Life on Marsland assesses the case for shared services

Over the past decade, some trusts and primary care organisations have moved their IT planning and support to shared services organisations. Iain Marsland argues there are still many arguments in favour of this approach. But the tide may be starting to turn against it. 

Outsourcing has always been a controversial subject, especially with respect to NHS IT services. NHS boards have often been reluctant to hand over public assets and NHS staff to the private sector.

They have been sceptical as to whether anyone could simultaneously save money and improve services. And they often fear losing flexibility; whilst contracts and service level agreements (SLAs) provide a notion of control, they also impose a degree of rigidity.

Since the 1998 IT strategy, Information for Health, introduced the concept of Health Informatics Services (HISs), internal outsourcing through shared services has provided an alternative option. The NHS now has a number of shared services organisations offering a range of services to NHS stakeholders, including IM&T.

As the NHS progresses towards 21st Century IT (the IT strategy published at the turn of the millennium), the role of shared services may need to be re-evaluated. “Some of the standard reasons for outsourcing are starting to look more attractive than ever.”

Revisiting the case for shared services

Two common outsourcing mantras are “never outsource your mission critical services” but ”let the experts do what they do best, and focus on what you do best.” These appear to be commonsense yardsticks.

Yet, although we would like to think of IT as mission critical for the NHS - especially with the roll out of electronic prescribing and decision support - it certainly isn’t core business.

In many respects, the National Programme for IT in the NHS (NPfIT) approach of application service provider (ASP) solutions is a form of outsourcing. Patient administration systems and GP systems are already run out of remote commercial data centres. Electronic prescribing and decision support will also be ASP solutions when they arrive.

Meanwhile, some of the standard reasons for outsourcing are starting to look more attractive than ever:

1. Lack of internal expertise

How many integration engineers do you employ? Have you recruited and trained the clinical analysts you need to deploy care records services in secondary care? These rare skills could be provided to a network of trusts, maintaining and sharing their expertise. Shared services could provide a cost-effective source of such folk.

2. Lower costs due to economies of scale

This applies across the spectrum of services and skills. One support desk can support many trusts. A small project team, information governance unit, or planning group can operate across multiple organisations.

3. Higher quality service, due to focus of the supplier

Unfortunately for the sceptics, it is true that the response time and resolution of user support requests can be dramatically improved when the same staff are employed by a commercial IT services organisation with standard and proven operating procedures.

4. Ability to concentrate on core functions (creating strategic capacity)

Wherever you look in the NHS, there is unprecedented change. Primary care trusts and trusts are awash with commissioning, service development, staff development and NPfIT projects. "Chief executives must believe that shared services are good for both patients and their bottom line."

Potential downsides

Outsourcing has its limitations and risks of course:

1. Introducing standard practices can make the service inflexible

In one shared service I have worked with, the help desk believed that all desktop problems were of equal importance: “a PC is a PC.” Unfortunately, the consultant with 20 patients waiting in clinic for his PC to come on line didn’t agree.

2. Once IT services are outsourced they are delivered subject to contract

Get the service specification wrong and you could face additional costs, much frustration, or both. One approach is to band the deliverables, but leave the boundaries flexible to enable different levels of services according to need, within a total fixed cost quantum. Need more project management this month? No problem! Installations will drop to accommodate. Rather like in house departments operate now.

3. Shared services will be formed from the staff, equipment and budgets of the constituent organisations

In a number of cases, the resource transfer has been than ideal and in some cases less than the local service actually operated with. This leaves shared services severely handicapped and facing a difficult future with an unsatisfied customer base.

Gut feeling

So, although formal programme management is the best way to manage multiple projects, outsourcing has its place where the projects involve a significant level of IT change and can enable the organisation to focus on its core business. The NPfIT drive towards ruthless standardisation certainly lends itself to a shared services delivery model.

However, on the ground, this still requires the hearts, minds and confidence of managers and staff to work. Chief executives must believe that shared services are good for both patients and their bottom line. Foundation trusts, especially, may no longer be comfortable with this approach. So I guess the jury is still out.

About the author: Iain Marsland has been in the NHS for 34 years, most recently as chief information officer for Essex Strategic Health Authority and previously as director of IM&T for acute trusts in Brighton, Sussex and Bristol. He is now an independent consultant.