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NHS to be using NHSmail by 2013

Tags: CfH   Comments   email   Microsoft   NHSmail   website  

18 Feb 2010

The head of the NHSmail programme has said that he wants “most” NHS organisations to have migrated to NHSmail by the time its current contract expires in July 2013.

In a briefing to mark the first anniversary of the service’s move to the Microsoft Exchange 2007 platform, Will Moss told E-Health Insider that 200 organisations – ranging in size from foundation trusts to individual GP practices – were due to migrate before the end of the calendar year.

Moss said the programme was still hoping to move NHSmail onto the Microsoft Exchange 2010 platform this year and that it would deliver some new functionality, including ‘inbound’ SMS messaging.

But he said its main focus was now on migration, boosted by references in this year’s Operating Framework and Informatics Planning guidance that told trusts not to invest in their own email services unless they could produce a business case that would stack up against NHSmail.

“The priority has to be to move whole organisations so we can decommission existing services,” he said. “There are 565 top-level organisations in the NHS and 1,000 GP practices.

“By the end of the contract in July 2013, we need to have done most of those. Whether that will be front, middle or end-loaded I do not know. It will be driven by trust priorities.”

Cable & Wireless decided to move NHSmail off its Mirapoint platform in July 2008. The move to Exchange 2007 started in January 2009, and 350,167 live accounts were shifted over 12 weeks.

Sign-ups have since grown steadily. NHS Connecting for Health announced this month that NHSmail had reached the “major milestone” of 500,000 registered accounts.

Moss told EHI that half a billion emails and almost one and a half million SMS messages had been sent over the service since last April. “We will be doing a companion piece to outbound SMS, which is inbound SMS,” he added.

“We hope to provide inbound SMS this year.” This would allow patients to communicate with the health service, and, specifically, to respond to appointment reminders – which could help to cut ‘did not attend’ rates.

However, Moss emphasised that the NHSmail programme is focused on helping trusts to carry out migration projects. It has developed a tool to copy data from Exchange 2003 and Exchange 2007, and is working on a similar migration tools for other email platforms.

It has also produced a bulk registration tool to sign staff up for NHSmail accounts. CfH says the migration tool was proved in a pilot project at Weston Area Health NHS Trust, which migrated 1,800 staff from Exchange 2003 to NHSmail in November.

The next high-profile organisations slated to move include Sussex Health Informatics Service and the Royal Free Hampstead NHS Trust in London.

CfH has been running a campaign to persuade the chief executives, finance directors and medical directors of the 60 largest trusts in England to sign up for NHSmail.

It argues that trusts that need to provide 2,500 mailboxes could save £879,000 over five years by migrating, with most of the savings being made on servers and other equipment and the rest on maintenance and support.

Moss launched a vigorous defence of NHSmail as an enterprise class service, in response to comments on the EHI website claiming that large organisations could not use it as their sole email system.

“We have got 200 organisations in this calendar year to migrate to NHSmail. They are not doing it because it is a laugh or they have nothing better to do. They think it is fit for purpose and has benefits for them.”

He also rebutted comments claiming that NHSmail could not be used with other applications, such as SharePoint and Office Communications Server, although he acknowledged that it would not integrate with trust Active Directories.

“The AD question that should be asked is: would we look at federating local AD instances with a national instance and the answer is we would, but only if they had our level of security and they do not,” he said.

However, he argued that it should not be much effort to run NHSmail alongside other services that used Active Directory, and that any effort would be reduced once the service became CRS Smartcard compliant, which should happen “soon.”

Link: The financial case for NHSmail

Lyn Whitfield

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Reader's Comments

1

An NHSMail & CFH Success

paul.stoker@nhs.net

18 Feb 10 13:02

A major success is reported, yet there is a distinct lack of comments on this article. Is everyone just interested in pointing the finger? Congratulations where congratulations are due, I say, well done to everyone involved. That’s not me, if anyone is wondering,


2

Love to - but!

18 Feb 10 16:02

Dear Will, We would love to explore the pros and cons of migrating a mature Exchange/AD environment that is proving full unified messaging including OCS, ESR, TLS encryption etc across LHCs with you, if only you would respond to our repeated requests to engage with you? We have nothing to hide and have no philosophical reason why we would not start to plan migration, providing NHSmail can deliver or at least provide a timeline to ensure the current level of services to the NHS trusts concerned?


3

Is this a wind up?

18 Feb 10 17:02

Paul I'm not sure if you are serious, but the fact you have a nhs net mail address tells me you might be.

