Connecting the NHS from within

07 August 2023

Maintaining connectivity within hospitals has always been a challenge – here’s why

Anyone who has spent much time in hospitals will have noticed the huge range in quality of connectivity from building to building and room to room.

Factors including budget constraints, legacy systems, regulatory and security considerations, and interference all contribute to what can be a shoddy experience. The buildings themselves are another common cause of connectivity challenges.

“The biggest factor is building design – as with many modern buildings, they must be built with sustainability in mind,” says Jamie Duncan, group marketing director, The Clarus Networks Group. “Materials such as concrete, steel, and Low-E glass, although excellent for energy efficiency, actually block cellular signals from penetrating the buildings.”

“And with an estate often being made up of several different buildings spread across a campus, this adds another complicating factor to mobile connectivity,” adds Simon Frumkin, CEO, Freshwave.

Hospitals also house MRI machines, X-ray machines, and other electronic devices that generate electromagnetic interference that disrupt mobile signals, says Duncan.
“And because hospitals tend to be high-footfall places, the WiFi is often overburdened, making it unsuitable for critical communications, especially when people are on the move around the building or campus,” adds Frumkin.

Chris Quinn, solution architect, TNP, says that, with the explosion of mobile and wireless devices in use by both NHS staff and patients, WiFi deployments are no longer fit for purpose.

“The latest WiFi platforms utilising cloud-based AI/ML to monitor service levels delivered to clients can streamline support activity by identifying issues and offering automated resolutions, reducing the workload of NHS IT teams,” asserts Quinn. “But WiFi alone won’t solve the problems - WiFi needs to be underpinned by a high-performance wired network that provides the level of segmentation and security to protect sensitive data.”

Frumkin agrees that WiFi will never be good enough for critical communications; “even WiFi 6, because it uses unregulated spectrum. That means that there are lots of people using the spectrum in an unregulated way. People next door could even be using it! WiFi also lacks the mobility function of mobile, which means that the signal can drop in and out as someone moves around a building.”

“Patients, healthcare professionals, partners and visitors have become accustomed to fast and reliable connectivity outside of healthcare settings, but as the NHS accelerates its own digital transformations, access to high speed and secure connectivity will unlock value from any digital transformation,” adds Richard Malizia, business sales director, Glide.

Putting patients at risk

Unreliable connectivity can have a shocking effect for everyone in the building.

“It can put patients at risk if staff can’t be located,” explains Frumkin. “It reduces staff productivity, as they spend time trying to get on the network to complete a task as simple as updating electronic patient records. It holds back productivity gains.”

Moreover, patients miss out on being able to connect with friends and family. “For patients, no mobile coverage means they cannot contact loved ones, or access mobile data for entertainment during long stays in hospital. For staff and patients, this can have a detrimental effect on their wellbeing,” says Duncan.

There are several initiatives targeting the digitisation of the NHS, including the 2020 announced NHS Long Term Plan, which outlines a mobile-first digital transformation strategy. With the phasing out of DECT phones and pages, mobile devices are key to many aspects of service delivery, including A&E support.

“However, poor mobile coverage means that staff cannot access vital voice and data connectivity, in many cases having to leave the building to make a call – this can lead to delays in critical information exchange, resulting in potential patient care errors and compromised patient safety,” says Duncan.

For NHS leaders working on digital transformation, assured connectivity is essential, agrees Frumkin: “mobile connectivity is the platform on which an infinite number of services can be built.”

The NHS Digital Cloud First approach, meanwhile, dictates that digital services should move to the public cloud unless there is a clear reason not to do so, to enable emissions reductions and reduce infrastructure deployment times.

However, “NHS Digital’s Cloud First approach and the increasing centralisation of services across NHS Trusts will place increasing demands on wide area connectivity, requiring high-bandwidth, low-latency connectivity between sites and data centres and high-speed internet connectivity,” says Quinn. “Legacy connectivity contracts with a single infrastructure supplier often do not deliver the full range of the latest technology solutions in a cost-effective way.”

Malizia believes that all IT and network managers should centre their efforts on four key outcomes for their organisation: “they should start with ensuring agility and high-performance managed network services reach the edge of their organisation network. They should also make sure they can handle unexpected events, reduce risk, and drive sustainability with high-availability connectivity. The ability to gain near real-time, data-driven management insights into their organisation’s network operations is also crucial. And finally, creating agility while maintaining their security posture across the full networking environment.”

Digitising the NHS

According to Malizia, some healthcare settings are beginning to adopt their own version of ‘Digital First’ - adding new technologies around video clinics and emerging AI diagnostics.

“However, failing to lay the network foundations will only cause them to fall further behind,” says Malizia, indicating that a ground-up approach is an absolute must.

“With the recently published Wireless Infrastructure Strategy including ‘our new hospitals will be 5G or equivalent wireless enabled, enabling us to take advantage of cutting-edge healthcare innovations,’ IT leaders in NHS Trusts will no doubt be considering their indoor mobile connectivity options,” opines Frumkin.

As such, according to Duncan, there are several aspects IT managers should consider when addressing poor connectivity:

Regulatory compliance - The market has been flooded with domestic-focused mobile repeater products that are not Ofcom approved, making their use illegal.

Compatibility - IT managers must consider compatibility with required frequency bands and technologies used by mobile network operators (MNOs) in the area.

Future proofing – The scalability of the connectivity solution, ensuring that it can accommodate increasing network demands and the potential for future expansions or upgrades, should be considered.

“The importance of connectivity is only going to increase in years to come, so IT managers must ensure they can deliver assured connectivity that meets their needs today and can also be built on for at least ten years into the future,” agrees Frumkin.

NHS IT Teams are under pressure delivering business as usual services, so engaging with the right partner offering a holistic range of network services across LAN, WAN and cloud will be critical to help the NHS deliver the cloud and WiFi services staff and patients now expect, says Quinn. “With the right planning and investment, high performance connectivity can be delivered across any new or existing NHS facilities. Connectivity can become the enabler of shared infrastructure, applications, and services across trusts at pace.”

Connectivity by design

Connectivity by design must play a bigger role going forward.

However, scarcity of capital to fund transformation initiatives is the overarching challenge, says Malizia. “NHS trusts that can find partners to solve this CapEx challenge will be the trusts that dramatically accelerate network transformation and will achieve it quicker than the industry benchmark.”

By incorporating robust networking infrastructure, efficient cabling systems, and wireless access points strategically placed throughout the building, planners can create an environment that supports seamless connectivity.

“It’s important for us to work with architects and construction managers to ensure that buildings are being designed to accommodate these technologies. This will ensure optimal performance of a distributed antenna solution (DAS), at the lowest cost per square metre,” says Duncan.

But it’s also possible to improve connectivity in older buildings by deploying mobile solutions.

“A working hospital is a complex environment, but it’s by no means impossible,” says Frumkin. “We’ve deployed connectivity on brownfield hospital sites and while it takes more time than doing so in a new build, it’s perfectly possible and indeed necessary to ensure that older parts of the NHS estate aren’t left behind.”

Duncan agrees: “thanks to our passive and hybrid DAS options, which have already been rolled out to over 50 NHS Trusts in the UK, there is no need for this to be an ongoing problem for pre-existing buildings. These solutions are flexible and can be retrofitted to any type building.”

With several initiatives in place, it’s clear that decision makers are all too aware of the import of in-building connectivity for staff and patients. However, due to the scale and complexity of NHS infrastructure, resolution of every ‘notspot’ and inconsistent signal will take time.