A new wave of government business technology leader is actively creating streamlined public sector services. To date each individual county, NHS Trust, emergency service or borough has an individual IT service. With government debt at an all time high, a stagnant world economy and the banking crisis continuing it\u2019s the collaborative nature of CIOs that is driving public sector organisations to share and approach their business models differently.\nRichard Gifford is Managing Director of Kent and Medway Health Informatics Service, a shared services organisation in Kent that has up to 280 IT professionals delivering technology services to 15 health providers, four acute hospitals at three NHS Primary Care Trusts (PCT) and one local mental health trust.\nMaidstone and Tunbridge Wells NHS Trustis the legal entity that hosts the Health Informatics Service (HIS), including the provision of accommodation for the organisation.\nGifford explains that three years ago the HIS was a managed service for Maidstone and Tunbridge Wells NHS Trust and not a healthy organisation.\n\u201cI came three years ago with the customer\u2019s eyes and it was basically a failed organisation with weak governance,\u201d Gifford says. \u201cThere was a need for transformation and I came here as an interim to begin that turnaround.\u201d Gifford has remained with the organisation that was set up in 2003 and today it is breaking even and has its eyes on making a profit.\nThe HIS has a budget of \u00a312 million, the bulk of which goes on the payroll. Computacentre, Dell, HP, BT, IBM Cognos are the primary technology suppliers to the HIS.\nSince the coalition government came into power the NHS has been at the centre of policy and operational reform as the Conservatives seek to put GPs at the centre of decision making.\n\u201cThere is a huge amount going on with the change to Commissioning Groups coming into force in 2013 and the end of the PCTs. The fragmentation of the PCT into Commissioning Groups means we have to forge relationships with the GPs,\u201d he says. Gifford has no choice but to embrace the change.\n\u201cIt is a brilliant opportunity to help these new services. It is all about the stakeholder management piece and how you manage it,\u201d he says of his organisation\u2019s role. \u201cWe are meeting with the GPs and Commissioning Groups as much as we can, so we are not waiting for things to happen. We are in a really good position because we are in the NHS.\nBefore the coalition Commissioning Group policy disrupted the NHS, the previous government spearheaded its NHS reform agenda around the National Programme for IT that sought to create a central single IT platform for the entire NHS. The controversial strategy provided NHS trusts across the country with benefits and obstacles in equal measure. Gifford explains that Kent as a county was not a big adopter of the National Programme for IT, the mail and imaging platforms were adopted, but the Cerner and major administration systems were not adopted.\nNHS IT bosses' management response to consumerisation\n\n\n\u201cThe problem with the National Programme for IT was integration; there was never a real plan to bring it all together. So that means that Kent has not had the pain that other NHS regions have.\n\u201cOur long term strategy is to be more independent as a service provider, where we compete with the private sector, so we have to be financially viable. If we are selling software, then we can make a profit. We have just won a couple of contracts from outside of Kent providing helpdesk services. I am also looking at offering data warehousing and business intelligence that provides trusts with patient risk strategy information.\n\u201cLooking at our back catalogue of developments there is a lot we can offer, so it is an exciting time as it is the commercialisation of what we do,\u201d he says.\n\u201cWe provide a full range of managed services from a catalogue,\u201d Gifford says of the desktop infrastructure, information management, training, project management, service desk, development, telecoms and web development on offer to NHS Trusts.\nBy design the HIS has focused on working with health providers in Kent as well as nearby Surrey. \u201cWe are local and we know the people of the local market,\u201d Gifford says of the difference between his organisation and a global service provider bidding for NHS work. \u201cWhen we get all the stake holders to agree and to move together, then we can move with some speed.\u201d Analyst house Gartner were brought in to benchmark the HIS against other providers and reported that the HIS is more cost effective than a profit oriented private sector provider.\nThe future challenge for the HIS is whether to become a profit orientated company itself or a social enterprise, Gifford says.\nThe HIC works with each of its client trusts to put governance in on technology and drive down costs.\n\u201cThe big wins come from consolidating the applications and datacentres,\u201d he says.\n\u201cTo have a common approach and common and a common architecture would be the thing to do,\u201d Gifford says of the transformation possibilities for all the Trusts the HIS provides. \u201cThe networking, infrastructure and datacentres are possibilities. But on many things they [the trusts] want to things themselves. For example , some trusts are very interested in the brand of PC they use.\n\u201cWe treat each customer as a separate entity on these issues, rather than try and bring them together. I try to be realistic with them and engage them.\u201d\nWhy the NHS National Programme for IT didn't work\n\nThat process and the challenge of GPs and organisations wanting to control their technology will not change with the move to GP Commissioning Groups.\n\u201cThese doctors are bright people,\u201d he says of his future client base.\nAs a technology organisation the HIS is challenging its clients to transform themselves using technology. Gifford says tablet devices with Citrix secure access to mental health records have been provided to mental health nurses and iPads are being deployed into some hospitals using the VitalPAC patient information system.\n\u201cMobility is absolutely key, the NHS is facing huge issues, people and buildings are its biggest costs, not the patient admin, so mobility and cloud computing could be very important to us in healthcare. But there are a lot of concerns and the NHS is rightly very risk averse. So for us it\u2019s about taking simple steps with bits of private cloud,\u201d he says.\n\u201cMy predominant role is the MD with the CIO knowledge that helps me work with the trusts to help them set their visions and achievements with technology, so my role requires two hats.\n\u201cIn my career I have transitioned across different industries. The transition to health was a big learning curve, but in terms of driving the HIS forward it the same challenge as other organisations. So I am getting people to start to think about how much time we spend and how we create benefits to be part of the HIS culture,\u201d he says.\nGifford had been IT Director at building services firm ROK up to 2008 when he joined Kent and Medway NHS.\n\u201cI decided to leave ROK as I was looking for a transformation opportunity and came across this health role and it looked fascinating with the complexity of it.\u201d The challenge and complexity will remain for the foreseeable future in the NHS.