About this Episode
When Matt Hancock announced that the NHS will adopt an Internet First strategy, it came as no surprise to those familiar to Public Sector telecommunications. The proposal was first made public around 3 years previously. The clear demand was to be able to use applications in Government the same way that people could access services from home.
As time has moved on, the detail of what Internet First actually means is becoming clearer.
In this episode, Lynne Magennis talks to Ian Wilcox of MLL Telecom – one of the SME’s who have been instrumental in transitioning an number of NHS customers from N3 to HSCN.
Health Sector Business Development Director, MLL Telecom
Ian has had the unusual experience in sitting both sides of the negoitiation table; responsible for procuring a large Public Sector telecommunications estate as well as winning Public Sector tenders for MLL Telecom.
Ian was involved in the development of PSN as well as HSCN, providing valuable input from a Supplier and a customer view.
Ian is based in Hampshire
Lynne is the Innopsis Director focused on Podcasts and Design.
From a chemical process research background she has moved into the telecommunications business. Her day job is working for the Daisy Group.
Outside work will find Lynne tending for her horses and dogs in the Home Counties.
MLL Telecom works to a set of core values to make sure we deliver a solution that doesn’t just resolve a short-term problem but provides first class-leading support for the lifetime of the project.
MLL Telecom’s experience and expert industry knowledge, combined with our commitment to agile and flexible ways of working, means we can rollout exceptional communications solutions fast and efficiently and get the job right first time.
MLL proactively seeks to innovate, develop and improve the services we provide at all times. Our open, consultative approach means we work with you to anticipate challenges, reviewing and refreshing connectivity and services so your network delivers best value throughout the lifetime of the contract.
We’re dedicated to offering optimum lifetime design for our networks, not just at the initial stages. In addition to this, because we’re a fully licensed operator with code system powers, we automatically have the planning permissions we need to rapidly deploy wireless circuits. Once the network is installed, we provide SLAs on every link. We also go the extra mile to give customers regular management reports, showing them exactly how their network is performing in relation to the bespoke SLA. If you prefer a rental model to a capex model, or need a combination, our flexible pricing structure means we can tailor services to meet your requirements.
01628 495 400
Health and care services now have an Internet First policy that states new digital services should operate over the internet. Existing services should also be updated to do the same at the earliest opportunity and ideally by March 2021. NHS Digital owned services will be updated or replaced to meet the Internet First policy.
Our services add the most value when they are readily available to the citizens, staff, services and third parties who use them to deliver high quality healthcare.
It requires careful consideration to make services available over the internet. The internet differs from private networks in terms of availability, performance and integrity.
The Internet First policy and guidance is aimed at owners of digital services in health and care. It provides practical support to make digital services available over the internet. It brings the industry best practice principles, standards and guidelines for internet presentation together into one place.
Internet First policy and guidance
This is the Internet First policy, standards and guidelines defined by NHS Digital. The document will help health and social care organisations make their digital services accessible over the internet. It will help describe how to make them secure, scalable and where possible consistent.
The strategic direction across UK Government has been Cloud First since 2013. This requires public sector organisations to consider and fully evaluate cloud solutions first before considering other options.
The Government Digital Services Technology Leaders Network reviewed the positioning of centralised private networks in January 2017 and confirmed that, for the vast majority of public services, the internet is OK. They say that new services should be made available on the internet, secured appropriately using the best available standards-based approaches. When we are updating or changing services, we should take the opportunity to move them to the internet. The Government Transformation Strategy February 2017 extended the digital agenda from the citizen to maximising the benefit of collaboration and flexibility across departments and government bodies.
In October 2018 the Secretary of State stated that online services, basic IT and clinical tools are far behind where it needs to be and that “We need to take a radical new approach to technology across the system and stop the narrative that it’s too difficult to do it right in health and social care” in his Vision for digital, data and technology in health and social care.
In line with the government strategic direction NHS Digital implemented an Internet First policy in March 2018. It sets the principle that all new externally accessible digital services provided by NHS Digital should be internet facing by default and for existing digital services to remediate at the earliest opportunity. The Secretary of State vision is for everyone to have access to digital health and social care services. To achieve this, the Internet First policy has been extended to become the Internet First policy and guidance.
Making digital services available over the public internet supports the requirements for health and social care professionals to work flexibly from a variety of locations, using a range of access methods. This will reduce complexity and cost for many organisations, particularly for small health and social care providers.
The policy is fully aligned to the Secretary of State aspirations and to the NHS Long Term Plan’s objectives to increase productivity of NHS Staff and deliver digitally enabled care. This Internet First policy and guidance supports the strategy and governance to remove the reliance of health and social care digital services on a central private network.
