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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 FTTC Connections

Due to increased demand placed on the network capacity of healthcare providers, we recommend that all sites using over 75% of available capacity on their FTTC connection review their network connectivity and move to a faster, more reliable connection.


All sites still using a fibre to the cabinet (FTTC) connection as their primary HSCN connection should review their connectivity. If appropriate, and where sites already physically have higher speed connectivity available, they should look to upgrade now.


It is particularly important to act now in advance of the anticipated winter pressures the health service will face and any second wave of COVID-19.

Why its 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 recommend that all sites using over 75% of current available capacity on their FTTC connection, as provided by your HSCN supplier, review their network connectivity and move to a faster, more reliable connection where available.

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.

FTTC connections can offer download speeds of up to 80Mbps, and upload speeds of up to 20MB, however these are often much lower depending on local factors, as well as contention on the network from other users. Limits to upload speeds hinder a site’s ability to:

  • upload large files
  • adopt Cloud hosted services
  • adopt Voice over Internet Protocol (VoIP) telephony and video conferencing
  • run multiple lines of data traffic

This considered, we are advising you look to upgrade from FTTC connections, where a better physical alternative already exists, in advance of a potential second wave of COVID-19.

How to upgrade connectivity

You should first contact your existing HSCN supplier. They will be best positioned to provide guidance on what higher bandwidth options are physically already available in the area and whether there will be a cost to upgrading your connection.

Note: when upgrading from a FTTC connection to a higher bandwidth option, it may be necessary for an engineer to visit the site to carry out the upgrade.

Next steps

If you have purchased a FTTC connectivity service, you should review your network utilisation. If it is running higher than 75%, and where you already physically have a higher speed connectivity option available, you should explore upgrading as soon as possible.

As mentioned above, you should prioritise speaking to your existing HSCN supplier to review the options available to you.

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 8:18 pm