29.07.2024
I don’t know, let’s go and find out together
A new government can bring a fresh start, and this new Labour government promises to usher in a new era of change.
I started my career in the NHS when the last Labour government came to power, and with it, the much-vaunted National Programme for IT (NPfIT) was in full swing. Championed by Prime Minister Tony Blair, the NPfIT was a vision of a modernised NHS and a single, shareable, digital healthcare record for every patient. It was meant to revolutionise the way the health service worked. However, instead of heralding a new age of efficiency, it is now widely perceived as another failed IT project, one of the most costly in history.
This new digital revolution brought with it new levels of complexity and uncertainty. Most management approaches before then tried to manage change using industrial-age techniques that had previously been successful. Think of factory lines developing a certain kind of product and only releasing the product when it is finished at the end of the line.
This meant that the first projects I was involved in took a ‘big bang’ approach to digital change, where the whole hospital went live at once when the software was ready. This approach to change created a lot of problems.
- Operational and clinical processes often had to adapt to the way the software worked rather than vice versa.
- Project managers complained that requirements kept changing, making it impossible for them to deliver.
- Medical professionals complained that they were never consulted on what they wanted the new system to achieve.
- There was reduced efficiency. A common complaint was that “we used to see 20 patients in a clinic, we’ve now had to reduce the numbers”.
Compounding the issues with these early digital projects was the taboo around admitting “I don’t know.” It was perceived to show weakness and insecurity. But as the example of the NPfIT showed, it’s often impossible to know all of the requirements in advance—the unknown unknowns. Once a system is in use, new needs are discovered, creating new requirements.
As our understanding of software deployments has grown more sophisticated so too have our approaches. Agile methods have become ubiquitous. Hospitals now often conduct smaller ‘go-lives’, rolling out changes on one ward, for example, before a wider rollout. This allows for testing, iterating, and making changes before a wider implementation.
Now there is a new Labour government and a new commitment to the NHS. A new era of change is beginning. So, when it comes to change, it’s okay to admit that we don’t have all the answers. At Keystream, we use a blueprint to explore and understand the readiness of any project. So, if you are embarking on any change and you’re unsure of what the next steps could be remember: You don’t need to know everything from the start – let’s go and find out together.
Latest insights
NHS Confed 2025: Making Space for What Matters
This year’s NHS Confed was a powerful opportunity to connect, reflect and learn alongside colleagues from across health and care. It underlined the transformation already underway in our system and the importance of collaboration, creativity and compassion in making it work. A consistent thread across the event was the need to create space for innovation….
Do You Say Please and Thank You When You Speak to AI?
I do…! We talk to AI more often than we think. Whether you’re unlocking your phone with your face, asking your smart speaker to play your favourite song, or using predictive text to finish your messages—AI is quietly working behind the scenes. But because it’s not always visible, we often don’t realise it’s there. And…
Northern Care Alliance – eDMS Discovery and Strategic Integration Readiness
Establishing a roadmap for eDMS consolidation and future EPR alignment. Northern Care Alliance NHS Foundation Trust commissioned Keystream to undertake a discovery phase to assess its fragmented Electronic Document Management Systems. Formed through multiple mergers, the Trust faced high costs, integration issues, and compliance risks. Keystream delivered a comprehensive review highlighting opportunities to consolidate systems,…
South Central and West CSU – Data Modelling Programme
Delivering a sustainable data analytics framework through collaborative programme design. NHS South Central and West CSU engaged Keystream to deliver a data modelling programme to enhance its analytics infrastructure. A contractor was appointed as Programme Manager to lead stakeholder engagement, build a roadmap, develop technical solutions, and implement staff training. The programme improved data access…
South West London Pathology – LIMS Implementation
Enhancing laboratory efficiency and collaboration across multiple hospital sites. South West London Pathology, including hospitals such as St George’s and Kingston, engaged Keystream to lead the deployment of a new Laboratory Information Management System (LIMS). A strategic programme director oversaw the project, assembling a specialist team and breaking the implementation into focused workstreams by pathology…
St George’s University Hospitals – Oracle Cerner RBAC Implementation
Delivering secure and compliant role-based access for over 10,500 users. St George’s University Hospitals NHS Foundation Trust partnered with Keystream to implement Oracle Cerner’s RBAC system, upgrading access controls in line with UK healthcare data standards. The project delivered 18 baseline roles and 48 variations, ensuring compliant, secure access for over 10,500 users. Keystream led…
Northern Care Alliance – Abandoned Referrals Classification
Using open-source technology to identify and categorise 1.1 million abandoned outpatient referrals. Keystream partnered with Northern Care Alliance NHS Trust to develop a repeatable, vendor-agnostic solution to address over 1 million abandoned outpatient referrals. The project delivered a classification tool that groups referrals by risk, enabling safe and efficient disposal. Built with open-source technologies, the…
St George’s University Hospital – Patient Flow and Capacity Management
Delivering operational improvements through real-time digital tracking and large-scale staff mobilisation. St George’s University Hospital partnered with Keystream to revitalise a stalled patient flow project, appointing a senior project manager to lead implementation. The aim was to roll out a new capacity management system that would serve as the core of digital operations. The result…
Croydon University Hospital – Maternity EPR Uplift and Optimisation
Enhancing maternity services through Cerner system optimisation and future-state planning. Croydon University Hospital engaged Keystream to assess and uplift its Cerner Electronic Patient Record system in the Maternity department. The work involved mapping current processes, completing a detailed gap analysis, and recommending future pathways for both Community and Maternity Services. The outcome positioned the hospital…
Barnet Hospital – Cerner Implementation in ICU
Linking ICU devices to the Cerner EPR system to improve efficiency and standardise data across the Royal Free London Group. As part of a group-wide upgrade to the Cerner Electronic Patient Record system, Barnet Hospital enlisted a Keystream consultant to lead ICU integration. The consultant worked within the Digital Devices Team to automate data flows…