Most organisations have spent the last few Covid years adapting to the way the world has become increasingly reliant on technology. Few, though, have done it at such breakneck speed and under such intense pressure as NHS National Services Scotland (NSS).
As the agency that provides central services for the NHS in Scotland, it developed in rapid succession many of the digital tools and systems that helped citizens through a national emergency.
From the QR code-based check-in app used by people to lodge their details with pubs and restaurants, a virus case management system used by 3,500 contact tracers and the eventual vaccine passport app, there seemed scarcely a week that went by without a paradigm shift in healthcare.
And that was just the public-facing services: behind the scenes, the rollout of 200,000 Microsoft user licences was shortened from nine months to three weeks – enabling the workers themselves to stay connected.
Before the pandemic, NSS had already been updating its digital strategy, with pledges to deliver more services via the Cloud, the slow and painstaking process of decommissioning legacy IT and automating where it can.
“Covid was a real game-changer for us,” says Mary Morgan, the agency’s chief executive.
“My organisation has a digital first approach now. But it’s no use if it’s not reliable, because there is no backup plan if you lose all your IT.
“You can’t go back to paper, because we’re dealing with such huge volumes of data now, with pictures in radiology being transferred from A to B, digitally; there are so many data-driven processes and they are only growing as we find new and more efficient ways of doing things. We are relying on digital to be able to operate and work.”
Morgan’s organisation was the public face of the new Scottish Wide Area Network (SWAN) framework agreement, awarded to BT in April this year.
As the contract owner for the network that connects more than 6,000 public sector sites – including schools, hospitals, GP surgeries and pharmacies – NSS is hoping the six-year agreement will deliver outsized benefits for itself and the public sector as a whole.
She adds: “The SWAN contract, for me, is about providing the fundamental infrastructure on which we can build new possibilities and opportunities.
“The demand for digital ways of working are ever-increasing, and we’ve never been ahead of that curve; the technology comes along and we just can’t keep pace with it in the public sector. So, we need to ensure that what we build is more than fit for the future.
“That means we’ve got to be resilient in the first instance, making sure that we’re able to keep the lights on and continue our business, no matter what.
“But we also now need to be more connected to each other than ever before – especially across health and social care, which exist on different networks. We’ve got to be able to bring those much closer together so that we can have plug-and-play ways of working.”
Modernisation across the health and social care is an ongoing process, she says. The impact of technology will be felt once more with the Scottish Government’s Digital Front Door project, designed to ensure citizens can access their medical records, allowing them to self-manage and contribute to their own health and care information online.
It is not an NSS-led project but the organisation’s central role in co-ordinating the way regional health boards work will be crucial to the way systems are integrated at a national level. Although some advocate for a similar rate of iteration for new IT projects as during Covid, Morgan stresses that the NHS is going through a “recovery period”, and the pace of change is secondary to the lessons collectively learned from the pandemic.
Change needs to be carefully planned and considered to avoid the pitfalls of a wholesale embrace of tech. Digital inequality, for example, is an area which concerns her. She does not want to see technological change exacerbate a widening poverty gap. While NSS seeks to impact wider society positively, its own workforce is also adapting to new societal norms.
You cannot collect blood remotely, of course – as an example, her agency supports the National Blood Transfusion Service – but Morgan now has staff who work wholly from home, others are hybrid and some prefer the binary separation of home and office roles.
“What’s really important is that we have grown-up discussions with our staff about what fits for them, and what they need,” she says.
“And that means a focus on outcomes and what we deliver, within the confines of nationally agreed terms and conditions, rather than where and when we actually do the work.”
This highly flexible approach to its workforce is no better illustrated than by NSS’s national contact centre, which is enabled by digital technology.
The centre was set up during the pandemic for contact tracing purposes and is now a much smaller unit. But it still handles inquiries and appointments relating to vaccinations and supports “Scotland’s warm welcome to Ukraine”.
“It’s a virtual contact centre,” says Morgan. “These are people who are working from home in a virtual environment.”
Even some realms previously thought impervious to digital transformation are moving with the times. The National Blood Transfusion Service is bringing technology to bear in the way it handles the national booking system, now online, and a paper-based questionnaire filled out by donors is also soon to go digital. All progress is inevitably welcome.
But Morgan sees transformation through the lens of what technology can enable – rather than for the sake of buying new IT kit. For example, NSS is currently going through a big internal business transformation process, improving the way it does its own administration, from finance to payroll and procurement.
“If you look back through history, you’ll notice that we have gone through the purchase of big IT systems, and yet we haven’t always been able to answer the questions around what we want these systems to achieve,” Morgan says.
“What we need to do now is not simply have a new IT system, or a widget, but to see what the business transformation goals are, and how technology can enable them. Because what we’re doing at the moment is not great, and we need to make sure that we can get that right.”
It is the reflection of a more mature, and confident approach within not only NSS but the wider public sector, on the front foot and able to tell the market what it wants, rather than simply be a passive consumer of technology.
And when it comes to that engagement with the technology suppliers in Scotland, and across the UK, Morgan wants to see much more receptiveness to coming together more and not be constrained solely by the value of their own contracts.
She says: “So, for me, it’s about how do all these big technology players come together so that we’re more than the sum of our parts. Because I don’t think we have the answer to that yet.
“But I think it will come, and when it does, I think we will get a lot more value from our contracts than simply saying, ‘You give us this widget, and we pay you. We do this and you do this.’
“And that value is not just about pounds and pence; it’s about the use of resources, it’s about people, infrastructure, and spaces – and about the experience people have when they use our services.”
