Clinical Innovation Is Outpacing ITSM Maturity. NHS Trusts must Close the Gap.
Gareth Martin
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Why NHS Trusts Are Progressing Clinically but Lagging Operationally: Bridging the ITSM Maturity Gap in Multi-Tenant Environments
Across the NHS, digital transformation has accelerated at clinical and analytical levels more rapidly than ever before. Trusts are making swift progress in areas such as Electronic Patient Records (EPR), digital consent (Concentric), command-centre analytics, medical device tracking, voice-recognition clinical documentation, and improved patient-flow systems. These innovations are unlocking new efficiencies and transforming care delivery.
But there is a challenge that many Trusts are now starting to feel acutely:
Clinical and analytics maturity is outpacing operational ITSM maturity.
The systems supporting the clinical estate have advanced, but the underlying service models, CMDB structures, dependency mappings, and real-time operational insights are not keeping pace.
For many regional NHS Trusts, especially those operating within multi-tenant ITSM environments shared across various organisations, the maturity gap is widening.
The Digital Maturity Divide: Clinical vs. Operational
NHS Trusts have achieved significant progress in clinical digitisation. Recently, the pace of adoption has increased rapidly:
- EPR consolidation and optimisation across multiple care settings
- Digital consent (Concentric) improving surgical readiness
- IoT and RFID-based medical device tracking
- Voice-recognition tools that accelerate clinical documentation
- Bed management systems supporting patient flow and command centres
- Analytics platforms provide real-time operational oversight
- AI integration improves triage, demand forecasting and workforce optimisation
These platforms generate immense value, but they create highly complex, interconnected digital supply chains.
Behind every clinical workflow today, a network of infrastructure, integrations, APIs, legacy applications, shared services, on-premises dependencies, cloud workloads, and ICS-level components exists. It forms an ecosystem of interdependent elements that need to be fully understood and managed proactively.
And that’s where the ITSM challenge begins.
Read: From Visibility To Value
Why Operational ITSM Isn’t Keeping Pace
Operational ITSM - the processes, models, and data structures that underpin service reliability - have not evolved at the same pace. This gap is most evident in three foundational areas:
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Service Models That Don’t Reflect Modern Clinical Reality
Many Trusts still depend on generic service models that map applications in isolation rather than considering end-to-end dependencies, clinical workflows, and integration chains.
As a result:
- The “EPR service” might be modelled, but not its dependencies on integration engines, PAS systems, imaging connectivity, legacy modules or shared services.
- Digital theatres may be categorised as a service, but without modelling their reliance on wireless, device tracking, bed boards, clinical desktops or API gateways.
Operational teams face fragmented visibility, leading to clinical disruptions that are more difficult to diagnose.
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CMDB Accuracy Has Become a Critical Weak Point
Most NHS CMDBs were not built for the hybrid, highly interconnected architecture now typical across Trusts. Data often becomes:
- Stale
- Incomplete
- Unreconciled
- Misaligned to real clinical workflows
This affects everything from incident response to change risk assessment and AI-driven insights. Without an accurate CMDB, even the best ITSM tools are operating at half capacity.
Read: You Can't Automate What You Can't Trust
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No Real-Time Dependency Visibility
NHS services evolve daily. Devices move. Virtual servers start up and shut down. Cloud workloads adjust in scale. Integrations change. New clinical modules are deployed. Legacy applications are phased out or only partially replaced.
Static service maps, especially manually maintained ones, can’t keep pace.
The result is that NHS Trust Service Desks often know what is down, but not why, where, or what else is at risk.
The Multi-Tenant: Scale vs. Specificity
Many regional NHS organisations now use centralised platforms across multiple entities.
There are clear, well-understood benefits:
- Economies of scale
- Shared support
- Standardised processes
- Centralised oversight
- Lower per-Trust licensing and admin costs
Multi-tenant ITSM also presents a significant operational limitation:
Shared ITSM platforms provide scale but lack the local specificity required by each Trust.
In practice, this leads to:
- Generic service models that fail to capture specific Trust environments.
- A single CMDB design applied across multiple organisations with vastly different estates.
- Change processes designed for the collective, rather than the individual Trust.
- Limited flexibility for modelling bespoke integrations or clinical pathways.
- Slower configuration and tailoring cycles due to shared governance.
- IT teams are working around the tool, rather than with it.
For Trusts that rely on unique combinations of systems EPR, Concentric, device tracking, voice recognition, bed management, and legacy applications, multi-tenant ITSM seldom provides the end-to-end clarity needed to support:
- Rapid incident triage
- Root cause analysis
- Clinical impact assessment
- AI-driven predictions
- High-velocity change
- Command centre operations
- Cyber resilience
Without an accurate, real-time, Trust-specific view of dependencies, operational maturity stalls even as clinical maturity accelerates.
The Risk: A Growing Operational Blind Spot
When dependencies aren’t modelled correctly or kept current:
- Resolver groups bounce incidents between teams
- Changes introduce hidden clinical risks
- Command centres lack system-level intelligence
- AI tools produce untrustworthy recommendations
- Clinical teams report repeated disruption patterns
- Service desks lack confidence in triage
- ICS-wide issues take longer to isolate
- Digital transformation slows down
For Trusts facing intense regulatory pressures, financial constraints, and increasing clinical demand, this lack of operational clarity is no longer sustainable.
The NHS doesn’t just need faster digital innovation. It needs operational control.
uControl: Rebalancing ITSM Maturity for NHS Trusts Using BMC Helix
This is where TekWurx uControl becomes a transformational capability.
Learn more: TekWurx uControl - Discover, map and optimised your IT environment
uControl is designed to provide NHS Trusts with the one aspect that multi-tenant ITSM environments find challenging to sustain:
Accurate, automated, real-time service understanding tailored to your Trust.
uControl enables Trusts to:
Automatically discover and reconcile Trust-specific infrastructure and application relationships.
Eliminating stale CMDB records and accelerating operational maturity.
Generate live dependency maps that model your actual clinical ecosystem.
Including EPR, Concentric, device tracking, voice-recognition platforms, bed management, imaging integrations, and legacy clinical systems.
Provide actionable, real-time insights for incident resolution and change assessment.
Reducing clinical disruption and improving service availability.
Operate confidently within a multi-tenant Helix environment
By giving the Trust its own tailored, accurate service view — even when the core platform is shared.
Enable AI-driven operations with accurate, reconciled, trustworthy data
Because AI on poor data simply accelerates poor decision-making.
Learn more: See the TekWurx uControl Case Study
Conclusion: NHS Trusts Don’t Just Need Tools. They Need Control
Regional NHS Trusts have developed exceptional clinical and analytical capability. However, without a corresponding increase in ITSM maturity, the NHS's operational core will continue to fall behind the innovations that enhance patient care.
Multi-tenant ITSM environments offer scalability, but they cannot provide the deep, Trust-specific dependency insight required for safe, resilient, and modern digital operations.
To close the maturity gap, Trusts require accurate data, real-time dependency mapping, and actionable service intelligence tailored to their estate.
That’s precisely what uControl delivers: clarity, confidence, and control.