Internet First definition
Internet First means that externally accessible health and social care digital services must be securely accessible over the public internet by default. This requires:
- health and social care organisations to have sufficiently scaled and functional Internet connectivity to support the needs of the organisation in consuming and where applicable providing internet hosted services
- IT service providers to offer suitable secure user access to externally accessible systems and services over the internet
- IT service providers to offer suitable secure application interfaces to externally accessible system and services over the internet
- digital services to be accessible over the internet at the earliest opportunity
HSCN has been designed to support the transition from private to public networking from the outset.
The public internet is that part of the internet that is open access to all consumers (for example, clinicians and citizens) regardless of the provider or location. However, user registration or password is usually required for the consumer to gain access.
Internet First applies to digital services
Digital services are the systems, applications and services used by healthcare professionals who require them to be externally accessible. It means going beyond being an on-premise service, accessible only on a local area network.
The network policy in health and care is that all digital services should use the internet to communicate unless they have specific (exceptional) needs that the internet cannot meet. However, many digital services will be affected. Priority should be given to those digital services that have significant numbers of users or which other digital service providers use to deliver complementary services. For example; digital services accessed for patient care, used by health and social care staff, authenticating users of a service, or structured/unstructured messaging.
Digital services that will be retired or replaced prior to March 2021 are out of scope of the policy and guidance.
With discussions around the Future Networks for Government (FN4G) gathering speed, Government Digital Service’s statement that ‘the internet is OK’, a potential shift away from PSN, NHS Digital’s outlines for the future of HSCN and the launch of Network Services 2 there is a growing emphasis on future public sector network services, connectivity and security.
No one solution fits all, and as public sector organisations by their very nature have differing levels of connectivity, security and service requirement we will look to break down and discuss the varied options open to the public sector’s technology departments and teams. We will discuss the potential of cost benefits, increased efficiencies and improvements to public services which can be obtained by the use of current and future network options.
The Public Sector Network Summit will address these issues whilst also focusing on the new Network Services 2 framework and the added benefits to the public sector that this new procurement model provides. Issues around security, zero trust, perimeter defined software and cloud connectivity will also be discussed in detail to provide
clarity in this ever changing network landscape.
Attracting circa 200 technology and network professionals from across public sector The Public Sector Networks Summit offers delegates the chance to hear and discuss policies, case-studies on excellent work already taking place around the country, engage with solution providers and network with public sector peers from central and local government, the NHS, emergency services, education and the voluntary sector.
Registration 08.30 – 09.30
Plenary session commences 09.30
Chair, Lynne Magennis, Director, Innopsis
Ieuan Trigger, Commercial Director Networks, Crown Commercial Service
Patrick Clark, Head of HSCN Implementation & Communication, NHS Digital
Following a 30 minute refreshment and networking break the day continues with a series of case study based presentations/seminars on subjects including but not limited to:
Perimeter defined software
Migrating from the PSN – post PSN options
Is the hybrid cloud for you?
Software Defined Ecosystems explained
Intro: When Matt Hancock announced that the NHS will adopt an Internet First strategy, it came as no surprise to those familiar to Public Sector telecommunications. The proposal was first made public around 3 years previously. The clear demand was to be able to use applications in Government the same way that people could access services from home.
As time has moved on, the detail of what Internet First actually means is becoming clearer. It doesn’t mean that Government departments will ditch secure private networks for domestic broadband, although we will see domestic broadband being used in some circumstances. What is becoming clearer is that Internet First will be about the Public Sector buying a variety of data access methods to suit both the site and the data being consumed or provided. This may mean a Social Worker using a 5G handset whilst dealing with a urgent family issue in someone’s home, or a nurse updating patient records in the patient’s home, a call centre worker providing emergency assistance, routine filing of case notes on Legal issues or Tax information being processed in a Cloud Hyperscaler’s environment. Each may need a different form of connectivity suitable to their needs.
This increased flexibility will come at a cost; each body will have to consider their security, availability, technical and service management requirements to ensure that can procure a service that will meet the needs of their business users.
As Internet First will not be limited to just Health and Social Care, it will encompass the whole Public Sector, this is likely to be a topic to be discussed at the forthcoming Public Sector Network Summits being held during September in both Leeds and London. Please see the show notes for details.
In this episode, we speak to one of the Sponsors of the event, MLL Telecom about their thoughts.
Lynne: Welcome to the latest Innopsis Podcast. Today we’re going to be talking with Ian Wilcox from MLL. So, Ian, we’re going to be talking about internet First today? What’s the MLL view on the landscape at the moment for Internet First?
