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Riak 2.9 Handoff Tests.html
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Riak 2.9 Handoff Tests.html
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<!doctype html>
<html lang="en">
<head>
<meta charset="utf-8">
<title>Spine and NHS Digital - Overview</title>
<meta name="description" content="A walk-through of the history of the major NHS programmes">
<meta name="author" content="Martin Sumner">
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<body>
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<div class="slides">
<section>
<blockquote cite="http://www.independent.co.uk/voices/commentators/oliver-wright-the-potential-was-huge-but-so-were-the-problems-2330925.html">
“The possibilities are enormous if we can get this right”
</blockquote>
</section>
<section>
<h2>Overview</h2>
<p align="left">Brief history, overview of structure</p>
<p align="left">Focus on evolution of national services - Spine</p>
<p align="left">Current positives</p>
<p align="left">Current constraints</p>
</section>
<section>
<h2>Brief History</h2>
<p align="left">pre-2003 - local spend increasing, limited integration</p>
<p align="left">2003 - contract five local service providers (LSPs) and national services (NASPs)</p>
<p align="left">2006 - existing providers fill gaps from LSPs</p>
<p align="left">.... LSPs suffer on appetite for change management, and technology delays</p>
<p align="left">2012 - expensive success in NASPs, costly failure in LSPs</p>
<p align="left">2016 - bespoke NASPs move in-house, commodity NASPs re-contracted, LSPs wound down</p>
</section>
<section>
<h2>Brief History - Benefit Realisation</h2>
<p align="left">2012 National Audit Office review - expected benefit realised</p>
<p align="left">Commodity services (e.g. network, mail, PACS) - 80% to 95%</p>
<p align="left">Bespoke national infrastructure (i.e. NASPs) - 69% to 72%</p>
<p align="left">Change programmes enabled by NASPs - 2% to 47%</p>
<p align="right">....Note that volume on Spine has nearly trebled since 2012</p>
<p align="left">Bespoke local services (i.e. LSPs) - 2% to 14%</p>
</section>
<section data-background="#A3C2FF">
<h2>NASP Success Story - Spine</h2>
<p align="left">Split between:</p>
<ul>
<li><p align="left">Core - the big volume heart of the Spine</p></li>
<li><p align="left">Identity - authentication, authorisation of professionals</p></li>
<li><p align="left">Secondary Use - focused on tariffing for secondary care</p></li>
</ul>
</section>
<section data-background="#A3C2FF">
<h2>NASP Success Story - Spine Core </h2>
<p align="left">Services supported:</p>
<ul>
<li><p align="left">Electronic Prescriptions (Primary Care)</p></li>
<li><p align="left">Demographics</p></li>
<li><p align="left">Summary Care Record</p></li>
<li><p align="left">Consent and subject access alerting, reporting and analysis</p></li>
<li><p align="left">GP2GP, eReferral, Pathology messaging</p></li>
</ul>
</section>
<section data-background="#A3C2FF">
<h2>Spine Core - History</h2>
<p align="left">to 2005 - Fast delivery, questions over stability</p>
<p align="left">to 2008 - Slow and expensive expansion, 2000 people</p>
<p align="right">... issues with incentives to use</p>
<p align="left">to 2013 - Availability/Scale at high cost ... </p>
<p align="right">... with functional lock-down</p>
<p align="left">2014 - transition to solution re-engineered in-house</p>
<p align="left">to 2017 - Availability/Scale at low cost ... </p>
<p align="right">... now with rapid functional evolution</p>
</section>
<section data-background="#A3C2FF">
<h2>Spine Core - The In-House Solution</h2>
<p align="left">Took <strong>100 man years</strong> from inception to 1-years service</p>
<p align="left">Requires just over <strong>100 commodity 1RU servers</strong> in live</p>
<p align="left">Release costs are <strong>< 0.1%</strong> of previous release costs</p>
<p align="left"><strong>90%</strong> reduction in operating costs</p>
<p align="left">Total running team of <strong>35</strong> people supporting and ...</p>
<p align="left">... Managing more than <strong>£10m</strong> pa of change backlog</p>
</section>
<section data-background="#A3C2FF">
<h2>Spine Core - The In-House Solution</h2>
