The demands on the UK’s National Health Service (NHS) are ever-increasing – and the more these demands grow, the more complex they become. The demands forced upon the NHS no longer concern organisation functions solely; they also include the demands of its users – present and future.

Consequences of the baby boomer era (one of the largest and longest living generations) are now catching up with, and will begin to immense strain on the NHS. Specifically stating, the influx in pensioners will result in the need of more care resources.

Furthermore, today’s service users are more connected than ever before. Due to the continuous exploitation of technological advancements, younger generations now anticipate modern and digital experiences, including ways to access services and information. To meet these demands, the NHS must transform their functions, operations, and services. Through establishing a cloud-based health service, the NHS can deliver agile, efficient, and scalable services that patients today await. The cloud not only provides a secure infrastructure for all past, emerging, and potential technologies, but it too will offer new and innovative ways to deliver health services, improve resources and so much more.

As a result, cloud-based health services can be the key to improving patient experiences, streamlining operations, mitigating risks and costs, and improving health outcomes. But it doesn’t stop there.

What does it mean to be ‘cloud based’ or take a ‘cloud-first’ approach?

The terms ‘cloud-based’, ‘cloud first’ and ‘move to the cloud’ are furthest from new concepts today. These phrases simply refer to the adoption of cloud, including to build on and deploy infrastructures (software, applications, and resources) across to the cloud, as opposed to remaining on-premises. Becoming a cloud-first, cloud-based organisation means to re-design, re-structure, build and deliver from the cloud.

Rather than owning, buying, or maintaining data centres and servers on-premises (legacy systems), organisations can instead acquire the technology needed on an as-needed basis – consuming only what they need, up-scaling or down-scaling more efficiently and instantaneously. The problem is healthcare organisations, like the NHS, typically operate through legacy systems.

Can the NHS move from on-premises legacy systems to the cloud?

When legacy systems were originally devised, they were designed for on-premises purposes only. They did not consider latency when end points and servers would become separated, nor anticipate the future of remote working and advanced technological developments. And rightfully so. There was no reason to create and design legacy systems any other way. The technology didn’t exist to create them in a cloud first way. Ultimately, at the time, it was the most secure and innovative decision.

So, can legacy infrastructures be migrated to the cloud?

Despite its challenges, yes.

Due to this nature of legacy systems, migrating these infrastructures across to the cloud isn’t considered “plain sailing”. There are many challenges that arise when migrating legacy systems across to the cloud, this includes costs, data protection concerns, and technical organisational specifications; even challenges around UX arise too. Today, organisations can determine how they wish to design their infrastructure. Making the choice to keep some data centres on-premises, and adopt a hybrid infrastructure or completely digitally transform their organisation to be truly cloud-first. Ultimately, the decision is completely up to the organisation.

Can sensitive data be stored securely on the cloud?

Whilst a cloud first approach can help transform the NHS, still there remains questions and concerns around the security of adopting this approach and storing data, applications, and other resources to the cloud.

What does it mean to “store data to the cloud”?

Storing data to the cloud simply means to send data across to the cloud and store said data to remote servers. These servers and the resources stored within your organisations cloud data storage, can then be accessed via internet connection from anywhere and at any time as opposed to being solely stored and accessed on-premises or through your computer device(s) and its hard drive.

So, can data security be assured when stored in a completely remote server and “in the cloud”?

To answer plain and simply: yes.

Many sectors and organisations today are advocates of the cloud for its accessibility, cost, and risk mitigation benefits. In fact, according to a 2019 cloud report, 91% of organisations questioned (from the financial, government, tech and education sectors) utilise the public cloud to store and manage their services, applications and resources, 72% use private cloud, with 69% of organisations opting for a hybrid cloud solution to better suit their specific needs and requirements.

Yet despite these cloud computing trends, for organisations that are dealing with sensitive data, concerns around security and compliance remain.

Notably, concerns for organisations dealing with sensitive data migrating to the cloud include:

1. Data security
2. Data loss
3. Failure of systems
4. Monitoring public cloud

These concerns follow previous ransomware-attacks, with fear and anticipation for the future. As a result, less than one third of NHS Trust organisations are yet to adopt any level of cloud services, with an estimated 79% of NHS respondents stating no plans to migrate to the cloud.

However, recent ransomware attacks and the decision to not adopt the cloud has also brought to light security vulnerabilities within the NHS and their current infrastructure of legacy systems. In fact, 9 month following the WannaCry ransomware attack in 2017, none of the 200+ NHS trusts across the UK passed their security vulnerability inspections.

But despite these security concerns of the NHS, it must be stressed that “yes”, sensitive data can be stored safely and securely within the cloud.

