What NHS organisations should consider when offered a free trial

Felix Vaal, ICT Project Manager at Chelsea and Westminster Hospital NHS Foundation Trust and Digital Pioneer Fellow.

How many supplier trial offers are in your inbox? The influx felt like a minor change at the time, but I now regularly feel the impact. It became apparent through my involvement in the Digital Fellowship that I’m not alone in this experience. By mid-2020 my inbox was full of suppliers, large and small; offering free trials for various solutions to all the challenges we were facing. Free trials are not new, but the Covid-19 pandemic created an urgency that made the supply and demand for them hit, what was for me, a new high. I believe this increase has had a significant impact on the terrain NHS digital innovation and strategy is now traveling on.

To start with I’d like to state unequivocally that free trials are great; free is better than paid. I’ve worked on many projects that started as a free trial. Suppliers can benefit greatly from successful partnerships with Trusts by developing their solutions, increasing their sector legitimacy and generating promotional evidence of effectiveness. This means while they aren’t altruistic, they are still very welcome and often generous. The point of this opinion piece is not to criticise their existence or any supplier who offers them, just to explore the considerations to be aware of when accepting them. 

Free doesn’t mean free

IFirst thing to recognise is that they’re not free, not ever. As a minimum, the adoption and governance time taken by the end users represents a cost. This is especially so for clinicians and usually goes far beyond training and the signing off of a new Standard Operating Procedure. On top of this there are usually Trust technical costs. These include but are not limited to; integration, testing, network, and reporting considerations. Integration in particular, is often ‘sold’ as a simple task for suppliers but for Trusts it requires highly specialist, expensive and limited resource. This is due to the mass of feeds already being processed and the testing governance needed to ensure live services are not impacted.  The three week integration is more often three months for a Trust. The significance of this is, when accepting free trials, resourcing must be considered and the actual costs understood.

Unending pilots

Trials have great value in testing solutions, informing Business Cases and generating lessons for further deployments. A regular risk however is the ‘unending pilot’. This would be typified by on-going scope creep and a failure to transition the solution into Business As Usual. When this happens, the support requirements (training, apps, reporting and integration) become a burden on the respective teams or an on-going demand for the project team. This seems especially apparent in free trials run by local departments. 

The grey areas

A common ethos for pilots is to fail fast in a bid to rule out the solution. The reality though can be a grey area or middling success, enough to continue but with significant limitations. This can lead to what is commonly referred to as the sunken cost fallacy where the money, time, and adoption already committed is perceived to be too costly to re-do. This is hard to judge and I feel was especially heightened during the urgency of the pandemic. Procurement processes are still followed but more than ever during this period there is less incentive to repeat work and accept upheaval after a pilot adoption.

Local vs central

Locally initiated trials can be a fantastic display of engagement but are not ideal. While they can often be embedded quickly, they can do so with little central visibility. That is until issues arise, usually prompting further potential challenges around security, accessibility, information governance, safeguarding and IT support.

My current project is centred on creating an end-to-end view of our patient pathways to increase visibility and provide tools for improved pathway management. One of the challenges has been how many systems patients now travel through, how they interact and the gaps between them. The project is now progressing towards patient communication and administrative automation, and the challenges are increasing with the diversity of new patient facing solutions. My time in the Digital Fellowship has shown me that many other Trusts are experiencing the same issues. Usually with solution overlap and strategy disjoints. This occurs between sites in the same organisation, even between the same services but much more frequently between Trusts. To the effect of; we need to introduce X to solve issue A but it overlaps with system Y on this site, and our neighbour Trust is using system Z which isn’t compatible. Standardisation of systems has long been a significant challenge within the NHS but after the last 18 months and the immediate needs of the pandemic it feels more complex than ever.

Free trials can be incredibly useful for both suppliers and the NHS.  However, their perceived flexibility and non-committal nature risks them being underestimated. Underestimated in terms of the true organisational costs, the project scope, risk, and most significantly now, their strategic impact. Offers are always welcome but should be considered, resourced and assessed as part of an overall digital strategy. This may mean that for many, free trials are no longer enough and evolved partnerships that recognise the true value are required.

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