Some insights and key observations from a June 2023 Freedom of Information Data request ~170 UK NHS Trusts were polled, of which 140 responded by the time this was published. This is roughly 64% of total.
To start, let’s understand (at a high level) what it is that an NHS Trust does? Wikipedia suggests that…
“An NHS trust is an organisational unit within the National Health Services of England and Wales, generally serving either a geographical area or a specialised function (such as an ambulance service). In any particular location there may be several trusts involved in the different aspects of providing healthcare to the local population.”
Fair enough.
Before we get into the stats, viewpoints or any of the other commentary, I would like to strongly caveat this by saying that I know (from experience) that the IT Service Management aspect, while important, shouldn’t reflect on the wider, stellar work done by the NHS, but it no doubt has an impact, directly and indirectly on the experiences and outcomes of both patients and staff.
So, would it be reasonable to expect that across these trusts that are, essentially, fulfilling highly aligned roles in the provision of healthcare services, that their operational structure would be relatively similar if not the same? Would one differ significantly from another within the UK? After all, they are providing, broadly speaking, the same set of healthcare type services (etc) AFAIK the majority are similar in nature and that there isn’t one that is doing something wildly different to any other – so it would seem to follow that their service management needs would likely be highly aligned and similar also…
Again then, are there any common denominators in terms of the solutions used to manage their support and service management functions and, where there are differences, what could be inferred from this.
Turning to the Freedom of Information act the question was posed ‘What ITSM solution do you use?’ and similarly, thinking that same challenges, same responsibilities, same solution right?…
Additionally, that as it all falls under the one banner of ‘The NHS’ there would be a high degree of commonality with respect to sharing of information / resources / availability and so on – I touch on interoperability and integrations further down.
Well… As can be seen, there are over 20 different ITSM solutions in use across all trusts, ranging from Enterprise grade through to in-house developed platforms and a number of familiar names in between.
Some have a greater footprint than others, granted, but nonetheless, still quite the spread.
So, what does this mean, are some trusts vastly different than others, are some facing challenges that require a specific feature from a specific toolset, are some more ‘digitally enabled or focussed’, is it geographically biased, is it a capability challenge? Is it a ‘we’ve always used X so why change’ mentality? Is it funding?
Geographically speaking…
So fair to say that healthcare issues / concerns, illnesses, Covid, broken bones and other related conditions don’t care where you live within the UK (or elsewhere for that matter) and that services that deliver support, treat and assist with these would need to be reasonably consistent across the UK (as well as further afield) – would it follow then that the toolsets in use would align or at least support, for example, a higher degree of integration capability and interoperability for securely sharing appropriate (patient) data and availability of resources / facilities?
The below infographic shows the top 6 deployed solutions by location, with no provider dominating any particular area, although Sunrise Software (why do they have a cloud as their logo and not a Sun?) seem to be popular in the North West area. London sees a broad variety of solutions in use across the respective Trusts (as does elsewhere…). So, geography, doesn’t appear to be a factor, not really a surprise. Does this mean then that integrations and interoperability (data sharing) is standardised across these solution sets so it doesn’t matter (for this aspect) which is in situ?
Ok, how about the size of the Trust, number of employees? The larger then the more comprehensive and enterprise capable the ITSM toolset needs to be?
Size of Trust
Finding specific information relating to the size of a Trust, in terms of employees is available publicly via the digital.nhs.uk website (there is a wealth of information available) so, based on number of employees, I’m using this for as a basis and focusing on the top 50 (largest number of employees) to give a more rounded representation.
Well, surprise surprise, no significant commonality here either, although ServiceNow has a clear presence, it’s not totally dominating the space. Also to add, a couple of Trusts are running dual systems (for some reason, making their life harder?)… so it would seem that organisational size isn’t a specifically defining factor, which again kind of makes sense as (in my mind) it’s a case of managing more of the ‘same kind of stuff’ (in VERY simplistic terms).. so you’d just want/need more licenses, resources (certainly) and perhaps some beefier infrastructure?
But all in all, seemingly no direct correlation here either… so how about the top ranking NHS Trusts? Any commonality there?
Top ranked NHS Trusts
Top 100 Hospitals ranking list is compiled using the Public View Hospital Combined Performance Score (HCPS) and I’ve looked at the top 30 to give a decent representation.
Seeing what ITSM toolsets they are using that support these outcomes again shows a wide selection with ServiceNow having a larger footprint (whilst still not dominating either). Also great to see Atlassian making in-roads here as Atlassian’s approach of empowering teams to work the way they see best whilst maintaining operational control is ideally suited to the many different departments and functions that rely on a backbone ITSM platform within a trust.
So it would seem that whilst important, the choice of IT Service Management solution doesn’t necessarily reflect on the amazing job these Trusts are doing in terms of delivering positive user and patient outcomes and experiences. Arguably it’s the processes (and people!) in place within these Trusts that are driving the positive outcomes here, which in turn are being supported by the various solutions in situ. No doubt complemented by a thorough and effective implementation along with a CSI program of work underpinning things…
Whilst not shown, when I looked at the top 10 NHS Trusts in this list, there are still 7 different vendors in the mix.. further confirming this.
Ok, so how about the best trust to work at, according to the staff?
Top Trusts to work at in England
According to data analysed by the Health Service Journal and referenced here – looking at the results from the question NHS Staff Survey for general acute and acute/community trusts who said they “agree” or “strongly agree” with the statement “I would recommend my organisation as a place to work”. University College London Hospitals NHS Foundation Trust came out on top!
For the keen eyed among you wondering why it’s not an even split between the 5 solutions, and without naming names, one of these Trusts responded that they have 2 ITSM solutions in situ… the questions this raises to me are:
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Why?
