The NHSnet, the National Health Service's private intranet, started out as a project in 1992, launching in 1995. Today the service has almost 10,000 connections, allowing NHS Trusts, GP surgeries and health centres to have a direct connection to the network. But now, the NHS is considering opening up the service to the public, and this could bring its own headaches.
Carrie Armitage is head of access to information with the NHS and the manager in charge of the NHSnet project. Speaking this summer at a north-western regional internet forum in Manchester, she said that the reasons for creating the NHSnet have now been overtaken by the general acceptance of the internet by the community at large.
"When we created the NHSnet, the internet was still in its infancy," Armitage told delegates, adding that, now the 10-year contracts forged with BT and Cable & Wireless in the early 1990s are coming up for renewal, there is a big question as to whether the private NHSnet should be opened up to all.
Despite the fact that it took until 1999 before the NHSnet had its own central messaging service and a user-friendly email addressing system, today it has 850,000 registered email users in its national directory and handles more than 2.5m messages a day. According to Armitage, the service has a budget of £60m during the current year, with £20m for mail and messaging facilities alone.
The obvious reasoning behind the NHSnet having its own infrastructure, Armitage explained, is the need for patient confidentiality, since the internet has had more than its fair share of security problems. Against that now, however, is the cost issue. The internet has become ubiquitous, while the technology for secure and authenticated transmissions has also fallen in price. Coupled with the fact that the NHSnet has reached the point where patients can be invited to access the service, the intranet is now at something of a crossroads.
"We've reached the stage where it is possible for patients to book their own appointments with their GP, so the issue of patient interaction across the NHSnet also has to be taken into account as we develop the network for its second decade," Armitage said.
While there is a strong cost-based argument to move the NHSnet network infrastructure over to the public internet, there is also the issue of internet reliability. The NHSnet, said Armitage, has a 99.99% "uptime", compared to the internet's uptime - in the UK at least - of around 98%. If the NHSnet were to be simply plugged into the public internet, the question is would NHS staff and their patients be able to cope with the NHSnet being down?
The answer, of course, is that NHSnet downtime equates to potentially significant losses, both in cash and patient treatment terms. As if all this were not enough to weigh up when considering the future of the NHSnet, Armitage told delegates that there is now a pressing need in some sections of the NHS for mobile access to the NHSnet service.
"There are now 600,000 to 700,000 PCs in the NHS, and we know that only a small fraction of these are actually connected to the NHSnet. As we expand the service, we also have to accept that the number of machines hooked into the network will rise significantly, so we also have to plan in advance for that expansion." To date, she added, the NHSnet has had something of a slow takeup, with most of its growth happening within the past few years.
Armitage says that Syntegra, which handles the NHSnet's email facilities on a managed message-handling service basis, has had 100% uptime since the main service started in 1999. Small wonder then, that Armitage and her team fear a migration of the NHSnet to the public internet would reduce service levels for both staff and patients. "How we develop the NHSnet in the coming few years depends on a lot of factors, but the issue of patient care has to be a priority," she said.
Given the flakiness of the public internet at the best of times, Armitage and her team have a task on their hands.
