Q&A – NHS Direct

Information Age (IA): Given the breadth of your service delivery channels – from call centres to online and interactive television services – how do you ensure that your IT department has the right mix of specialist telephony and website skills?

Murray Bain (MB): I have 50 IT staff, but it’s never enough. So some of our technology is [managed] internally and some of it is supported via a managed service. The main application used in the call centre is a managed service, but the website we look after ourselves: it’s hosted by our managed service provider but we look after the site development.

BT is our main telephony support service and they supply the technology and maintain the telephony technology. Call centre technologies tend to be a bit specialist, plus we’ve refreshed those over the last two years: they’re pretty much as good as you can get now. We now use VoIP [voice over Internet Protocol] over a shared network – but the challenge with that is stability.

With a traditional telephone technology, time division multiplex (TDM), it never fails: you always expect to go home and pick up the phone and it will work, whereas if you’re in front of a PC you expect your PC to fail from time to time and you reboot it. Telephony solutions now are using PC technologies, so that telephony is going to fail more often now than it has in the past, and that [requires] a mindset change.

IA: So how does the use of VoIP affect the telephone service’s risk profile?

MB: It’s a case of making sure you have resilience in place where it needs to be and that your systems are carefully managed – so change control is very important. We all take risk but we have to be very, very careful.

Up to 3% of our calls will end up as a 999 disposition, so they are people who have potentially rung the wrong number. We never know therefore when the next call is going to come in that should be 999. So we have to be very, very careful with the systems we run, and we invest a lot of time and effort into building resilience into the service.

What VoIP gives you is flexibility – to upsize and downsize. We have flexibility across the country with five telephone exchanges that are all networked together, so they effectively work as one. Wherever a call comes into the service, we’ll try to answer it locally; if we can not answer it locally it will go to the next available agent, so the patient is getting a much quicker and better service this way. So there’s normally more than one way of doing things in the service.

We are using the NHS wide area broadband network (WAN), N3, which
is one of the largest shared networks in Europe if not the world, and that’s an adventure in itself.

IA: You rolled out the digital TV service in 2004: what new challenges did this present? 

MB: It used to be dealt with by a different group, and I’ve only just taken it on. It is a challenging environment and I don’t come from a television background – I’m more about the business and IT. What I’ve found is that it’s quite traditional technology. Without being disparaging, it’s very clunky. There seem to be a lot of hurdles in the way the content has to get to a certain state before it is broadcast and it’s also quite bespoke, whereas in the IT industry now we have quite a lot of standards – it doesn’t really matter what piece of kit you buy it’s probably going to work with what you’ve got. So the IT industry is much more mature than the TV industry which stills runs on a proprietary basis.

This year we are re-procuring our television services. Currently, we operate on the Sky platform and Freeview as well. With the Sky platform we a have managed service supplier; we supply the content and they publish it but to the two platforms and it has to be published in different mediums – to which I ask why? Why isn’t it in Word or HTML or XML? It just seems overly complex. So we will need to address that as part of the re-procurement. Digital TV is also quite restrictive and expensive when you compare it to something like the Web. You’re restricted as to how much you can publish, because of the bandwidth restrictions, and by what you can do with the buttons [on the remote control].

CV

Name: Murray Bain

Title: IT Director

Organisation: NHS Direct

Highlighted challenge: To ensure that patients can access medical information and services via a burgeoning variety of methods, while receiving a consistently excellent service across all.

Background: Bain has worked for NHS Direct for nine years, prior to which he worked in the financial services sector.

IA: Do you have any plans to expand into new technologies in order to increase access points, such as mobile for instance? 

MB: Very much so. That’s a development for this year. We’ve done a complete platform refresh, and I guess we are a little bit behind the curve because we’ve been concentrating on getting the platforms right to deliver some of the added advantages. I’ve been talking to colleagues about what we’re doing with SMS, and how to interact with a patient on SMS. But again it’s about getting the content right and putting it in a format that’s usable and useful to the patient. It’s OK if you’re just asking where your nearest GP is, but if you’re asking for more detail how do you present it in a way that is useful? We are also looking at how we can assess a patient using web technology. There’s more opportunity on the web to give information than in a call centre, for example.

IA: The Connecting for Health project has arguably called into question the way both the NHS and the public sector in general manage supplier relations. What is your philosophy on this?

MB: It’s always challenging when dealing with suppliers. We all shout at each other from time to time, and I operate a challenging environment. What I say to them is that I don’t care who made the mistake, I want to know is what happened, do we understand what happened, and how we are going to stop it happening again? That’s very important to me and I want all the suppliers to work together – it’s not a blame exercise it’s a learning exercise. It’s a way of building in trust between the suppliers and myself.

It is however a challenging environment and on the managed service side we’ve had 99.5%-plus availability for about four years now – that’s high availability for a 24×7, 365 days-a-year service. It’s a challenge to maintain that but it’s essential to the service. We’re often very busy at evenings and weekends, and that irregularity also creates a challenging environment for most suppliers as well. I am the biggest customer in both areas of business to those suppliers, however, so that allows me to engage at fairly senior levels when I need to.  

IA: Although you don’t come under the Connecting for Health scheme do you have any views on the project?  

MB: I think everybody’s heart was in the right place, and everybody knew what needed to be done. But the problem was that it was presented as an IT project, but it’s not an IT project, it’s a change management project with an IT component. And that’s the difficulty. I believe it’s been treated as an IT project and therefore either the technology or the technologists have been blamed. But the biggest issue for me in changing systems is the cultural issue.

The technology is the easy bit; it has its challenges, but actually you can work through them. But trying to change the culture, particularly of clinicians, is tough – they are very bright, well-educated professionals, and they have different perspectives. They’re about patient safety and welfare and the technology we provide is merely there for support. The organisation I run, for example, couldn’t operate without the technology, but it’s merely a support service.

Connecting for Health needed to update the technology, but I think they should have updated the processes and the culture of the people using those processes alongside that. I think it will do what it set out to do, but I think there is a lot of resistance from the clinicians. Some don’t understand the project and are therefore fearful. The people issues were the ones that were less well tackled possibly than the technology issues. It could always have been done better, but actually it’s achieved quite a lot.

Pete Swabey

Pete Swabey

Pete was Editor of Information Age and head of technology research for Vitesse Media (now Bonhill Group plc) from 2005 to 2013, before moving on to be Senior Editor and then Editorial Director at The...

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