At times the news pages of mainstream and business media give the impression that all NHS projects, especially those involving process change and technology, are failures. But there is a counterbalance to these tales of disaster – success stories.
Head of one of these success stories is Dr Simon Willcock, programme director for the NHS Electronic Staff Record (ESR), a new nationwide system that provides NHS trusts with a platform for payroll and staff management.
The NHS is the world’s largest publicly funded health service, providing free healthcare round the clock. It is also the largest employer in Europe. Since the NHS was divided into a series of trusts in 2004, each individual trust has managed its own pay and staff. As a result, healthcare in the UK had no single standard for pay and staff management until the launch of ESR.
With every trust pursuing its own procurement course for pay and staff management, it was impossible for the Department of Health (DoH) to accurately count how many people work for the NHS and how big the wage bill needs to be.
“There was little integration between the different systems. Payroll systems were ageing and often we saw green-screen technology,” Willcock says. Many trusts were looking for new pay systems individually.
Willcock is confident his project will reduce NHS costs by £273m. It will do this in three ways: a single entry of data; a focus on costs; and key performance metrics. ESR is tasked with providing the NHS with four main improvements in knowledge and management of staff. It has to streamline the cost of maintaining employee records; provide greater data protection and central management of staff records; deliver to the NHS a single repository of employee data, with a single record for each employee that can be accessed anywhere in the NHS system; and improve services to NHS staff including the accuracy of staff records.
As a result, the DoH will receive reports on a regional level and will be able to gauge costs and improve efficiency accordingly. However, the system will not be used for the management of agency staff, on whom the NHS is increasingly dependent. Many NHS trusts operate their own agency staff systems, known as banks, and these can be added to the ESR system if the trust chooses.
“The NHS needed a workforce planning system,” Willcock says. “There were a var-iety of pay systems and HR systems that provided unreliable reports.”
The closest the DoH had to a measurement of NHS staff numbers was a census – a snapshot of the organisation little different to the national census that occurred in 2001. “A census is only accurate on the day it is carried out for an organisation such as the NHS,” Willcock says.
The ESR project was formed in 2001 and kicked off with the selection of the Oracle Human Resource Management System and Oracle Payroll applications. From the off, Willcock and his team, along with Oracle integrator McKesson, have been dev-eloping a workforce management system for the NHS that will have real-time reporting abilities. Monitoring will allow efficient management of staff, staff costs and issues such as absence and training.
McKesson is an integration company that specialises in the healthcare sector and is the main contractor for ESR. “There was a need to build in the capabilities – the skills were not in the NHS,” Willcock says of sel-ecting McKesson.
The DoH decided to grasp the nettle and become the procurement body for a nationwide system that not only provided NHS trusts with technology for its processes but also set a standard for payroll and staff management, and in return would provide the DoH with clarity about staff levels. “The NHS took on a significant amount of responsibility for this,” Willcock says of his employers.
“The NHS is a moving landscape, such as changes to pay scales, shared financial services and consultants,” Willcock says of the challenges involved in the project. “Each NHS organisation can, and does, act as its own legal entity.” Each one also has its own pay scale. “This makes it harder to impose a corporate standard. In a corporation there would be a standard set of terms and conditions.”
By March 2008, implementation to NHS trusts in England and Wales was complete. The implementation is a shared process. “Ninety-nine per cent of the data from each trust is loaded by our team,” Willcock says. He reiterates, “We take as much responsibility away from the trusts as possible.”
Once implemented, trusts can liaise with the ESR team on what functionality levels it requires. Trusts can choose to add self-service, which allows NHS staff to access their records via an internet front-end, or a trust may choose to pass training and learning management on to ESR.
Once a trust has adopted ESR, Willcock assures them they will receive two-to-three years of development support and guaranteed technical support until 2014. A central team, employed by the NHS, will remain in place to provide ongoing development.
Interaction with the NHS trusts has been a central theme for how Willcock has run this project, which included 50 per cent of the development budget being handed over to user groups he formed. “We have national and regional user groups that focus on issues such as payroll and HR manage-ment,” he says.
Trusts and Strategic Health Authorities are now working with the DoH to develop a workforce performance metric to allow accurate reporting to take place and be guided by agreed standards.
But what of the patient? Willcock says: “The importance of staff within the NHS cannot be undervalued. The patients will have better managed carers,” which he believes will in turn improve the quality of the care they receive.
“ESR enables employees to have more control through self-service and direct access to their records. They will then have a better human resources experience.”