Cloud service providers (CSP) like Azure, G-suite, and Amazon Web Services (AWS) provide encryption tools, practice documents, and guidance features that specifically address security of data management.

For more detailed insights, and as an example, Microsoft Azure invests into native security capabilities, making Azure resilient to ransomware attacks further prompting organisations to defeat the techniques of cyber-attackers. Using backups, security is provided whether your data is in place or in transit. Azure Backup also provides built-in monitoring and reporting tools, alerting you to any unauthorised, suspicious, or malicious activities.

For further protection of data, applications and resources, Azure also provides Azure Security Centre, whereby data can be properly governed, and identity can also be tracked and managed through IAM and multi-authentication. These are just few things CSPs can provide, and when combined, allows for organisations to protect their cloud environment against threats and strengthen security postures.

With government and financial departments – those themselves that manage critical national infrastructures and sensitive data too – having adopted the cloud, it’s time for the NHS to truly consider a cloud first approach. As the cloud is most certainly reliable, holding a strong ability to store, protect, and manage data in compliance, safely and securely.

What are some benefits of migrating to the cloud?

By migrating to the cloud, organisations can work on re-designing an infrastructure that will meet their organisation’s unique needs and requirements. This could even include retaining some on-premises servers for security and control reasons, alongside a multi- or hybrid-cloud structure.

Despite healthcare organisations specific worries concerning the costs (time and money) of migrating to the cloud, especially following cuts in funding, true benefits can be seen when establishing a seamless migration strategy to the cloud. In fact, organisations make the move from the sole use of legacy systems to the cloud to save money.

Through adopting a cloud first approach, the NHS can achieve more than just internal operation goals and improve their reputation through innovation. The NHS can also set out to attain and be well on track to their carbon neutral agenda – which they aim to achieve by 2040.

How? By embracing cloud computing, the NHS could remove excess server capacity. In addition, cloud service providers (CSP) like Azure and Amazon Web Services (AWS) have reaffirmed their commitment to sustainability, with plans to reduce and remove their carbon footprint, shifting to a 100% supply of renewable energy by 2025. Whilst Google’s G-suite had reached this milestone back in 2017, and now hold four consecutive years of 100% renewable energy. In effect, this will contribute towards the NHS and their aspired carbon neutral state.

So, what exactly would a ‘cloud first’ approach look like for the NHS?

A cloud first NHS looks innovative, considerate, ethical and agile.

Innovative in moving with technological developments in all areas. Considerate of its patients, demands and environment. Ethical in its environmentally friendly use of storing, collecting and analysing data – as well as being environmentally driven to a carbon neutral state. And lastly, agile in its ability to adapt, scale and improve services in a consistent and near instant manner.

The future of the NHS: harnessing the potential of cloud

Prior to Covid-19 the NHS was hesitant to fully embrace the cloud and begin their digital transformation journey. However, the pandemic truly accelerated the adoption of cloud – challenging prior perceptions and even dealing with legacy technology constraints. In fact, the global pandemic established the true urgency for the NHS (alongside other healthcare providers across the globe) to reassess their infrastructures and technology choices – all in spite of their fears, concerns and hesitancy to do so – and consider new tech that could help manage workloads, prevent employee burnouts, reinforce standards and much more.

This was later affirmed by then Health and Social Care Secretary, Matt Hancock in a PR release discussing the positive impact technology has had on health care providers’ abilities and the “vital role” it will play in the future:

“…the power of using the best available technology and developing new technology quickly has proved its worth – saving lives and keeping our health and care service standing at a time when it was under unbelievable strain like never before.”

“This pandemic was the time when healthtech really came of age… it helped us through this crisis protecting our most vulnerable and bolstering our NHS.”

“Now is the time to bottle the spirit we’ve seen – the ingenuity, the creativity and the adaptability – and put it in service of those solving the new challenges ahead.”

So, what does the future look like for the NHS following the pandemic and plans to adopt a cloud first approach?

Through harnessing the potential of the cloud, the NHS could exploit various opportunities that will not only tackle inefficiencies, but reduce costs, save time, and improve its resilience. A cloud-first NHS holds the ability to bring organisations together and collaborate, sharing sensitive information as well as workloads (where needed), securely, with respect of legislations and regulations. As a result, this enables the NHS to continuously meet their standards, improve their services and care abilities, which ultimately improves the experiences and health of its users.

For example, through cloud technology, patient records can successfully be democratized with strict controls – meaning data can be retrieved anytime, anywhere with granted access – which has been found to be vital in supporting the health and needs of health care users.