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Can’t you get one to do the functions of both? (poor implementation, lack of skills)?
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What impact does that have in terms of compounding management overhead with respect to vendor / asset / CMDB management, spend, in house skills and other aspects…
Again though, interesting to see that no singular ITSM solution making the workplace a more recommendable environment for prospective employees.
What about best trusts against targets, perhaps not the best comparison, but still, could be interesting to see whether there is any correlation or not…
Best NHS Trusts
Telegraph.co.uk has a comprehensive set of stats gathered from NHS data that’s freely available, and to rank trusts, they have aggregated four key metrics: patients waiting more than 18 weeks for hospital treatment, A&E patients waiting more than 4 hours to be seen, cancer patients waiting more than 31 days to start treatment and patients waiting more than six weeks for a test.
Looking at only the NHS Trusts who are at 87%+ according to this and as it appears this data is updated, this is as of 12th July 2023
Ok, still a mix, but BMC Software supporting over a quarter of these Trusts in this measure… Read into that what you will, and interesting to note that there is a reported ‘In House’ solution also being used amongst these.
But overall, no immediate correlation here, people and processes in place are driving these outcomes and whilst falling short of targets set, certainly still admirable and hopefully helping identify areas where targeted improvements can be made. I can’t help but wonder whether it all comes down to (and this has been widely speculated/commented upon within various news sources) a resourcing issue fundamentally?
Resourcing
We’ve all seen the news and have experienced the Covid pandemic and what that meant in terms of being able to access healthcare, say no more.
Cost, Resources and/or Desire to change
I mentioned cost in my review of Local Councils and it would be remiss not to comment on this again, is it simply that cost of solution, allocation of IT budgets and TCO, ROI are the defining element? Possibly, and especially at a time when there is record inflation, costs going up daily, managing spend wherever able is a factor on everyone’s mind. But I do wonder, especially within the NHS (and the frequent news about resourcing challenges and spend etc) that there just isn’t the appropriate level of time/resource available to undertake a comprehensive evaluation, (or program of improvement maybe?) and it’s just easier to continue on with what is already in place as there are more important issues to address?
An IT Service Management (or perhaps more appropriately within healthcare, an Enterprise Service Management) solution is a must across all digitally enabled organisations today, given the spread shown, where possibly one solution is seen as much the same as another (aside from price) what level of learning curve is there in respect to the value, outcomes and positive experiences these solutions can deliver, some better than others? Especially when implemented appropriately and optimised for strategic initiatives and relevant use cases?
Should we look at the exec level within NHS trusts? Many trusts are run by clinicians, who have become leaders. These are people who are amazingly skilled, but don’t necessarily perhaps understand the underlying technology that supports the trust – their specialities, knowledge and experience lie elsewhere. So when it comes to budget allocation they inherently know that spending money at a clinical level improves patient care, but maybe are not so easily able to see how something like an ITSM does. Does there then need to be more emphasis on IT leaders in trusts being able to build the business case for spending that is not front line?
Or indeed that there is a resistance to change at the risk of ‘upsetting the apple cart’ ? I doubt this, as it seems apparent that the NHS understands the need to change and adapt to meet the pressures present.
To use the same example as before, when you buy a home (a significant purchase, I’m sure you’d agree), and post the evaluative process, you need to furnish it with appliances, furniture, decorate, ensure all fixings are in good order, maintain the plumbing/electric etc i.e. you’re spending time, effort and money to ensure that this is the appropriately setup living space for you and that it meets your needs accordingly now, and into the future!
Similarly, with your IT Service Management solution, all of these solutions are configurable (some more so than others) so it’s certainly worth spending the respective amount of time and effort in fully understanding and appreciating the capabilities available, and making your ITSM fit for purpose, maximising the capabilities to the nth degree to realise and surface the value it provides, in turn helping drive and deliver the outcomes you want and need to be successful.
Some conclusions/observations/questions
Seeing as across these Trusts the solutions in place are varied and there isn’t any singular denominator, perhaps the questions again turns to the vendors and see what could be inferred about them and their respective solution offerings?
Is there a deep enough understanding of the workflows, healthcare environment, pressures in place, specific case management and other activities, that ITSM could improve (yet isn’t) to deliver better outcomes? Onboarding of staff is just one example having seen paper based forms (stacks of!) still being used as part of this process, easily handled within an ITSM solution meaning that new joiners (or leavers/movers) have the appropriate access, tools and whatever else from day one! BMC Software showcased a great example of this earlier this year at SITS
What level of knowledge share and best practice (ITSM specifically) is being done across Trusts that that are using the same software? It would seemingly make sense that if you’re using X and have hit upon a great piece of configuration, or a clever workflow that has solved Y and improved staff/patient outcomes, are there barriers to this?
While there is no single vendor monopolising here (good?), and does that mean that one solution is ‘just as good as another’ (and it’s solely down to the great job the sales team did in the tender response and proposal?) it would be highly insightful to understand what vendors have to say and perhaps share what is in their respective product pipeline from a healthcare POV, so over to you, Sunrise Software, ServiceNow, Hornbill, Ivanti, ManageEngine IT Service Management, Freshworks, BMC Software, Alemba, Atlassian, 4me, SolarWinds and all the rest – let us know!
If you’d like further information about this dataset or any other details, get in touch and let’s have a conversation.
Xcession specialise in helping organisations improve user experience, agility and service management productivity by providing consultancy, professional services, application managed services, support and maintenance around ESM and ITSM solutions. Get in touch and let’s explore some ideas in how we can help you ensure you’re using the most appropriate solution for your needs!
