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SPECIAL REPORT

Addressing NHS Connectivity Challenges and the Role of Scalable Networking Solutions Preparing the NHS for Next Generation Connectivity A Perfect Health Storm The Need for Connectivity in Healthcare A New Order to Meet Evolving and Changing Needs The Essential Requirement for Modern Care

Published by Global Business Media


Tailored Connectivity Services for Healthcare Updata, part of Capita plc, is a pioneering connectivity services integrator. We are dedicated to providing end-to-end network services that address the requirements of the NHS, now and in the future. In the increasingly connected world of health and social care, we provide the network solutions needed for the secure collaboration and sharing of information with carers, patients and citizens across the NHS and other care organisations.

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Visit www2.capita-ites.co.uk/connecting-the-nhs to book a free healthcare connectivity assessment to evaluate your existing and future requirements.

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transition away from an N3 service at scale


ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

SPECIAL REPORT

Addressing NHS Connectivity Challenges and the Role of Scalable Networking Solutions Preparing the NHS for Next Generation Connectivity A Perfect Health Storm The Need for Connectivity in Healthcare

Contents

A New Order to Meet Evolving and Changing Needs The Essential Requirement for Modern Care

Foreword

2

John Hancock, Editor

Preparing the NHS for Next Generation Connectivity

3

Updata Infrastructure UK Ltd

Published by Global Business Media

Published by Global Business Media Global Business Media Limited 62 The Street Ashtead Surrey KT21 1AT United Kingdom Switchboard: +44 (0)1737 850 939 Fax: +44 (0)1737 851 952 Email: info@globalbusinessmedia.org Website: www.globalbusinessmedia.org Publisher Kevin Bell Business Development Director Marie-Anne Brooks Editor John Hancock Senior Project Manager Steve Banks Advertising Executives Michael McCarthy Abigail Coombes Production Manager Paul Davies For further information visit: www.globalbusinessmedia.org

The opinions and views expressed in the editorial content in this publication are those of the authors alone and do not necessarily represent the views of any organisation with which they may be associated. Material in advertisements and promotional features may be considered to represent the views of the advertisers and promoters. The views and opinions expressed in this publication do not necessarily express the views of the Publishers or the Editor. While every care has been taken in the preparation of this publication, neither the Publishers nor the Editor are responsible for such opinions and views or for any inaccuracies in the articles.

The End of N3 Benefits of HSCN Meeting the Challenge Next Steps Updata and the HSCN Case Study: Scottish Wide Area Network

A Perfect Health Storm

7

John Hancock, Editor

The Context of Today’s NHS What Generates the Pressures? How Technology Can Help

The Need for Connectivity in Healthcare

9

Camilla Slade, Staff Writer

Demand Growing Faster Than Resource Supply UK Healthcare Delivery Reforms Finding New Ways to Be More Efficient Why the NHS Needs Digital Connectivity

A New Order to Meet Evolving and Changing Needs

11

Peter Dunwell, Correspondent

Connectivity, Joining Up the Components in Healthcare Delivery Improving the Infrastructure for Connectivity

The Essential Requirement for Modern Care

13

John Hancock, Editor

On the Clinical Front Line, Connectivity is Vital Connectivity Challenges The Importance of Connectivity in Healthcare

References 15

Š 2017. The entire contents of this publication are protected by copyright. Full details are available from the Publishers. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical photocopying, recording or otherwise, without the prior permission of the copyright owner.

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ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

Foreword T

HE MANTRA for our times could well be, ‘I want it all; I want it now’. It’s what we have come to expect in many aspects of life and work. People no longer accept that, in order to get something done, they will need to wait until the required materials or information have been sourced, located and sent to them, which could take days by post or courier. But there is a serious point to this; the sooner and more completely we are able to get on with a job the better it will be for the person on whose behalf we are doing it. That is particularly true in healthcare and its associated sectors where changing demographics and evolving patterns of ill-health mean that increasing numbers of people have long-term and complex conditions that require long-term and complex solutions. These will often source the resources they need from a number of professional disciplines and across several sectors. It all requires better connectivity to ensure that any one professional can work from anywhere at any time as if they were in the consulting room with full access to records and capabilities. To that end, the NHS is addressing its connectivity and

allows NHS providers to access national applications and information, no longer fit for purpose. It is due to come to an end in March, 2017. The article goes on to examine the benefits of the new Health and Social Care Network (HSCN), which will give NHS bodies a wide choice of products and services. However, there remains a lack of awareness within many NHS organisations of the options that will become available through the HSCN. Although some progress has been made, still more needs to be done. We start with an article that overviews the range of challenges that currently confront the NHS before drilling down for Camilla Slade to look more closely at the sources of why the NHS needs connectivity. Peter Dunwell then looks at how connectivity can improve working and outcomes in the NHS and he looks at how NHS connectivity is soon to change. Finally, we consider how improved connectivity will align with the needs of a health service that is joined up within itself and to work ever more closely with a range of sectors and agencies.

our paper looks at that. This Special Report opens with an article by Updata Infrastructure, which looks at how new technology has made N3, the single-supplier framework, which

John Hancock Editor

John Hancock has been Editor of Primary Care Reports since its launch. A journalist for nearly 30 years, John has written and edited articles, papers and books on a range of medical, management and technology topics. Subjects have included management of long-term conditions, elective and non-elective surgery, Schizophrenia, health risks of travel, local health management and NHS management and reforms – including recent changes and the fall-out from them.

