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Creating a new NHS England: NHS England and NHS Digital merged on 1 February 2023. More about the merger.

NHS winter pressures: advice for health sites with ADSL connections

Due to increased demand being placed on IT networks, all healthcare sites using an asymmetric digital subscriber line (ADSL) connection should review their connectivity and move to a faster, more reliable connection type.


All sites still using an ADSL connection as their primary Health and Social Care Network (HSCN) connection should review their connectivity and, if appropriate, upgrade connectivity now, in advance of the anticipated winter pressures the health service will face and any second wave of COVID-19.

Why it's necessary to consider upgrading existing connectivity

Given the unparalleled challenges caused by the COVID-19 pandemic, the world of work, and particularly healthcare provision, has changed beyond recognition. With the increased demand being placed on the network capacity of healthcare providers of all sizes, we are recommending that all sites using an ADSL connection review their network connectivity and move to a faster, more reliable connection type which is, at a minimum, superfast broadband.

In the event of a second significant increase in COVID-19 cases, combined with added winter pressures, it may be necessary to offer an increased suite of remote services, including video consultations for patients and increased remote working for staff. According to Microsoft usage statistics, a high-definition video call requires a minimum download/upload speed of 2Mbps. As such, networks can quickly come under strain if staff need to move work to a virtual environment. 

The best ADSL connections can offer download speeds of around 24Mbps, but the maximum upload speed is 1.5MB. This limit to local upload speeds is a severe limitation and will prevent multiple users being able to work concurrently. This considered, we are advising you to move away from ADSL connections in advance of a potential second wave of COVID-19.

Moving away from an ADSL connection is also a requirement under the GP IT Operating model at the next procurement cycle. The GP IT Operating model states that ADSL services should no longer be procured for primary connectivity and existing ADSL primary connections should be upgraded to superfast broadband at the earliest opportunity.

How to upgrade connectivity

You should first contact your HSCN supplier. They will be able to guide you as to what connection types are available in the area and whether there will be a cost to upgrading your connection.

For any upgrade from an ADSL connection to an upgraded connectivity type, it may be necessary for an engineer to visit the site to carry out the upgrade.

Next steps

If you are still using an ADSL connection and believe you need to upgrade your connection, you should begin work to upgrade your connection type as soon as possible. As mentioned above, you should prioritise speaking to your existing HSCN supplier to review the options available to you and a first step towards moving away from ADSL.

Please contact the Access Logistics Hub by 16 October 2020 with a copy of the quote from your HSCN Supplier for a contribution towards increasing your capacity until March 2021.

Further to the above, NHS Digital requires your organisation to undertake that it, its partners and its sub-contractors are fully compliant with the Public Contract Regulations in respect of how any procurements or contract variations under an existing contract relating to these connectivity upgrades are carried out.

If there are any further questions regarding this process, please contact [email protected] for guidance.

Last edited: 12 October 2020 8:17 pm