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Rebuilding NHS Spine with Open Source Software

BJSS delivers UK public sector’s largest Open Source-based system.

Comprising over 20,000 individual primary and secondary care sites, pharmacies, opticians, dentists and education and training establishments, NHS England provides care services for individual patients. Integral to the delivery of its services is Spine 2 – the largest public healthcare IT system in the world. BJSS in collaboration with the HSCIC combined Open Source Software and its BJSS Enterprise Agile delivery approach to achieve dramatic cost savings and efficiency improvements for the NHS.

Spine 2 is available 24/7 and on average 99.97 per cent of the time. It handles more than 400,000 unique user logons and about 250 million messages every month. 

As announced by the Rt. Hon. George Freeman, Minister of Life Sciences, continuing to operate the legacy system would have cost the NHS an additional £21 million per year.

Business Context

NHS Spine 2 forms part of the critical NHS national infrastructure that supports the provision of healthcare in England.

It handles more than 400,000 unique user logons and about 250 million messages every month. Designed for zero data loss and 99.97% availability, it is highly resilient, has over 20,000 endpoints, and is used and supported 24 hours a day 365 days a year.

Spine 2 replaced a complex legacy system which was commissioned in 2004, built using a Waterfall development approach, and which had taken more than 15,000 man years to develop. Its complex licensing and support regime led to substantial vendor lock-in and unsustainable recurring costs. As announced by the Rt. Hon. George Freeman, Minister of Life Sciences, continuing to operate the legacy system would have cost the NHS and additional £21 million per year in addition to the substantial infrastructure footprint that required to operate it.

It was decided to completely re-architect, re-engineer and rebuild Spine using Open Source products, introducing new features and bringing it under full in-house control.

BJSS Solution

In partnership with the HSCIC BJSS has rebuilt the NHS Spine using Open Source products and the BJSS Enterprise Agile delivery approach.

From a user perspective, Spine 2 could be seen to be a ‘like-for-like’ replacement. However, it benefits from significant performance and resilience improvements. Spine 2 also introduces new features including streamlined workflow applications, the ability to share child protection data across all NHS touch points, and a new birth notification and a registration application for midwifery staff to record new births.

At its peak, 33 BJSS staff contributed to the project, providing architecture, development, testing, operations, data migration and project management services- at a fraction of the delivery cost of the legacy system.

At its peak, 33 BJSS staff contributed to the Spine 2 project, providing architecture, development, testing, operations, data migration and project management services- at a fraction of the delivery cost of the legacy system.

The legacy system was unwieldy and difficult to maintain, comprising a very large bespoke codebase, many servers and other items of hardware and relying on a large number of complex underlying software components. BJSS took this approach:

Simplified Technology Stack
Wherever possible, small-footprint software, proven on an Internet-scale, was selected – ensuring future scalability. The system benefits from a resilient, scalable, distributed architecture and NoSQL storage.

A Rationalised, Maintainable Codebase
Spine 2 comprises less than 200,000 lines of bespoke code and a limited number of underlying software components. This substantially more efficient codebase is easier to maintain and has facilitated bringing the system back into in-house control.

Reduced Infrastructure Needs
The system has recorded a tenfold improvement in performance despite requiring one tenth of the infrastructure of its predecessor.

Open Source
12 Open Source products ranging from databases to developer tools sit at the heart of Spine 2. Providing a viable alternative to commercial packages, they deliver significant capital and operational cost-savings for the NHS whilst eliminating vendor lock-in.

End-to-End Automation
Lacking automation, the legacy system carried a large administrative overhead. Spine 2 was built from the outset with automation in mind and includes comprehensive end-to-end test, deployment, service recovery and operational automation.

Continuous Delivery
Change is considered to be a normal and regular feature of the Spine 2 environment. This is enabled by the adoption of a Continuous Delivery approach – automated testing combined with continuous integration and deployment allow software to be developed to a high standard and be easily packaged and deployed to test environments. This has resulted in the ability to rapidly, reliably and repeatedly deploy enhancements at low risk and with minimal manual overhead.

Key services across the NHS are dependent on the SPINE, with more than 250,000 staff each day using the system’s core functions, such as the personal demographic service, the Summary Care Record and e-Prescribing. Processing more than 200 million transactions every month, the SPINE is one of the most complex of such systems in the world. The successful migration of SPINE 2, will not only deliver a better service to users across the NHS, but also significant savings to the taxpayer. This implementation is therefore a great example of an effective partnership between the public sector and small innovative suppliers.

Rt. Hon. Jeremy Hunt, Secretary of State for Health

The project was delivered using the proven BJSS Enterprise Agile approach. BJSS worked closely with HSCIC to refine a collaborative way of working and supporting toolset and processes ensuring predictable delivery and a smooth transition to in-house control.

Dramatically Reduced Costs
Spine 2 delivers wide-ranging efficiency savings. Resourcing and operational costs have been slashed while the system also occupies a much smaller IT footprint based on commodity hardware and Open Source software.

Responsive to Change
The two to four year change implementation time of the legacy system has been slashed thanks an architecture and delivery process that accomodates change.

Improved User Experience

While Spine 2 is more responsive, the system’s look and feel changes mirrors the legacy system in order to minimise training costs. Spine 2 also introduces several new applications and features to improve operational delivery and patient care across the NHS.

Increased Flexibility
Spine 2’s architecture enables further efficiencies across the NHS by enabling other suppliers and systems to easily integrate.

System Returned to In-House Control
By bringing the system in-house the NHS benefits from a substantial reduction in day-to-day running costs.