New Year’s Day 2017 was a low point for the London Ambulance Service. At 12.40am the computer aided dispatch system crashed at one of the busiest times of the year for the capital city. But low points often lead to an opportunity to embrace major change.
Ross Fullerton joined the London Ambulance Service as CIO in May 2017 because he wanted to take on the challenge of modernising not only the technology of the London Ambulance Service, but also the approach to technology by the whole organisation.
London Ambulance Service has 6000 staff and we are split between 4000 in the ambulances and 1000 staff in the emergency operations and 111 centres and another 1000 in the support services.
As the ambulance service for the nation’s capital, it is the busiest ambulance service in the UK, operating from 70 ambulance stations, which respond to 1.2 million emergencies for the eight million residents of the city a year.
On arrival Fullerton had to go into repair mode to ensure the organisation didn’t suffer from an outage to the level it had done earlier in the year. The CIO is direct about the causes of the outage - under investment.
We are not worried about the infrastructure now and we have shored up the operating procedures for just such an issue. We have also had some changes in the team to cement operational resilience and we have brought in IT people with blue light experience, as well as some people with commercial partnership backgrounds.
It is interesting to note how organisations whose primary purpose is emergency response have, in the past, not realised how interconnected their IT is and therefore also have a need for an ability to respond to their own emergencies. Fullerton is clearly confident he has triaged that issue.
The good news is that the areas of under investment have been identified and dealt with.
Now in 2019 the organisation is always aware that there is a level of inherent technological risk in the service, but Fullerton is confident it can respond.
We recently had the chair of the organisation say ‘we must not have these issues again’.
Now we need to move forward to ensure that the systems understand the patient and the NHS and that is how we will work with the electronic care record.
Fullerton says of how he is integrating the ambulance service back into healthcare. Work has already begun, over 4000 iPads have been put into the hands of London Ambulance Service frontline staff with connectivity provided by Vodafone. The computer aided dispatch system is set to be replaced soon for the control rooms and interestingly the procurement is being done on a national scale. And, to Fullerton’s point about understanding the patient and the NHS, the new control system will capture a great deal more information, the CIO says.
This way we can start sharing information with the hospital, so the information is already there before the patient arrives.
Fullerton is also assessing how video can play a more important role in healthcare.
If a patient calls us we can use the smartphone to evaluate them, so for example if it is a case of major bleeding we can assess what is the best form of response.
Fullerton’s modernisation of technology at the London Ambulance Service has three key elements - modernise technology, the team and to be a key part in the overall modernisation of the NHS.
There is still a lot to do on the culture change.
Like many of his peers, Fullerton arrived at the London Ambulance Service to find that not only had the technology not received the right levels of investment, but the IT team had not been getting the appreciation and development that they need to keep pace. A quick win for the CIO was the adoption of the Pluralsight online training platform, which he says has received good feedback and is growing in popularity with CIOs.
We need to look at how we become more of a commodity and standardise the technology that we use. So we will have some more effective uses of the cloud.
In tandem this will change how the London Ambulance Service works with the technology community.
There is a lot of potential for our suppliers to use our brand and for us to be more effective with our brand.
Fullerton and his team are already delivering change that will improve the experience patients have of the NHS. To the patient there is just the NHS, they don’t see the structure of primary care trusts and ambulance services, especially when they are in need. So simplifying the operating divisions between organisations like hospital, mental health trusts and the ambulance service is vital and an area where results are already being delivered.
The service treats people in an end of life scenario and in those cases a patient may not want the ambulance to scoop them up and take them to hospital. Our teams can now see if a patient has an end of life plan and act accordingly.
Those are the kind of developments and improvements to the service that make this type of role worth it.
Fullerton has also embedded his IT team more closely to the frontline paramedics to ensure all parties understand the value of the service they offer and the pressure they are under.
We get to go out with the crews and witness how these tools are being used and it is mind blowing.
Technology is the heart
Like all the best digital transformations the technology is only part of the story. Control rooms and ambulances have worked the same way for over 10 years.
Since Fullerton became CIO London Ambulance Service has led the delivery of a biometric version of the NHS Smartcard identification platform, developed by NHS Digital to ensure its paramedics can securely authenticate themselves via an iPad and connect to the NHS Spine and share information.
The pilot for this is getting a really strong response. Access to information changes the decisions we are able to make and it is an example of a joined up way of working between the NHS and the London Ambulance Service.
In early 2019 the Department for Health announced the creation of NHSX, which it describes as a joint unit to bring technology benefits to patients and clinicians.
I applaud the work they have done with NHSX and the pace this has brought to decision making.
Despite the need for pace and change, London Ambulance Service and Fullerton are aware of the need to retain technologies and processes that do the most important thing - keep operating in an emergency. As a result, pagers and the venerable fax machine still have a place.
We genuinely rely on them, for example when the 7/7 bombings took place the mobile networks got overloaded, so we will keep them for an emergency and there will be fax machines for communications between the control rooms, so if there was an emergency we could move to fax. They are a carrier pigeon equivalent if we needed it, I wish there was a better answer.
Fullerton’s arrival at the London Ambulance Service in 2017 was at a time when the NHS was in a real purple patch of leading CIOs making a significant difference to the health service. At the time it was NHS trusts attracting CIOs with a significant track record of major change, whilst ambulance services were not bringing in those talented leaders. But in discussion with Fullerton, it is clear that there is potential for major change in ambulance technology usage.
Hiring a CIO with experience of leading major change is only part of the response though, organisations have to support those CIOs once they arrive. Fullerton is not on the board of the London Ambulance Service, but tells digicomica he has regular access and in many ways this is more beneficial.
It it’s hugely valuable as you gain a much clearer view of pressures and opportunities across the organisation. However it also takes up a lot of your time and that is time that you do not then have for your team and your suppliers.
Whatever the challenge, it is clear Fullerton is passionate about the challenge and the opportunity that technology offers ambulance provision.
CIOs are really evolving to the overall change strategy of organisations. Here, you always feel connected to the mission.