Our delivery directorates 3. Platforms and Infrastructure

We plan, build, co-ordinate and run the national IT infrastructure on which the NHS and social care system relies. Hundreds of thousands of frontline professionals use our systems every day to quickly and securely share vital information and to organise the care received by patients.

Our Digital Delivery Centre is at the heart of this work. It is a world-class product design and development hub with a proud record, over the past five years, of improving the reliability, security and performance of the NHS’s major national IT systems, while also delivering tens of millions of pounds a year in savings.

In 2018-19, the Digital Delivery Centre team in Leeds developed the IT behind the NHS login, which will provide a single, easy-to-use system for verifying the identity of people requesting access to digital health records and services.

It is a key enabler of the effort to give individuals more control of their own health and care through digital systems, because it provides an easy to use key for accessing information across digital platforms, while ensuring only the appropriate people can see that information. In September, we began testing the login with 3,400 patients across England as part of the private beta of the NHS App.

In November 2018, we began piloting a new national capability, the National Record Locator, which allows authorised clinicians, care workers and administrators to find and access patient information held in other care settings to support direct care.

The system is initially being tested in the North West, North East, Yorkshire and London with mental health nurses and paramedics.

It allows them to find out whether individuals they are treating have a mental health crisis plan, which can influence key decisions such as whether an ambulance crew will take a patient to A&E or to appropriate community-based care.

The initial service only allows users to find out whether an individual has a plan in place and where to find it, but an upgrade later this year will allow them to retrieve plans through the system and be integrated with Local Health and Care Records (LHCRs).

In the future, the National Record Locator will allow clinicians to quickly locate and access a much wider range of records across the system.

Information about children’s contacts with the health and care system is currently divided between systems provided by four GP suppliers, five child health system suppliers as well as other specialist screening systems and paper-based recording. Children can slip through the cracks.

For example, it could be used to rapidly locate ‘end of life’ care plans in a crisis situation or vital information about children arriving in an emergency department.

In March 2019, we launched the National Events Management Service (NEMS), which supports the Digital Child Health programme.

It adds a highly flexible information-sharing capability to our core NHS Spine infrastructure – and is vital to integrating a fragmented information infrastructure for children’s health and care. The National Events Management Service links this diverse infrastructure.

Details about a child’s interaction with a health and care setting (an ‘event’) can be recorded in that setting’s system but then automatically published to other authorised systems that have ‘subscribed’ to hear about it. This provides a simple but powerful tool for tailored information sharing (for example, providing A&E information relating to vulnerable children to relevant professionals).

In the first two days of operation, the North East London Foundation Trust achieved a 20% increase in the timeliness of new birth notifications from out of area maternity units, which helped health visitors to see new families three to four days sooner.

The new National Data Opt-out service was launched in May 2018 using an IT system developed by the Digital Delivery Centre. It gives people a secure and easily accessible way to opt out of their confidential patient information being used for reasons other than their direct care and treatment. Once an individual has registered a national data opt-out (either online or offline), the system tells organisations handling their confidential patient information that it should not be used for research and planning purposes. The system allows individuals to change their choice at any time.

We also went live in May 2018 with new ways for health and care staff to access national IT systems without relying  on the established method: a smartcard and smartcard reader. The smartcard method can be cumbersome and tends to tie frontline professionals to desk-based computers.

The new staff access service, called NHS Identity, initially allowed staff to use a one-time-only passcode to submit statistical data.

Our DDC team in Exeter worked with Public Health England and NHS England to provide data and rapid analysis to support the response to a serious IT-related failure in NHS breast screening programmes announced by the Secretary of State for Health and Social Care in May 2018.

An issue with a computer algorithm had resulted in large numbers of women aged between 68 and 71 not being invited for final breast screening appointments.

Our team developed and implemented solutions to safeguard the women who had missed appointments and prevent a recurrence of the problem in future.

Our Texas cloud platform is designed to help fast-moving development teams, providing integrated processes for building and deploying new services, end-to-end control of functionality and more information about application performance and user experiences. It will reduce running costs, increase reliability and performance, accelerate development times and improve focus on providing quality services that users need.

