in flight a significant programme of automating a number of manually intensive time-consuming processes,” says Nick. “We’ll also be doing more to investigate fraud and error. If we can stop people making errors in the health system and make it easier for people to understand their entitlement to free or low-cost prescriptions, it will help save the NHS money while offering better support to customers. We’re looking a lot around data analytics as a solution to this.
“Workforce systems are big for us too because we have NHS Pensions, the main employment service record system and NHS Jobs 3 – the replacement for the main recruitment board – under our remit. All of that puts new demands on the technology infrastructure.
“On top of all that we’ll be looking closely at the likes of utility and flexible computing, supported by our new partnership with Agilisys, that will move us away from traditional on-premises data centres that are made up of tin and wire. That will involve moving the whole approach from an asset-ownership technology model to a utility computing model. It’s clearly a big change to make but it will unlock the opportunities for the rest of the business and enable national, transactional services to become more accessible and better suited to the needs of users. It’s an exciting time ahead.”
The work with Agilisys is critical to success going forward – and this partnership trend is only set to spread across the public sector. “Of course, the right skills and experience are crucial to making cloud transformation a success,” explains Sean. “With demand accelerating, we’re likely to see more organisations leaning on private sector partnerships to support their cloud ambitions, or to transfer essential skills. Indeed, growing awareness that there are proven paths for success and trusted partners ready to help may explain today’s confidence in cloud.”
All-in-all, 2019 is going to be a big year for the NHSBSA, with plenty of exciting initiatives being worked on that will deliver, first and foremost, better health outcomes for people.
Nick concludes by saying: “We want to make better use of digital services, big data and utility computing to improve outcomes. That means we have to avoid using technology for technology’s sake, but to really drive improvements within the health system for all involved. That requires a business approach in the technology space. Tech is the enabler to drive better service and that’s the thinking we’ll take into everything we do over the coming year and beyond.”