Ian: At the moment we see most of the business that we’re doing coming through the HSCN secure network, because that’s based on the policy of NHS, so it’s just a direct replacement of N3, but there’s no real surprise that there was the announcement around Internet First. So, while we’ve been focusing on getting HSCN up and running and delivering the services, in the back of our minds we’ve been saying, “Well actually we need to design the network and development services so that migration can be smooth and seamless.” It then means that health organisations can basically take their time, do it when it’s right. It’s not a straightforward one bang switch either. You can gradually migrate, services can be moved into the cloud, you can move from private cloud to public cloud and things like this. So it’s really making sure that as a supplier that we’re ready for that agenda.
And it’s something that I say that we’ve designed in and built and I would imagine a number of other suppliers have basically done exactly the same, because the announcement wasn’t a bolt out of the blue. It’s government policy. We were expecting it to come at some point.
Lynne: What form of your preparations taken as much as you are able to tell us, obviously?
Ian: Well, it’s basically the policy of making sure that the network isn’t a barrier. It’s as simple as that. Knowing that customers will want to move from HSCN to cloud services and internet. Making sure that we designed our network so that as they move almost application by application, if they want to, from HSCN environments or cloud environments, that we’re not putting a barrier in the way. We can simply help them with that journey.
Lynne: How do you think that customer journey is going to pan out?
Ian: I think it’s going to take a long time. They’ve designed a lot of applications, designed around being in the N3 environment. So that the level of security that that provides, so you know that you’re effectively working in a walled garden. Then to move to internet where you know that you have public cloud services that we’ll be using, things like that. You’ve got to make sure that your applications are robust enough to work in that environment and that your network is robust enough so that if you’ve got critical services that you’re putting on Internet First, that you know you’ve got sufficient backup capacity that you can achieve the availability that’s needed. We talked to a lot of health organisations about multidisciplinary team meetings, which seems to be at the top of their agenda at the moment. If you put that into the clouds, that’s actually a critical health issue. You’ve got these key consultants all getting together, going through critical clinical needs. You’ve got to face up to the fact that if you put that in the cloud, you’re in a different security environment, you’re in different availability, you need to take into account before you make that decision. I’m not saying it’s the right or wrong decision. That’s up to the health organisations to do it, but we’ve put ourselves in a position that we can do either. We can live, continue to live within the HSCN environment, and I think there will be a lot of applications certainly for a number of years that we’ll need to continue to live in that environment until there’s a lot of confidence. I think that’s what Dermot Ryan was basically intimating in some of the things that he’s said. This isn’t going to be a big bang. It’s not going to happen overnight. It’s going to be quite some time. If everyone can get off HSCN in five years I will be incredibly surprised. Stuff just doesn’t work in those sort of timescales.
I don’t believe it’s actually gonna cost health organisations a lot of money. The way we’ve engineered it. The way that the commercials work in the UK, there isn’t a lot of difference between providing an HSCN connection as opposed to providing an internet connection. There isn’t a significant commercial difference. Certainly not as far as we’re concerned, because we still got to provide the boxes and wires. We’ve still got to provide the connectivity in the back end. It’s just a case of where does it go? Does it go out to the internet? Does it go into HSCN? Does it go out to PSN? Does it go out to Azure? That’s really where the price differentiation is. But apart from that most of the costs are the same. They’re still going to expect the same level of service. They’re still going to want to have an account manager who they can phone up and talk to. They’re going to want to increase bandwidth. They’re going to want to discuss things. It’s a partnership certainly with the larger health organisations and that’s going to continue and there’s a cost involved with that. And it doesn’t matter whether it’s internet first, whether it’s HSCN, it’s all the same cost base.
Lynne: So we’ve heard from NHS-Digital, actually within another podcast that they felt that the internet break-out has not at the moment been purchased heavily within the HSCN procurements. So I’m a health organisation. I’ve bought my HSCN connection as part of an aggregation procurement. I’m in the process perhaps if being migrated, but I need to have one head on Internet First in the future. Where, from MLL’s point of view, do you think the customer should be moving next and what are the bites they’ve got to take to eat that elephant?
Ian: So it’s people sitting within the HSCN, in the main, wanting to access services on the internet. That’s useful for users. But as soon as you start putting a lot of applications out there, you start hosting applications in different places. Whether that’s the right approach or not, I don’t know. Perhaps you should be looking at bringing the security policy back more into the organisation, in setting the policy, rather than trying to control everything through central points.