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ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

Preparing the NHS for Next Generation Connectivity Updata Infrastructure UK Ltd

T

HE NHS of the future will have at its heart a commitment to patient-centric care and quality of care. It will deliver services which meet the specific needs of each individual and which allow citizens to manage their own healthcare decisions with ease and clarity. The Five Year Forward View brings NHS and social care organisations together to work more closely and make healthcare in the UK more flexible, personal, and dynamic. And at the same time, transformation of services must help the NHS meet unprecedented budgetary constraints, help drive efficiency, and reduce waste. The new world of Health and Social Care Network (HSCN) connectivity will impact health and social care services, and with impending termination of the N3 contract at the end of March 2017, NHS organisations should have already begun to lay the groundwork to build the NHS network of tomorrow.

The End of N3 N3, the single-supplier framework which allows NHS providers to access national applications and information, was designed more than 10 years ago. It is a national private network, managed centrally and delivered by a single supplier on a long-term contract arrangement. With technology moving on apace, the N3

Tailored Connectivity Services for Healthcare

infrastructure lacks agility and flexibility, and is no longer fit for purpose to meet the needs of an evolving healthcare service with limited funds. NHS Digital, (formerly The Health and Social Care Information Centre (HSCIC)), which manages ICT for the NHS, recognises that the requirements for information sharing and network access have transformed dramatically since N3’s introduction, and is seeking to address this head-on with the new Health and Social Care Network (HSCN). Originally a transition gateway was proposed to link new suppliers to the current N3 spine applications. However, the incumbent determined this would prove too difficult to manage. Therefore, all new suppliers now await a peering gateway, the delivery of which has been awarded with a live date in mid-2017. Not only will the N3 framework terminate at the end of March 2017, but the associated funding will also expire. All future funding will only be available for HSCN accredited services.

Benefits of HSCN Through the existing network, NHS bodies could be forgiven for feeling they had no choice of supplier, and were given little opportunity to offer input and feedback themselves. HSCN will be designed to give them network services that are fit for their specific purposes. Health and Social Care

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ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

The first and most pressing challenge which needs to be overcome is communication within the healthcare industry

providers will be given a wide choice of products, services, service levels, contract terms and price, effectively creating bespoke packages to meet their unique needs. HSCN will create an open marketplace of certified service suppliers (Connectivity Network Service Providers (CNSPs)). It will open up the landscape for more competitive pricing and a diverse supply chain, as well as encouraging innovation. In addition, the new network will help reduce the overall cost base, while also maintaining assurance, security and confidence in the network that all NHS organisations use. HSCN is designed to offer an interoperable network between health and social care organisations, both within the NHS and outside. It will result in greater integration of health and social care services, flexible and remote working and access to national, regional and locally-hosted applications – while reducing reliance on central infrastructure and services. At the heart of this transformation is better patient care and improved patient outcomes. Through HSCN, NHS bodies will be able to reach out to patients faster and more effectively, cut cancelled appointments, offer full and simple internet services to patients and improve the quality of data they collect. It will be easier for staff to update records from home or while on the road, and it will offer a secure and robust method of sharing vital patient information between different healthcare providers.

Meeting the Challenge Successfully shifting from a 10-year-old, highly established, single-supplier marketplace would pose a challenge for any industry. Within the NHS, there are additional factors to consider, not least the fact that providers on the HSCN will be 4 | WWW.PRIMARYCAREREPORTS.CO.UK

required to manage and share confidential and sensitive data whose accuracy could be a matter of life and death. The new infrastructure needs to be secure and reliable, providing an equivalent level of service and maintaining trust, while understanding the need for delivering cost savings. The security of N3 was enforced through the Information Governance Statement of Compliance (IG SoC). However, this has been retired by NHS Digital and new obligations are currently being drawn up. This security vacuum has created more uncertainty while the replacement is agreed. However, as the industry already has to meet several compliance standards to service government clients, including Public Sector Network (PSN) compliance, CAS-T accreditation and ISO27001/2, NHS Digital has determined to align their HSCN Obligation Compliance criteria to these standards. Therefore, with NHS Digital basing its new connectivity services upon the current PSN infrastructure, it would seem very likely that those bodies currently accredited should be able to support NHS obligations. Continuity of service will be critical to NHS organisations. Whatever option is chosen for future provision of secure network services for the NHS, there is a need to transition easily and efficiently from the existing arrangements to the new arrangements and ensure there’s no impact to patients and service. If responsibility for funding the new arrangements is to be devolved to local NHS organisations, as is being proposed, then there will also remain a need to manage national standards and boundaries between local networks. The physical challenge of installing new network must also be considered. In many areas, the


ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

Tailored Connectivity Services for Healthcare opportunity to piggyback on existing PSN networks could offer a sensible and cost effective way of putting the infrastructure in place. But there will be some parts of the country where the new network will require an overhaul of infrastructure which has been in place for several decades, and where fibre will need to be installed in places it hasn’t previously existed. It poses a significant civil engineering challenge. Taking into account all of the above, and in addition to the ambitious timeframe within which this new marketplace needs to be established, the first and most pressing challenge which needs to be overcome is communication within the healthcare industry. Given that the terms of the existing N3 contract expire imminently and do not allow for any further extension, there is an urgent need to act to deliver transition to the new provisions quickly. And yet there remains a distinct lack of awareness within many NHS organisations of the impending contract end, or where they should go for impartial advice. Many are unaware of the options that will become available to them through the HSCN and the benefits that being able to shop around will offer. Progress has been made within the market over the past six months, but awareness is patchy, and still more needs to be done to rise to the challenge. There is a compelling need for NHS organisations to plan what they intend to do to replace their existing infrastructure as soon as possible, and to make sure that replacement connectivity is cost-effective, secure and reliable.

Next Steps The new HSCN will undoubtedly change NHS connectivity for the better. The open market will kick suppliers into action and drive competition and the end results will mean more efficiency and

agility for customers. Network packages will be designed to meet their needs exactly, and patients will be better served as a result. Network connectivity between organisations and patients is what the N3 replacement is for. It supports the wider technology drivers of digitalisation – a paperless NHS – and mobilisation and integration, which are key to the Five Year Forward View. The HSCN can provide secure mobility at Trust locations such as hospitals, surgeries and third party locations such as care homes, as well as offpremise, which will help secure the personalised, mobile, and integrated healthcare of the future. However, it is clear that more needs to be done to communicate the benefits this transition could bring, and the timeframe within which it needs to be delivered. Above all else, NHS providers will want to be reassured that they are putting their network – and patient data – into reliable and experienced safe hands. They have the opportunity now to explore the marketplace and get the best possible deal for their practices and patients, but they need to move quickly if they are to make the most of this opportunity. NHS organisations must mobilise now in order to be ready for the termination of the N3 network and secure the best solution for the needs of their patients. The needs of one Trust will not be exactly the same as the needs of another. But a fundamental benefit of next generation connectivity will be the ability to create a bespoke network which is fit for purpose for each organisation. To make the best of this opportunity, the first place to start is to look at the supplier market.

Updata and the HSCN Updata provides secure network connectivity to enable better care quality and improved

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ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

Updata provides secure network connectivity to enable better care quality and improved patient experience for health and social care organisations, delivering sustainability and transformation for the NHS of tomorrow

patient experience for health and social care organisations, delivering sustainability and transformation for the NHS of tomorrow. Updata, alongside the other main PSN suppliers, invested heavily in supporting HSCIC’s creation of the new obligations to ensure security is maintained without impacting flexibility and innovation. We have been working with NHS Digital for the past six months to ensure we can become an HSCN Stage 1 approved supplier in early 2017. Updata will incorporate the delivery of HCSN infrastructure as part of its standard services. The technical and operational requirements to be an HSCN supplier have already been implemented by Updata, so this is Business as Usual. The basis of the HSCN connectivity is the PSN, of which Updata is already part. The use of PSN also means Updata can interconnect all its local government, police, ambulance and other government agencies directly to the new HSCN. This makes use of the CESG approved 705 (Health) VRF, which allows non-PSN accredited bodies to transfer data over the PSN. To find out more about the network services that Updata can offer, visit www.updata.net, email info@updata.net or call 01737 224422.

Case Study: Scottish Wide Area Network The Scottish Wide Area Network (SWAN) is the only existing example of successfully transitioning away from an N3 service at scale.

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Updata has a framework contract to deliver SWAN, a single public services network for the use of all public service organisations within Scotland and is connecting schools, hospitals, GP surgeries, pharmacists and local council offices. SWAN is providing connectivity to some of the most inhospitable places in the country and connecting the most remote NHS outposts, from the Highlands to the Islands. SWAN allows all its customers to benefit from economies of scale as well as increasing productivity and collaboration. It acts as the gateway for N3, the Internet, Janet and PSN frameworks and offers technical services such as DNS, NTP, mail relay, web filtering, remote access plus hardware and support. Updata is ultimately aiming to reach 5,500 sites across Scotland, including schools, hospitals, GP surgeries, pharmacies and local council offices. So far more than 4,000 sites have connected, across every geographical area in Scotland. Key clients of SWAN include central Government departments, including the Scottish Government and the Scottish Environmental Protection Agency, as well as 50 per cent of local authorities. As well as delivering reduced service costs, cutting the cost of procurement and enabling greater collaboration, SWAN is helping to unify network assurance. By applying a common standard of data assurance, it simplifies public sector interaction and ensures greater security for data transmitted internally and externally.


ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

A Perfect Health Storm John Hancock, Editor Some say that the NHS is in crisis but what are the individual elements that have put it in this position?

The Context of Today’s NHS These days it isn’t possible to consider anything to do with the National Health Service (NHS) without looking at the circumstances and pressures that determine its current condition and what it needs to do to continue into the future. This paper is, of course, about connectivity but, like any other innovative process and technology, connectivity has to serve a purpose. In a service that will be under budgetary and capacity pressure for the foreseeable future, any new ideas must be able to address real needs – innovation for its own sake would be an unaffordable luxury in the modern NHS. As far as connectivity is concerned, it fits very well as a ‘new approach’ described in the House of Lords Select Committee September 2016 report on ‘The long-term sustainability of the NHS’1, “Pressures brought about by demographic changes, increasing demand and rapid developments in innovative new medicines require new approaches to delivering healthcare to ensure continued sustainability of the NHS.”

What Generates the Pressures? The underlying pressure is, of course, a seemingly infinite demand to be met from definitely finite resources. That demand has resulted from a combination of demographic changes and capability improvements. In simple terms, the demographic change has come about with a rising population, and that can be largely traced to immigration, improved treatment and management of health issues and increased life expectancy. Of these, most experts would cite the latter, increased life expectancy, as the most significant.

reduction in physical capacity: a group of older people who are at the highest risk of adverse outcomes such as falls, disability, admission to hospital, or the need for long-term care.” That is the conclusion of Catherine Thompson’s article in NHS England News2, ‘Meeting the challenges of an aging population’. This issue with older people is often epitomised in the rather crude term ‘bed blocking’ which, as the Telegraph reported in January 20173, “has risen more than 40 per cent in a year as hospitals continue to be overwhelmed with people needing care…” Bed Blocking occurs when a patient, usually, but not always older, no longer requires hospital treatment but still requires care. Until that care at home or placement in a care home can be arranged, the patient has to stay in hospital making the bed unavailable. The problem is covered in more detail by the Economics of Social and Health Care Research Unit4, “Elderly individuals living at home who suffer trauma, such as hip fracture or stroke, generally require immediate hospital care. Usually this is followed by long term care which can be provided either in their own home or in a residential or nursing home. Getting the balance right between hospital and residential/nursing home care is key to improving the care pathway.” At least part of the problem can be where lack of connectivity makes it difficult for hospitals to identify where the long-term care services are available or for long-term care providers to know when a hospital’s patient might need their services.

Tailored Connectivity Services for Healthcare

An aging population “Our population currently has more than three million people aged over 80 years old. By 2030, this figure is projected to almost double, and by 2050 reach eight million. Today, one-in-six of the population is aged 65 and over, and by 2050 it will be one-in-four… For a significant number of older people, advancing age is associated with frailty. In medicine, this is often defined as a

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ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

The NHS must harness new, transformational technology and exploit the potential of transparent data... We must be ready and able to share these data and analyses

Long-term and complex conditions Another NHS England publication ‘The NHS belongs to the people’5 identifies “… a number of future pressures that threaten to overwhelm the NHS. The population is ageing and we are seeing a significant increase in the number of people with long-term conditions - for example, heart disease, diabetes and hypertension. The resulting increase in demand combined with rising costs threatens the financial stability and sustainability of the NHS.” The report continues to explain, “the NHS must change to survive… To do so, the NHS must harness new, transformational technology and exploit the potential of transparent data... We must be ready and able to share these data and analyses.”

Lifestyle influences But it isn’t only older people who become unwell or who suffer from complex conditions. Sadly, also, too many of the health problems today are self-inflicted. As My Health London6 puts it, “The way we live now is also having a negative impact on our health. Drinking too much alcohol, smoking, a poor diet with not enough fruit and vegetables and not doing enough exercise are all major reasons for becoming unwell and needing to rely on our health services. Increasing numbers of overweight children show us that this problem is currently set to continue.” Add to this that the NHS has been the architect of demand on its services through its success in treating increasing numbers of patients for a growing catalogue of conditions which, in many cases, mean an extended life expectancy and it is clear that expectations have changed. My Health London again, “Now, we all expect so much more [of the NHS]. From advice on healthcare management through to mental health and social care, contraception, antenatal and maternity services,

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vaccination programmes and the fast, efficient processing of our medication and appointments.” The conclusion in the NHS report? “New thinking about how to provide integrated services in the future is needed...” And ‘integrated services’ require ‘joined-up thinking’ which, in turn, requires connectivity between people and between systems.

