The NHS has long been criticised for spending too much money on admin. While doctors and nurses heal people, admin staff are only really noticed in their absence, leaving politicians free to demand that the resources responsible for keeping an organisation running are cut back to the bone. It sounds good from the podium, but can be harder to achieve in practice.
But this was the challenge Tony Williams was faced with in Greater Manchester last April. As the head of service management at the region’s newly created Commissioning Support Unit (GMCSU), Williams was told to deliver the same IT support service with fewer staff, pulling together a confused network into one neat service.
"Each of the ten previous organisation had their own separate IT service desks and IT functions which were all set up completely independent of each other," he said. "They had never worked together in the past."
Between the ten organisations 11 separate helpdesk systems had to be consolidated, including HP Openview, LANDesk and Sunrise, among others. Not only was this a software problem, but one of skills and working practices. "Even the service hours were different," Williams said. "We had to look at all that and see how we could bring it together."
GMCSU had to provide IT support for 13,000 people working for its various clients, including 12 clinical commissioning groups (CCGs)responsible for buying healthcare, various GP practices, and the unit’s internal staff. And according to Williams the group was running 81 different services in 434 flavours for those clients.
To solve this, Williams broke the project into phases. First all departments had to be moved to a central location from which GMCSU could be coordinated as one. Once that was done, staff numbers had to be reduced and efficiencies had to be created, both on a technology level and in terms of the day to day running of the service.
For this he need an IT platform, and so he invited vendors to pitch for him. "Partners in IT and ServiceNow were the clear winners," he said. "Previous experience meant I knew that this was a reliable option too." Implementing the platform proved so successful that the launch was brought forward two months from September to July, the sort of NHS news that rarely makes headlines.
A number of innovations followed, the first being a self service portal bringing the number of support calls down from 14,000 a month. Initial requests for help are now sent through the portal, allowing the service to collect data on what needs to be fixed, as well as reducing transaction times. Personnel management was also streamlined, with staff no longer reliant on using spreadsheets to manage the recruitment, holidays and work patterns of their staff.
Cutting software is easier than cutting jobs, but the departments’ contracting of much of the work meant that Williams was not forced to lay anybody off personally. "Out of the total number of staff we inherited, 36 people, there were less than 16 permanent employees on the service desk," he said. That total had to be reduced by half, and ten teams had to be reduced to three.
Doing more with less involved running a skilled service desk. Those working at GMCSU include people with twenty years of experience in computing and so-called "digital natives" who are new to the job. According to Williams: "It’s definitely the people who made this happen. I’ve been lucky enough to have some really able people work with us and enable us to get to this position."
Having reduced annual staff pay costs from £1.1m to £500,000, much of the work now is in fine tuning the organisation based on data. "It enables us to have a clear quick understanding of what’s going on in the organisation," Williams said. Real time metrics are now a basic part of working life, and allowing the services to improve incrementally.
Williams experience shows that skilled labour is vital for making the most of software, a factor often overlooked by computer journalists obsessed with the technology. IT managers should make use of both to cut costs and create lean, effective companies – perhaps proving that politicians are not always wrong.
