Tech 100: 'Digital transformation doesn't mean we're talking about big IT'

Christopher Wroath’s voice slows as if he’s trying to reassure an audience of anxious faces. “You’re going to be alright… It’s going to be alright you know… It’s going to be fine,” he says after running through a list of steps public sector organisations should take when weighing up whether to embark upon a digital transformation. As NHS Education for Scotland’s (NES) lead on the area, his words are borne out by more than a mere hunch.

A specialist health board tasked with delivering education and training to all NHS staff north of the border, NES appointed Wroath to the role of director of digital transformation in August 2014 to “shake things up”, according to one of his colleagues. A review commissioned by the NES board into all things digital had reported four months earlier, recommending that the organisation ditch its silo set-up for the purposes of delivering digital.

“It was a fairly standard public sector information environment,” recalls Wroath on when he joined the organisation. Information systems and websites, although “pretty well put together”, were “all very disparate”, having mirrored the organisation’s internal structure, which had been designed around specific groups within the healthcare profession, whether it be doctors, dentists, nurses or such like.

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“That’s how public sector organisations generally have done things from the middle of the first decade of the 21st century and that has been a successful model in terms of being able to deliver set functions to set cohorts,” he says. “But what it isn’t is joined-up and in a digital landscape that is the wrong way round.”

The month following his appointment saw the creation of a single group to draw together all digital staff resources within NES, a foundation for what would follow.

Agile methodology – which sees different aspects of software development carried out at the same time rather than waiting until the end to get users’ feedback – was introduced after Wroath had been exposed to the way of working at the Government Digital Service.

“For me, it wasn’t even so much the fact you ended up with excellent software that people wanted to use, it was more the fact that it removes the risk,” he says.

The health board then went live on Microsoft’s Office 365 cloud platform earlier this year, the first NHS board in Scotland to do so. Over 900 users were migrated from GroupWise to Office 365 over one weekend with only 24 unable to access historic emails on day one of the transition. More than 830,000 files were also migrated into Sharepoint from Alfresco with around 5,000 not migrated or having issues.

Findings of the pilot project were presented at September’s national eHealth leads group, which brings together the 22 most senior technical people in each of the NHS boards once a month, and NHS Greater Glasgow and Clyde now have a pilot team in place with a view to ramping up activity in the next financial year.

“It’s true to say that the progress to date wouldn’t be possible without agile and it wouldn’t be possible without cloud,” says Wroath. “Those are the two underpinning principles that made the whole development of the digital transformation possible. I am on record as saying before that I don’t think before 2014 it would have been possible to do the kind of transformation that we have achieved now.

“The use of commercial cloud by public sector just wasn’t in a place that was able to do that, whereas I think that is now not the case. I think the adoption of commercial cloud or indeed any kind of cloud solution is expected as opposed to something that would be considered to be risk taking.”

This combination of cloud and agile methodology has been behind the in-house development of Turas, a single place where any person working in health and social care in Scotland will be able to access all the services they need over the course of their career.

Five niche applications are currently running on the platform with a sixth – Turas Learn, which will pretty much cover every individual working in the NHS – set to go live in April, allowing the creation of personalised training records. Agile means that the applications are in a "constant state of release" with around four upgrades a year based upon everyday feedback.

Data gleaned from use of the platform by staff will ultimately culminate in a stronger evidence base on who, what, where and when individuals make decisions around entering and leaving the health profession, believes Wroath. As far as he’s concerned, the eventual outcome will be a Scotland that is considered a more attractive place to learn.

“When the platform matures in a couple of years’ time, I think the unified experience that individuals working in the NHS will have will undoubtedly make it a better place to come and work, train and learn, attracting people to train here and then they won’t go away.

“The platform is not just for the NHS, it’s going to be for social care too. And after that who knows? It’s a public sector paid-for platform so NES is very much of the view we need to get as much of Scotland using it as possible. There is no point reinventing the platform wheel when you can just focus on your data and your applications inside a secure platform. We very much want to be promoting that.”

What separates NES from others at this moment in time is “they’ve done it”, says Wroath. “They didn’t stop at the brink, take a step back and reconsider or do it in a half-baked way, they actually went for it.” A willingness to follow their example does exist, he reckons, an opinion informed in part by work with the Care Inspectorate after being invited in in the last fortnight. “In Scotland we’re lower down on the curve [for digital transformation] than we should be but there is now a building appetite,” he adds.

Even amid the changes that have been pursued, headcount across NES has not increased. Instead, the focus has been on up-skilling existing staff. Public spending watchdog Audit Scotland last week warned that some NHS boards risk not being able to balance their books this year amid “unprecedented levels of savings” required of the entire service. Financial belt-tightening is just as much a reality for NES.

“We’ve got really good capability now but we don’t have the capacity to match our ambition at the moment,” admits Wroath, a reality he concedes is “slightly frustrating” for him. “But that’s how it is on the ground and you have to manage that.”

Asked if the situation was down to lack of money or skills, he adds: “One leads on from the other I think is the best way of putting it. It’s difficult in the NHS to recruit the kind of technical skills that we want at the salaries that we can pay – that is just a fact of life.

“Also, bringing people in onto the books is a recurring funding issue so NES has to be sure that it has that money in a recurring cycle for the foreseeable future. And the practical, on-the-ground reality is we’re probably going to have less money. There is a tension there so every time I might raise the spectre of bringing more people on to the books, I get a look from everyone going, ‘Ooh’.”

Investment in staff training in the year to April was around £40,000 greater than in previous years while agency and IT contractors have been brought in as and when required over the last two-and-a-half years, programming being a key area. Going forward, it will “not [be] quite so much about you can’t have this, not so much no, but let’s shade what we can deliver and when we can deliver it,” he suggests.

Major IT upgrades within the NHS have a habit of not going smoothly. Lengthy delays to NHS 24’s call handling and IT system, which is more than £40million over budget, are testament to that.

However, the changes embarked upon by NHS Education for Scotland should not be seen as a complex overhaul, intimates Wroath. “What is important to say is that (digital transformation) is not big IT, we are not talking about big IT, we are not talking about £40m/£50m projects that require four years and almost certain failure.

"What we’re talking about are small incremental steps based around proof of concepts, based around agile methodology, based around engagement with users who will use the service.

“That is possibly the last really big thing we have got to get through to the public sector, which is, ‘A digital transformation sounds like big IT. Ooh, that’s scary, that’s something which doesn’t go well’.

"Whereas actually the message is digital transformation is not big IT, digital transformation is taking back control of your information and your services in a way that is achievable across organisational and sector boundaries. It’s very, very achievable now.”