IT is key for productivity gains but processes must be standardised first

The phrase ‘unwarranted variation’ has spread into the NHS vocabulary through the Getting It Right First Time (GIRFT) programme and the standardisation of clinical practice, to enhance patient safety. But unwarranted variation is just as applicable to a much more plain, but arguably much more variable, aspect of NHS operations: IT.

I want to be clear in my definition of IT here. I am not talking ‘digital’, which concerns patient records or data sharing, I am talking about the more purist technical and support elements: servers, networks, devices, software, support etc.

Integrated care boards (ICBs) have found themselves working within a landscape of multiple providers using different bits of IT for the same functions. The argument for clinical service standardisation is a complex and nuanced one as outlined by GIRFT, but what about IT? How can standardising IT be used to gain productivity wins?

Rule of thumb

There is a useful rule of thumb to evaluate the suitability of standardising anything: how mature and generic is it? Areas like servers and networks are highly generic and not specific in the NHS in almost any way. They are ubiquitous across all industries, which leaves little room for any NHS provider to argue that they need to use different ones to their neighbouring providers, or even other industries.

…there is really no argument for why one acute provider would need different devices to another acute provider

It is the same with devices. Yes, the NHS does need specific hardware compared to non-healthcare settings, but there is really no argument for why one acute provider would need different devices to another acute provider, for example. 

There are clear financial savings to be made through economies of scale. Tim Ferris has recently penned a paper saying, essentially, that technology should be consolidated at an ICB scale, because there are economies of scale. Dr Ferris also hails the cyber security benefits of a simplified technology landscape.

Building a more responsive system

So there’s not just financial savings that are available, standardising IT can build a more responsive system with more flexible capacity. Centralising existing IT teams (within ICBs?) will break down siloes and create more diverse and flexible resource pools. For example, one provider’s cyber team may have expertise in networks, and another team may have a real talent in software security, and another team, in devices. At the moment, these teams do not have access to each other’s expertise or capacity and are unable to learn from each other and scale their expertise outside of their own trust. By bringing them together, you create a team that is more flexible, adaptable, scalable and resilient. The same theory applies to all areas of foundational infrastructure: larger multidisciplinary teams are better.

…while some areas of ‘back office’ IT are relatively easy to consolidate, the picture gets a lot more complex the closer you get to patient care

However, while some areas of ‘back office’ IT are relatively easy to consolidate, the picture gets a lot more complex the closer you get to patient care. Dr Ferris cites the example of consolidating sprawling clinical software estates into singular electronic patient records (EPRs) as providing a potential challenge to tech standardisation. But using our rule of thumb, are EPRs mature and generic? Arguably, yes, the core of these software behemoths are. So, they seem a good candidate for standardisation, or ‘managed convergence’. 

But what about the clinical services they need to align with? Are all the clinical services, workflows and processes that these EPRs need to represent standardised? The answer is no. This means that the closer you get to patient care, standardising IT needs to consider the potential challenges of standardising the processes that are supported by IT. This leaves two possible outcomes for software that supports variable clinical practice. Either practice is standardised and it succeeds, or the one size of EPR doesn’t fit all and the effort fails. The frontline digitisation programme is too early in its journey to see which of the outcomes becomes prevalent. 

But the key thing here is this: if you are going to successfully standardise technology that supports variable and complex clinical practice, it has very little to do with the technology, and everything to do with people. If you do not start with standardising workflow, processes and services then you will fail. 

It’s worth remembering where this has failed in the past. The National Programme for IT (NPfIT) also tried to implement a handful of clinical systems across large geographies, with fatal assumptions about the standardisation of care across the NHS. It would be a shame to see this happen again. But, there are opportunities for productivity gains in generic foundational infrastructure technologies that we can and should exploit readily.

Thomas Webb is founder and CEO of Ethical Healthcare Consulting. You can follow Ethical on X @Ethicalhealthuk and on LinkedIn