06 March 2018

Even its most ardent admirers would likely acknowledge that the NHS has a mixed record for transformative ICT project delivery. But the rollout of the Health and Social Care Network (HSCN) shows that architects of public healthcare networking have gained much from experience. 

The HSCN is the broadband infrastructure that replaces the NHS National Network – N3 – which had connected NHS England locations and 1.3 million employees since 2006. Its successor went live in April 2017, and user migration between the two systems is due to be completed by March 2019.

Designed and built by NHS Digital in partnership with suppliers and customers, the HSCN connects England’s health and social care practices via connectivity procurable from a choice of suppliers unlike N3 which was owned/managed by BT.

In October 2017, dictation and clinical records management solutions firm Crescendo Systems became the first organisation to access the HSCN. Its connection came from MLL Telecom, one of the earliest of the 26 Consumer Network Service Providers (CNSPs) that have so far attained HSCN compliance.

Better operating expenditure management is one of the compelling factors of the HSCN modus operandi; network managers can apply critical evaluation to providers until they find one that offers the best value package for their requirements.

Darren Turner, general manager at Carelink – the healthcare managed infrastructure and network services business of Piksel  – says the cost for HSCN connectivity is “significantly less” than for N3. “So organisations can now have the bandwidth they need at the price they can afford. With N3, we have had a single provider – BT – deliver network services its own way to the healthcare sector. That has been a good fit for many organisations, but the needs of many others are [arguably] better served by small- or medium-sized providers that offer more customised services.”

Gareth Ricketts, healthcare lead at Updata Infrastructure (part of Capita), adds that the HSCN offers several other potential benefits: “For instance, new technologies unavailable under N3 will be now available to the NHS – such as G.Fast, FTTP-on-Demand, SD-WAN, and so forth. Also, NHS bodies will be able to engage more closely with their supplier to focus on meeting operational needs rather than just buying a circuit.”

According to NHS Digital, a requirement to provide value for users at all stages of adoption is designed into the HSCN specification. 

N3 has been around for a long time during which network prices have dropped, and Sally Westwood, head of portfolio compliance/HSCN lead at KCOM, agrees that NHS organisations can now expect to make significant savings with the new network. “We have seen stats which suggest that organisations that have moved from N3 to HSCN have seen between 30 and 65 per cent savings.”

Of course, Westwood acknowledges that not every organisation may be able to achieve this. However, she also points out that HSCN compliance obligations represent a supplier overhead that will make it difficult for them to offer ‘commodity’ prices. “If healthcare [organisations] want to maximise their cost efficiencies, they must take opportunities to consolidate networks and challenge CNSPs to come-up with innovative ways to make that happen,” says Westwood.

Carelink’s Turner is likely to concur here. He believes the HSCN presents a great opportunity for organisations to look at overall connectivity requirements, and assess whether there is benefit from consolidating under a single supplier. “Some CNSPs also provide connectivity to other government networks, so there are opportunities to reduce the number of suppliers that healthcare organisations have to deal with, and to negotiate on prices for packages of services.”

The cost cutting network? 

Many healthcare sector network managers whose trusts are still at HSCN adoption planning stage have yet to discover if the replacement service really will deliver performance gains and cost savings as promised. And as Updata’s Ricketts further notes: “There has been no funding provision made in this process for cost of change, it being assumed that the derived cost saved from cheaper services will cover this shortfall.”

According to the CNSPs Networking+ spoke to, although the new network should offer demonstrable benefits over the old, the switch from N3 to the HSCN is not necessarily a straightforward like-for-like transition. And while long-term operating expenditure savings may well accrue, in the shorter term HSCN adoption must be managed carefully to avoid costly service disruptions.

“Transitioning from one service provider to a one-to-many service providers environment is a transition that requires careful management,” warns Afshin Attari, director of public sector at Exponential-e. “It is important to understand legacy and future networking architectures to match them to services and their topologies so that technical interdependencies are not broken by the transition. Like any transition, the plan needs to be robust and approached with the objective of doing everything possible to reduce risk.”

NHS England uses many legacy systems, so it is vital to understand the dependencies of these systems and how those dependencies will be impacted by network change. “Network managers need to follow a process of risk assessment, identifying users, remediation planning and knowledge onboarding. CNSPs will have many examples of transitions they have managed, lessons they have learnt. This is something that healthcare IT change leaders should tap into and utilise,” says Attari.

