As the scope of cuts to the UK public sector becomes clearer, the holy grail becomes finding places where money can be saved with no impact on frontline services. No one wants fewer hospital beds, cuts to school meals or mothballed paramedic crews if we can make do with fewer email servers and fat terminals. Socitm logo The …
"The implication is that the government is such a big client that suppliers will want to accommodate procurement requests if at all possible." is the funnies thing I've read in a long while.
Consultancy firms will happily sell any old shit to the NHS, and the NHS will throw money at consultancy firms. The recent london ambulance debacle has amply demonstrated that the public sector cannot procure the correct IT solution to save its (or anyone else's) life.
Much of the problem with NHS IT and doing things remotely is crippled by DSL and BT having such a strange hold on the market.
There could be a lot more centralisation and cloud based services if the connectivity was there. 50-100MB cable everywhere with high speed upload.
I do not want my medical records on the cloud
And anyone who does is an idiot imho.
My NHS IT plan...
Here is my proposal for the NHS IT infrastructure, it is probably poorly informed and politically impossible, but that has never stopped anyone writing before...
This article, and the others about the NHS recently, got me to I thinking that the NHS should follow the example of nebula.nasa.gov, they are building a cloud infrastructure specifically for NASA and it's dependencies. Then NHS departments could just bid for server time and pay appropriately.
The NHS could replace their local server facilities by buying five ISO container data centres (North, South, Scotland, Wales and NI) which could load balance between each other over a 10 GB/sec backbone provided by C&W or Level3 (or anyone other than BT). Modest staffing at each site could be backup support the other sites and provide remote management capabilities in the event of staffing issues. The containers can easily be supplied with generator power from the hospitals existing solutions and also have their own UPS battery backup on-board just in case. They can also have their on-line UPS batteries maintained by local renewable energy sources (such as solar, CHEP, wind, etc) and thus reducing the demand on the grid.
Combine these core server farms and backbone with a leased PWAN network between large sites (like hospitals), which is often not as expensive as it sounds if you know how to negotiate, you would have a fast and powerful network which was cost effective due to central purchasing. Local offices like doctors surgeries can survive with ADSL2+, or EFM for larger sites, into a PWAN linked to the fibre WAN. The PWAN could be sub-divided into divisional trust regions but still linked to the same core backbone with it's VLANs, preserving regional independence but taking advantage of central purchasing.
Use something like MokaFive Baremetal to deal with desktop locations instead of traditional Desktop Virt. That would help the security and support issues because you can remotely lock and retire any asset or you can rebuild a broken computer quickly and automatically. Local IT staff can the be delegated to look after a much smaller asset base with no servers to worry about, just desktop hardware assets and telecoms kit. Traditional Desktop Virt would be a risk if links were lost, but if computers had a local copy of their image they could be managed remotely with reduced risk. Distribute support between the core sites and balance the peaks/troughs between the sites. For example NI has higher unemployment and has a great many people who could do this job but by distributing the support between centres you reduce the need to centralise costs and can make use of existing office facilities without building new specific infrastructure.
Fail-over and disaster recovery would be de-centralised in this design, costs would be reduced and energy costs would be reduced. Reduced energy footprint at remote sites would improve the environmental consideration. Cooling could be managed because load-shedding could be used (google style) or in the event that cooling failed in one container it wouldn't be an issue because the other regions could cover the load. Security could be managed through a distributed core database which was related to HR databases, thus if someone was suspended their privileges could be revoked quickly. A national VLAN structure would allow regional control to be maintained and sites could have a powerful multi-core network appliance attached to their VLAN switch which would provide flexible firewall and VPN functions that provides further security protection on a local basis. Internet and government intranet peering can be achieved and managed through multiple DMZ VLANs.
Oh, and they shouldn't commission anything custom, they should buy it as COTS (commercial off the shelf) because the NHS has a history of wasting money on huge IT projects. I would view this as a radical but it need not be a 'millennial' project. Sites could even migrate slowly rather than all together at once. Some would be tempted to build fancy new offices and server rooms for such a project, but I wouldn't; I would suggest just utilising existing facilities assets as much as possible. The server assets could be retired organically as they are migrated to a virtualised infrastructure. The whole thing can sit on-top of the existing infrastructure until eventually everything is migrated.
Trusts would be encouraged to use these centralised facilities through the cost savings of centralised purchasing and yet they would retain their own independence by being able to manage their own virtualised assets rather than handing power to some over-lording authority. Local connectivity decisions can be made to suit the local needs rather than being imposed from the top because a centrally supported PWAN infrastructure could connect to any type of connectivity, but it would be for the PCT or managers to judge if deviating from standard wholesale communications infrastructure was justified.
