Industry voice: Central and North West London NHS is moving from outsourcing to smart sourcing as IT director Owen Powell and deputy director Nigel Tazzyman take back control of its digital future
A clinically and geographically diverse organisation, Central and North West London NHS Trust started life as a mental health trust serving the people in its area. Today, following ambitious growth bidding for work across regional boundaries, over 7,000 staff provide mental health, addiction, sexual health, community and district nursing and offender care in communities as far north as Milton Keynes and down into Surrey.
The trust manages 1,000 beds and provides services across 130 sites with a turnover of over half a billion pounds a year. To do this effectively it needs robust, 21st century technology to underpin operations.
By necessity, the overriding technology approach is ‘mobile first’ with IT director Owen Powell and his deputy Nigel Tazzyman both adamant that all staff should have access to all the technology and information they need, at the point of care - wherever and whenever they are.
Unsurprisingly, the technology driving this operation is not insignificant, investing a budget of around £16 million a year. However, both director and deputy believe that more value from this spend can be delivered than has been to date.
Both arrived in the organisation at a time when IT operations had previously been outsourced to a major outsourcer. However, with that deal due to expire in November, they saw the opportunity to radically improve the trust’s technology and build a platform for the future. Passionate about delivering value for money and better services they are bringing the skills and technology back in-house to build a modern, flexible ICT service. In simple terms, the objective is to ‘fix the infrastructure’, ‘add value to clinicians’ and harness future technology for the trust’s benefit.
The duo have a pragmatic commercial approach, aiming to rationalise and take back control of the trust’s ICT by splitting contracts into manageable sizes and taking a best of breed approach to digital infrastructure and services.
Of course, the cloud plays a key role in this plan. However, not ‘any cloud at any cost’, rather a considered approach to getting the strategy right and delivering value at all times during the journey to cloud.
Like most NHS trusts, Central and North West London NHS Foundation Trust has a plethora of legacy systems and infrastructure and must ensure robust security across them all – at all times. The potential risks to patient care involved in a ‘one step’ large scale migration are simply unacceptable. A hybrid cloud approach and planned migration, minimising risk, are therefore essential, and the trust turned to managed service provider, data centre and cloud specialist Rackspace for advice, support and implementation of a new digital platform fit for the future.
There are clear advantages in a hybrid cloud approach. It provides the flexibility for an NHS trust to satisfy some complex requirements in the integration of patient information from different sources, and to manage the data for its administrative and financial operations. It makes it possible to determine which elements are most appropriate for a public or private cloud, and link to those that remain in the data centre. This can be important in creating the ‘best of breed’ digital infrastructure and clinical systems that can handle sensitive data and optimise the delivery of care.
Crucially, it also enables a gradual transition to the cloud, enabling the trust to explore the options and assess the impacts of migrating a specific system on its own terms. This lays the ground for a controlled - and carefully timed - evolution that it is easier to manage, provides the ability to assess costs one step at a time and minimises risk.
At the same time, this approach provides scope to react to ongoing advances in technology, providing the agility and flexibility to incorporate new offerings from industry to improve patient care as they are developed.
Cloud itself is evolving all the time, with new capabilities and services that increase its promise and this can be harnessed along the way. And, as Powell and Tazzyman are proving, this can be done through strategic management of relatively small contracts rather than one big, all encompassing deal full of complexities and contradictions.
But it comes with challenges. For example, the elements using public cloud, or software-as-a-service, on a ‘pay as you go’ basis make it difficult to accurately assess all costs up front, and it can be difficult to align with any outsourced services that use their own IT systems.
In addition, there is no ‘one size fits all’ deal for the NHS. The experience of the National Programme for IT in the 2000s demonstrated that a heavily centralised rigid approach does not work; it is a highly diverse sector in which organisations fulfill different functions and face differing local demands. This means they need considerable flexibility in approaching the change.
Central and North West London NHS Foundation Trust has broken its technology down into three strategic platforms: the digital infrastructure platform and network; a service platform for provisioning and supporting the use of hardware and mobile devices; and a clinical information systems platform.
Over the past 18 months Powell and Tazzyman have developed a range of expertise in-house in contract management, project management, technology support and managing the behavioural and cultural change required to move from ‘outsourced’ to ‘smart sourced’.
The team has an in-depth understanding of the relationship between clinical and administrative information systems; the approach to prototyping, building and scaling solutions; the ergonomics of technology in a healthcare setting; and the appropriate pace of change within the NHS.
Rackspace comes to the partnership with a wide range of capabilities enabling Central and North West London NHS Foundation Trust to rationalise and optimise its operating environment whilst reducing costs and opening up future options - including the management of hybrid cloud with its RackConnect service that can extend across data centres and public and private cloud offerings from Amazon Web Services, Microsoft, OpenStack, VMWare and Google Cloud Platform.
It is managing all core elements of the hybrid platform, including hardware, software, security patching and operating systems, complementing the consultancy and applications management from Central and North West London NHS Foundation Trust and freeing up staff to focus on the overall transformation strategy.
This robust digital platform will underpin the capability for staff to work from any location, making them more flexible in their working habits and helping to provide better information at the point of care. It also enables adoption of current and future enhancements to the clinical SystmOne platform to improve the efficiency and bring online emerging technologies, such as new diagnostic tools and artificial intelligence.
This 'smart sourcing' approach to delivering a solid digital infrastructure platform-as-a-service should encourage other healthcare organisations to be bold in their digital transformations.
However, the complexity of this undertaking cannot not be underestimated: getting the timing and migration of systems right for a combination of managed data centre, public and private cloud is essential. Indeed, it takes many organisations - not just those in health - into areas in which they have no direct experience. Most will benefit from support that responds to their specific specialist and local demands.
Inevitably, trusts need to develop their own modern, digital infrastructures. But in future they will be able to draw on the expertise and experience of both Central and North West London NHS Foundation Trust and Rackspace to reduce the cost and risk in doing so. Smart sourcing could be the simple way forward.
To talk about the art of the possible when it comes to smart sourcing and taking back control of your technology, contact Rackspace by calling on 020 8734 8107 or by visiting the Rackspace website here.
Meanwhile you can catch up on the UKA Live discussion with the Police ICT Company, Norfolk County Council, Central and North West London NHS Trust and Rackspace below: