18 April 2019

Transition to the Health and Social Care Network has been a challenge for NHS network managers and their service provider partners. Now it’s time to see how HSCN can enable cost-saving digital transformation in public healthcare, writes JAMES HAYES

The mass migration from the outgoing N3 network to the new Health and Social Care Network (HSCN) infrastructure is one of the UK’s biggest technological initiatives: that such an important NHS ICT project has attracted so little media coverage is a reflection of how successfully the roll-out has been managed by the parties involved, from overseeing agency NHS Digital, through to the service delivery providers, and ultimately, its healthcare sector customers.

The replacement to N3 – the IPbased VPN that had connected NHS England and Scotland locations and 1.3m employees since 2006 – went live in April 2017, and user migration between the two broadband networks is now largely complete. Designed and built by NHS Digital in partnership with suppliers and customers, HSCN connects England’s health and social care practices’ data exchange needs via connectivity procurable from a choice of 26 registered Consumer Network Service Providers (CNSPs) – in contrast to the BT-owned/managed N3.

CNSPs must achieve two stages of HSCN compliance. Stage one primarily demonstrates that they can deliver HSCN connectivity in a way that meets the obligations and standards set out by in the HSCN Obligations Framework. Stage two compliance is achieved when suppliers provide NHS Digital with detailed solution design info, and successfully connect to the HSCN central services (including the HSCN Peering Exchange). Once compliant and up-and-running, CNSPs are equipped to take their services to the new buyers’ marketplace and re-establish relationships with healthcare sector customer, existing and new, including the NHS and its supply chains.

Network managers in the NHS have been too busy over the last 12 months to publish progress reports on the restructurings they have had to effect at their end of the change; CNSPs, meanwhile, are, again, well-placed to provide perspective on how this transition has proceeded. Networking+’s review of HSCN roll-out in the February 2018 issue heard from CNSPs as they prepared to embark on the last 12 months of the transition schedule, and detailed how, in addition to the technological challenges faced by NHS network managers, their colleagues dealing with service procurement were also on a steep learning curve, as they become accustomed to new market conditions.

Reports from a changing frontline

“Procurements for services have progressed in line with expectations,” says Mike Thomas, managing director, Innopsis (trade association for suppliers of digital infrastructure and services to the UK public sector). “It’s a good sign that the number of suppliers is higher than anticipated. It demonstrates the attractiveness of the market. There have also been sales of HSCN services in addition to the migration of N3 circuits, which again indicates whole market expansion as a result of HSCN.”

“As with any large and complex data network migration involving multiple customers, suppliers and a legacy transition network, it takes a lot of plan-and-prep to migrate these services, especially those that provide critical health and social care,” Sam Winterbottom, head of public sector sales, Gamma, points out. “The majority of the N3-to-HSCN procurement activity, conducted and awarded over the last 12 months via aggregated procurements, is the relatively straightforward bit. Customers and suppliers who have won HSCN aggregated procurements, are now primarily focussing on this migration activity.”

According to Martin McFadyen, head of public sector at Virgin Media Business, nationwide roll-out of HSCN is still mixed: “Some parts of the country have steamed ahead, while other parts are playing catchup,” he reports. “Many of our projects are already complete, but there is still work for the NHS to do.”

“Procurements for services have progressed in line with expectations.” Mike Thomas, managing director, Innopsis

HSCN is “being delivered – however, to state it is ‘largely completed’ would be a little optimistic,” agrees Gareth Ricketts, major accounts-health lead at Capita IT & Networks. “[But] for such a large migration, the overall picture is positive.”

“Many of the organisations that have already migrated already benefit from higher bandwidth connectivity at a much lower operational cost than the legacy connectivity,” according to Iain Shearman, managing director at KCOM NNS. “As more organisations migrate, NHS Digital will be able to decommission larger parts of the legacy network. This will accelerate cost savings to the NHS and will deliver tangible ROI.” More on ROI later.

No pain, no gain

The journey to this brave new addedvalue communications environment has, of course, thrown-up some pain points along the way, observes Thomas. “The lack of updates to the site records [for the] three years prior to HSCN procurement and the scale of the estate being migrated, has meant that the quality of the information and the requirements were significantly different to those initially reported in many areas,” Thomas says. “The result is that time has been spent making sure the sites exist, have the correct addresses, and the services requested are appropriate for the requirements. This has meant that a number of sites have been able to procure better services than anticipated, often for less than budgeted.”

The basic connectivity has “caused few issues”, says Ricketts. “The main ‘pain points’ for NHS infrastructure managers have been the overlay services, like voice and teleconferencing.” The issue with overlay services has been highlighted by the supplier community for years, Ricketts acknowledges, but warns that without a central solution to the problem, the current national provision could splinter into a series of smaller Community of Interest Networks, “which could mean these services are both more expensive, and less integrated, across the country.”

“Customers and suppliers who have won HSCN aggregated procurements, are now primarily focussing on this migration activity.” Sam Winterbottom, head of public sector sales, Gamma

“The other key pain point is probably around the actual migration of circuits from the Transition Network to HSCN in itself; the migration of existing IP addresses would be one example,” Sam Winterbottom at Gamma says. “De-risking this migration process is vital, and NHS Digital have gone a long way to ensure migrations are as risk-free as possible.”

“The biggest pain point in transitioning to HSCN is overcoming the legacy of having separate health and social care organisations. The benefits can only be fully realised by taking a joined-up approach, but this requires structural and cultural shifts,” says McFadyen. “Smaller organisations have told us they don’t have the right skills and knowledge to manage the change. They’re looking for guidance on the services that should be replaced, and how to access funds to manage the transition.”

“From my discussions with network managers, all of us have been on a learning path to understand the split between the bandwidth of a tail circuit at a site and the size of the bandwidth required to connect to the HSCN core,” says Gamma’s Sam Winterbottom. “In some conversations I have had, most of an organisation’s data traffic is between their own sites, and so they simply don’t need their HSCN bandwidth to match the bandwidth of each individual tail circuit.”

“Network managers do know their networks inside out, and add real value when sharing operational insights,” says McFadyen. “They also understand how their organisation is evolving, and what pressures and challenges that will mean for their network in future. When organisations ‘think big’ about how they deliver services in future – using the HSCN as an opportunity to transform operational capabilities, for example, and offer new services like virtual consultations – there’s more scope to add value.”

Connectivity change opportunity?

When it comes to an appetite for HSCN user organisations to see adoption as an opportunity to revamp their broad ICT structures, no conspicuous trend seems yet to have emerged. Virgin Media Business’s McFadyen describes it as “a mixed bag” with NHS organisations (and their suppliers) falling into one of three groups: the first perform simple like-forlike replacements which tend to miss some of the wider opportunities. The second group invests in its wide-area network at the same as HSCN, and benefits from greater choice and competition in the market which, ultimately, helps drive down its costs. And thirdly, there are those organisations that take a strategic approach, take a step back and procure an environment for the future which takes full advantage of the HSCN opportunity.

“A culture of incumbent extension has been the norm in the main, whereby BT and Virgin have maintained the current service provision, with a ‘soft’ switch from N3 to HSCN,” explains Ricketts. “Therefore, we have not seen many large-scale reviews of enterprise communications. This is partly because of the need to maintain service and partly because the holistic review of a [given] Trust’s enterprise communications requires too many people to put aside time and resources they don’t have.”

However, migration from N3 to HSCN has offered “a chance for healthcare organisations to review their connectivity requirements,” avers Gamma’s Winterbottom – and that has meant a complete review for some of those organisations. “The requirements for bandwidth have increased in comparison to those being delivered through N3. And, it has been a good time to review; as the ‘internet first’ policy gains momentum and more and more services move to the cloud, an organisation’s bandwidth requirements will increase.”

Health-social care integration

“Where organisations are still at various stages of migrating to the new network, there are some clear needs identified in terms of what IT needs to deliver,” reckons Jason Hall, director at BT Health, writing in the 2018 iGov ‘Connectivity across the NHS Survey Report’. (The survey polled a cross-section of IT job roles across NHS, Clinical Commissioning Groups, and the wider healthcare sector.) “The need to do more for less is a key focus for customers in thinking about their IT strategy. HSCN offers huge opportunities as a platform for health and care organisations to underpin digital transformation strategies and [fundamentally] transform how healthcare services are delivered.”

“Some parts of the country have steamed ahead, while other parts are playing catchup.” Martin McFadyen, head of public sector, Virgin Media Business

The iGov report also found more than 50 per cent of its respondents to be reviewing their IT strategy in the 2018-2019 timeframe, and looking for collaborative options – often with social care organisations, adding additional complexity to the HSCN implementation challenge.

“From a commercial perspective, the drive for more bandwidth has been helped by the introduction of multiple suppliers in a competitive HSCN marketplace, which has resulted in lower costs for more bandwidth,” says Gamma’s Winterbottom. “We hear this daily. However, the conversation around requirements has changed. Tail circuit bandwidth at each site does not necessarily mean that the same HSCN core bandwidth is required. There is a little more scoping discussion required to find a solution that best fits than there was under N3.”