Why would the Head of NHS mail not want this? No surprise there, and no reason why they would say it's not fit for purpose.

There are many reasons why this will not be so, although undoubtedly NHS mail works as a mail system. Whether it's worth what we pay for it is another matter, but if the business case is built on the premise that we would spend £879,000 over five years on 2,500 mailboxes then I can certainly see why certain people would believe that.

The reason I hadn't responded earlier was because I was laughing too much.


4

Encryption

19 Feb 10 08:02

Since that nice young young Mr Nicholson (sorry, Sir David) wrote to us all about encryption, data security and information governance, I have had to stop using my NHSmail account for much of my day-to-day work.

Silly isn't it.

If I'm emailing another NHSmail (or dh.gsi.gov.uk) user, all is indeed groovy.

Alas, for the legion of other people I have to work with, any encrypted attachment is stripped. The days of sending an encryypted winzip archive (renamed from '.zip' to '.zap' with instructions in the email) are now behind me.

I know that getting them to sort out their own NHSmail account would address this, but those pesky patients, social workers and 3rd sector workers keep getting in the way of NHS CfH's utopian idyll.

Now if the left hand (Digital Information Policy Unit) and right hand (CfH) would get their act together, life would be more pink, fluffy and practical.


5

More questions than answers - Who can we trust to provide an unbiased - informed view

19 Feb 10 10:02

This does seem to be rattling on.

Q1. Is NHS Mail as it is currently implemented fully fit for purpose and able to comprehensively provide / support the range of encryption required by NHS CEO (and best practice)?

Q2. If it's not - will it ever be?

Q3. If it is and the dissenters that have contributed to these pages are either misinformed or just being plain difficult (I doubt it) - where is the published specification for NHS Mail that confirms this?

Q4. Is NHS Mail fully costed? and does it provide advantages and value for money?

Q5. Are we just trying to implement another plank of the programme because someone has that as a job description?

The underlying and fundamental communication means for the whole of our health service needs to be fully adopted based on actual performance and capability and not on political expediency as we may be seeing here and probably seeing with aspects of the national programme.

Just saying -- GET ON WITH IT!! is not only an insult to those that have legitimate concerns about its adoption (and probably zero interest in maintaining the status quo by the way). It says much about the lack of depth of the engineering approach that simple / basic / fundamental issues appear not to have been addressed and if they have, insufficiently communicated.

Whoever is in charge in allaying fears... Get on with it and zero spin.


6

Shouting from Ivory Towers........ sat behind desks....

19 Feb 10 12:02

Why would we bother to move to a central contract just before it ends? The noises from other parts of NPfIT are that when contracts are ended, or functionally reduced, the Trusts will have to foot the bill. This has been stated in terms of Lorenzo, N3 and the Enterprise Wide Agreements. This appears to part of the cost saving strategy for CfH, pass it on to the Trusts, hence saving the NHS nothing. The iSoft business plan is also reliant on it!

Those sat in their Ivory Towers do indeed need to take a walk on the wild side and help to deliver patient benefits. A letter to Finance Directors stating "£879,000 savings" is not the way we do business on the shop floor. We create options appraisals and business cases based on many aspects, finance included. Did the people writing the £879,000 "business case" letter consider all the options, the workflow and the governance requirements around e-mail?

There seems to be a great many SHA/CfH people trying to justify their existence at the moment, sat behind a desk.........


7

NHSmail "savings"

19 Feb 10 14:02

£879k saving (I think not) - your not the only one laughing!


8

£879,000 -- prove it.

19 Feb 10 14:02

Like other readrs I have more than a little trouble believing the figure of £879,000 as the value fo savings over 5 years for switching to NHSmail.

Perhaps Mr Moss, or one of his CfH colleagues could provide a more detailed breakdown of how this marvelous figure has been calculated. 

I also presume that there will be careful monitoring of actual savings and reporting back of any shortfall against the £879,000 figure.

 

 


9

Costings

lyn@e-health-media.com

19 Feb 10 16:02

The link at the end of the story takes you to a page on the NHS Connecting for Health website that carries a pdf of the detailed calculations behind the £879,000 figure.


10

Wrong url!

john.bishop@leics-his.nhs.uk

19 Feb 10 16:02

Sorry Lynn the link takes you to google!