Indeed, the initial migration phase will probably incur upfront capital expenditure costs. Ian Wilcox, business development director/health at MLL Telecom, says organisations must undergo exacting planning and preparation for the service swap, adding: “In order to move to HSCN, organisations have to procure new connectivity services from an accredited CNSP. Generally, this will mean that new circuits and equipment need to be installed.”

While this may provide a straightforward fallback to N3 should the migration experience problems, others also agree that it entails additional investment in ICT infrastructure. For instance, Carelink’s Turner says new routers will normally be required for a new connection that, on average, will cost a “few thousand” pounds. Network managers who, for whatever reason, miss their migration window, will then have to decide if they want (or are able) to continue with other aspects of the programme or leave the new routers in their boxes pro tem.

UKFast announced in early February 2018 that it had been awarded stage one compliance to provide services through the HSCN. As a result, the hosting provider says it is the only provider to offer HSCN connectivity directly from a government-approved data centre. The company’s CEO, Lawrence Jones, says that as NHS organisations move to more web-based services with more people trying to connect to the HSCN, all the infrastructure has to be in place and it has to be able to scale at a moment’s notice. But he puts a more positive spin on the issue when he says: “[This] is not only a convenient moment for NHS services to upgrade their enterprise communications, but it’s a reminder that legacy hardware may not have the capability to deal with the increasing demands of NHS users on the new network.”

And speaking from the perspective of a CNSP, Ricketts says changing out one network to another is “business as usual” with few extra challenges compared to any other public sector body. “In any transition, minimalising disruption is down to good project management, and CNSPs have much expertise in this area.”

MLL Telecom’s Wilcox adds that NHS Digital recommends carrying out tests to ensure applications that were accessed over N3 can still be accessed over the HSCN. “If this runs smoothly, then users experience a short break in service, after which they should see no functional change. We see savings and performance improvement over N3. Annual rental is reduced, and any one-off installation costs can be amortised if capital budget is not available, which would still offer a reduced rental.”

KCOM’s Westwood goes on to point out that according to NHS Digital, in order to transition fully from N3 to HSCN by August 2020, 3.5 migrations will need to happen every hour of every working day for the next two years. She says there is currently a “trickle” of migrations coming through, but the expectation is that this will become a torrent over the next six months. “NHS Digital can only handle a set period of migrations each day so during the migration peak getting a slot will be tricky – especially as the number of slots available is locked four months in advance.”

Where possible, Wilcox advises NHS network managers to try and keep their HSCN architecture similar to their N3 setup. He also says that while there is a tendency to want out-of-hours migrations at key sites, in MLL Telecom’s experience it is actually better to do this during the working day – even if this involves a short break in service. “Any issues with user access to N3 systems will be picked up immediately and can be resolved while IT staff and CNSP engineers are on-site,” says Wilcox.

Don’t race to the bottom 

Exponential-e believes that N3 to HSCN transition practicalities are not necessarily the main issue facing IT change leaders within UK healthcare organisations. “It is more the complexity that presents a challenge,” says Attari. He warns that the sheer volume of circuits that need to be switched is where the potential for a few technical ‘gotchas’ come in. “It’s important to understand the logistics of the transition and understand the technical checkpoints that need to be considered to assure continuity of service. With an estimated 33,000 circuits to be switched over the next two years, there is only a small window when change can be enacted. If an allotted window is missed, another won’t open again for some time.” 

Jones is likely to agree here and says that because the HSCN is a new network, everybody wanting to be hooked-up has to have a new connection. “There are around 15,000 current connections to N3 that need to be transitioned to the new network, which almost means digging up the street and laying new fibre. That’s why the major pain, as we see it, will be in the actual wait to get HSCN-connected.”

All that could mean that an NHS trust’s move to the HSCN is delayed, and value gains are deferred.

For Chris Wade, commercial director at The Networking People (TNP), the biggest ‘pain point’ for many NHS consumers will be in deciding on the overall network strategy. “The choice of delivering HSCN on a site-by-site basis, or centrally to a single point, and using a traditional WAN to deliver it, will be difficult for many. This is also confusing for many network managers when faced with the choices offered by SD-WAN, as this is not a choice that has previously been available for them.”