How Technology Can Help In one sense, the NHS is caught in a perfect storm. Putting together the points above, there is an increasing number of people who need its services and those people will need the services for longer than did previous generations. On top of that, the needs relate to more complex and multiple conditions. And there is a greater number of things that the NHS could do and a growing level of expectation as to what the service is expected to do. But there remains that finite resource budget with which to do it all. In situations like this, organisations often turn to technology to help resolve at least the data handling element of their operations and the NHS is no exception. In August 2016, Raconteur, looking at the future of Healthcare concluded that ‘New Technology can offer a cure for the NHS’7 saying, “Apps, telemedicine, and trackers and monitors linked to smartphones open up a new landscape of patient engagement that could drive the biggest hammer on health costs – prevention… healthcare technology surges from a cottage to powerhouse industry.” The article continues to cite, NHS England chief executive Simon Stevens; “Now – at a time when the NHS is under pressure – rather than just running harder to stand still, it’s time to grab with both hands these practical new treatments and technologies.” And the way to leverage the best returns on that new technology will be to ensure that it all works together… connectivity.


ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

The Need for Connectivity in Healthcare Camilla Slade, Staff Writer Getting access to information when it’s needed wherever it’s needed is essential

Tailored Connectivity Services for Healthcare

to delivering high quality healthcare

Demand Growing Faster Than Resource Supply In the previous article, John Hancock set out some of the challenges that are creating the context within which topics such as connectivity have to be considered. He also mentioned that the resources available will always be finite but, on a per capita basis, it could be worse than that. “Health service spending is to fall per head, even though the population is getting older, the chief executive of the health service has warned.” was the stark report in The Telegraph in October 2016. The article8 quoted Simon Stevens, chief executive of NHS England who said “the health service had ‘a big hill to climb’ coping with financial pressures amid growing demand from an ageing population. He told the Commons Health Committee that the NHS was getting the levels of funding it had sought from Government, this year, but would face significant challenges in the three years ahead. One way in which these challenges are being addressed is through a

reorganisation of the infrastructure through which healthcare is delivered.”

UK Healthcare Delivery Reforms Healthcare delivery is an ever-changing scene with new treatments, new drugs and remedies, and, in the case of the UK NHS, new delivery structures to address the challenge of finite resources having to satisfy infinite demand. This has been particularly addressed in the UK’s Primary Care Service, the first point of contact with the NHS for most people and where 90 per cent of patient interactions with the service take place. Changes to healthcare delivery in recent years have focused on primary care and especially on GP (General Practitioner) practices (the main delivery point for primary care), as well as the architecture within which they work. Up until March 2013, GP practices sat in a top-down structure headed by Primary Care Trusts. On 1 April 2013, that all changed so that GP practices have controlled their own budgets since then and

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ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

Pressures brought about by demographic changes, increasing demand and rapid developments in innovative new medicines require new approaches to delivering healthcare to ensure continued sustainability of the NHS

undertake commissioning of care for patients for which, in order to leverage the best economies of scale, GP practices are grouped together; the new organisations that they have created are called Clinical Commissioning Groups (CCGs). This reform has put the onus for quality of delivery firmly with the GP practice and has made many practices and CCGs look hard at ways in which technology might be able to improve their service while better managing costs. In addition to these big structural changes, the NHS is well aware of the need to make process changes. In its report on ‘The long-term sustainability of the NHS’ the House of Lords select committee summarised that9 “Pressures brought about by demographic changes, increasing demand and rapid developments in innovative new medicines require new approaches to delivering healthcare to ensure continued sustainability of the NHS.”

Finding New Ways to Be More Efficient Among a number of technology based answers to the NHS’s current predicament, there is a range of solutions that can improve records creation and maintenance, and reduce the need for storage as well as improving accessibility. Put together, the implementation of these solutions has been called ‘the NHS 2020 paperless target’. In his comment piece for the National Health Executive ‘What is needed to achieve a paperless NHS by 2020?’10 Dr Phil Koczan identifies a number of requirements to ensure that the new system is feasible and that it works, including “Technology to support data sharing. There are several projects in place that are sharing data for direct care, both for delivering integrated care and supporting emergency care through sharing with the 111 systems. Discharge summaries are now largely sent by electronic means and other correspondence is following that route. Organisations within a local health economy are coming together to drive this change forwards.” Although, in light of the report by Dr Robert Wachter’s digital health advisory board to the Department of Health11 there are likely to be some

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delays in the final delivery of this paperless NHS, it all points to a key place for connectivity in the new order.

