Western Sussex Hospitals Trust was one of the very few NHS organizations to be awarded an overall ‘Outstanding’ rating by the Care Quality Commission in its 2016 report – one of only five trusts out of 136. However, while patient care was awarded top marks, the trust was suffering in another area – its technology infrastructure, according to Grant Harris, head of the trust’s IT Operations.
I spoke to Harris not long after the recent wave of ransomware attacks that hit so much of the NHS, but fortunately for him and his employer, Western Sussex was not hit. This was down to a combination of modern systems, intelligent patch management and security investment, as Harris explained:
We’ve only got one percent of our estate on XP, the rest are Windows 7. We’ve been patching within a couple of days of Microsoft releasing patches. In terms of where we are compared with other trusts, we’re in quite a good position.
We also put in Sophos Intercept X last month, sort of anti-ransomware. We’ve been quite proactive on that front.
However, while Harris was happy with the IT security provision at the trust, this was not the case with its previous service desk system, which fell far short of outstanding.
Western Sussex Trust, which runs Worthing Hospital, St. Richard’s Hospital in Chichester and Southlands Hospital in Shoreham-by-Sea, had been using a shared service provided via a Commissioning Support Unit (CSU) for 10 years. But in 2015, the service took a nosedive overnight. Harris said:
They were breaching all their SLAs because someone up above made the decision to get rid of all their temps - and they were running with quite a high percentage of temps on their desks - without telling their customers. Overnight we ended up with a shocking service, 16-minute waits on the phone, it was just impossible to work like that.
The poor level of service was impacting the reputation of Harris and his team across the business. Helpdesk calls from the trust’s 7,500 end users were not being passed on to the internal IT team to deal with, and Harris’ team were unable to log in and view the calls themselves.
The trust knew it had to find a new supplier, and decided that rather than go out to tender as part of the group using the shared service, it would take the service back in-house instead. Western Sussex gave notice to its outsourcing partner last February and agreed a cut-off date of 1 November for its old helpdesk service, leaving the trust with eight months to investigate, test and deploy a new system. Harris said:
That was painful. We looked at about 14 helpdesk products, sat through about a month’s worth of concepts. It became quite clear early on that some of the tools out there are pretty awful. Some of the older legacy systems that have been around for years and years haven’t evolved in that time and were very dated.
Harris drew up a comprehensive list of requirements to pinpoint the trust’s priorities and make the selection process a bit easier. These included a much greater deal of automation and a user-friendly website. With the previous service, Western Sussex had a share of virtual 30 agents, and its usage was actually about 6.5 people. As the trust only has physical space for six people, having an excellent self-service portal with features like auto-suggest and live chat was imperative.
Another aim was to ensure requests and problems logged by the portal went to the right team in the first place, to increase first-contact resolution.
Harris marked all 14 products against his list, leading to a shortlist of just three: Freshservice, Hornbill and Sunrise. Only at that point were the contenders asked for costs, something Harris did not do in the early stages as he wanted the products to be judged on merit and how suitable they were to the Western Sussex environment, rather than which was the cheapest.
The only financial remit was that the new service could not cost more than the shared service; while all three came in below that figure, Sunrise cost about four times as much as the other two. Harris said there was very little in cost between Freshservice and Hornbill, but the latter was lacking in some functionality.
Harris was also impressed with the enthusiasm shown by the Freshservice team during his initial meetings with them, while he found Hornbill rather “lacklustre”.
Although the trust has ended up with a cloud-based service, Harris said this was not a factor on the list of requirements.
My guys like to touch and feel stuff. My technical team were more keen to have an on-premise solution. It’s just a fear factor of it being stuck in the cloud and not being as responsive as an on-premise solution, but we certainly haven’t found that to be the case.
The team ran a proof of concept of Freshservice, and came across no performance issues. That, coupled with the ability to hand over update management to the vendor, helped allay any fears about the cloud system and on 12 September, Western Sussex signed a deal with Freshservice – leaving six weeks to configure and roll out the new service for a go-live date of Monday 31 October.
The key obstacle to hitting that deadline was the micro-team Harris had available for the project – just 1.5 people. With a bigger team, the new system could have been up and running in a week, he noted.
Western Sussex has been impressed with the results so far, with 120 tasks automated and 130 items listed on its Freshservice portal. User satisfaction has leapt, meaning Harris and his team are no longer pariahs across the organisation. The old helpdesk system had a user satisfaction rating of 59 percent, compared to 94 percent for Freshservice.
User calls are now being resolved in an average of 9.2 hours, compared to 2.5 days; the SLA is being hit 97 percent of the time compared to around 75 percent; and first-contact resolution has leapt from 60 percent to 92 percent for the past six months. Harris added:
Because of increased reporting, we can see when our busiest times are and then our helpdesk engineers jump on the phones for those times just in case we get a surge. On average, the pickup time was 16 minutes on the old desk, and that was an average, not the maximum. The average pickup time for the past six months was 22 seconds. So there’s a significant difference to the service and how our users perceive it.
The move away from the outsourced shared service - which along with the switch to Freshservice has seen the trust roll out new anti-virus, desktop imaging and desktop management systems - will result in savings of hundreds of thousands of pounds over the next five years, according to Harris.
If we’d stayed on the toolset that the shared service was using for helpdesk, that was going to cost us round about another £50,000 a year for a poorer solution.
Harris expects some of the other NHS organizations that originally decided to stay with a CSU for the service, to switch at some point.
We’ve had a couple of them come in over the last two weeks and had a look and been very impressed with what we’ve done.
We’ve been vanguards in a few technologies now. We were the first Freshservice NHS customer as we were quite keen to work with them but also to act as a reference site for them and for other trusts. The more we can get it out there, the more likely they are to develop things for us that we need or to cut the cost even.
Now the organization has completed its move to a cloud-based service desk system, the next step in its digital transformation is document digitisation – a project also underway at North Bristol NHS Trust. Western Sussex is implementing Kainos Evolve to digitise all its medical records, for both scanning the existing records and also to create the electronic documents to replace paper forms. The five-year project kicked off last year, although Harris is optimistic that it will be completed within three.