11

That link

lyn@e-health-media.com

19 Feb 10 17:02

You are right. How odd. I spent some time finding it as well. Try this one. Or Google 'NHS Connecting for Health + the financial case for NHSmail'. I'll change the one in the story. Lyn.

http://www.connectingforhealth.nhs.uk/systemsandservices/nhsmail/about/financial


12

Business Case

20 Feb 10 10:02

I have now looked at the numbers

So anyway, there I was trying to persuade the missus that I needed a new car every year. The case is cut and dried:

The depreciation on the one I have is £5K pa

If I did as many miles as I could that would be around 100,000 so I'd have to have it serviced four times in the year and put two sets of tyres on it.

I'd probably have to put a new engine in and that would cost me £5K

Because it is a Japanese car I need to take it to Japan for the best service

My old car is therefore costing me £30k per annum just to keep on the road. It's a no brainer.

It's no wonder the country is nearly £200Bn in debt with idiots making decisions like this.


13

Saving to a local organisation... but?

21 Feb 10 12:02

I welcome the spreadsheet and narrative, but can transfer of costs to a central place really be counted as an overall saving to the NHS per se? There may be benefits of scale but not all the cost will be saved -- e.g. what price the time taken to queue for service from a centralised help desk ..... etc ??


14

methinks the lady (or gent) doth protest too much!!

22 Feb 10 12:02

Best to remember that the spreadsheet and narrative uses a 2,500 user email system as its baseline.

Therefore extrapolating this to real-life numbers - the projected cost of providing email (not using NHSmail) in the nhs over the next 5 years (taking a very conservative figure of 500,000 users) is £175,927,600

(calculated from the total number of nhs email users out there divided by 2,500 and the result multiplied by £879,638).

.. or just under £352 per user (c.£70 per year) - can these numbers really be taken seriously or are they just plain silly?

Assuming that NHSmail actually fully meets the service and information governance / confidentiality requirements of the health service and the total cost of provision is much less than the local alternative, the case for NHSmail is almost certainly compelling.

The numbers published however appear to be based on hard selling the migration based on cost alone rather than selling on the basis of quality and service improvement.

What is the total (burdened) cost of NHS mail provision - is that number published? It can only be hoped that it is a tiny fraction of the £175m for 1/2 million users.


15

It is not an encrypted email system

roseneath@ntlworld.com

22 Feb 10 22:02

It is a mailing system which has cleartext at both ends but uses an encrypted tunnel for email transport. That is not encrypted email. Encrypted email means that the mail is encrypted at one end such that even the sender cannot then open it, once locked, but only the recipient with their own key. Ie completely locked to the casual observer.

It might be fun to play with, but I wouldn't use it for sending patient data unless it were proper end to end encryption such as pgp/gpg. Of course if I send an email to Dr Haematologist with pgp, then Referral Management Centre wouldn't be able to read it and I guess that might be quite upsetting for them.


16

NHS Mail has institutional endorsement but ambiguity still rages

23 Feb 10 11:02

The BMA - RCN and Chartered Society of Physiotherapy have all endorsed NHS Mail - see http://tinyurl.com/bmarcn

Is it possible that these organisations are not fully aware of the concerns raised in this thread?

Following the outcry over national data loss at the end of 2007 - the then interim DG of CfH - Matthew Swindells - wrote to all SHA CIOs with specific guidance re: personally identifiable information - the letter is here  http://tinyurl.com/ylqcgx9

The first paragraph is crucial;

"I am writing, further to the recent letter from David Nicholson, to formally confirm that the movement of unencrypted person identifiable data held in electronic format should not be allowed in the NHS."

The letter shoudl be read in full for the full context however the statement is unambiguous.

Whilst SSL encrypts messages in transit - the data (mail messages which will have person identifiable content) is not encrypted and is retained in cleartext at either end as pointed out by the previous poster. Is the Jan 2008 statement from CfH therefore consistent with what is being requested by the same organisation in practice i.e.. a wholesale move across to NHSMail?


 

 


17

Main points

23 Feb 10 14:02

First - The main reason large Trusts are not taking it up are valid ones of usability and integration

Second - Those Trusts provide mail systems that do the job for a fraction of what "they" think they do

Third - This is not some esoteric argument over who has the best encryption system. As someone pointed out PKI actually means that people who need to see things cannot.


18

Difficulties with NHS Mail as a corporate email system

chris.evers@nhs.net

23 Feb 10 17:02

These include:

No published service level agreement

No facility to restore mailboxes

No or limited compliance with many IG Toolkit measures

No flexibility on mailbox limits

No ability to archive without using an Outlook PC client


19

Disadvantages of NHS net email addresses

23 Feb 10 22:02

1. Though NHSnet addresses are permanent so one should always be able to catch up with mobile individuals, at least with Trust email addresses one stands a chance of guessing where mail comes from (though many domains are somewhat cryptic), given that many folks' signatures are minimal or non-existent (though I admit that others are so expansive - many unfortunately as a result of imposed house 'style' and disclaimers - as to waste ink & paper if printed)

2. Unless things have moved on, NHSnet email requires one to remember 3 passwords which is why I no longer use it - it is essential to write them all down to be able reliably to enter the nth letter of each to get in, thereby defeating the objective of this extra 'security' . . .


