interviews

Agile workers and a true shared service

NHE talks to Mark Bostock, director of NHS Informatics Merseyside, a not-for-profit shared service providing IM&T to trusts across Merseyside, about recent innovations and how it is driving efficiency.

Information management and technology in the NHS is not just a back office function: at its best, it can help clinicians deliver care more efficiently, which is better for the patient and for the organisation.

Truly mobile IT and apps can help do this, and the shared service for IT across the Merseyside trusts is in the vanguard. NHS Informatics Merseyside – the new name for the NHS North Mersey Health Informatics Service – has been introducing agile working through its own in-house range of mobile apps. The team at Informatics Merseyside thinks the potential savings per clinician per year are even higher than the £3,000 found on average in a recent DH pilot report.

Mark Bostock is director at Informatics Merseyside. He told NHE: “I think we’ll see more of this around the NHS: it’s the only way forward. Historically, the NHS hasn’t relied heavily on IM&T. But we’re getting more and more to the point now, with electronic patient record systems, where the clinician can’t deliver patient care without IM&T. There’s such a high reliance on it these days and there’s a real need for a high-quality service to be delivered.”

Simplicity vs safety

The difficult balance with agile working practice is the balance between convenience for the clinicians, and information governance issues around data security and patient safety.

Bostock said: “Information governance and privacy are absolutely paramount in everything we do.

“Even with advances in telehealth technology, even in large cities such as Liverpool, you’ve always got blackspots where you can’t get a connection. The other problem has been, if you’ve got a laptop or something in front of the patient, it’s intrusive into the delivery of care. We’re getting to the point now, with some of the products we’re delivering, that they can incorporate disconnected working – so the clinician can input information, and then the device will send that information back to a central system when it gets a connection.

“There’s also an ability to deliver a subset of the information system, so the information that clinician needs for that specific delivery of care is presented, and the information he or she needs to input back in. That means we can use more appropriate devices, that are quicker to access the information on and boot up, and can always be on, and are not as intrusive. They are, for the first time, being seen as a benefit to the clinician, rather than as something intrusive.

“Each organisation we work with is different. “There are some core systems, obviously, but particularly in Liverpool, it’s quite a complex health economy: all the different specialist trusts, a large mental health trust, different acute trusts with different systems. This software can be tailored, quite easily, to the requirements of each organisation.

“We’re beginning to roll it out at one of our trusts, Liverpool Community Health Trust – it’s quite a forward-looking trust and very keen on innovation, and has been working with us in partnership.”

The apps are viewable on tablets and smartphones, and use a remote system that’s fully integrated with back office systems. All patient records are kept and updated in strict accordance with DH governance standards and Informatics Merseyside’s own, which includes encryption and the ability to wipe all the data on a device remotely.

Stephen Appleton, clinical informatics lead for the QIPP ICT programme at Informatics Merseyside, said: “The benefits of disconnected working – agile working – are immense. More flexibility and efficient working practices, increased time with patients, reduced travel times will increase the quality of healthcare provided and will all repay the investment in developing service specific apps.”

Inward and outward

Informatics Merseyside is expanding, and wants to continue to do so. It employs more than 320 staff and services more than 30,000 users at trusts, hospitals and other medical facilities in the North West (see panel).

Bostock said the organisation sees itself as very much part of the NHS, and that its not-forprofit status means all the money it makes can be ploughed back into improving services for its partners.

He said: “We came into being in 2006, really to bring up the standard in IM&T across that patch. We’ve clearly done that: we’ve achieved a lot of economies of scale, and have also brought a lot of strength in depth, in terms of removing ‘key person’ dependencies and bringing in a more robust and resilient service.

“We’ve got a good track record of demonstrating how we’ve been able to improve services for the people we work with, but the more partner organisations we get, the better the economies of scale become, and the better we can perform.

“So, we’re in a position now, with the new Health & Social Care Act, and competition coming a little bit into the NHS, where we’re having to look at ourselves as having to compete against the private sector. We’re now a Merseyside service, rather than just North Mersey: we’re increasing our position across a wider patch. But in the future, I see us selling services to customers outside of Merseyside, definitely in the NHS and maybe to the private sector as well, all with the sole purpose of reducing costs and improving quality for our existing customers and partners.”

He admitted that geographic constraints meant that further growth in some of its operations, such as networking, would be difficult. But he said: “There are other things that we could sell at national or even international level: service desk, project and programme management services, software development, business intelligence. Those we could really deliver at scale.”

Intelligent customers

The amount of IM&T it offers to each partner varies, from specific services to whole gamut, such as at Aintree University Hospitals NHS Foundation Trust, though most trusts retain their own director of IM&T or similar person, who drives the internal trust strategy and is that organisation’s informed/intelligent customer.

Informatics Merseyside’s QIPP team also functions as an R&D department. Bostock explained: “They concentrate on looking for innovation, horizon-scanning, and looking at what’s happening around the rest of the NHS, so we’re not reinventing the wheel. They look for best practice in IM&T, liaising with some of our partner organisations in the private sector to see what’s being developed.

“Over and above innovation that brings a good ROI – which obviously the finance director will be pleased about – we also work with clinicians to see what we can do to make their life more productive and easier.

“Expectations are often very high, but we usually find that there are people in these areas who are keen to work with us, and the sooner they start recognising the benefit, particularly the benefit to the patient in terms of quality of care, then they become really keen to work with us and develop systems and technology.

“We’re constantly striving to get the right balance between value-for-money and quality. There are a lot of things on the agenda for us, such as the strategic partnerships I talked about, increasing quality, clinical innovation, telehealth, cloud computing, video-conferencing, the stroke network, crosspathway working…

“Something else we’re looking at, that we’re able to do because we’re such a large organisation, is strategic partnerships with the private sector that can augment some of our services. That can make us a lot more responsive and means we’re able to draw on specialist skills that it probably wouldn’t be economical to have inhouse.”

Tell us what you think – have your say below, or email us directly at [email protected]