Some eyebrows have been raised with the indication that the Health and Social Care Network (HSCN), although still not fully bedded in, has a limited shelf life.
The issue took on a higher profile a couple of weeks ago when Health Secretary Matt Hancock highlighted the issue in a speech to the King’s Fund Digital Health and Care Congress. It came with NHS Digital’s publication of guidance on the move to an ‘Internet First’ approach to connectivity that points towards the public internet rather than HSCN being the default approach – at least in the long term.
It adds that HSCN has been designed from the outset to support the transition from public to private networking, and prompted thoughts that health and social care organisations should begin to look at secure public internet connections sooner rather than later.
This reflects the Government’s broader guidance that public sector organisations can begin to use public internet services, which now have appropriate levels of security, rather than relying on the Public Services Network (PSN) or HSCN. But it has also raised some voices with the message that there is no reason to hurry, and the immediate focus should remain on the HSCN.
Innopsis, the trade association for IT suppliers for the public sector that has been pushing the cause of the HSCN since its inception, is indicating that the principle of Internet First does not necessarily reflect the immediate demands.
Its managing director Mike Thomas says: “In common with all public sector bodies there is a general acceptance of wanting to move towards an internet approach, and for quite valid reasons.
“There are whole sections of the public sector that could be served by public facing internet applications with adequate security and resilience. We fully endorse that view, but it needs to be done in an organised way.
“The major issue at the moment is that most of the applications that the NHS and most of the public sector want to access are not internet facing and cannot be without an enormous amount of development work.”
He says the digital services dependent on secure connectivity – such as those for patient records, information about medical conditions and people’s personal circumstances – do not yet have the safeguards for the public internet, but have been built for more contained networks such as HSCN and PSN. And for many of those which are already running on the specialised networks it would take a significant investment to adapt them for the public internet, not least because some of the developers would have moved on.
Thomas sees the possibility for change, saying that digital care applications might be able to develop in a similar way to those used for banking, with a public internet interface but back end systems within secure private networks. This could allay concerns about keeping health and social care data secure.
But shorter term he sees more scope to develop the applications to work on HSCN.
“As the apps are there and as they become internet available there will be a migration,” he says. “But at the moment we have to use what we have.”
Other elements come into play. He says the HSCN provides NHS Digital with a good idea of where traffic is routed, where any problems could be and how to bring multiple suppliers into a single environment. Also, he claims app developers from overseas have shown a willingness to use the network, especially when they want to work on large cloud platforms such AWS, Microsoft Azure and Google.
The indications from NHS Digital, which manages the HSCN and provides a lead on technology provision to NHS England, has been cautious about the ultimate timeframe and reiterates the point that it is early days for the transition.
Its director of infrastructure programmes, Dermot Ryan, says it is “the very start of the journey” and agrees that for now organisations should focus on using the HSCN.
“At the moment we are consulting with stakeholders and NHSX as the programme sponsors. Together we are carrying out scoping work so that we can work out what needs to be done to make the secretary of state’s vision a reality and to determine timescales with the right balance of challenge and realism.
“We understand that each digital service is different and will experience its own challenges in moving to Internet First. Some will be relatively simple, while others will be far more complex. Our aim is to share learning and guidance and to set standards, processes and policies that make it easier to make the shift.
“Irrespective of the size of each change, work will need to be carefully planned and executed to ensure that risks are appropriately managed.”
But he adds that the organisation is aiming to make the NHS e-Referrals Service for booking hospital appointments available exclusively over the internet in the next few months. And he says that longer term the transition to Internet First should make it easier for people to access services, improve interoperability and reduce the complexity in network connectivity.
He also makes a point that may not have emerged so clearly in the early discussions around the HSCN, that it has been designed specifically to support the transition to the internet without the need to change network connectivity.
“It is a hybrid network which means that it provides internet and private network access seamlessly over a single physical connection while providing great value for money for organisations,’’ he says. “Independent benchmarking has shown HSCN to be the best value form of network connectivity with prices cheaper than equivalent commercial grade internet connectivity.
“Right now, most health and care organisations need a mix of both internet and private network connectivity and the HSCN market can provide that cheaper and more securely than anywhere else.”
It amounts to a message there is no need for a sudden shift in how care organisations are planning their connectivity, but that it’s more a case of HSCN for now, Internet First for the future.
Image by Sean MacEntee, CC BY 2.0