20

The Closed Shop

24 Feb 10 19:02

As a contractor of 25+years of providing services to the NHS (both clinical and IT) - I am not 'entitled' to an NHSnet email address because "I don't work for a trust".

I rely on ms-outlook (as with rest of the world as an industry standard) when communicating with my NHS colleagues - NHSnet simply takes to much away to make it useful.


21

are ALL clinicians and allied health professionals entitled?

25 Feb 10 10:02

Given that a service as large as the NHS relies heavily on temprary, contract (inc Locum) staff, are ALL the individuals who are likely at any time to be handling patient identifiable information provided with an NHSmail account? The orevious poster suggests that there is a 'class' of NHS worker who isn't covered.

Much has been said in this thread about whether or not SSL (in transit) encryption ACTUALLY complies with the edicts from top NHS management after the publicity surrounding the child benefit fiasco a couple of years ago and there appears to be no confirmation forthcoming from senior NHS IT people to ratify this - is this something that EHI could take up?

The report into the Mid-Staffordshire case which highlighted that NHS management did not listen and then attend to genuine concerns raised appears to be the case here as well.


22

Time for some independent benchmarking? 2013 contract termination.

26 Feb 10 17:02

I'm confused!

The figures quoted by CfH are for a single Trust and come out at £70 per year per email account. Far higher than most Trusts pay, but let's put that to one side.

It would be interesting to see a benchmarking exercise between NHSmail and an email service hosted by a shared service - delivering economies of scale, whilst maintaining a local service desk. It would be also be useful to see a breakdown of the number of registered users of NHSmail and the number of individual people who have logged on in, say, the past month. Are accounts ever deleted after a period of inactivity, or are they left on the system to keep the stats up?

The call in the NHS OF/Informatics planning for a business case is easy to counter. The NHSmail contract ends in 2013 - so the costs of migrating from a local service to the National one, plus the cost of migrating onto "something else" needs to be taken into account and an estimate made of service charges beyond 2013*. Given our current costs are far less than the £70/user/year the business case for NOT migrating to NHSmail is very strong.

I'm not a lawyer but any contract of this magnitude would surely need to go back out to tender via OJEU? The chances of central funding being made available beyond 2013 is pretty remote in the current economic climate.

NHSmail was a bad idea back in 2003 when it was first mooted. It is better now than it was but putting lipstick on this particular pig doesn't make it any less of a pig. It is slow (restricted by N3 bandwidth rather than our local service which runs on a 1Gb backbone and 100Mbps switched LAN services between server and clients), not very user-friendly, unencrypted (unlike our local service), its SMTP domain addresses give no idea of who a person works for undermining corporate identity (I'm contracted to work for my Trust, not for "the NHS") and it only has three years left to run.

* this argument applies to all NPfIT contracts - the first big one to come up will be PACs - which should be fun!

 

 

 

 


23

NHS Mail…the Publics perception of all this…?

28 Feb 10 12:02

 

I’ve been compelled to comment on the NHS mail comments as an ordinary member of the public and a taxpayer.
The money/resources referred to in earlier comments isn’t NHS Trust’s own money. It is ours the taxpayers of England.
Surely there is a bigger picture here, the NHS.  Clearly the NHS needs an efficient and effective 21 Century national electronic mail system that supports the delivery of 21 Century care and all that entails (inc. confidentiality of information sharing etc).
QIPP and the increasing challenges on Public Finance is going to be with us for some time. We need leadership in terms of a mail system for the NHS, we need transparency and we need hard evidence from those leading the trail on this.  Above all the NHS needs to get on with this. 


24

NHSmail: CfH responds

lyn@e-health-media.com

04 Mar 10 10:03

I asked NHS Connecting for Health if it would like to respond to the points made in the comments to this article.

In particular, I asked the agency to respond to the issue raised about the compatibility of NHSmail with the requirements set out in David Nicholson's letter, post the HMRC debacle.

In response, the agency has updated the NHSmail 'myth buster' section of its website, here: http://www.connectingforhealth.nhs.uk/systemsandservices/nhsmail/summyth

Lyn Whitfield, managing editor, E-Health Insider.

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