ITSM transformation for NHS Lothian
Case Study:
NHS Lothian Freshservice Enterprise Service Management Case Study
NHS Lothian had been using an ITSM platform that had reached the limits of what it could deliver. Their system supported around 26,000 staff and served a population of more than 850,000 people, making them one of Scotland’s largest health boards. However, their ITSM system had become expensive and difficult to extend.
Xcession was selected to work alongside Freshworks as the implementation partner to deliver an enhanced and expanded system, upgrading from an ITSM deployment to a four-workspace Enterprise Service Management (ESM) system encompassing the business areas of IT, HR and Employee Relations, Procurement, and Recruitment.
This case study covers both the deliverables and requirements of the programme, and looks at the benefits achieved by the board during phase 1 of the project.
Business Challenge
Together with two neighbouring health boards, NHS Lothian had operated a legacy ITSM platform for around six years. The system covered incident, change, and request management but had become difficult to extend.
Each additional capability that the board required carried additional licensing or third-party costs that were becoming increasingly difficult to justify. The existing system consumed up to 400 fulfiller licenses, two dedicated internal platform specialists, and an external support contract, but progress against ITIL and SDI maturity objectives had stalled.
The most significant desired improvement was that the board wanted to extend service management beyond the IT department into other business areas. HR and Employee Relations, Procurement, and the Recruitment team all operated via spreadsheets, PDFs, and shared mailboxes, and bringing those functions onto the legacy ITSM system was not commercially viable.
Project Overview
The first step was to perform a structured six-month evaluation in which NHS Lothian and Xcession, and Freshworks worked together through discovery and challenge workshops, platform demonstrations, a guided trial, competitive positioning, and the development of a business case. The guided trial gave stakeholders hands-on, practical access to allow them to assess core functionalities such as self-service, admin, integration, and catalogue management.
Once this process was completed, Freshservice was selected as the platform to deliver ESM functionality to NHS Lothian on the basis of lower total cost of ownership, inclusive and affordable licensing, the availability of integration and automation capabilities which required no additional purchase, and a simplicity of administration that supported internal ownership of the platform.
Delivery then followed Xcession’s standard, six-stage integration model: discover, design, configuration and build, testing, production preparation, and then go-live support.
Key Deliverables
The key project deliverables encompassed six areas:
The four business areas which would be using the new ESM system performed requirements workshops, resulting in Business Requirements Definitions, workflow designs, Service Level Agreement definitions, and process requirements. For three of these departments (excluding IT), this was the first structured service design exercise ever undertaken.
Secure user management and access control was achieved by configuring Azure Active Directory provisioning and single sign-on (SSO) authentication schemes, allowing users to sign in once and then access and use multiple services.
The workspaces supporting all four business areas were configured in parallel, keeping all functions to a common delivery timeline. During this step, incident, change, problem, and release management were configured to ITIL-aligned processes, alongside service catalogue development, self-service portals, reporting, and analytics.
Alongside the build process, administrator and train-the-trainer sessions were delivered as an integral part of the statement of work, and the internal team took an active role during the user acceptance testing stage.
The build was completed on schedule on 27th February 2026.
User acceptance testing across all workspaces took place in March 2026, followed by the go-live and hypercare. The final project board reported green status, with no open issues.
NHS Lothian commissioned a second phase, covering workflow automation, approval routing, FreshService journeys, and a live chat feature. The Joiner Journey completed testing in July 2026.
Benefits to NHS Lothian
By implementing Xurrent, delaware achieved substantial improvements in its service management approach, leading to numerous tangible benefits:
At NHS Lothian, 800 new doctors typically onboard in each six-month rotation, a process which was previously handled entirely manually across all involved business areas. The Freshservice Joiner Journey that replaced these manual processes is estimated to remove around four full-time- equivalent roles of administrative effort; capacity that has been returned to the involved teams at two of the busiest points of the year.
User satisfaction for the NHS Lothian service desk stands at 95%, up from 86% the previous month. This figure continues to trend upwards as staff adoption of the portal grows.
HR and Employee Relations, Procurement, and the Recruitment department all joined the IT department in moving away from spreadsheets, PDFs, and shared mailboxes and onto a single unified platform accessed through one self service portal.
The knowledge transfer program enabled NHS Lothian to administer, configure, and extend the platform internally, removing the expensive third party support and licensing dependencies that the previous ITSM system required.
Add-on charges and additional fees had previously blocked new capabilities. With the new system, the board has a solid cost base against which it can reliably plan as adoption continues to grow.
With the ITSM system and the initial ESM footprint now in place, NHS Lothian is now assessing extending the platform to cover laboratories, pharmacies, and estate management, which would consolidate request handling, approvals, and asset data which is currently held separately.
Self-service password reset automation, which currently
handles around 2000 requests per month and requires two dedicated staff, isscheduled for release soon, which will further reduce user friction and return working hours to the IT team.
Client Feedback
“The introduction of Freshservice as our Service Management Platform has been brilliant. The platform, and the support of Xcession, has allowed us to massively increase our ability to automate what were heavily time-consuming and manual processes.
Approvals, AD account creation, cross-functional workflows like the Joiner process are all examples that have more than delivered against the underpinning business case. The opportunity to support other critical services within the board is very exciting, and there is a lot more to do within digital itself.”
James Forrest, Digital Customer Services Manager, NHS Lothian
Conclusion
Xcession’s implementation of Freshservice for NHS Lothian replaced a constrained and limited ITSM deployment that only supported one business unit with an ESM platform that now supports four distinct business functions.
By implementing Freshservice, the board reduced its cost base, removed its third-party support dependency, and gained the ability to develop the platform without external assistance. Service desk satisfaction continued to climb throughout Phase 2, which has moved the project from migration into a continuous optimisation phase.
Let’s Talk
Isn’t it time your team experienced the benefits of seamless enterprise service management?
Your ITSM and ESM platform holds immense potential, but many organisations only use a fraction of the available capabilities. Low platform utilisation can lead to underwhelming ROI, increased shelfware, and missed automation opportunities.
Xcession ensures your platform is fully optimised, seamlessly integrated, and delivering measurable value. Whether you're implementing, expanding, or integrating your platform, our structured approach helps IT leaders unlock the full potential of their investment. We make sure you get the most from your Freshworks investment, helping you deliver benefits across your organisation.
Let’s talk about how Xcession can help you maximise your investment and drive real business outcomes.