The digital telephone system behind the NHS Direct helpline is one of the most complex in Europe – and a too-rare example of government IT success
The UK government is not always linked with the phrase ‘successful IT project’.
But frustratingly for those at the helm, the ones that do succeed rarely receive a mention in the column inches. For Murray Bain, former IT director for NHS Direct and now CIO of the East of England Ambulance NHS Trust, wiring up one of the world’s largest non-military networks was one such project.
“The [NHS Direct] telephone system is one of the most complex in the EU, with five switches working together,” he says, which together handle an average of 22,000 calls a day.
The chief problem the NHS Direct service addresses is the tendency for people to present themselves at a hospital’s accident and emergency wing with relatively minor complaints, tying up scarce resources and diverting them from real emergencies. In many cases, an advice and referral service would be just as effective for the patent.
“NHS accident and emergency has always struggled with inappropriate attendance; people turning up with a cut on their finger,” Bain says.
The telephone helpline he inherited was plagued by in-built inefficiencies, as it relied on 22 separate sites that were not interconnected, which meant that once a call was transferred to a site it had to be answered directly or abandoned. “There was an inability to cope with peaks and troughs,” Bain explains.
Consequently, calls could not always be dealt with in a safe and suitable timescale for the patient. If this was in danger of occurring, call records would be faxed to another site and added into a second database, resulting in duplicate patient records as well as delays.
Bain acknowledges that the service’s target of 90% of calls answered within 60 seconds was one it had “struggled to meet for the first five years because the infrastructure was in the way.”
His solution was a VoIP service built across five enterprise-class Nortel CS1000 devices. “Calls coming in to one of five devices could be answered by the next site,” Bain explains. Calls could also be recorded and archived into an EMC Centera fixed content storage device, for both investigating complaints and quality assessment.
“Because it’s a virtual solution, you can take any site offline and it’s inconvenient rather than disastrous – calls are still answered elsewhere,” Bain says.
Data security also had to be considered carefully. Following the HMRC lost-CD data debacle “the NHS tightened up information security. The whole industry is now very conscious of how they move data around.”
Despite the problems that bedevilled the national NHS database project, Bain acknowledges that the NHS Direct upgrade “is now seen as one of the more successful government IT projects.”
The key to its success was “a carefully managed roll-out over a period of time,” he says, a process incongruent with ‘big bang’ project management philosophy. “Strong change control was essential. As it was, the service never went offline.
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