Simon, Andy and Laurence talk about the delivery of the UK's COVID-19 testing and vaccination booking system. The directors share exclusive information about the technical specifications and operational challenges they have been facing. The episode covers details from the initial concept development to the final integration of a system that can handle more than half a million bookings per hour.
What is the role of ACF Technologies in the COVID-19 National Testing and Vaccination Programme?
Simon: We were invited into a formal RFP process. The connections that we had there were from the marketing and the networking that we do. We had a relationship with Deloitte in the background, which gave us that platform to be invited into an RFP. It was a standard RFP process. Those suppliers out there that get their business through RFPs, we all know that there were good RFPs and bad RFPs. What I mean by that is they need to give you the opportunity to not just answer to a requirement. They need to give you the opportunity to flex your muscles and show exactly what your solution can do with RFP. This one was pretty well written. It was quite targeted, quite detailed. The only small issue we had was that it was given to us on a Friday and we needed to respond with a full proposal and documentation by Monday. We had precisely three days to complete the documentation and get it all back, which was good for us because most of our business historically has been through RFPs anyway. So we have the experience and the documentation. We knew how to respond to it within those time scales. What we're providing is ultimately a software platform for the testing and vaccine projects, I'm sure Andy and Lawrence will go into it in more detail, but essentially for the testing projects, we're here to allow our patients to book themselves appointments. With vaccines, it's similar just with more kind of process management in the background.
What qualified ACF Technologies in this project?
Simon: The reasons that we were perfectly qualified for this was our experience delivering projects of this scale. We work with a lot of major high street retailers. The Department of Work and Pensions use our solution to manage Universal Credit. So it was quite clear from the outset that our platform had the capabilities to deliver a project of this size and the fact that we had delivered projects of this size as well, which is, I think more important ultimately, our ability in delivering not just the speed, but the quality required here. As you can imagine this we had like a four week time period to get a project of this scale live. Obviously quality had to be absolutely essential in the delivery of this. It is both the products that we've got and our kind of experience and capability to deliver that put us head and shoulders above everybody else.
What approach was taken with the delivery of this project?
Andy: The challenge was getting this set up and implemented as quickly as possible. Certainly, on the testing side of things, we didn't have a lot of time to plan anything like the procurement was done really quickly. Our initial aim was to try and get proof of the concept up and running as quickly as possible. We got some initial requirements of what was going to be needed and then looked to build it out as quickly as possible to get to the proof of concept stage, which took a week or so before we had what was essentially a working system. And then a few weeks later, we were fully live. That was really the key, to get out there as quickly as possible, have the client start testing and using it, gets user feedback on the journeys that we'd help them implement.
And then after that, as it is pretty common these days as a case of trying to drive towards a really iterative delivery approach, so continuous integration delivery, especially with the testing project we were doing, that was we had a lot of changing, changing scope and changing requirements as we went through. It was really important for us to keep on top of that change and deliver things as quickly, as efficiently as we could.
And then with the vaccine project that we've been doing most recently, it was a really a similar approach in one of the main reasons that we were selected in the first place was because we had a solution that was really capable of off the bat. And we were just able to build on top of that because there have been lots of different niche requirements that the NHS have wanted that we've been able to deliver on. And we've just pushed that through over the last few weeks and months since we've been able to work on it. That's just generally been our approach. Most importantly, after we've delivered it as well, we've been able to leverage our 24/7 seven support coverage that systems like this need. And certainly, it was familiar with what Boris talks about and the requirements of the vaccine side of things. Certainly, it's going to be a 24/7 service for people to be able to look into and we're totally in line to support that.
Lawrence: Probably the reward of this project is the culmination of several years of hard work in the background in creating a solution that can do this type of thing in the first place. We as a team and as a business have lots of research and development and effort into creating what we feel is kind of like the industry-leading product in this particular area. So when the need arose, we kind of had the product almost ready to go, obviously not specifically designed to what the NHS was asking for, but fully capable of doing what they wanted.
What challenges did you face during the delivery of the project?
