A shared service for the NHS

Source: National Health Executive Sept/Oct 2012

Kent and Medway Health Informatics Service completes around 500 projects annually, received nearly 170,000 calls last year, and earlier this year won a tender to provide an FT outside its own geographic area, Surrey & Borders Partnership, with an IT service desk and portal.

But the HIS’ managing director, Richard Gifford, admits that things have not always been so rosy and there had been a “chequered history”. He said: “Things came to a head four years ago. I came in then as a consultant, when there was a question mark over the HIS, to see what the options were: either turning it round into a first-class service, or repatriating the staff back to the trusts.

“First and foremost, transforming the HIS required an understanding of what the trusts wanted, and what they didn’t want, and for us to position the HIS in line with that. We’ve had to really demonstrate efficiency and effectiveness of service provision.

“We’re through that period now: we’ve got a very stable and successful HIS which is providing excellent services and we’ve got good relationships with all the trusts in Kent who we supply services to. There isn’t a trust in Kent that has its own large IT team doing everything: the HIS is very much the supplier of choice.”


The HIS is a not-for-profit organisation, with a remit to break even. In 2011/12 it achieved a £2,000 surplus on an income of £10.5m, while also coping with £400,000 cost pressures thrown up by reduced customer spending through a cost improvement programme and further income generation.

Gifford told us: “We do look to reinvest in services: we’ve got an enduring business model that allows us to do that and enables us to move forward. We don’t want to just be ‘cutting our way to success’, which is not a strategy.”

Its customers are its partners, Gifford explained, and there are full risk-sharing agreements in place.

When the HIS was formed in 2003, its 600- odd staff had been TUPE’d from the trusts’ own IT and information management teams. But Gifford said it was soon realised that some tasks were best done in hospitals, for example clinical coding. “That went back to the hospitals quite quickly,” he said.

Shared service

The Kent trusts, as clients, have retained their own heads of IT, working with project managers and business analysts, but the HIS is now the key supplier of IT.

Although previously set up as a managed service through its host trust, Maidstone & Tunbridge Wells, KMHIS has now become a true shared service. It employs around 250 staff.

Gifford said: “We’ve been working to put in place service catalogues, pricing models, contracts and risk-sharing agreements that all the parties have now signed up to. So now we have a strong governance model and a means of taking the HIS forward on that basis.

“Underpinning all of that we’ve been looking at creating further efficiencies, not least in the internal workings of the HIS – the operating model. Winding the clock back, we had a number of localities: East and West and Medway, three IT departments, essentially, with the associated redundancy and competition between them, different standards, duplicate management structures. We’ve moved from having a regional way of doing things, to putting in place a functional model. So now we have a desktop service, managed on a Kent-wide basis, rather than having three or four.”

Supporting commissioners and providers

Discussing some recent advances and solutions offered by the HIS to its customers, Gifford highlighted the HIS text messaging service, which goes beyond a traditional appointment reminder function for patients by linking it to staff availability.

He said: “Not only are we texting patients to remind them about appointments, but when they arrive for it we link that to resources available: so if a clinician is over-running, or not there, the job can be assigned to someone else to help things flow through.”

The HIS is keen to offer more business intelligence services, via its HISbi team and application, based on IBM Cognos. Gifford argues that it is in a great position to support new commissioners in a changing landscape.

HISbi’s GP Management Information System, GPMIS, is a bespoke reporting system for the CCGs covering Dartford, Gravesham and Swanley and West Kent and Weald, which helps commissioners understand clinical activity in their area and gives them the financial information to support their commissioning capabilities. The end result is improved patient care, more efficient use of resources, and a system that can more easily identify high-risk patients.

Gifford explained: “We’re doing a lot of work at the moment on stratification. We’re exploring primary data in public health and bringing all of those pieces of data into a central repository, then allowing clinicians to cutand- slice that data. Financial management as well, allowing CCGs, for example, to look at the cost of conditions and so on, and appropriate treatment.”

Another is in the security arrangements for mobiles and tablets devices. He said: “The value added we bring to that is managing it in a secure way. If one of those devices is only allowed to be used on Ward E, we have to make sure that if it goes elsewhere, or leaves the hospital premises, it doesn’t work but can be tracked, for example.”

Among the HIS’ achievements during 2011/12, it built 22 websites for its customers, implemented a new email directory for the Kent Community Health NHS Trust following the merger of the community health provider arms of the PCTs, installed a new data centre at Medway NHS FT, helped transfer IT services during the Tunbridge Wells Hospital move, and built, configured and tested new digital breast screening technology across three Kent hospitals.


We asked Gifford whether its winning of business from the Surrey & Borders Partnership NHS FT was a sign of things to come: does it want to expand outside of its own geographical borders, and are there natural limits on that?

He said: “We are keen to market our services elsewhere, and we don’t feel constrained by county boundaries. We want to ensure the NHS receives the very best services, at the very best price. KMHIS is well-positioned to do that.”

Feedback from its existing clients has been excellent: KMHIS enjoys a customer service satisfaction rate of 96.1%, with even higher scores for learning & development training satisfaction (98.5%) and information governance training satisfaction (98.7%).


KMHIS staff are keen to keep an eye on the wider world of healthcare IT to see what lessons can be learned and what ideas can be adapted.

Gifford said: “We employ people who have a love of technology. They keep themselves appraised of what’s going on in the marketplace.

“We do look at what other trusts are doing, mostly those closer to home: the South Coast SHA region, for example, where we’re in regular dialogue with our colleagues over at Sussex, Hampshire, and Surrey.

“As far as future provision is concerned, if we’re going to be the best service provider in our region, which is our vision, we do need to focus on the strategy and implementation, and to do that we need to pay more attention to the marketplace and potential partners and so on. We have plans to develop further capabilities in that area. “On a more technical level, when things do come up, and we need to look into a particular technology area, we do have a multidisciplinary team that comes together to do that and look at the implications and various scenarios.”

The future

Gifford said he is excited about the future, but there are serious challenges ahead too. He explained: “There’s a lot of turmoil in the NHS at the moment, and the financial constraints are only going to continue: the brakes aren’t going to come off the spending. So for the HIS, that means we need to keep getting more efficient, and keep looking at where we add value. That’s going to be on helping trusts further with their strategies and their implementation.”

He said key areas he was looking at were things like electronic patient records, and health modelling and forecasting, plus looking at offering consulting services outside the county.

Gifford said the key reason for this success was simple: paying attention to customers. “We’ve been quite ruthless in our transformation. First, understanding what it is the customers wanted, then setting up a service to deliver against that, using metrics agreed by all the partners.

“We don’t always get it right. We do listen to feedback, and we’re keen to get as much of that as we can, good or bad, to continually improve what we do.

We’re relentless in pursuit of feedback; whenever we finish a job, we’re always leaving customer satisfaction surveys behind, and my managers are targeted on getting a certain response rate.”

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