Why the NHS Needs Digital Connectivity According to the Oxford dictionary, connectivity is the state of being connected or interconnected. That sounds straightforward and it doesn’t only apply to digital technology. The concept of ‘joined up thinking and processes have always relied on human connectivity but that might not always be able to work in all circumstances. What if the information that is needed to ensure a joined up process is held in a computer system and/or in a different location to where it is needed? or if the health worker who needs the information is in the field at the time? BT’s paper ‘Helping health go digital’12 under the heading ‘Connecting professionals with patients’ explains; “The government’s National Mobile Health Worker Project pinpointed how mobile working can cut costs. Monitoring 11 sites over the course of a year, they found (among other benefits) that mobile working helped healthcare professionals spend more time with patients (an increase of 104 per cent) and less time travelling (a decrease of 33 per cent).” A prerequisite to mobile working is connectivity so that, in their digital environment, people who need information can always access it from wherever they are. In truth, NHS efforts at digital technology have not always been unqualified successes so new systems have to deliver improvements to the way clinicians work rather than just reduce the workload of NHS administrators. As Dr Phil Koczan puts it in his article (see above), “Unfortunately, many clinicians are disillusioned by technology as, historically, systems have been slow, clunky and difficult to use, particularly during consultations when patients are present. Improvements in technology, mobile devices and techniques… are beginning to change this perception.” In the next article, Peter Dunwell will look at connectivity and the NHS.


ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

A New Order to Meet Evolving and Changing Needs Peter Dunwell, Correspondent Putting the outcomes first to ensure that service delivery matches user and patient needs

The University of Bristol Centre for Academic Primary Care13 sums up the job of primary care, “The aim is to provide an easily accessible route to care, whatever the patient’s problem. Primary health care is based on caring for people rather than specific diseases… An important role is acting as the patient’s advocate and co-ordinating the care of the many people who have multiple health problems.”

Connectivity, Joining Up the Components in Healthcare Delivery To an increasing degree, all of those requirements will need to engage different team members within a practice, and experts from outside of the practice and will require access to all of the data relating to a patient’s condition and past history. In the past, that would have required a time-consuming process of ‘to-ing and fro-ing’ to consult with different people in and out of the

Tailored Connectivity Services for Healthcare

practice, as well as request and obtain patient records from the various places they might be held. It was a form of connectivity but a very unwieldy and inefficient one. So, little wonder that, in today’s NHS, digital connectivity to join up the many digital data sources that are needed, is a hot topic. BT’s paper ‘Helping health go digital’14 sums it up nicely, “We’ve never been better connected than today. With over 60 per cent of the UK surfing the net from their phone, people aren’t tied to an office to do their day jobs. It’s only going to get easier to work on the move – whether that movement’s within a hospital or in the community. Better connections mean healthcare professionals can pull up patient records in a couple of swipes, display an X-ray on screen on the wards, or update a prescription in a patient’s home.” It also means that professionals can better access the information they need to place patients into the right care environment for

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ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

Currently with N3, users have a catalogue service derived from IT technical specifications. Because of that, while it’s a good service, it is focused on technology not outcomes

their condition and to make most efficient use of the resources available inside and outside of the National Health Service. NHS England’s National Pathology Programme paper ‘Digital First’15 explains, “The need for transformation in models of delivery, focussing on producing great value care with the best outcomes for patients, has never been greater. Early diagnosis to prevent premature mortality, care of long term conditions, and acute care, are all areas in which pathology has an enormous role to play, not only in supporting clinical teams, helping design pathways, and making results visible and interpretable for patients, but also in innovation to make the pathways faster and better. Pathology is leading the way in the use of digital technology, with the automated disciplines at the leading edge.” (author’s italics).

Improving the Infrastructure for Connectivity N3: the old order To support this end, the NHS has upgraded its connectivity infrastructure. The structure until now has been N3. According to Wikipedia, “N3 is the national broadband network for the English National Health Service (NHS), connecting all NHS locations and 1.3 million employees across England.” The NHS itself describes N3 as “a Wide Area IP Network (WAN), connecting many different sites across the NHS within England & Scotland. It also connects to other networks via Gateways, notably to the Internet via the Internet Gateway.”16 This is not the place to go into the full technical specification of N3, if for no other reason that it is being replaced by architecture better fitted to the needs and demands of the NHS today. Sufficient to say that, “N3 is lacking in agility and flexibility and is no longer fit for purpose to meet the needs of an evolving healthcare service. One of [its] limitations… is the N3SP portal, where customers have to pay a premium for extra bandwidth to

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meet their particular needs... A further issue arising from this lack of flexibility is that the network standards could make it difficult for organisations to deploy and manage their own applications, especially Unified Communications solutions. This, from Government Computing17, refers to the white paper ‘Next Generation Connectivity for the NHS’ published by Updata. HSCN: the new order To better reflect the evolving priorities of the NHS and its need to work with outside agencies in order to leverage the best use from its own resources, the new infrastructure is called the Health and Social Care Network (HSCN). As NHS Digital18 puts it, “The HSCN replaces the current centrally managed N3 national private network. Instead, HSCN offers a standards-based network that will enable multiple suppliers to provide interoperable network services to health and social care organisations.” On a technical note, “HSCN will be an interoperable ‘network of networks’ provided by multiple suppliers who will adhere to common and open standards. It will act like a single network provided by many suppliers. This means health and care providers can access services and share information, regardless of their location or network supplier.” That statement again from NHS Digital explains the enhanced flexibility of HCSN. As a final word, Gareth Ricketts, Health Sector Lead at Updata Infrastructure neatly sums up the change. “From an NHS perspective, HSCN offers a more flexible and operationally focused solution. Currently with N3, users have a catalogue service derived from IT technical specifications. Because of that, while it’s a good service, it is focused on technology not outcomes. HSCN is an opportunity to say ‘you have this need now and the service will meet it but you also need your service solution to be able to react to changes in the operational requirement’ HSCN is about the technology serving the user not dictating what the user can do.”


ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

The Essential Requirement for Modern Care John Hancock, Editor Connectivity is not an accessory but is the infrastructure and enabler of the new order

Tailored Connectivity Services for Healthcare In some senses, the new order of general practice ownership of patients’ needs and GPled commissioning of services will only work if connectivity becomes an organic part of the system able to deliver whatever the user and their patients need. All parts of the NHS work hard to deliver excellent service in often challenging circumstances but, perhaps the most complex area of all in organisational terms is general practice (GP) and it is at this level in the service where, particularly in light of recent changes to commissioning practice, connectivity could be said to be most important. GP practice is complex and busy.

On the Clinical Front Line, Connectivity is Vital “GPs deal with a whole range of health problems. They also provide health education, offer advice on smoking and diet, run clinics, give vaccinations and carry out simple surgical operations. GPs usually work in practices as part of a team, which includes nurses, healthcare assistants, practice managers, receptionists and other staff. Practices also work closely with other healthcare professionals, such as health visitors, midwives, mental health services and social care services.” This from NHS Choices19 sums up the complexity of general practice and

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ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

Connectivity is not simply nice shiny technology to add a cool perspective to work. It is an application of technology uniquely suited to the circumstances of today’s health environment

the interoperability between disciplines and services for which connectivity is essential. Also, Citizens Advice has found that20, “80 per cent of GPs report that dealing with non-health issues meant they had less time for other patients’ health needs. If non-health demands could be met in other ways, this could free up GP time to focus on patient healthcare.” The more easily GPs can connect with other clinicians, professionals and service providers, the more likely they are to be able to deliver the service they want for their patients.

Connectivity Challenges In the preceding article, Peter Dunwell covered the systems used to support connectivity in the NHS and, of course, there will be challenges in moving from the old N3 network to the new HSCN infrastructure. With all its limitations, N3 worked and users will be familiar with it so the transition to HSCN will need to ensure that not only do users understand its benefits but also, the transition does not itself hinder work. It’s the usual requirement of change management. Also, as always, there are cost considerations. But funding will be organised along the lines of the new order that it has to serve. Referring to NHS Digital21, “HSCN connectivity funding arrangements will support the adoption of network services. The arrangements will enable flexibility in the commissioning and provision of new services that meet local needs. From 1 April 2017, central funding – currently used to pay for NHS N3 connectivity – will be devolved to clinical commissioning groups (CCGs) to pay for legacy N3 connectivity and future HSCN connectivity. All allocations will include funding to cover the costs associated with setting-up new HSCN services.”

The Importance of Connectivity in Healthcare Whatever the challenges, it should be clear by now that connectivity is a prerequisite for the twenty-first century model of healthcare services with their emphasis on joining up whatever facilities the patient needs into a seamless, patient driven, outcome focused whole. John Nosta’s January 2014 article22 in Forbes magazine ‘Digital health in 2014, The imperative of connectivity’ ties the subject up very well highlighting both the limitations of a technology driven solution, “Build it and they will come. I sense that this may be a

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guiding principle to digital health. Build a sexy device or a cool app and the democratization of healthcare will magically appear.” and the ultimate holy grail of “a profound re-invention of technology that may very well make digital health invisible as a device yet indispensable as a reality for health and wellness.” In preceding articles we have seen that connectivity is not simply nice shiny technology to add a cool perspective to work. It is an application of technology uniquely suited to the circumstances of today’s health environment. Yes, it enables users to input and access data and information from anywhere to anywhere at any time so that being in a patient’s home, say, a clinician will have no less access to the information needed to treat that patient than if they were in a hospital or GP practice consulting room. But, more importantly, it makes possible the integration of several different types of service (healthcare, social services, long-term care…) into a unified package to meet all of a patient’s needs without the need for them to have to leave one (say, hospital) before being picked up by another (say, home care). The other key requirement is to be able to adapt quickly to change so that users hardly notice what has happened but can simply continue to use the system as they always have. Stepping out, for a moment into the commercial world, Esteban Herrera in his blog for CIO ‘Connectivity is the new currency’23 explains, “The future is about connectivity... connections could be between systems in the traditional sense, but they also will be between people. They definitely will be between systems and people… These connections will be continually redefined; the ones that are made today may not be as valuable as the ones made tomorrow because, by their very nature, networks add value when they expand.” Connectivity is a key element in any modern health and social care system. Let’s give the final word to Deloitte Centre for Health Solutions24 “Connected health or technology enabled care (TEC) is the collective term for… eHealth services. TEC involves the convergence of health technology, digital, media and mobile telecommunications and is increasingly seen as an integral part of the solution to many of the challenges facing the health, social care and wellness sectors, especially in enabling more effective integration of care.”


ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

References: House of Lords Select Committee on the long-term sustainability of the NHS www.parliament.uk/documents/lords-committees/NHS-Sustainability/long-term-sustainability-nhs-committee-written-evidence.pdf

1

2

NHS England, Meeting the challenges of an ageing population www.england.nhs.uk/2015/02/catherine-thompson/

3 The Telegraph NHS bed-blocking rises 42% in a year, new figures show www.telegraph.co.uk/news/2017/01/12/nhs-bed-blocking-rises-42-year-new-figures-show/ 4

Economics of Social and Health Care Research Unit www.york.ac.uk/media/che/documents/papers/researchpapers/RP86%20Lay%20summary.pdf

5

NHS England, The NHS belongs to the people www.england.nhs.uk/wp-content/uploads/2013/07/nhs_belongs.pdf

6

My Health London, Today’s NHS – our current challenges www.myhealth.london.nhs.uk/help/nhs-today

7

Raconteur, New technology can offer a cure for the NHS www.raconteur.net/healthcare/new-technology-can-offer-a-cure-for-the-nhs

Telegraph, NHS spending will drop per head… http://www.telegraph.co.uk/news/2016/10/19/nhs-spending-will-drop-per-head-despite-ageing-population-and-gr/ 8

House of Lords Select Committee on the long-term sustainability of the NHS www.parliament.uk/documents/lords-committees/NHS-Sustainability/long-term-sustainability-nhs-committee-written-evidence.pdf

9

NHE National Health Executive, What is needed to achieve a paperless NHS by 2020? www.nationalhealthexecutive.com/Comment/what-is-needed-to-achieve-a-paperless-nhs-by-2020

10

Digital Health, Watcher calls for extension to paperless 2020 target www.digitalhealth.net/2016/09/wachter-calls-for-extension-to-paperless-2020-target/

11

12

BT, Helping health go digital www.globalservices.bt.com/static/assets/pdf/events/NHS-digital-transformation-June-2016.pdf

13

University of Bristol, What is primary health care? www.bristol.ac.uk/primaryhealthcare/whatisphc.html

14

BT, Helping health go digital www.globalservices.bt.com/static/assets/pdf/events/NHS-digital-transformation-June-2016.pdf

15

NHS England, National Pathology Programme www.england.nhs.uk/wp-content/uploads/2014/02/pathol-dig-first.pdf

16

NHS UK, N3 http://www.n3.nhs.uk/technicalinformation/n3networkoverview.cfm

Government Computing, NHS organisations warned to sort out their post-N3 connectivity http://healthcare.governmentcomputing.com/news/nhs-organisations-warned-to-sort-out-their-post-n3-connectivity-5004315

17

18

NHS Digital https://digital.nhs.uk/health-social-care-network

19

NHS Choices www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/NHSGPs.aspx

Citizens Advice www.citizensadvice.org.uk/Global/CitizensAdvice/Public%20services%20publications/CitizensAdvice_AVeryGeneralPractice_May2015.pdf

20

21

NHS Digital, Connectivity funding https://digital.nhs.uk/health-social-care-network/connectivity-funding

Forbes, Digital Health in 2014: the imperative of connectivity www.forbes.com/sites/johnnosta/2014/01/02/digital-health-in-2014-the-imperative-of-connectivity/#1a140fe3a2ff 22

23

CIO http://www.cio.com/article/3088078/it-industry/connectivity-is-the-new-currency.html

24

Deloitte https://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-connected-health-sm1.pdf

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ADDRESSING NHS CONNECTIVITY CHALLENGES AND THE ROLE OF SCALABLE NETWORKING SOLUTIONS

Notes:

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Tailored Connectivity Services for Healthcare Updata, part of Capita plc, is a pioneering connectivity services integrator. We are dedicated to providing end-to-end network services that address the requirements of the NHS, now and in the future. In the increasingly connected world of health and social care, we provide the network solutions needed for the secure collaboration and sharing of information with carers, patients and citizens across the NHS and other care organisations.

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Visit www2.capita-ites.co.uk/connecting-the-nhs to book a free healthcare connectivity assessment to evaluate your existing and future requirements.

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transition away from an N3 service at scale


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Addressing NHS Connectivity Challenges and the Role of Scalable Networking Solutions  

Primary Care Reports – Addressing NHS Connectivity Challenges and the Role of Scalable Networking Solutions – Updata Infrastructure

Addressing NHS Connectivity Challenges and the Role of Scalable Networking Solutions  

Primary Care Reports – Addressing NHS Connectivity Challenges and the Role of Scalable Networking Solutions – Updata Infrastructure