<p align="left">(Nearly) like-for-like functional replacement ...</p>
<p align="left"><strong>99.999%</strong> available since go live</p>
<p align="left">Supports over 300 message interactions, five UI applications</p>
<p align="left"><strong>43M</strong> messages a day<p>
<p align="left">Provides accesss to <strong>2bn</strong> records and documents</p>
<p align="left">The NHS waits more than <strong>1,000 working days less</strong> each day</p>
</section>
<section data-background="#A3C2FF">
<h2>Spine Core - The Change in Approach</h2>
<p align="left">Technology - learn the lessons of Google etc</p>
<p align="left">Contractual - accept risk, make incentives natural</p>
<p align="left">Management - embrace Agile/LEAN ethos</p>
<p align="left">Operations - a consistent response to failure<p>
<p align="left">Delivery - automation everywhere</p>
<p align="left">People - focus on value, not unit cost</p>
<p align="left">Architecture - continuous improvement in simplicity</p>
</section>
<section data-background="#A3C2FF">
<h2>Spine Core - The Change in Approach</h2>
<p align="left">Bending on the previous principles has led to reduced success</p>
<ul>
<li>Identity Services - operational cost, opportunity cost</li>
<li>eReferrals - go-live stability, operational cost</li>
</ul>
<p align="left">There exists continuous pressure to bend on principles</p>
</section>
<section data-background="#E6E68A">
<h2>Current Positives</h2>
<p align="left">Flexibility at scale</p>
<ul>
<li>Reduce the cost of experiment</li>
<li>Reduce the fear of success</li>
</ul>
<p align="left">Growth without incentives</p>
<ul>
<li>Volumes doubled, systems reach 100% reach</li>
<li>Suppliers cannot retreat to blaming the centre</li>
</ul>
<p align="left">Symbiotic success</p>
<ul>
<li>EPS penetration ... eases transition of SCR to pharmacy</li>
<li>PDS penetration ... eases transition to eReferrals</li>
</ul>
</section>
<section data-background="#E6E68A">
<h2>Current Positives</h2>
<p align="left">Evolving standards</p>
<ul>
<li>Adding HL7 FHIR, plus other RESTful services</li>
<li>Maintaining legacy interfaces at low cost</li>
</ul>
<p align="left">Platform Extensibility</p>
<ul>
<li>Zero change to Spine operational cost for new applications</li>
<li>Now looking at broader integration, public-facing services</li>
<li>Landing of M&V, PCRM, FGM, CPIS, DTS, NOOM onto Spine Core ... add an app per quarter</li>
<li>Same patterns/teams/approach driving Flu Pandemic Service, SUS+ etc</li>
</ul>
</section>
<section data-background="#E6E68A">
<h2>Current positives</h2>
<p align="left">Integration complexity improvements</p>
<ul>
<li>Consistency of response time vital at centre</li>
<li>Spine as a point of triage truth</li>
<li>Spine adding layers rather than suppliers adding layers</li>
<li>The slow process of validation enforcement ... legacy of history means Spine complexity for bad data handling</li>
</ul>
<p align="left">Identity</p>
<ul>
<li>Migrating from model dependent on smartcards</li>
<li>Need to be mobile friendly</li>
<li>Emerging options for identifying citizens</li>
</ul>
</section>
<section data-background="#E6E68A">
<h2>Current Challenges</h2>
<p align="left">Culture catch-up</p>
<ul>
<li>People & processes wedded to predictions</li>
<li>People & processes wedded to slow speed of change</li>
</ul>
<p align="left">System depends on customer-systems</p>
<ul>
<li>Customer-systems not engineered to same standard</li>
<li>Customer-systems not fast to change</li>
</ul>
<p align="left">Legacy of LSP failure</p>
<ul>
<li>Fear of national initiative</li>
<li>as pre-2003 - local spend increasing, limited integration</li>
</ul>
</section>
<section data-background="#E6E68A">
<h2>Current Challenges</h2>
<p align="left">Summary Care Record may not be the answer</p>
<ul>
<li>Investigating Record Locator service</li>
<li>Investigating GP system connector</li>
<li>... but perhaps SCR is under-appreciated</li>
</ul>
<p align="left">Hard to drawback the legacy of necessary assurance</p>
<ul>
<li>Assurance <b>used to</b> protect the service</li>
</ul>
<p align="left">Centralisation and fear</p>
<ul>
<li>Security, safety and consent under the microscope</li>
</ul>
</section>
</div>
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