COMMENT: It’s time to write a new open source future for healthcare

Luke Morton, chief technology officer at Made Tech, argues that if the NHS does not properly mandate open source it is effectively allowing the IT industry to privatise the health service

The NHS's Book a Virtual Visit solution is a great example of how open source software works for the NHS

It’s hard to talk about the silver linings of a global tragedy like coronavirus.

But, if we must, then as Satya Nadella has said ‘we’ve seen two years’ worth of digital transformation in two months’.

A wide scale, life-threatening emergency necessitates action, and the technology industry has stepped up with a sense of urgency never seen before

It’s happened across the private and public sectors, but health and social care, sitting at the heart of the response to COVID-19, has seen more than most.

A wide scale, life-threatening emergency necessitates action, and the technology industry has stepped up with a sense of urgency never seen before.

And, in response to calls from healthcare, the Government, and the public, we’ve seen solutions that have made an instrumental difference – from contact tracing to antibody testing and video consultation and virtual hospital visits.

The public and health and social care is finally getting the technology it needs.

We recently developed an open source ‘book a virtual video visit’ service for two London trusts following a social media plea from chief information officer, Sonia Patel, in just 48 hours.

It was in wards just days later, facilitating many hundreds of visits between patients and their loved-ones and clinicians.

And we must continue to embrace the start-up approach to technology development and implementation.

But, as and when we emerge into a post-COVID-19 world, there is a real threat that we settle back into bad habits.

Now we have the chance to write a new future - to mandate open source and reap the benefits, providing a sea change that will transform healthcare technology for the benefit of citizens

Currently there is ann over reliance on closed proprietary systems, big costly rollouts that do not deliver, and data that’s locked into individual systems, inhibiting interoperability and better outcomes for health and social care.

And now we have the chance to write a new future - to mandate open source and reap the benefits, providing a sea change that will transform healthcare technology for the benefit of citizens.

Monolithic technology

In the industry we’ve long been accustomed to kicking the big IT suppliers when it comes to monolithic systems, and their knack for taking our healthcare providers and the wider public sector hostage by locking them into big contracts.

But today this is not just the preserve of the big bad wolf. Smaller suppliers are slipping under the radar with solutions that are just as closed, with public data effectively being owned by not four large IT companies, but many smaller ones.

It’s all very well for tech start-ups to replace the old guard of big suppliers that didn’t build technology very well, but if you are not mandating open source, you are effectively replacing them with a privatised approach to digital.

It’s all very well for tech start-ups to replace the old guard of big suppliers that didn’t build technology very well, but if you are not mandating open source, you are effectively replacing them with a privatised approach to digital

Where is the openness and transparency that most citizens would want with their health data?

It’s fairly easy to see how bringing in private organisations to provide health and care services would lead to the privatisation of our NHS, but the privatisation of one of healthcare’s biggest assets, its data, is in danger of slipping under the radar.

Surely, it’s better that public data is held by healthcare organisations where there is the expectation that data will be managed and used in a way that benefits society, not a private organization?

We don’t want public data locked away in legacy systems. Instead the transparency and flexibility offered by open source gives data back to these groups.

More transparency

Private technology companies should be more transparent about the tech they are building by taking principles of NHSX and publishing code, even if they are not licensing it out for re-use, so the public can see how you treat data.

It’s a good builder of trust, but public and peer scrutiny also keeps us all on our toes, creating better technology that saves money, time, and improves lives.

Look at the COVID-19 contact tracing app.

NHSX published its code, security and privacy designs as part of its commitment to transparency so that techies could ‘look under the bonnet’ of the app to ensure the solution was the best it could be, or indeed highlighting where it was lacking.

Personally, I hope that strong leadership by NHSX will move the needle for open source and, as a result, increase the number of vendors that adopt it

And coverage of the source code reached mainstream media in a move that has taken the debate out of IT circles and made it central to public debate.

That was an important move to engage the public in an app that the Government needs them to willingly adopt, and even more so when it is based on capturing and mapping public data.

The ‘book a virtual visit’ service was built and delivered following a call from Sonia Patel. It’s an NHS solution, built by us in the open. And our hope is that trusts will be able to use the source code to ensure this service can have as wide and as positive an impact as possible.

Leadership is critical

The NHS has been pushing open source for a number of years now.

With the dismantling of the National Programme for IT there was an optimism fed from the benefits of open technology.

Finally, trusts would be able to take ownership of their technology and code, taking systems and tweaking them to make IT work for them, rather than the supplier.

And there was hope this would drive up standards and quality as trusts were no longer beholden to supplier code.

But, for all the initial optimism, it never really got off the ground.

Last year with the emergence of NHSX, open source was firmly back on the agenda and there is hope that its leadership will continue to drive adoption of open source in the coming years; a hope that is buoyed up by the public's new ‘interest’ in source code from the systems that capture its data, and technologists' unwavering commitment to holding the Government to account.

Personally, I hope that strong leadership by NHSX will move the needle for open source and, as a result, increase the number of vendors that adopt it.

And, in an ideal world, I would like to see NHSX standing much more firmly behind its wish to mandate open source.

COVID-19 has forced transparency from a central point of view and we are on the tipping point of this becoming the way things are done in the future, creating a watershed moment for open source in public services, and a very welcome end of supplier privatisation of public data

It’s undeniably the future, but there is a need for the supplier community and the NHS to work together to deliver on its promise.

Trusts cannot do it alone. They might need to lean on supplier skills and resources in the traditional way, while keeping the integrity of its code and ensuring that public data is kept within the walls of Government for the benefit of citizens.

So, as silver linings go, COVID-19 has forced transparency from a central point of view and we are on the tipping point of this becoming the way things are done in the future, creating a watershed moment for open source in public services, and a very welcome end of supplier privatisation of public data.

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