Earlier this month the NHS reached its 70th anniversary, however with ongoing concern and ambiguity around the organisation’s future, how can those responsible for investment in the public health service ensure it lives on beyond another 70 years?
Peter Ford, Public Sector Industry Principal at Pegasystems, argues that the NHS still needs to improve efficiency, especially in relation to customer service, and build for change even with the additional government funding that has been made available. Practitioners should have more autonomy in how the technology in our health service is developed and deployed.
History and challenges
Today’s customers expect to interact with the National Health Service just as they would with their bank or online retailer. Citizens expect on-demand, high-quality service whether they are unfortunate enough to experience an accident or require elective treatment. The NHS is expected to deliver those services while meeting the expectations of an overwhelming digital customer base.
Addressing these scenarios with the right technology, process, and organisation should be achievable. However, the organic evolution of the NHS means it is now plagued with numerous challenges:
- Manual processes, or only partially automated, lacking the orchestration of end-to-end case lifecycle management
- High cost legacy, siloed systems that are difficult to both use and change
- A complex IT estate that has multiple, fragile, integration dependencies that only give a partial view of the constituent
- A total reliance on scarce IT staff
- Commercial-off-the-shelf (COTS) and bespoke solutions implemented in a waterfall fashion that do not reflect the business need and cannot easily be re-used across geographies
- Complex policy and regulations for healthcare eligibility and delivery
- Lack of constituent online self-service and contextual guidance
- Organisational structures, processes and systems set up to serve limited channels that existed 20 years ago
With the expansion of digital technology, the NHS is faced with responding to a more demanding constituent. Citizens are tech-savvy and want to be able to interact with the NHS on their mobile devices, on the telephone or face-to-face, without losing context. They want self-service that guides them through the complex online advice, rules or criteria they must fulfil. The NHS has to provide those services through whatever channel a citizen prefers.
Fundamental to providing a citizen-centric service on every channel is treating the interaction in the context of the user’s history and existing information held about them. This information typically exists but is held in disparate systems and is supported by a combination of both manual and automated processes. The citizen usually has to visit different parts of the NHS to get the care they need. The ability to use “any door” (access to any NHS service routed to the appropriate set of services) and receive the end-to-end service based on one visit, simply does not exist.
The ability to provide an end-to-end service is severely inhibited by the existence, or in some cases complete absence, of rudimentary work management solutions. Without automated management of a patient or citizen “case” (in this context case means any piece of work that needs to be completed) services will remain disconnected.
The NHS is under pressure to improve the way service is delivered, albeit with an additional recently awarded £23bn funding envelope. It must still pursue better ways of working and efficiencies to provide better service to an ever extending range of treatments and patients.
The traditional options – custom code and COTS
The NHS struggles to modernise legacy systems. It is these aging mission-critical applications that make the rapid delivery of citizen-focused service so inefficient and hard to measure. They are costly and risky to update as policies change.
The NHS and systems integrators working for them typically have had two choices for modernising operations, and neither of these has worked particularly well. Custom development costs too much and is usually obsolete by the time it is delivered.
Lower-cost, commercial-off-the-shelf (COTS) applications are inflexible and inadequate, forcing the NHS to wait for vendors to deliver what they need. Additionally, these solutions cannot be easily shared to cover both common and specialised delivery across NHS participants.
The old adage, “re-use before buy before build”, still rings true but re-use is dependent on the solutions you currently have in place and the extent of the new solutions required/funding available. To change solutions wholesale is neither practical, because of the extent of risk involved with system, process, and organisational change, nor affordable. There is an alternative incremental approach that makes this possible.
The better way – Enterprise Platforms
An enterprise platform is computer software used to satisfy the needs of an organisation rather than individual users and come in three types:
- Systems of record (e.g. SAP ERP)
- Development toolsets (e.g. Java Enterprise)
- Unified Enterprise Platforms (those that can spawn multiple different solutions using the same platform (re-using common software components), prebuilt applications, and underlying tools)
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Systems of record have their place in command and control situations but that’s not where the NHS is. Policy and treatments are constantly changing and Systems of Record are not the best option because needs are dynamic and likely to change.
Custom solutions also have their place when the need is esoteric; however, as previously stated, these are not best placed to suit multiple changing needs in a cost effective way.
Fortunately, there is a clear “best option” to build and manage healthcare applications: a Unified Enterprise Platform. Not all application platforms are built the same and one must consider the time to value and the ability to change as policy evolves.
There are key considerations when choosing a unified enterprise platform as defined above. The platform will need to meet the needs that exist today but also have an underlying architecture that is able to flex and meet those that emerge in government and societal environments that are ever changing. The platform needs to be ‘built for change’.
By implementing a unified platform based on the same core engine, not a collection of stitched together applications that will increase total cost of ownership, the NHS can scale to meet the needs of hundreds of thousands of customers at the same time.
Furthermore, it allows healthcare practitioners to turn information into insight by using inherent artificial intelligence to convert information held in multiple silos as well as within the enterprise platform to deliver a predictive service to citizens. Without a unified platform, decisions will require multiple manual interventions to obtain a complete picture of the case and deliver the next best action.
Another benefit is that a unified platform can be easily localised, meeting the needs of multiple business units, channels, products, geographies, and customer segments. This reduces cost of implementation, ongoing change and support. Deprived of a unified platform, agencies will not be able to use their single application to seamlessly serve full the range of their citizens.
By engaging more citizens through more channels ensuring a consistent user experience across all channels—desktop, mobile, interactive voice response (IVR), social— means applications can be designed once and used anywhere with zero additional work required.
It might seem obvious but, it is also important that the user experience on any platform is easy to use. Facilitating a user interface that presents easy to understand, intuitive screens that are designed to suit the purpose they are being used for means NHS staff and citizens will be more likely to use the system and will be more efficient when they do.
A unified platform should have pre-built integration capabilities to allow for it to be used across multiple systems that may hold existing information. In this way it should provide a 360-degree view of the citizen, their family, and their treatment history. It should connect citizen-facing solutions, such as customer relationship management (CRM), to those in the back office that support processes such as treatments and lifestyle advice for health promotion. This will help prevent having “swivel chair” workers inefficiently pivoting from one system to the other as they serve the customer.
Case Management is another aspect which will see improvement. Being able to simplify and automate work through digital process automation and case management can help quickly build business applications that deliver the outcomes and experiences that citizens demand.
The NHS faces some real challenges to serve the public as they expect and deserve. The key is to implement change incrementally using unified enterprise platforms that can provide single solutions to meet multiple similar, but not identical, needs.
These platforms exist but care must be taken to select one that is built using the latest IT capabilities available and that can easily adjust to future change. These capabilities will deliver efficiencies though self-service and case management and an application that can keep pace with policy changes. By doing this the NHS can become proactive to citizen needs, offering “any door” to the services that they are entitled and making suggestions on preventative health care rather than just delivering treatments.
Ultimately, it will improve the efficiency of the service to provide a higher quality of service to a wider population and customer base and make best use of the additional £23bn it has been awarded.