Cloud technology also enables services to be distributed across different areas of the U.K. when overwhelmed i.e., London 111 calls were successfully handled in 2021 by a team located in Newcastle when London resources became overwhelmed. The machine learning and artificial intelligence (AI) tools offered through the cloud by CSPs can provide risk stratification within patient cohorts, that will further support healthcare professionals with easy to consume diagnostic insights. Through combining the technological developments of the cloud, and the various tools, healthcare professionals are now provided with new and on-demand insights, that holds the potential to transform patient outcomes and improve the NHS’ services.

These are just few examples of how the cloud has helped transform and improve the services of the NHS, plus the potential it holds. According to Chief Medical Officer and Director of the International Public Sector Health for Amazon Web Services (AWS), Dr. Rowland, there are five attributes that the cloud offers health care systems. These give attributes suggest that our cloud-first NHS will be:

1. Agile
2. Cost effective
3. Innovative
4. Scalable and hold elasticity
5. Efficient

An agile NHS

Agility, in reference to the NHS and the services they provide, through the cloud can apply to the NHS and its healthcare professional’s ability to review, think, and understand information more quickly or “on-demand” as well as deploying information, applications, resources, and/or servers in a matter of minutes.

A mere example of this is cloud-platformed telemedicine solution, created in India. The Indian government successfully rolled out the telemedicine cloud solution during the pandemic within 19 days across four states – a completely free services, available seven days a week. Today, the platform enables more than a billion people to seek virtual care and is now live across all of India and its 23 states. This proves the power that the cloud holds, and its ability to offer agile scalability, allowing organisations to face challenges head-on and respond quickly when demand raises.

A cost-efficient NHS

A cloud-first NHS is flexible and cost efficient. The cloud is considered to be a model of considerate lower costs – especially for organisations managing system-wide infrastructures and connectivity.

“How?”, you may be wondering. Well, unlike legacy systems, with the cloud you only pay for what you use and the services you require as opposed to a recurring, agreed upon fee. There is no guessing of data capacities, the cloud simply adjusts to the scale of your organisation and amends payments accordingly. So, if your organisation scales-up, payments will adjust, and if it scales-down – you guessed it – payments will adjust. And this isn’t a month-by-month case either, adjustments and prices are amended accordingly on a day-by-day basis. Meaning that through the cloud the NHS can not only save money but get more for their money.

An innovative NHS

The cloud allows healthcare organisations like the NHS to be more innovative. With a cloud first approach, the NHS can focus on their goals and missions, focusing on the delivery of their services and solutions for patients as opposed to their infrastructure. The cloud offers a variety of innovative tools, resources and even collaborations. For example, through the cloud, organisations can integrate data from multiple sources – something that legacy systems are typically not able to do. By understanding the value that data holds singularly, as well as alongside other areas can present the NHS a multitude of optimisation opportunities, capturing new value and open doors to improved services, healthcare solutions and so much more.

A scalable and elastic NHS

Through migrating to the cloud, the NHS holds the ability to become truly elastic. As demands of the NHS increases, its ability to adjust with legacy systems can be difficult. This is due to the nature of legacy systems and its restrictive ability to scale. Through the cloud, the NHS holds the ability to increase its capacity and successfully scale up (or down) as and when required.

With legacy systems a lot of cost – time and money – is spent on guesstimating how long the hardware will last and how best to assign resources. This is because legacy systems don’t allow for growth. This is not the case with the cloud. With the cloud you can add or subtract power to existing cloud servers and upgrade your RAM, storage, or CPU. This allows organisations to adjust to demands or decreased usage efficiently and effectively. Ultimately improving costs and productivity.

An overall efficient NHS.

None the less, as Dr. Rowland states himself, technology alone cannot improve outcomes. It is the strategy that drives effective digital transformation and migration to the cloud. It’s understanding what can be built, utilising technological developments and how it can be used effectively, in addition the drive and leadership of ensuring that the technology is used appropriately, by the right people, at the right time and place.

Conclusion

“Care empowered by artificial intelligence (AI) and machine learning through the cloud is no longer aspirational…”, according to Mathias Goyen, Radiologist and GE Healthcare’s Chief Medical Officer for EMEA, “…it is mandatory and a ‘must have’ component of delivering healthcare in the future.”

The cloud holds the power to truly transform the NHS, helping them achieve nearly all of their goals, and take them to higher highs. The NHS, and other healthcare organisations alike must look to the cloud as a “mandatory”, “must have” solution. The solution for improving its services, mitigating costs, improving patient experiences, achieving all of their internal, sustainability and ethical goals and so much more.

The cloud provides virtually limitless storage, as well as computing and database capability to build new and innovative solutions and services to serve their patients. This ultimately provides the NHS with the opportunity to provide the access and delivery of patient-centred care, improving outcomes at lower costs, through the utilisation and acceleration of healthcare data – only ever using and paying for what they use and need, as opposed to a fixed cost as what is done with on-premises, legacy systems.