Build it big, build it cheap, keep it flexible and give it scale...
I'll get me coat, it's the white one.
Nice one that. Where were you seven years ago?
I can tell you where I was.
I was negotiating such system with the NHS along with lots of other suppliers/competitiors. And you know what? We built it and it only cost the NHS £500m. Now I help run it and it's working out a damn sight cheaper to run that anything we had before in the UK. It's even cheaper than some of the huge US private medical systems and they are all about squeezing the very last penny out. It's bullet proof too.
Now if the Trust IT Managers would only start using it the NHS might start to realise some real benefit. All patient records run across it all ready, so don't even bother whinging about that. Rio is up and running as is PACS, More and more Acute apps are rolling out. The sky's the limit really, especially now ITK has got the go-ahead.
Labour put it in but I fear the Tories will reap all the benefits.
Can cloud save the NHS?
that is all...
The cloud can only bring benefits to people who actually know what they're doing.
NHS has a looong history of not knowing what the blazes is going on anywhere, so cloud will only further muddy things up.
It's a bad idea, and therefor NHS will pick it up and run with it as far as possible. Expect to soon hear "hey, we're putting NHS IT in the cloud, all will be better as soon as we're done". And it'll only cost £1.5 billion".
So clouds may reign..
I just liked the pun that's all.
I suggest spending the money on university research grants to design secure and implementable protocols for sharing medical data, database implementations of the protocols and proof of concept clients. Then publish the whole lot and let the private sector get on with it. That way when it fails it won't be a total right-off because we may get some computer graduates with big system experience and universities with some decent bloody facilities and the big-brains of the future may not bugger off to the US.
Flippant Disregard For Data Security
In keeping with the way other government agencies look after our data, I wouldn't be surprised to find all our records being kept on an old NAS drive someone found in a skip.
As an active (unwilling) participant of the NHS, I would suggest that all this is unnecessary expense for little gain. We have a very successfull "emergency" records system in the country that provides immediate information on background and contact information. Beyond that, IMHO, we should only have detailed medical records at one location, the primary location for treatment. In the vast majority of long term treatment, this is satisfactory, and avoids issues of confidentiality, dupliction, accuracy and dare I say ownership. I only want one physician managing my treatment, not a virtual team. Limit the electronic sharing to appointments.
The UK surface area is roughly that of the state of Oregon.
Specifically 94058 sq miles Vs the 95,996.79 Sq miles of Oregon. So how many state and federal data centres does *it* need to cover this area I wonder?
IIRC El Reg mentioned the UK has about 194 government data centres.
Equally seriously why do specialist staff *have* to be located *at* the centre?
Experienced good quality staff who get to *practice* their skills regularly are about the most valuable resource *any* IT operation has. Unlike *any* bit of hardware you can't just order up a blank copy and clone the software.
NuLabor spent shed loads on broadband links in the NHS. It's long *past* people started making them useful to allow IT staff to be shared across sites (and the number of IT sites to be *radically* reduced).
One of the *few* successes of the NHS IT programme (often mentioned as there seem so few of them *to* mention) is the medial imaging archival and transmission system.
*Why* can't something like that exist to share the highly skilled IT specialists across multiple sites?
As for the cloud. A big system stores all the data remotely at a site users cannot get to cannot change (if they don't like the data security polices of the country it's in) and cannot even find out what country it's in in the first place.
Yeah. What can go wrong with *that* plan.
And what's the size of the population in Oregon against that of the UK? The NHS is not about the size of the geographical area served, but rather the size of the population.
The question is why does the UK need *so* many government data centres in the first place. For the record Oregon's population is 3.8million in 2010. I doubt their administration is any more paper based than the core of the UK's systems.
Is the speed of light slower in the UK? The round trip time Lands End to John O'Groats at the speed of light is just under 7.8ms. Most humans would find response times 10x that acceptable. Putting them somewhere nearer the centre would roughly halve that.
I'm not suggesting actual *consolidation* of departments sharing hardware. Just putting most of that hardware in fewer (but much larger) centres. Physical security, power and thermal management and comms are all subjects where *bigger* is better
Yes - what a great idea NOT!
Everything's going great until a fault develops and ALL the NHS functionality goes tits up. Great idea hmmm.
The cloud is a myth and its services are vaporware if an emergency develops at the central server point. Don't put all the eggs in the cloud basket.
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