Management > CIO

Getting Wales' NHS on the PSN: it's a question of culture

Jo Best Published 28 February 2012

Getting Wales' NHS on the PSN: it's a question of culture

Wales CIO Gwyn Thomas shares his views on how settling technology issues is less important than persuading public sector bodies to work together. Jo Best reports

While the PSN continues to make creeping progress ahead of the forthcoming release of its two key frameworks , the health service in England is seen as a potential sticking point for its wider adoption.

Gwyn Thomas, CIO of Wales, has had first-hand experience of getting the various strands of the health service to work together through the Public Sector Broadband Aggregation (PSBA) project, a Welsh Government led PSN scheme that has connected the networks of health, local government, education and other public sector organisations after it was established in 2008.

For Thomas, getting health and other bodies to join the PSBA was a matter of getting the organisations to sign up to an "adopt or justify" approach around 18 months ago after the establishment of the Welsh Government's Efficiency and Innovation Board, which demanded ideas on where IT could be used to cut costs.

"The really creative ones were around applications, online services huge organisational change. Of course, that's where the big benefits are, but that takes years," Thomas told a recent event organised by networks company Updata. In the short term, the PSBA was the best and almost only solution to cost-cutting in the short term.

With thousands of sites already connected, public sector organisations were asked to either adopt the PSBA, or justify why not.

"The business case was incontrovertible, both strategically and operationally. We got to a position where I didn't have to persuade people because we had critical mass. They had to justify not joining, and a lot of the resistance then collapsed, because you can't.

"You can't justify, on technical grounds, more than one broadband network in a country the size of Wales we only have three million people. You can't justify it on strategic grounds of information sharing we've already signed up to collaborative working and collective working. You can't justify on financial grounds because you get a better deal," Thomas said.

The better deal was enshrined in the original, "very simple", spec for the PSBA, according to Thomas, which read: "We're not paying any more money, we want more, we want better and we want faster."

Such simplicity helped sell it to other public sector bodies and the chief executives that run them.

"They're not bothered about codes of connection and this, that and the other. As long as I could say more, better, faster, whatever, it sounds good.

"That got us the buy-in, which got us through the business case process and that got us to procurement. That's just the starting line, though the race started then. That was really about delivery, and that was the hard yards."

While the chief execs may have be indifferent to the technical aspects of the PSBA, technology played its part in spurring the PSBA: take-up was undoubtedly given a push by the impending ends of network contracts such as the education sector's Lifelong Learning and health's Dawn2. "It wasn't a burning platform but it was smouldering we couldn't stay where we were," Thomas said.

Moving to the PSBA was given another helping hand by what the CIO sees as the political will within Wales to embrace collaborative working.

"That's not to say it's all beer and skittles€Â¦ one thing I've found in Wales, at least you get stabbed in the front. You can have a really good discussion but you know before you leave the room OK, you've got a problem, and that is I suppose a manifestation of that collaborative working."

Some of the ground work for the PSBA's own collaborative efforts derived from Informing Healthcare, a programme launched in 2003 to foster better information sharing in Wales' health sector, which forged the cross public sector engagement and laid a "bed rock of goodwill" of which the PSBA took advantage.

But generating momentum for the project needed continuous effort: for example, thanks to NHS organisational reshuffles, the finance directors of some health bodies who had agreed to join the PSBA were no longer in the same posts when it was time to sign on the dotted line six months later. Thomas said he then had to expend a great deal of shoe leather and carry out a lot of "grunt work" to convince the new finance directors to press ahead.

"We became in a sense the marketing directors for PSBA," he said.

"It's a no-brainer at strategic level it falls apart when it comes to each individual organisation or GP because it's moving a situation from what was just not tenable to one which is world class. If it costs £5 more they won't do it, so you have lift the business case up to a strategic one," he added.

Around a year ago, the process of convincing health to join up was completed, with Wales' health boards, trusts and GPs onboard key for the wider take-up of the PSBA.

"We didn't need everybody, all we needed a tipping point. Health was a key customer as soon as you could say health's on board it made the business case."

There are now more than 100 major organisations on the PSBA, and 5,000 sites more than double the amount that was estimated would be needed.

But the hard work isn't over: with the network in place, collaborative working and information sharing now has to become a reality across Wales.

"The technology is not the important thing, this is all about culture. A network is, in a strange way, a boring piece of infrastructure, but it's also an utter manifestation of human relationships it's at the root of whether you can pull off collaboration," Thomas said.

"I used to go round to people and say, 'you're spouting words of collaboration and cooperation but if you can't agree to dig holes in the ground and lay cable, you've not got a prayer in joining up education, social services, health and so on.'

"Often, not just with PSBA but with IT generally, we end up to argue about the wrong things. Why? Because sometimes it's easier. [Technology issues] are an easier debate to have than 'are we going to work together?'."

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