Ricketts also advises network managers to quickly become familiar with HSCN procurement procedures so that they can avoid the need to pay costly, third-party advisors for help with that aspect of the transition. “The N3 procurement model of purchasing a limited number of fixed connectivity services through the N3 catalogue meant NHS bodies’ procurement departments have little or no experience of using government tendering processes.” 

This lack of experience has led to NHS bodies employing external consultants to create tenders, followed by a race to the bottom as cost is the only differentiator. Ricketts warns: “This appears to be saving the NHS monies. However, it could lead to network failure with serious operational implications due to the type of low-grade services offered by some CNSPs.”

TNP continues by saying organisations need to consider the N3-HSCN migration in terms of their overall connectivity requirements that will include current N3 services, ISP, WAN, and cloud services. “NHS network managers should not assume that they will consume HSCN connectivity/services in the same way that they have consumed N3 connectivity/services,” says Wade. “This means that the whole landscape in terms of applications and overlay services is likely to change, as the cost of bandwidth to HSCN reduces due to it moving towards being a commodity service. [NHS] organisations could, therefore, use it as an opportunity to streamline, cost-reduce, and improve the network connectivity they currently have.”

Is it safe?

Given recent NHS cyber attacks (notably WannaCry in May 2017) security will be a high concern for any HSCN user organisation. Despite remedial action taken at many trusts post-WannaCry, a Public Accounts Committee was recently told that 200 of them fell short of the Cyber Essentials Plus certification when subjected to on-site assessments by regulators from the Quality Care Commission.

According to KCOM’s Westwood, the HSCN is built on the CAS(T) industry security standard which is designed to provide secure telecoms for government and related organisations, and is run by CESG of the National Cyber Security Centre.

She says: “This is a similar approach to that for the Public Services Network (PSN), but HSCN has additional features – for example, a data security centre and advanced network monitoring for internet-based traffic. It also has a network analytics service which analyses network traffic data to detect and investigate potential security attacks. So HSCN is secure. However, in today’s environment we still recommend that healthcare organisations consider encryption at the application level, in line with government Cyber Essentials guidelines.”

Turner adds that security was always a big part of N3 and remains significant to the compliance process for the HSCN. “CNSPs must provide evidence of their information security practices which have to meet all relevant NHS/UK public sector security standards. These are ongoing requirements for CNSPs that will evolve to incorporate any relevant new initiatives, and will always be a strong focus of the continuing compliance process.”

MLL Telecom’s Wilcox also points out that the cyber security management obligations on CNSPs mean that potential threats can be identified early and addressed rapidly across the whole HSCN supply chain. But he goes on to warn that this should not be seen as totally secure, and so each organisation needs to assess the risks and put in place the protection needed to mitigate possible threats. “HSCN is a private network domain with defined boundaries, and there are measures in place to police this domain and protect the boundaries. Simplistically put, it’s more secure than the internet, and less secure than PSN.”

Exponential-e’s Attari supports this view when he says that the HSCN is not “quantifiably” more secure than comparable networks and would not, for example, protect the NHS from another ransomware attack. But unlike N3, he says the new network is much easier to overlay services over. “As a result, organisations can create a proactive security posture. More importantly, the HSCN is designed to evolve – it offers more compatibility to aggregate the required technologies so that healthcare organisations have a holistic view of cyber threats.”

The “one pipe” to bind them all

Innopsis is the industry association for suppliers that provide network services to public sector bodies. It worked with NHS Digital to create the obligations framework for the HSCN and says that at its heart, the new network is an open transport network designed around a set of operating standards and principles.

“The restrictions of the past – network availability and type – have been removed, and the only consideration now really needs to be about information assurance of the application using HSCN,” says the association’s innovation director Michael Bowyer. “I think of HSCN as the Apple app store for connectivity. Suppliers and consumers are free (for a fee) to create or consume services, and as long as they are compatible with the HSCN standards, then they will work.”

Ultimately, the HSCN will enable NHS organisations to implement digital technologies that will benefit both staff and patients alike.

“Simple things like ensuring data is in the right place at the right time across multiple devices and in a secure fashion, will improve the patient journey as the NHS re-engineers itself for the digital age,” says Attari. “These benefits come from the ability to deliver multiple services over ‘one pipe’. Empowering different trusts to securely aggregate their connectivity requirements brings not only extra agility, but also the ability to realise significant cost savings.”