In a perfect world everything would run smoothly. Buses would arrive on time, people would be happy at work and public services would be efficient, wide-ranging and comprehensive. Procurement of information technology in the NHS shines a 1,000-watt bulb on the fact we do not live in a perfect world.
The NHS is a source of great pride to many people in Britain – of this there is no question – but the benevolent warmth that bathes the service is a response to its core principle of universal care; it is certainly not a reflection of the institution’s operational competency.
It’s not very efficient, as we all know. This is a problem in itself, but adding to it is an ageing population with increasingly burdensome needs and austere constraints on budgets. These married together have created a situation where solutions play second fiddle to problems.
It is universally accepted that new and buzzy technology will play a big part in sorting out the mess, and the sooner providers deploy IT systems capable of boosting efficiency, the better.
Luckily, in the UK we have a stock of start-ups and agile smaller businesses with brilliant ideas of how to fix problems with high-tech solutions; we have the blue chips capable of delivering projects on a national scale; we have a market worth billions of pounds over which big-money investors hover like birds of prey; and we have a dire and immediate need.
Yet somehow in this perfect market there are enormous fissures preventing the smooth transit of supply to demand that seem unbridgeable. Experts, from consultants to technology vendors, are waking up to the problems and they agree that it’ll take an almighty effort to plug all the holes.
“There are many companies capable of delivering the technology,” explains Jeremy Cummin co-founder of digital healthcare consultancy D Health. “We know there is supply and demand, so why don’t the two meet and why aren’t solutions being deployed? There is an obligation to look at this market, see why it is broken and work out how to mend it.”
There exists a golden opportunity to save buckets of cash and sort out the nation’s pending health nightmare in one sitting
Mr Cummin observes two major factors at play; one relates to the cellular nature of the NHS. As centralised control wanes, the organisation increasingly looks like a cluster of autonomous healthcare providers – more than 450 in total – all with their own cultures, needs and budgets.
They procure supplies, including technical equipment, computers and software, as individual entities and in doing so they sacrifice the economies of scale that an organisation employing 1.3 million people would otherwise wield.
Smaller orders mean higher costs and unit prices for each bit of tech are way above what they should be. A related issue is the popularity of faddish short-term pilot schemes, which don’t promise repeat orders, meaning only a tiny fraction of technology vendors secure sustainable contracts.
“There is a real cultural issue as well,” says Mr Cummin, alluding to the second perceived problem. “The suppliers are focused on shipping lots of kit because that’s how they make their money, but the culture of the healthcare providers is delivering health benefits; so there is a disconnect between what the buyers want to buy and the sellers want to sell.
“The consequence is manufacturers selling lots of boxes that the service providers don’t know what to do with, so they end up just sitting on shelves. It’s important providers get contracts right so they receive the goods they want to buy, not boxes that have only a minimal impact on their ability to provide a service.”
This is a view echoed by growing businesses everywhere and entrepreneurs intent on providing solutions to the UK health sector, but finding themselves exasperated by procurement processes, driven mad by the lack of transparency, accessibility and joined-up thinking.
It’s not a great basis for an organisation compelled by a string of targets to update and modernise its infrastructure in the near future. The Department of Health must deliver £20 billion in cuts by 2015, yet the NHS has been handed the target of becoming paperless by 2018 – something which will save money in the long-run, but requires an injection of big bucks now.
“For vendors and partners looking to engage and work with NHS organisations, there are huge bureaucratic processes and internal politics to navigate, made all the more difficult by frequent organisational restructuring within the NHS,” says Greg Howett at jetNEXUS.
Ron Swann, chief executive of Smart Day Group, paints a picture of disunity and infighting where unqualified managers hold the purse strings, but are at loggerheads with other important stakeholders throughout the organisation.
“It has evolved from purchasing of IT systems being carried out jointly by locally employed IT experts and clinical department heads to a system of remote procurement groups purchasing products and services from large corporations,” he says.
“These purchasers are so often not fit for purpose and their installations are resisted and sometimes deliberately scuppered by local IT groups and end-users. This has resulted in the NHS falling behind the rest of the developed world, and war zones being created in hospitals between management, clinicians and IT support staff.”
Jim Burke, managing director of Accenture’s health business in the UK, believes that smarter buying is a big part of the solution. He argues for more clarity of purpose from health services and a more structured approach generally.
“Many elements of IT are a commodity and should be bought on that basis with organisations collaborating to secure the most advantageous deal,” he says. “Other IT solutions are much more complicated, and need to be handled as complex and discreet procurements.
“The NHS has had little experience of major technology procurements in recent years and certainly not at the local level. Trusts need to focus first on what it is they want to achieve for their organisation and clinical services, and then where can they derive the most benefit, financial and otherwise.”
The flip side of all this, of course, is that there exists a golden opportunity to save buckets of cash and sort out the nation’s pending health nightmare in one sitting. It’s as simple as knowing what is being bought and why, then snipping off the fat.
As Jim Docherty, public sector specialist at Dell, points out: “According to numerous analyst reports, between 20 and 40 per cent of software assets that organisations have installed just sit on the desktop and don’t get used.”
Alas, successive programmes of change in the NHS seem to have muddied the waters, and we are getting further and further away from a clear understanding of what tech is being bought and why. A quick remedy is called for, but then this is the NHS we’re talking about.