First phase of NHS 24 system re-launch goes live as cost fears persist
Six organisations now using telephony functions of previously withdrawn system; auditor general argues continued scrutiny will be vital despite “reasonable steps” taken to avoid further delay
NHS 24 said it has commenced a phased re-launch of a revised operational system that will support its telehealth services as new findings from Scotland’s auditor general have found current development costs to be 73% higher than initially budgeted.
The Scottish telehealth organisation opted to withdraw the new operational system, which is intended to handle telephony and online services, shortly after going live last year owing to concerns about the effectiveness of its staff training and wider fears about patient safety.
In favouring a phased relaunch strategy initially focused on planned care telephony services, NHS 24 has said the first phase of the system went live with six care services on September 26. A full national rollout of the system and its wider functionality is anticipated to begin in 2017, with the next phase of the project aiming to see NHS 24 partner with a single health body that can test the whole system and functions in a controlled environment.
However, in findings released last week, Audit Scotland said that after six years of significant investment to implement the new IT system, projected costs rose by nearly three quarters of their original estimate to £131.2m as a result of a failure to introduce the new technology successfully.
“Whilst significant challenges remain NHS 24 is now taking reasonable steps to mitigate the risk of further delay. It maintained the existing IT system, minimising the impact on services for patients and met 14 of its 15 key performance indicators,” said the auditor’s findings on the project.
Audit Scotland also warned of additional difficulties facing NHS 24 to meet future financial targets, particularly in the case of further delays to the new system.
With rollout work continuing, the findings warned that it would be difficult for health organisations using the system to meet their financial targets without significant efficiency savings.
"Each of these health boards is experiencing prolonged and considerable challenges which continue to have an impact on the way they operate and deliver services,” said auditor general Caroline Gardner.
"While action is underway to try and address these issues, there's no quick fix available and recovery will take time. It's important that the Scottish Parliament and the Scottish Government closely monitor progress, to ensure circumstances do not worsen, to the detriment of staff and service users."
Audit Scotland’s full report noted that with the appointment of Angiolina Foster as NHS 24’s interim chief executive in March, several new arrangements are being put in place for the new system to address concerns that had been raised during reviews.
Along with working to establish an Independent Contact Centre Specialist Advisor to help support NHS 24’s board, a number of other bodies have been set up including a Technical Assurance Group that is made up of IT directors and eHealth experts working across Scotland.
NHS 24 is also said to be in the process of creating two scrutiny groups aiming to take a critical look at the project.
- A Partner Assurance Group led by Scotland’s deputy chief medical officer that will scrutinise plans for introducing the system
- An organisational Assurance Group giving oversight of organisational improvement plans and efforts to ensure staff are ready and comfortable with use of the new technology
Responding to the report, NHS 24 chief executive Angiolina Foster said it fully acknowledged the findings, noting how delays to the system had led to significant increase in costs as it seeks to understand mistakes made.
"NHS 24 has been providing telehealth and telecare services safely to patients across Scotland for more than 10 years. We take more than 1.5m calls per year which deliver a safe and effective service for patients,” she said.
"We look forward to fully implementing the new system in 2017, which will not only enable NHS 24 to continue to deliver improved patient-centred services during the out of hours period, but will allow for the development of new ways of offering health and care to people across Scotland well into the future. It provides a key asset to NHS Scotland offering the capability on which new and improved services will be developed."
Sources with knowledge of the development and use of the operational system have previously argued that numerous concerns had been raised around functionality, training and overall staff engagement concerning the technology's implementation. Whistleblowers also alleged that concerns were too easily dismissed as a fear of change rather than legitimate worries about safety and training quality.
According to findings of an NHS 24 Board paper that was released later, "Weaknesses in the training and familiarisation approach" were seen as resulting in a lack of operational experience and reduced staff confidence in the system.