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University Hospitals Plymouth NHS Trust (UHPNT) is reaping the benefits of hosted digital services for healthcare and has big plans to go further still, after swapping out its run-down N3 broadband service for a new connection into NHS Digital’s Health and Social Care Network (HSCN).
The trust’s hub at Plymouth’s 900-bed Derriford Hospital is one of the largest medical facilities in southwest England, employing about 6,500 staff to provide general district hospital services to around 400,000 people in and around Plymouth. It is also a regional trauma centre and provides specialist services such as cardiac, oncology and renal surgery for all of Devon and Cornwall.
Also, its IT team provides services and support to Livewell South West, a community-interest social enterprise set up a couple of years ago, which employs about 2,500 people in mental health, community and rehabilitation services.
UHPNT IT manager Rob Harder takes up the story. This time last year, the trust had two N3 links serving its organisations, a 100Mbps link from Derriford and a second 25Mbps link from nearby Mount Gold Hospital, home to the Livewell organisation.
“For two to three years we were suffering during a growing period of the day, from about 7.30am to 4.30pm, when our bandwidth available to connect to N3 was saturated, and no level of quality of service [QoS] could compensate for the fact we had outgrown the capacity of the connectivity available to us,” says Harder.
“We were unable, because of the constraints of the contract between ourselves and NHS Digital, to get any more connectivity than we had, and we had outgrown it, which was having a significant impact on a number of services.”
With UHPNT increasingly looking to run services in the cloud – a number of key services, including patient administration, email and clinical radiology, were already run in software–as-a-service (SaaS) form over N3 before the HSCN upgrade – the situation was becoming increasingly untenable.
Making matters worse, although both the N3 links theoretically had resilient backups, the actual levels of resilience they could have provided in the event of a genuine IT disaster was an issue, with a number of backup routers being held in the same racks with the same power supplies.
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It was clear that N3 – which dates back to the early 2000s and was run entirely by BT – was no longer up to the job, so when the opportunity to move to HSCN came along, Harder was determined to be an early adopter.
“The N3 contract was too long and outgrew itself before the opportunity to refresh and replace came along,” he says. “Going from N3 to HSCN is a natural evolution of network connectivity for health and social care organisations, and when the HSCN initiative was introduced, we were really keen to go early because through discussions with NHS Digital we realised we would be able to get more bandwidth, and there would be more suppliers, which would introduce competition, which is always good for driving down costs.”
UHPNT was already involved with the Devon Sustainability and Transformation Partnership (STP) IT group, which collectively decided to run a countywide procurement for HSCN – something actively promoted by NHS Digital – led by Plymouth back in the summer of 2017. The group received bids from eight suppliers, and went with Buckinghamshire-based MLL Telecom because, according to Harder, the cost and quality of the bid were head and shoulders above the rest.
The contract with MLL was agreed at the end of 2017, with implementation set to begin in January 2018. However, Harder admits he was uneasy at the prospect.
“It’s fair to say the state of network connectivity in the UK is still quite poor,” he says. “While it’s extensive and thorough in built-up urban areas, even in Plymouth, where we have cable Virgin Media competing with BT, it still astonishes me sometimes how poor connectivity is and how long the lead times are for connectivity services.
“I say this on the basis that when we went into the project, I didn’t have great expectations from an implementation perspective. I worried we were going to hit problems with delays, despite MLL doing everything it had to do.”
MLL project management consultant Anthony Akadiri, who took ownership of the Devon HSCN transition, says that from a project management perspective, each NHS organisation within the STP was treated as a separate project, but delivered working with a single project manager representing all the organisations.
“Because I had one single point of contact that I could update to from a governance perspective, it let us work with Rob’s teams day to day on site surveys, installations and so on,” says Akadiri.
“As MLL was one of the first organisations to migrate NHS trusts onto HSCN, we’ve got the scars from the process and we understand what we need to do to ensure minimal impact, so at kick-off, I knew what would be the most suitable times to access sites, and so on, upfront. What we could then do was understand what times would be suitable for each organisation to have downtime, so we could schedule it in advance.”
Because all the organisations in the collective signed their contracts with MLL at once, Akadiri could also schedule migrations and circuit delivery processes, and prioritise delivery of HSCN based both on lead times and how quickly each site needed (or wanted) to move over.
“I had fortnightly project calls with the project manager representing the collaborative, which worked well because he had oversight of the progress all the sites were making, and then could cascade internally,” he says.
Harder says: “In the event, we did have some delays because of connectivity implementation, but MLL was able to very capably hold our hand through the migration. It was seamless. We had a couple of minutes of downtime early in the morning.”
Throughout the planning process for HSCN, NHS Digital and other stakeholders have made it clear they have tried their best to design the procurement so that some of the pitfalls that have dogged similar public sector network procurements in the past are avoided.
Harder adds: “With N3, we had a very inflexible service thrust upon us – OK, there was a catalogue of services, but once you reached the peak of those, there was nowhere else to go. You had it their way and it was restricted.
“What they have done with HSCN is taken away a lot of those restrictions while maintaining a compliance approach to providing a health and social care network that is fit for purpose for the modern day.”
Notable benefits, says Harder, have been the ability to take charge of his own procurements, to use framework contracts that the NHS is already familiar with from other services, and to contract with suppliers that can work flexibly with his organisation to create bespoke contracts.
Following its network upgrade, UHPNT now has two gigabit fibre links available to it, giving it more bandwidth capacity than it can possibly use for the time being – and its networking costs have dropped by 20% almost right away.
But for Harder, the real pay-off is that the clinical staff don’t see or notice anything. “Their focus is on patients, not making the network work, which is my job,” he says. “So in that regard, it’s been great that we’ve been able to move on from N3.
“People expect networks and Wi-Fi to be pervasive and available everywhere, and they bring those expectations into work. They don’t expect the network to slow their ability to do their jobs on a day-by-day basis.
“I’m sure if you speak to the key clinicians we’ve worked with closely from an IT perspective, they will tell you there has been a significant benefit and change from going to HSCN, because they’re not now seeing any issues from being unable to access key services.”
Crucially, he says, the pre-HSCN issues where users struggled to connect to externally-hosted services “literally disappeared” the day the new connections were turned on.
“Touch wood, they have been reliable ever since, and we’re now seeing pretty steady utilisation through the working day of around 200Mbps,” he adds.
With a huge amount of capacity to spare, Harder is now exploring the possibility of expanding his relationship with MLL to potentially create a local multi-protocol label switching (MPLS) network to connect the NHS’s various other sites around Plymouth back into the Derriford hub to integrate them into HSCN, as well as investigating additional overlay services on HSCN, such as videoconferencing.
In terms of UHPNT’s cloud journey, the trust is also talking with Microsoft about bringing in Office 365 and other productivity tools, and the possibility of delivering that through the Accenture-run NHSmail service – something that NHS Digital is currently trialling.