“We took part in the main waves of aggregated procurements for HSCN migrations, mainly throughout the first half of 2018. We were somewhat surprised to find that nearly all these large procurements contained hardly any actual HSCN connectivity. Most of these procurements – around 80% – were for intersite connectivity, joining together outlying clinics, hospitals, social care, and education sites,” says Darren Turner, general manager at Carelink. “While we could compete on providing actual HSCN connectivity, we had a significant commercial disadvantage for inter-site connectivity, where network providers with infrastructure already in place were able to offer rock-bottom pricing. So yes, almost without exception, healthcare organisations have taken this opportunity to migrate their entire network infrastructure.”

“For such a large migration, the overall picture is positive.” Iain Shearman managing director, KCOM NNS

“In the early stages, much of the emphasis has been on the connectivity delivery,” says Iain Shearman at KCOM NNS. “As the project gathers increasing momentum, however, the focus is now moving to how HSCN can be utilised as an enabler for the NHS strategic digital transformation programme.”

Return-on-investment

“On the basis of the pricing levels that were winning some of the large aggregated procurements – and assuming the migrations are completed as scheduled – I expect a pretty rapid ROI to come in a combination of actual savings and increased performance,” declares Darren Turner at Carelink. “We were seeing bandwidth charges 80-90 per cent lower than the rates we’d become accustomed to on N3.”

“The closure of the N3 Transition Network points-of-presence, and the reduced budget requirements experienced by the organisations who have migrated, will deliver the HSCN ROI,” says Thomas. “However, this would just be in the terms of ‘like-for-like’. In addition to the fiscal savings, the increased capability, increased supplier market and the increased sets of services and overlay services will add a further level of benefit.”

The introduction of stratified competition into the NHS market via the HSCN has meant a major reappraisal of connectivity charges, says Ricketts, which in the main has considerably improved the ROI for the NHS: “This program by this measure has been a great success and considering the scale and criticality of the network, such a relatively smooth transition must be applauded.” However, although basic costs have been reduced, “the chance to tackle the bigger issues and move towards the strategic goals of ‘Internet First’ and ‘Cloud First’, were never really addressed.”

In this context, the fact that expenditure savings are dependent on HSCN’s operational life expectancy, and that emergent connectivity technologies will likely see the NHS undergo further digital transformation as it progresses into the 2020s, should be factored into any longer-term ROI expectation.

“The NHS can demonstrate value right now,” avers McFadyen. “HSCN provides clarity to suppliers, supports interoperability, offers greater choice and encourages competition in the market – essential to driving down cost and price. It also provides an opportunity for thirdsector community organisations to play a role in a holistic care system. Even this early on the transformation journey, and using only the coarsest measure for value (price paid), NHS customers are already realising truly significant savings. And the benefits start as soon as customers take their first steps.”

“Over the next 12 months, once migrations away from the HSCN Transition Network and onto HSCN proper have kicked in, the NHS will be able to demonstrate significant return-oninvestment, agrees Winterbottom. These migrations “would never happen without the hard graft of health organisations and their IT managers.

They have been working closely with their internal stakeholders and suppliers to make it happen.” Winterbottom adds: “There are a lot of moving parts to be considered, and progress has been slower than expected – but let’s not forget, it has never been done before!”

An early HSCN adopter

Humber NHS Foundation Trust provides a range of services to around 60,000 people in the Hull and the East Riding of Yorkshire region. It employs 2,500 staff across 70 sites. The Trust’s acquisition of geographically-distant new sites, plus the ever-increasing demand for enterprise network and internet access, prompted it to use the launch of HSCN as an opportunity to review its then network provision. Migration to a HSCN-based solution enable it to rationalise its legacy infrastructure, which has led to greater capacity, cost savings, and additional resilience for both Humber and the smaller, local Trusts it provides support services for, Humber reports.

An increase in the number of sites with network connectivity means that frontline staff can deploy the applications patients require, supported by faster access to clinical information during consultations. This has led to increased patient awareness of some of the systems and services available over HSCN – and heightened demand.

Humber NHS foundation trust head office

By early adoption of HSCN connectivity, and with support from NHS Digital and technology partner KCOM, Humber devised what it calls a ‘novel networking solution’. This has allowed more open access to health information, protected by HSCN’s security-enhanced features. In conjunction with other developments this has reduced time wasted for corporate and clinical staff. This leads to less frustration with underperforming connectivity and increased satisfaction and health outcomes for patients and staff, reports report Paul Wright, IT operations manager at Humber.

“The implementation of the new network across East Yorkshire has enabled staff to work in an agile fashion, reducing the time spent travelling across the county, supporting an ageing network infrastructure,” says Wright. “It allows trust IT support staff to work more closely with our colleagues in other trusts, building relationships to help us to improve the service we provide for interconnectivity across our supported trusts.”