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Questions on the use of cloud in integrated care


James Henigan SCC

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There are great opportunities but also a series of challenges in harnessing cloud services for the integration of health and social care, says James Henigan, managing director of SCC Hyperscale and SCC Cyber

The landscape is changing in health and social care, with a clear consensus on the urgent need for a stronger integration of the two - and that technology is going to be a prime enabler of this.

Cloud systems are going to be at the heart of delivering an integrated health and care system, making it possible for organisations to collaborate, share data and applications and develop new models of care, and are expected to be a big factor in supporting the new integrated care systems (ICSs).

A UKAuthority survey of 113 professionals in health and care showed that, when asked how important this would be, on a scale of one (not important) to five (crucial) the average rating was 4.25. But there are complex issues to address to ensure that new investments in cloud will align with plans for the closer integration of care services.

Further research by UKAuthority, supported by SCC, revealed that some of these issues are in the nature and development of cloud services, including that the market may not be quick to provide applications in the public cloud that match legacy systems. A survey question on whether respondents had any mission critical applications that are unsuitable for migration to the public cloud prompted 45% to say that this was the case, with 45% saying they did not know and only 10% that it did not apply.

This is reinforced by doubts over whether the broadband infrastructure in some remote areas is capable of supporting mobile use of high performance clinical applications, even with the availability of the Health and Social Care Network.

Public/private mix

Organisations also have to decide on the appropriate mixture of public and private cloud and on-premise datacentres in their digital estates, and ensure they have the capability to move data, applications and workloads between the different options as required. Another survey question revealed the mix is likely to lean towards public cloud, but it will be between ICSs and the organisations that work with them to decide on the details. The factors underlying this will be subject to change over time and it is unlikely that a definitive formula will emerge as every ICS has its own unique mix of legacy technologies and infrastructures to work with.

There are technical challenges such as ensuring the crucial data can be moved into a cloud service, which can be difficult when using legacy systems that were not designed for data to be shared or migrated, and when dealing with legacy suppliers that could be reluctant to make it possible.

New sources of data such as assistive technology, virtual wards and digital twins add to the complexity and volume of data involved. There are likely to be challenges in structuring the data to become compatible with that from other sources and work within an integrated care system.

Underlying these points is the fact that, with multiple organisations at differing levels of digital maturity involved, it is not realistic to expect all of them to change their systems in unison, and some may not have the resources to make their data compatible with others.

Managing the complexity requires a new level of skills, as does the ability to assess specific cloud services and manage data and applications effectively. It has been on the agenda for some time but only 18% of survey respondents indicated their organisations had the skills required, with 31% acknowledging significant skills gaps and 51% saying they sometimes need external support.

Procurement problems

Commercial and procurement issues also pose a challenge. Some digital leaders in health and social care worry about the cost of cloud services, especially as more specialist services for clinical processes become available; and there is a need to make sure there are no hidden costs in making expensive changes to internal systems and data flows.

The move to cloud has created a different set of financial demands in running a digital estate, shifting away from the traditional need for extensive capital investment in on-premise infrastructure and fixed term software licensing at set prices to a more fluid model.

An ongoing issue that has been difficult to resolve is whether the money for cloud services comes from capital or operational expenditure. The nature of cloud indicates that IT budgets traditionally channelled through capex do not fit easily within the pay-as-you-go model; but traditionally public sector bodies have found it easier to make the case for capital rather than operational funding. This dilemma has been around for some time but organisations are still grappling with it.

These are just some of the issues, and a more comprehensive picture can be found in a new white paper published by UKAuthority Inform and SCC. It conveys the complexities in more detail and highlights three key points for making progress.

Hyperscale advantages

One is that the hyperscale cloud providers are likely to play a crucial role, with flexible platforms and infrastructure on which to build new services, high levels of expertise and strong cyber security.

Another that cloud provides for a mindset change among digital leaders, in which they are freed from many of the day-to-day pressures of managing IT and able to devote more attention to strategic issues, working with senior officials and service teams on modernising services.

The third is that in planning for change, digital leaders should talk not about migration but transformation. Focusing on a ‘lift and shift’ approach to cloud can produce some benefits, but not on the scale of looking at how the services could provide new possibilities for working between teams, more inventive use of data and bringing in more stakeholders. This will provide the scope for new approaches to individual care and public health initiatives, and make a big contribution to the closer integration of health and social care.

The full white paper, Integrating Care in the Cloud, can be downloaded below.

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