How the NHS can de-risk its modernisation to upgrade safely and efficiently

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Steven Shepherd, Healthcare Director, SAS UK, explores how upgrades can be made in a way that is cost-efficient and where the NHS professionals asked to use those systems are comfortable with the upgrades

‘Out with the old, in with the new’ is a phrase we often hear when discussing modernisation. Of course, this is the very premise of modernisation: replacing a system or product which is old and outdated with something new. However, it’s a phrase that is often taken far too literally.

Within the NHS, there are certainly legacy systems that are in desperate need of upgrading. However, it is not always necessary or beneficial to rip out and replace these systems with the most up-to-date, high-tech solutions available. Such an approach has led to upgrades that have been hard to adapt due to added complexity and the need for extensive training. This can be a huge waste of invaluable NHS funding and, ultimately, public money.

There is an alternate approach, which can be taken to help maximise NHS funding and make the lives of NHS staff easier. The key lies in building bridges between the old systems that need replacing and the most up-to-date technologies which will eventually replace them at a sustainable pace.

Don’t run before you can walk 

Back in November 2020, MPs warned that plans to modernise NHS IT systems were risky and expensive. Historically, this has often been true. In 2014, for example, the Department of Health embarked on a digital journey to achieve a paperless NHS by 2018. However, the target was not hit and instead it was moved back six years and watered down.

Across the industry, there are very few examples of organisations that have successfully built a new technology city of the hill and managed to transition 100% of users to it.  More often, users straddle the old and the new, resulting in increased IT costs and little of the efficiency improvement promised.

Many of the IT systems which exist in the NHS are extremely outdated when compared to the latest technologies. For example, last year it was revealed that some of the IT within the NHS left staff with 15 different computer logins, and £40 million was set aside from the Government to help hospitals and clinics to introduce single-system logins. However, in some instances, replacing these systems with the newest ones available would be like upgrading someone’s phone from a Nokia Brick to the latest iPhone. The user might have all the latest gadgets, but the change could be overwhelming and, as a result, some of the key new features might be underused or not utilised at all. When it comes to software such as analytics systems, it’s crucial that staff trust the technology, while feeling there is progress.

Therefore, the NHS should look to create bridges between the current legacy systems in use and the latest technology. This means gradually upgrading the systems they have, rather than tearing them out completely and replacing them with something radically new. It’s an even-paced retrofit instead of a full-on revolution.

Historically, this approach of replacing old with new in a more gradual way has worked well. For example, in the 1600s, Edinburgh’s Old Town had become overcrowded and an unpleasant place to live. As a result, the elders decided to create New Town, but not before they built North Bridge first. In fact, the bridge was built over 80 years before New Town was established. This gave access to places of work and familiar services while enabling both Old and New Town to be policed as one city. New Town then became a trusted place to live and work, rather than a competitive choice to Old Town. The end result has seen Old Town buildings modernised, now providing some of the most sought-after property in Edinburgh. The integration of old and new works, but only because North Bridge was there to facilitate it.

Taking the right steps

For the NHS, the equivalent of North Bridge – connecting the Old Town to the New Town – is identifying legacy systems that can be updated, rather than replaced entirely.   Often there are low cost and low-risk upgrade paths that bring out of date technology back in line with the latest technology via a proven path.  By moving to modern technology this way you open up options to integrate with other technologies more easily and take advantage of cloud economics (remember the software cost is typically 5-10% of the total solution compared to the infrastructure and support costs of 80-90%).

I believe these legacy systems can then be updated incrementally, in a way that improves their performance and capabilities but not to a point where the people using them are left overwhelmed and confused. This will hopefully help the NHS to avoid the scenario where upgraded systems are not being used effectively or perhaps not being used at all.

If one thing is certain, upgrading the NHS’ IT systems is not a question of ‘if’ but ‘how’. Even before the pandemic, creating a faster and more integrated NHS IT system was crucial. However, with an accelerated shift online, these upgrades have become even more important, from both an efficiency perspective and for security purposes. Just as Edinburgh did in the 17th century, the NHS must ensure it builds bridges between how it operates now and how it wants to function in the future. Bridging the gap with one big leap poses far too great a risk of falling short.


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