NHS – will this pandemic re-emphasise funding for its systems? 8 steps to ensure fit for purpose procurement

By Allan Watton on

The effects of Covid-19 on the NHS and its staff are likely to be felt long into the future. The current crisis has seen an unprecedented demand for acute care, particularly intensive care units, which has led to significant efforts to increase the resources available to hospitals.

This has involved, among many other things, the reorganisation of hospital facilities, redeployment of staff and equipment, and a drive to draw in more human resources and skills from both recently retired and newly graduated individuals.

Although we have yet to see an end to the current wave of the pandemic, pressure is mounting to begin preparations for a ‘post-Covid’ world – or at least one where the coronavirus does not have top billing.

This article looks to investigate the systems and solutions that could be prioritised to help the NHS (and other organisations involved in digital transformation) to face the challenges of the future. It then takes the lessons learned from other strategic digital transformation initiatives and provides eight steps to assure fit for purpose procurement and contracting.

Drive for Digital Transformation

This pandemic has highlighted numerous services within the NHS that need to be better equipped to meet the future demands of the country. Long before Covid-19, and the subsequent lockdown, there were many ongoing discussions about the role of technology in the delivery of effective healthcare at scale. However, for the NHS, and many other organisations, hopefully this crisis has been the push required to turn discussions into action.

Evidence of some of the most fundamental changes that have occurred during the pandemic are within primary care. GP practices, for instance, have transformed their working procedures and changed to remote working, with video appointments in 93 out of 100 cases replacing face-to-face contact, according to a BBC analysis. This is a stark contrast to the 1% of appointments conducted via video just 12 months earlier.

Despite momentum for change, some of the emergency technology solutions utilised during the crisis are not necessarily suitable for long-term care delivery. The NHS requires a more robust way of delivering its ongoing solutions.

Nowhere is this more evident than in the NHS patient waiting list for routine surgery in England, which is predicted to surpass 10 million people by the end of the year. It is clear that acquisition and solutions development needs to be carefully considered in order to ease the mounting pressure on services and to replace ageing technologies which are also holding back the provision of care.

Transitioning to Modern Technology

Change brings challenges, as shown in numerous projects where the transition from legacy to digital has often produced little else but a costly hole in public and private sector finances. One such example was the (at the time) new patient record system project (NPfIT) launched many years ago.

The aim was to revolutionise the way technology was used in the health service by paving the way for electronic records, digital scanning and integrated IT systems across hospitals and community care. However, for various reasons – clarification of specifications, technical challenges and disputes with suppliers – the project was disbanded by the government 11 years after it was started. Unflatteringly, this was described as ‘the biggest IT failure ever seen’, with the cost to the taxpayer being reported as in excess of £12.4bn. Some estimates suggested it was as high as £20bn.

Moreover, technological issues can be expensive to rectify. Faults in the patients record management software, Lorenzo, reportedly led to an estimated 14,600 patient discharge summaries not being sent to GPs over an 11-month period, two years ago. This NHS IT system failure is reported to have cost somewhere in the region of £7m to fix.

These are just a couple of examples of significant public sector centralisation projects, where the risks of failure are traditionally high. While individually these particular projects had questionable value, investment has continued at a local level to maintain and optimise systems. It is at this level that the funding and innovation needs to continue and improve.

8 Steps to Successful IT Procurement and Implementation

Amid warnings that the UK is facing a steep recession, it is likely that the NHS and other public sector organisations will come up against even tougher financial constraints, despite government assurances to the contrary. While this can be seen as an opportunity to stimulate suppliers to improve original thinking in their service delivery, the scale of the challenge ahead of us is unprecedented.

With our experience of developing, optimising and managing over 500 strategic relationships across numerous NHS and other public sector digital transformation system procurements and upgrades, evidence has identified the following eight steps which will assure a smoother upgrade to newer technology, systems and solutions for the purposes of transforming operational effectiveness:

Step 1: Clear Expectations

This is the foundational. You need to have clear clinical aims and objectives when considering the development of new systems within your care and operational pathways. This allows for those delivering care – and those supplying the systems and infrastructure to support that care – to understand the wider context for the use of those new systems.

Internal teams need to fully understand and buy into the use of any new systems that will change the way they will be working. As they will be on the front line, it is vital that they not only have a complete understanding of the ways in which new systems will enhance their practices and patient care. Furthermore, internal teams are a valuable source of real-world insight into the efficiency and effectiveness of the new systems and with their help those systems can be further optimised and improved.

For suppliers developing or procuring new technologies or solutions, it’s important that they also have a clear vision of your expectations so they can determine where their strengths can be most effectively deployed and if any weaknesses exist that they would be required to warn you about.