Andy: We found that one of the key things is how people actually end up using. All these systems, they're invariably designed in a room, virtual room in this case, where people come up with ideas of how they think the system should work, how the system should flow, what the different use cases are going to be. Then when it comes to reality when you actually put it live, you realize, oh, the people use it like that. It's funny how people work when they actually get a system and there are different ways people try and work around problems. It just means you have to then evolve and adapt the system to cope with it or make it easier for people to use. With both projects, we've had similar scenarios where we've we've put it live and then we find out that this is something that we can tweak that will make a user experience better. Certainly, we've done it well and the vaccine project is getting as early user feedback as possible, which helps when we do the concepts. They can never be fully prepared for how people end up using it.
Does our software support the configuration of all vaccine types?
Lawrence: Yes. We have worked very hard on putting together a system that does allow for a wide range of vaccine types and business rules and use cases. We wanted to make sure that we didn't just meet the needs of the NHS as it stands now, but future-proof it because we know in the future there may be extra vaccines that come out. That may be a change in the dosing regime. We don't know that. So we need to make sure that we are fully prepared to make those changes with as minimal impact as possible. There are some complexities added to that. With the different vaccines that there are or there may be different dosing regimes, spacing between your first dose, your second dose, we need to make sure that that is included in the solution. We need to make sure that we cater for all of the other unknown scenarios or complex scenarios, such as what if a user misses a dose or is late for dose? What if there is the only capacity to deliver their first dose and they need to come back at a later date to then book their second dose? How do we enforce that spacing between the different doses of the different vaccine types as well?
How do you design the system to be able to support patient with accessibility needs?
Lawrence: I suppose accessibility in our system falls down into a couple of different areas, actually. First of all, when you use the system, if anybody has used it or at least seen the system, you will be asked very early on in your journey, do you have any accessibility needs? Do you need a hearing loop or induction loop or do you need step-free access or do you need Braille translation service or sign language service? Many other things. And then off the back of that, all of the individual sites that are within the solution have all of their accessibility capabilities if you can put it that way, logged. So we know site A has disabled car parking and wheelchair access on site B has an induction loop, and so on. So when you go through and you choose your requirements, then the sites we return to you meet your needs. So you'll always have an option to go to a site that is accessible for you. The second part of it is the actual website itself, the booking website itself, we've put a lot of effort into making sure that this meets the NHS' accessibility requirements for mobile responsive navigation, for keyboard navigation, because we need to make sure that everybody can use this system no matter what challenges you might face in navigating a technical system, using a device of some sort.
How do you manage the availability of vaccines and staff across many locations?
Lawrence: There are quite a few different solutions that we've got that are capable of doing it, and we've deployed like two really different ones for both the testing project we worked on and the vaccine ones because they've got a different kind of operating models. For the COVID testing side of things, it's been quite a centrally managed solution in the individual test sites and not always directly responsible for saying their availability. Also, there's been quite a nuance with how the testing sites operate. So a lot of them, as you probably know, have been mobile testing sites as well, which literally spin up, spin down in a matter of days, depending on where they need to go for a hospital or whatever it might be. We've got a specific particular tool that you can at any time say affects all of the states of testing sites and say which ones are active and which ones alive and what their availability is over the coming days. And that can be changed. Really, it's all just real-time, obviously. But the ability to change all of them at once centralizes has worked really well for the testing side of things, especially with the mobile units that they've got deployed. And then a slightly different approach for the COVID vaccine project, where we've given a lot more flexibility and I guess responsibility for the actual site managers to look after each of the vaccine sites. They have a diary manager tool that we allow them to use, which gives them full control of when they're know how many doses or how many vaccines they're able to offer and what times they're able to offer those, what days they are able to offer those on repeating patterns. They can really get a detailed level of when they want to do it. That's worked really well for especially in the kind of scenario we are in at the moment, where, as it's got to be pretty well documented. They've shifted around how you get dose 1 and dose 2, for example. So going back to what Lawrence was saying earlier about the flexibility of making sure it's future-proof. The fact that on one day you have to have a dose 21 days apart, and then the next week, all of a sudden it's 12 weeks apart. And that's been something that the system has been really easily able to cope with. A lot of the users had all the power to be able to to to manage that. And then on top of that as well, was the actual ability to set all that up. We've got some great reporting tools that sit behind it that really not just a kind of individual site level, but at a national level, we're able to really quickly see the status of the whole estate and the availability of the sites, how booked up they are, what capacity they've got, what's left, so you can identify where the gaps are, which certainly helps a national reporting level.
