Look. It’s time we talked about something. NHSland has a problem. A debt problem. A technical debt problem of immense proportions. We’re friends. We can talk about this. Openly. We want to help.
Beveridge identified Five ‘Giant Evils’. We’ve also identified five giants. Five giant factors that compound the technical debt in NHSland: Security, Legacy, Speed, Cost, Freedom. Beveridge’s work was instrumental in establishing the NHS. And we love the NHS. We want to help the NHS deal with these giants and end the downward spiral deeper into technical debt.
Giant 1 : Security.
The ‘NHS’ must have 70m+ patient records, 1.2m employees, a 1m or so desktops, countless more indirect users from third parties, thousands of locations, and a spaghetti of interconnected infrastructures. This would be a significant challenge within a single enterprise; when distributed around the many individual organisations that make up the NHS the challenge is gargantuan.
Giant 2 : Legacy.
We know you’ve still got Windows XP running. And just as soon as a majority finish migrating to Windows 7, Microsoft end mainstream support for it. Oh, and Windows 10 mainstream support ends in 2020, just about the time you’ve all gone paperless… And then there are the applications prescribed by The Centre that must be deployed, each with its own dependency on a Java version long since retired, each with a specific browser version that conflicts with another. Each update released comes with fear and loathing.
Giant 3 : Speed.
Medicine is fast; responsive and agile. NHS tech is slow; reactive and cumbersome. Modern software development leverages browser technologies and network services to rapidly get functions and features to users, while in NHSland cascading roll-outs of fat desktop applications remains the norm. Shortening the tech life-cycle and increasing the pace of delivery are aims that we’ve been hearing from Innovation Accelerator Challenge Award Competitions for years. There won’t be any Fast Followers when there are only Slow Leaders.
Giant 4 : Cost.
Typing, font changing, saving, attaching, sending, receiving, tracking changes, Replying To All, shared calendars, instant messaging, meeting invitations, chat, video conferencing: these are common functions of commodity software. There are several ‘feature comparable’ office applications on the market, with prices ranging from £FREE to £000’s. Why pay for one software package when a comparable and compatible alternative can be used for free?
Someone recently told us the license cost per-seat for disk encryption software. For 1300 or so machines, spreading the costs over a 5 year subscription for affordability, licenses were £12 each. That’s around £15,000. At one organisation. The numbers bleed into zeros when the charge for over the whole NHS is considered. For software capability that could be acquired for £nothing.
Giant 5 : Freedom.
The legacy dependencies, ever present security challenges, increasingly frustrated and dissatisfied users, costs spiralling in direct proportion with the reduction in finances. These factors restrict customers and vendors alike. We want to help the NHS break free from these constraints.
To provide tech that is Secure, Modern, Fast and Free to the NHS.
And slay giants.
Marcus is a self-described 'General Hacktitioner' GP, Emergency Physician, specialist in clinical IT, and a programmer of an increasing range of languages that he barely understands. He founded Open Health Hub with Rob Dyke and Ewan Davis back in 2012, and since then has been trying to create positive change in NHS IT.