Lynne: Rather than depending on an HSCN connection to solve your security problems, you should be perhaps looking at buying a box standard internet connection of a decent quality and then looking at holding that security in house?
Ian: I think that’s the way that it should be looking to go, because a lot of the customers that we’re talking to have got inbound requirements as well. They may want to host stuff. We’re seeing health organisations hosting stuff and managing stuff for other health organisations. So again, they’ve got the inbound requirements, and actually moving it out from a centralised point, putting it closer to the end, maybe the right way to go. I’m not saying that you need to sort of have management of individual boxes, but having a policy that you can put out there, that suits that organisation, rather than having it nailed down as one policy at the centre.
I can understand why NHS-Digital have gone on that route. And I think it’s the first step because it continues that walled garden approach, that you can basically protect against threats where people are trying to get out to the internet. But I think as the market moves on, as the way that you can manage these services and have perhaps software defined networks, maybe the way to actually move that agenda forward. But yeah, I can see that that central firewalling service could actually fade away and be replaced by a more devolved approach in the future.
Lynne: So HSCN may transpire to be a step along that path rather than the path itself. So what, in your opinion, what benefits are our end users going to see from moving into internet first? Firstly, from the health organisation side?
Ian: I’m not sure that sure the end users will actually see a lot of benefits, to be honest. The reason I say that is because they’re sitting at their terminal wanting to do stuff. They don’t care where the stuff’s being done, as long as it works, as long as it’s there when they need it, with the performance that they need. That’s really all they’re interested in. A lot of this is actually around the commercial arguments of saying, can internet first deliver us something at a lower cost but still give us the same level of service? Because this is, again, this is something that we’re always discussing in looking at it and thinking, well what’s the argument for going into the private cloud, sorry, into public cloud? Going into internet, and it is when you sit in the end user’s desk, it’s purely, do I get the service? So it’s the people that are buying the service are actually the ones that are interested in this because it’s the commercial benefit they will get out of it.
Lynne: So do you think they’re going to be able to have access to more applications or better applications, or again do you think it’s going to be pretty much business as usual but just a little bit better?
Ian: I think it’s going to be business as usual. Because if you’ve got an application that you want to use and it’s hosted in the cloud, you should be able to find a way of getting access to it. It may be in the short term, it’s got to be an arrangement where it is privately hosted, and then you migrate to something that’s just a cloud service. But there’s nothing preventing you getting access to any applications as long as you know how to basically buy it, to be honest.
Lynne: So if we’re not seeing any particular benefits for the corporate end user. What about the end user sitting at home? The patient end user.
Ian: They’re using the internet anyway. So, if they’ve got stuff that they want to use that the health service want them to access, the health service will put those up on the internet like they do now. So patient booking systems are available on the internet. As far as patients are concerned, that is an internet service. How it’s actually delivered, whether it’s delivered behind a firewall from a private cloud, from a public cloud, they don’t care as long as they can see it on the internet. It’s the IT department’s job to engineer that so they can get to it, they can use it and it gives them the service they want.
Lynne: So how do you think the health organisations ought to be preparing if they haven’t already got it in their minds?
Ian: It depends whether they see it as rigorous policy or not. I mean, they may decide that actually HSCN is the way for them to go. Okay. Internet First might be something that’s something in the future. The biggest barrier I think is the way they specify and procure the applications. Making sure that that information that rests in the cloud, it gives them the level of assurance that they need, that they would’ve had if they’d have had it in a private data centre perhaps hosted in their data centre. So that’s what they need to consider. What’s the minimum level security, so it’s information at rest. How do you secure that? If it’s in a public space, you’re talking about encryption, what level encryption do you need? And then the networking service, are you comfortable putting this information in the clear over the internet, or do you need to encrypt it? Because on HSCN, if it’s in a private hosting environments, a lot of information can be held in the clear, can be sent in the clear because you know that that walled garden gives you a level of confidence that you need. If you put it out in a public cloud, what more do you want to wrap around it to make sure that it’s safe? Because you’ve got equivalence here, you can have one security policy that says, “My security policy is run, I get my information over a secure network, in a secure data centre that I know where it is, and my information’s safe.”
One security policy can build around that. You can build another security policy around putting it on the internet, in cloud hosting. And you’ve just got to look at the risks and the threats and say, “Am I willing to accept that risk for the cost savings that I’m going to make by going Internet First?”
Lynne: From a Innopsis members’ point of view, from the supplier’s point of view, what do you think is to be the spectrum of offerings from us? Are we going to range from commodity based connections, which I’m sure you’ve got a view on, right up to fully managed services? How far do you think that spectrum’s going to reach?