In fairness, getting to a clear articulation of your expectations and objectives (below), are the two hardest and most time-consuming activities your management and front line teams will undertake when progressing through digital transformation initiatives.

Please do not underestimate how long steps 1 and 2 will take you. It will normally take 3 to 6 months in practical terms to get them properly articulated. If you do these right, you can contractually rely upon them and avoid misunderstandings with your prospective suppliers.

Step 2: Clear Objectives

Evidence has identified that in the most successful strategic and digital transformation projects, objectives are clear, well-articulated and quantified. So, move beyond aspirations and talk specifics with your supplier.

If you do not connect the dots with quantified objectives for your prospective system/solution project, then it will be far more difficult to determine whether objectives have been met, milestones have been achieved and existing measures have been surpassed, justifying the cost of the change in the first place.

Many objectives are challenging to quantify. For instance, putting quantified values on improved patient care. However, it is important to do so for all primary project objectives to avoid misunderstandings with your digital solution suppliers.

Step 3: Strategic Supplier Management

On any project, both client and supplier side teams must perform. If either does not, then the other will struggle to meet expectations. It’s very easy to point the finger of blame when things go astray, but it’s important to appreciate that there are responsibilities on both sides that must be adhered to. It is, therefore, important to consider from the very beginning the behaviours that should be encouraged from all concerned, and how to identify when they are not being followed.

It is also important that your supplier understands, wIth crystal clarity, the reasoning behind the changes their efforts will bring about in order to encourage innovative thinking, and a commitment to follow this through to actions that could improve the project’s outcomes. This is why clarity in steps 1 and 2 is so critical.

Step 4: Be Contract ‘Enabling’

Contracts are all too often considered as documents of last resort when ‘recourse’ is sought for issues in the relationship. However, the most successful contract structures are created to encourage an ethos of support and teamwork between client and supplier towards agreed aims. These promote the right behaviours and professional attitudes, clearly stating quantified expectations, but also governance in fostering a strong and productive relationship where everyone is pulling in the same direction. Evidence of success across more than 500 strategic relationships dictates  that the most effective contract structures are reverse engineered from steps 1 and 2.

Step 5: Evidence of Aligned Culture and Proactive Support

When choosing your supplier, it is important to consider more than just their technical capacity and competency. You’ll need to determine whether they have the will and an historically evidenced interest in providing their clients with guidance, building commercial trust and incorporating the correct behaviours into their delivery.

Step 6: Early Market Testing

You will want to gain best advice from your suppliers, but this does not have to wait until after you have selected them. Early market testing means going out into the marketplace to critically analyse your expectations and required outcomes, to determine whether they are realistic or whether adaptations will be required to fit in with constraints regarding your resources, budget and timing.

Strategic suppliers should be experts in their field – you are considering them for that very reason – so it is important to tap into their expertise to determine whether schedules and budgets, objectives and outcomes are achievable.

Step 7: The Supplier and Solution Selection Process

As an NHS organisation, or if your organisation is in the wider public sector, you already know you have to evidence a fair, transparent and equitable supplier/solution selection process. You will already be methodical and you’ll document all the issues to prioritise and key decisions by the selection panel.

This ensures that you make the right commercial decisions, but will also ensure there is less risk of your decisions being challenged by those you do not select as your suppliers.

Create a Terms of Reference for your preferred supplier to base its own due diligence exercise on, work with them to ensure that they fully understand why you need this project completed, and the impact of success, or failure.

Step 8: A Fit for Purpose Contract

Your contract should be an organic document, one that offers as complete a picture as possible – incorporating the Terms of Reference for precontractual scoping, along with the outcomes of the subsequent discussions you engaged in – but also one that allows the relationship to adapt to changing circumstances (including a biannual review and refine meeting to update the contract to reflect the realities of the relationship).

Most importantly, it is critical to contract the supplier for its advice, separately, to the digital solution you purchase from them. In this way it allows the supplier to have a much greater understanding of your objectives, and allows you to contract, in practical terms, for the fitness for purpose of the solution to meet your expectations. This will significantly reduce the chances of your requirements being misunderstood and lead you to a successful implementation, on budget and within your expected time frame.

Conclusion

Investment in digital transformation and solutions is necessary for the NHS to keep up with new challenges and greater demands on its time, its workforce and its resources. We have seen the issues faced on major strategic digital projects in the past, along with centralised systems that failed to deliver on their promises.

However, these failures have provided us all with valuable lessons, the evidence of which has been the inspiration for our eight steps above. Covid-19 has placed a significant strain on our NHS, but it will not be the last challenge we face, so it’s more important than ever that we have a health service that’s fit for the future.