Here’s to five years of the new NHS Spine

Like any milestone birthday it’s a time for reflection, writes Andrew Meyer, director of NHS Digital’s Digital Delivery Centre.

Have you achieved what you wanted in the time passed, are there opportunities missed, have you been resilient over the inevitable bumps along the way? It’s contemplation not only on the path travelled but also on the journey planned.

I found myself at a similar juncture last week as the NHS Digital Delivery Centre reached a significant marker. Spine II turns 5 years old on 22 August. While still in single digits, it feels like it has gone through its own ‘rite of passage’. Like those early years with any youngster under your charge, the time goes all too fast and it can be easy to rush past the important developments.

I had the honour to lead the team on Spine II through its early trials, tribulations and teething issues. For those of you who haven’t heard of the Spine, it is that national digital infrastructure which supports the NHS. Spine I, the previous iteration, was delivered externally through a third party. It ran for 10 years, had an army of people running it and it cost the NHS and public purse a sizeable amount. The service was good – for the time – but change was slow. It had a 12-month change window and it wasn’t flexible. The contract with the external provider was coming to an end and standing still wasn’t an option, we had to evolve.

Our starting point was to build a system that was like for like, but we needed to achieve more transformational goals too, like vastly reducing its running costs and creating infrastructure that would be resilient to change. We knew that to achieve this we would have to do things significantly differently and that the only way to really own these goals was to bring it in-house and do it ourselves.

It was a big decision that required a lot of people to take a huge leap of faith. Getting it wrong was not an option, the national health care system relied heavily on it. If it were to fail, its impact would be felt immediately by hospitals, clinicians and ultimately by patients.

It was a controversial move. With so much at stake, perhaps unexpectedly there was a cohort that felt this was a risk too colossal to take. Fortunately, we also had some forward-thinking backers who shared our vision – and some of our confidence – in making Spine II a success.

So what did ‘doing things differently’ mean? It meant moving away from large systems integrators and enterprise licence software to open source, it meant using different technology like NoSQL databases and it also meant creating a DevOps team and adopting an agile approach to delivery. Each element of this was a major step change to how things had been done before. And of course, we had to run it ourselves, no longer would we be able to pick up the phone because something had broken – it was all down to us! So fast forward from this momentous decision, armed with a talented but lean team, a small budget and a lot of heart, Spine II was born.

This was five years ago and what a long way we have come.

Spine II is made up of four primary components – Summary Care Record, the Demographics Service, the Electronic Prescriptions Service, and Messaging.

The scale of the Spine is immense. 500,000 health professionals use it daily. It holds over 2 billion records, supports up to 47 million messages every day and a Summary Care Record is viewed every four seconds. This includes vital information needed in emergency environments including medicines, allergies and adverse effects. It holds 90 million demographic records, which are longitudinal records that stretch from cradle to grave and hold your address, GP information and preferred language. The Electronic Prescription Service supports two million electronic prescriptions per day. Finally, messaging, which is essentially a transport mechanism supports 17 million transactions per month. Together the Spine supports 28,000 healthcare IT systems across 21,000 organisations.

The stats are dizzying and to the average citizen mean very little. Perhaps easier to relate to are other services and functionality that is run on Spine such as: the National Record Locator which went live in a pilot late last year in collaboration with the Ambulance Service and Mental Health Trusts and provided ambulance technicians access to mental health crisis plans for their patients; the Mobile SCRa which currently gives ambulance technicians mobile access to Summary Care Records enabling them to triage and treat based on live information regardless of location, but has the potential to bring benefit in a broad range of settings; and our on-going work contributing to the transformation of Digital Child Health via the National Events Management Systems and the Digital RedBook.

They say for the young the days go fast, and whilst I may have lost a little more hair in the process, this is certainly true for Spine II’s early years. Our goal was transformation and we have achieved just that. Stability is undeniable given availability levels and consistency. Cost savings over the last five years are in excess of £100m. Functionality is far greater than before. The 12-month change window reduced dramatically with releases made every single week. The server estate went from 3,000 to 300, and our lean talented team of 55 not only run the service day to day but also devote time to developing the new products and services.

Spine will continue to grow and mature of course, but for today I think both the journey and the destination are worth celebrating.

Happy Birthday Spine II.

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