We have also completely reorganised our teams supporting data services, merging separate specialised project teams and implementing an agile approach. Informed by our own experience of developing our Digital Delivery Centre from the teams that worked on the insourcing of the Spine infrastructure (as well as industry leading practice such as Spotify’s approach to agile working) we have now established three ‘tribes’ in our main product areas designed to work quickly and flexibly like small start-ups.

At the individual project level, we put together nimble multidisciplinary teams that work across project boundaries and focus relentlessly on delivering real benefits for users.

We are already seeing major improvements in the systems that underpin our data processing. One team reduced 100,000 lines of SQL operations to 30,000 and has identified opportunities for further simplification. We have accelerated responses to some data queries significantly. For example, analysis in response to a parliamentary question, which would have previously taken several hours, took less than 20 minutes.

At the same time, the Secondary Uses Service continues to provide data to our Data Services for Commissioners Regional Offices (DSCRO) colleagues the day after (and to NHS England two days after) the monthly deadline for providers to submit their commissioning data. We have also increased the number of national derivations applied by the Secondary Uses Service system to data and increased the frequency with which records related to emergency care are shared with arm’s length bodies and commissioners.

The Health and Social Care Network (HSCN) programme is replacing the old centrally managed NHS broadband network with modern connectivity that helps organisations to access internet and cloud-based services safely while providing access to secure digital services that are only available over the NHS private network.

More than 90% of NHS organisations have now procured services, achieving average savings on like-for-like services of 74%, and are in the process of migrating to HSCN, with 27% of the old network having now been switched off. We expect the migration to HSCN to be completed in 2020-21.

92% of users of NHSmail are satisfied with its service, according to a survey in November, compared  to 73% in 2015. The number of accounts on NHSmail has grown by 12% since March 2018 and we are testing the service with GP locums, junior doctors and independent midwives to ensure they have the access to secure email they need to share information effectively with their colleagues. Our main targets for expansion in 2019-20 are care providers, dentists and optometrists.

In April 2018, NHSmail accounts were synchronised with the Azure Active Directory, Microsoft’s cloud-based identity management system. This allowed NHSmail users to access the new NHSmail Office 365 Hybrid service that went live in September 2018, offering integration with Skype for Business, Microsoft Exchange, and the NHSmail contacts directory. It was the largest synchronisation ever implemented on the Azure Active Directory, involving the transfer of more than two million directory entries in five days.

We also further strengthened NHSmail’s anti-spoofing capability, ensuring the service continues to maintain the highest levels of security, in line with National Cyber Security Centre guidance.

The NHS WiFi programme now covers 95% of clinical commissioning groups, including 7,300 GP practices, and more than 95% of secondary care trusts. That means 55 million people across England have access to free NHS WiFi connectivity when they are visiting GP surgeries, clinics and hospitals. In practice, it can significantly improve access to digital services, help and advice.

For example, a patient can download an app to help them manage a health condition while they are talking to their doctor or make choices about referrals while they are in a care setting.

For many people, particularly the younger generation, reliable and free WiFi access is now expected of any public service and NHS WiFi has made this a seamless experience. It is also helping staff easily access digital services across settings, improving collaboration and information sharing.

The introduction of free WiFi in local GP practices is helping community midwife Julie Haigh provide a better service for people in remote parts of Cumbria.

“Submitting information on the spot made a real difference,” says Julie. “Before, I would have had to drive back to my practice to enter it on the system or even do it during the evening, once I was at home. It saves me time and it saves the NHS money, because it cuts down on travel costs and paper costs.

“During one consultation, my client was unwell, so I arranged for throat swabs to be taken. She collapsed later in the day and was taken to hospital. They could see the details I had submitted earlier and were able to act quickly. It turned out she had sepsis.”

Julie says it is a boon for the people she works with.

“Having free WiFi in GP practices is a great leveller, alleviating socio-economic disadvantage, especially in farming communities. Not everyone has a car or can afford internet access, which adds to the isolation they feel once they’ve had a baby.

“Support is crucial for the wellbeing of both my patients and their babies. I can now sit side-by-side with my clients and input their data onto our maternity systems in real time. I can show them how they can access reputable and clinically-approved support on a wide range of issues on their smartphones.”