The NHS is being asked to do more. That isn't new in itself, but the demands that are being put on trusts and their IT teams are being ratcheted up by the coronavirus pandemic.
They are being asked to prepare for more COVID-19 and a difficult winter. To recover the backlog of elective care that has developed over the past 18-months. To change in response to the arrival of integrated care systems and their agenda of more joined-up, more person-centred care.
Chief information officers acknowledge they are struggling to find the time and resources to do everything that is being asked of them. To find the resources to keep their infrastructure patched and up to date. To prepare for system upgrades and deployments. To comply with changing legislation and regulatory requirements. To do that blue sky thinking.
So, what is the solution? The answer isn't going to be 'work harder' or 'employ more staff' or 'outsource'. Staff burnout is a real concern, and even when there is the money available to expand the team or bring in consultants, there are going to be constraints on doing it quickly. Instead, I believe that trust IT leaders need to take a holistic approach. The first element is to find a partner to help you to break the cycle of firefighting, so you can focus on doing a few, important, new things, faster.
The second is to get clarity about the scale and nature of those requests and to engage the organisation in prioritising them, so transformation and technology work together. And the third is to create a modern, cloud platform that can support heritage systems and cloud-native development.
Find the right partnerThe important word here is partner. The NHS often talks about vendors and suppliers, while companies talk about contracts and procurements. What trust IT leaders should be looking for is a different relationship, in which there is effective sharing of risk and reward.
Of course, trusts will expect to work with a partner that understands the 'big stuff' - the strategy, the complex systems, the integration, the absolute importance of security and safety - but what they should ask is whether they are focused on delivery.
The kind of partner I am talking about is not just the lowest cost company that can fix a few upgrades, but a partner with breadth that can complement your existing teams and help them to develop for the future. A partner willing to take something that is broken, or not working as well as it should, and fix it, and then hand it back - while equipping the trust workforce with the skills to keep it that way.
Prioritise and planThe next element is to sit down and take a hard look at all those requirements, projects and requests, and to get a complete picture of what is being asked of IT. CIOs need a framework for doing that, with metrics so the organisation can decide what is most important.
That might be patching and maintenance, or meeting new legislative or regulatory requirements, or preparing for upgrades, or a new system implementation, or doing that blue sky thinking. The important thing is to give the trust's business and clinical leaders a framework for prioritisation, so that isn't just left to IT.
Through this process, it becomes possible to move towards a model that I sometimes call "pragmatic transformation". Change that is deliberate, that has an end-goal in mind, and is grounded in reality. A good framework also makes it possible to tackle projects in a logical order: to find the three or four issues that need the same fix, so they can be fixed in less time than it would take to get to them individually.
Create the right platformFinally, trust IT leaders should be thinking about how to get their own teams to work in new ways. This can be difficult, because the health and care system does not generally write its own software.
While there are exceptions, organisations tend to deploy packaged products; that limits the amount of flexibility that they have over the testing, deployment, and maintenance of systems and their associated infrastructure.
To maintain all that packaged vendor software, while innovating rapidly enough to meet the demands of the recovery and reform agenda, trusts need to adopt a hybrid approach. By that, I don't mean 'do everything you are doing now, and add even more to the list' or 'shift everything that you are doing on-premise to the cloud'.
Instead, I mean look at how modern IT is done in other sectors, and adopt the best of that approach, and bring the cloud to you. Bring the hyperscalers such as AWS or Microsoft into your data centre. That way, you can continue to run your heritage applications, while creating new products that are cloud-native from the outset.
Around that, trust IT leaders need to introduce a new mode of operation that brings infrastructure and people together. We've all heard of 'dev ops', or getting the development team, and the testing team, and the deployment team together in the same place.
We need a 'tech ops' or, as we're talking about health and care, a 'clin ops'. A model that pulls together the way work is commissioned, its resources, the technology that underpins it, and the way outputs are delivered. This is what I mean by taking a holistic approach.
The NHS finds itself in a new situation in which it is constantly being asked to do more to respond to the demands of recovery and reform. Its IT teams cannot play their part if they are working with outdated ways of prioritising, managing and delivering technology. To address new demands, they need a new approach.
I believe that means finding a partner to create headroom by focusing on delivery. Lifting prioritisation to the board, the C-suite, and professional leaders. And creating an agile platform supported by a clin ops model to make it possible to both maintain heritage systems and build new ones at speed.
As a technology supplier, we have been on this journey with hundreds of customers in other sectors and in healthcare globally. We know what it takes to drive a conversation about business transformation that is enabled by technology. As the NHS is asked to do more, that is the dialogue that trusts need to have with their IT leaders, so they can deliver the pragmatic transformation that organisations, clinicians and patients need.