What kind of volumes does the system work with?
Andy: We've done loads of different types of testing for both the testing project and the vaccine project. It's centred around a few different scenarios, so not just a case of pure bookings, but also tried to simulate the actual usage in real-world scenarios as well. Generally, I think the stats of what the UK government are trying to achieve, a fairly well documented of wanting to hit several million vaccines a week. And generally, we've tried to scale that to mean that at peak hours you might be needed to allow the system to book up to, let's say, 500.000 appointments an hour and however many a minute. That equates to, not my strong point of math, but that's where we kind of focus. A lot of the testing is just pure volume within an hour, let's say, and half a million an hour is roughly what we are aiming towards. But on top of that, it's not just a case that happens over an hour and that's how it's going to be perfectly spread. There's also and what we found with the testing as well is that you can have a member of government make an announcement live on TV that so so testing is available, such and such area has a vaccine available. Then within 10 minutes, your system's got a whole heap of requests in a really short space of time. Certainly, we saw that last year around when schools are planning on coming back. We had a real ramp-up of people wanting COVID tests. And that's certainly something that we've we've had to test towards and deal with. There's plenty of lessons learned there that we've had for the different scenarios. And again, going back to what I was talking about how people use the system in reality. There's been a lot of testing on both of these projects.
Lawrence: I can add to that a little bit. In order to achieve those sort of numbers with fairly complex business rules, driving it behind the scenes as well, we've essentially adhered to all the best practices for solution design, infrastructure and all of those sorts of things to make sure that, you know, we can meet those numbers, we can keep it as stable as we possibly can and also make that solution as future-proof as possible as well.
Why did you choose an appointment booking model instead of a walk-in model?
Simon: The difference is really between efficiencies and external factors. The walk-in approach can be set up as efficiently, but it relies more on predictive analysis because you don't really know where the demand is going to be. You don't know when patients are going to arrive, tests or a vaccine if you just let them walk into facilities. Having an appointment approach allows you to fix time slots and availability of your staff and your resourcing, so it's a lot easier to manage. Plus, as I mentioned the external factors, a lot of consideration needs to be taken into account in the location, the physical location of test centres, for example, particularly the ones in London. You want to avoid causing traffic. You want to kind of encourage social distancing. You want to protect the staff that are working at the facility. There's lots of kind of background external factors that just help keep people safe when you use an appointment based solution.
What advice would you give countries which are looking to implement a similar solution like this?
Andy: The key for us was to get to that point of proof of concept as quickly as possible and get real user feedback as quickly as possible, because that determines what changes we are going to need to make and also the ongoing testing of the project as well, and continuous integration, continuous delivery really drove that forward change that we were going to have to implement. Certainly just getting user feedback as quickly as possible to understand what's going to work and what's not. And then and that doesn't just apply to when we say users, that doesn't just apply solely to consumers of the system. So let's say the citizens who are actually having the tests and getting the vaccines. The back end users of the system are important as well. For example, in the vaccine project we have done most recently, there's really a lot of responsibility on the people, the site managers that are responsible for saying how available is their site, how many vaccines can you deliver, what times you open. Getting those users on board with training programs and documentation on what they need to set up and making them comfortable with how to do it, because that ultimately is what drives the system and makes the system work as best it can. And then finally just trying to cater for the different types of testing you're going to need to do because these are such in-demand systems and they're such crucial critical systems. Really, the testing behind it is just critical to get right.
This article summarises podcast episode 35 " ACF Exclusive: Delivery of UK's COVID-19 Booking System" recorded by CX Insider. For more information, listen to the episode.
Written by Valentina Svobodova