Ian: I would be nervous about anyone in the NHS taking a commercial broadband. The stuff that you use at home for the simple reason that it doesn’t have the service management wrap around it. The fixed times, there’s … well, we’ll do it when we can in the best possible time. We’ll try and get it fixed. There’s no commitment there, particularly on home broadband. And you’re not gonna get the level of service that you would get, if you start looking up the spectrum, even using ADSL, but using ADSL but a commercially robust ADSL. It’s got the service wrap round it. It’s got guaranteed SLA’s and things like that. That’s where you need to start. But if a GP surgery went out and said, “I’m just going to buy home broadband for my Internet First.” We wouldn’t sell it to them, because we know that that’s the wrong thing. And from our own private point of view, purely selfish points of view, the bad publicity we would get if it went wrong, it wouldn’t be the GP’s fault. It would be the supplier’s fault, because they’re very good at bashing suppliers when, they shouldn’t be bashing suppliers if they bought the wrong thing. So, if someone came and tried to buy something like that off us, we wouldn’t sell it to them.
Lynne: So we’ve got that at the bottom end of the spectrum. Where do you see the top end of the spectrum?
Ian: Well, if you’re talking about large hospitals, we’re already looking at 10 gigabit requirements into large hospitals, particularly where they act as the hub for the local GP’s. So if you’ve got a CCG that’s got 150-200 GP’s, maybe they’re hosting stuff, the applications for those, and they’re doing, well, the example I used earlier, multidisciplinary teams. You’ve got the high quality video conferencing services and things like that. They’re looking at 10 gigabits of service that the low latency it will give, the guaranteed bandwidth, so they’re not going to get contention on the bandwidth.
And that that’s what they’re looking for. And that high end, again, are you looking at doing the internet, are you’re looking at a private, because as soon as you go out on the internet, you’ve got no guarantee of latency of QoS and things like this. Within a private domain you can guarantee that point to point quality of service over an MPLS network. So again, these are the things that they need to take into consideration.
I mean, Skype at home, it’s fine. You get the odd glitch and things like that, and you suddenly get it stopping jittering for a second. You can live with that. When you’re talking about detailed graphical information that they’re sharing, they don’t want to have a discussion, they don’t want to interrupt sessions. Their time is really valuable. Do you want to take a risk of doing that over an internet service with a video conferencing service hosted in a cloud data centre somewhere hanging off the internet, because you’re just relying on so many bits of the supply chain to be working properly and deliver. There may be a view that actually with things like multidisciplinary teams. You need to know the whole supply chain so you can guarantee that you will get the quality of service that you need for those types of applications.
Lynne: Because multidisciplinary could include people from overseas looking at and over-seas surgical procedures or whatever across the ocean. Don’t really want a lot of jitter there, do you?
Ian: They’re in different time zones and things like that. It is very difficult to get these people into a room. They have a fixed time every day, every two days, every three days, however many times they have it. But that is their slot where they don’t have any patients. They go in and they discuss difficult cases, and multidisciplinary requirements. So again, there is no way that you want to put the service in that could disrupt that in any way.
Lynne: So what about the service wrap? As I say, I’m pushing you up to the other end of the spectrum. How far do you feel the service wrap might be able to be pushed within these organisations into a fully managed IT service, consultancy, security, and all the rest of it?
Ian: Certainly within the IT departments, in the CCGs and the Trusts. Yes. I mean, that is a relationship that we’ve found all the new customers that we’ve had on HSCN. They welcome that environment engagement. They want to talk, they actually want to be involved in the detail and making sure that what they’re buying is what they need. They come to us for advice, and they’ll sit down and they’ll talk it through and work out what the best way of doing things is.
And that’s what they’re looking for. And you’re right, there’s a cost associated with that. So we need to recognise that for those organisations it isn’t, it shouldn’t be a race to the bottom. It should be, you need a service and part of that service does come with a cost. And as long as they understand that. Well, I think a lot of the IT departments, certainly within the customers that we’ve got on HSCN, they recognise the value of what we can bring, and I think they recognise that there is a cost involved in having that service.
Lynne: So Ian, the leading money question, is there going to be anywhere coming up where we can talk to you about these subjects?
Ian: Yes. In September, we’re going into the Public Sector Networks Summit and we’ll be at both events on the 17th in London and the 24th in Leeds.
Lynne: So we can come and talk to you on your stand?
Ian: Yes, of course. Please. We’ll be more than happy to see you there.
Lynne: MLL will be there in force. Thank you very much indeed for this morning.
Ian: Okay, thank you.