Well, it looks as if, once again, nobody has nominated me for ‘Healthcare IT Champion of the Year’ at the EHI Awards.

I’m not sure what I need to do to win a nomination, but I guess I need to raise my game. They say money talks; which makes me think that if I could save the NHS a large sum of money – let’s say £50m – it might happen next year?

Going mobile

I was at a colleague’s retirement dinner the other night and the spouse of a partner I was talking to worked in the telecoms industry.

I found it fascinating that he had recently introduced iPads to his 500 strong mobile workforce, and the devices had paid for themselves in four weeks. His staff used to spend one day a week in the office just doing paperwork; now they spend five days out there doing the job.

I was amazed that he’d calculated the return on investment so quickly; but of course he works in the real world. I once spoke to the chief executive of a community provider who admitted he had no firm idea how many district nurses he employed or what they were doing at any particular time.

Alas, while doubling the number of patients a district nurse sees might bring all sorts of benefits, it’s not going to save £50m. Next idea.

Embracing virtualisation

I read with interest that the NHS has done a deal with Microsoft to extend support for Windows XP – the operating system that came out in 2001 and that was supposed to retire in April this year.

Amazing isn’t it. We can’t get our act together to replace it, so the easier option is to just keep paying. Perhaps it’s cheaper in the long run.

What would seem to make sense – a completely virtualised environment from where you are pushed a new, virtual machine each time you log-on – is obviously too hard to do.

And yet, other organisations have done it. This is exactly how the computers in my local bail hostel work. Perhaps it’s the links or the age of the kit that stops the NHS from following suit?

In this context, I was interested to see a ‘computer on a USB’ project for the third world. The problem in the third world is computers tend to be old and at the lower end of the spec, with a mixture of hardware and accessories.

In response to this, some bright spark has created an entire computer on a USB stick that will work on any computer, no matter how old.

They think it will revolutionise computing in developing countries, by giving people access to a standard, modern operating system for next to nothing; without having to pay licenses to traditional OS makers.

 If it’s good enough for the third world, it might just work on the NHS. Unfortunately, however, saving on Microsoft licenses will only generate a few million.

Ditching the servers  

So on to the next idea – servers. Now, I grew up with mainframes and mini computers and dumb terminals. Along the way came the PC.

After that, we had fileservers and then server side applications. As the internet exploded, more and more servers were required.

If you wanted to host your own website or service, you used to buy your own server and put it in a data center. Often, you had to pay extra for the privilege of having someone walk up to it and reboot it when it crashed.

A friend of mine, who wrote and now owns an online accountancy package, told me recently that things have changed. His server was getting old and needed updating.

At first he was trying to decide whether to buy another. He has some plans to expand, but a bigger machine was expensive if he didn’t use it.

Then he realised that the days of owning your own machine are long gone. Virtual, scalable servers are in. You have your own virtual machine and you can give it more memory or processing power instantly – it can just cope with demand and charge you for use.

He was amazed. Another friend recently told me that this is happened at a much bigger level. He runs an IT company and has moved his entire operation over to Microsoft’s Azure platform.

He has saved a fortune in the process. And here is the key; cloud-based, scalable servers and storage have never been cheaper or more accessible.

When my primary care trust shut down and moved out of its building, the biggest issue was what to do with the servers.

A huge room full whirring away, running who knows what apps and storing who knows how many Word documents, all run my a small band of technicians.

The cost of moving it all somewhere else was so high that I believe they thought about renting the whole building just to keep it going.

This would have meant having an empty building – except for that one room. So, unsurprisingly, it moved in the end.

How many other PCTs or clinical commissioning groups or commissioning support units had the same issue and now have the same kind of server set-up? How many hospitals have a room full of servers? They are bought presumably as capital? And are run at what cost?

Get rid of the lot. Cloud the NHS. Every organisation can have as many virtual servers on the NHS cloud as they need/can pay for. I have no doubt it can be run cheaper than the existing costs.

Half way there…

Let’s do some sums. Let’s start with my area’s primary care systems. My understanding is the license fee per practice for a GP system is around £12,000. Some of that must be going to pay for the datacenters the suppliers use.

They claim they have multiple redundancies and the latest kit, so a good couple of grand must be paying for them.

Now, one option might be for those companies to outsource to the cloud rather than run all their servers in-house. It might be cheaper for them and allow them to make more profit.

But the trick is not to allow them to do this. You must say that to be on the GP Systems of Choice Framework, which seems to be the goal of every IT company I've spoken to lately, a supplier must use the NHS cloud.

The cost of doing that should be deducted from the amount paid to the contractor, thereby saving the money and keeping the ownership and security and control with the NHS.

Let’s say there are 8,000 practices in England and that their server costs are £3,000 each. Eight thousand practices times three thousand pounds is £24m. Add in the hospitals, community systems and so forth and I reckon I've saved close to £50m; even accounting for the costs of running the cloud.

Is it possible? Well sources tell me other government departments are doing the same with IL6 secure hosted complete cloud platforms.

Dr Neil Paul

Dr Neil Paul is a full time partner at Sandbach GPs; a large (22,000 patient) practice in semi-rural Cheshire. He is also one of the directors of 4GPs Ltd. Dr Paul has been involved in primary care IT and health service management for more than ten years in various roles, including PEC member and urgent care lead. In his spare time, he writes medical iPhone software and is a keen photographer.


Entries are still open for the Healthcare IT Champion of the Year category of the EHI Awards 2014 in association with CGI, if you would like to nominate Neil – or anybody else who has made an outstanding contribution to NHS IT over the past year.

Nominations close at the end of June, for voting over the summer. Full details of this and all the other awards on the dedicated EHI Awards website.