We are in a defining period for the healthcare sector, and no avenue is being left unexplored to ensure the UK continues to deliver a world-leading healthcare service, despite the challenges it has faced over the last few years.
One approach to improving healthcare is through embracing the idea of making data freely available within the immediate healthcare ecosystem, and extending it beyond that to stakeholders.
The success of this direction was clearly demonstrated during the acute first phase of the COVID-19 pandemic, and the consequent surge in demand for government services and information, which placed a significant burden on IT departments.
NHS Test and Trace was formed – later to become the UK Health Security Agency (UKHSA) – with an integral role in safeguarding public health.
The pandemic put significant strain on government budgets, with IT departments having to tackle their increasing backlogs of change and new service requests, while maintaining existing services, without having the resources to hire new staff or upskill existing employees
And it had to quickly scale up systems and infrastructure to handle increased website traffic, online applications, and data processing related to health services, while pressed to deliver new data services to support informed decision-making at all levels, for ministers, health practitioners, and for the public.
During this period, it became increasingly clear that timely delivery of data has a crucial part to play in delivering a world-leading health service.
As one example, the COVID-19 dashboard updated information daily, showing exactly where outbreaks were occurring and the trends over time.
It was one of the first attempts by the NHS to distribute data at scale, and during its peak it handled 300,000 visitors per minute.
Complex hurdles in every direction
Like many healthcare organisations, UKHSA had legacy systems and technical debt to deal with. And, at the time the pandemic unfolded, these all posed challenges in terms of interoperability, scalability, and flexibility.
This made it all the more challenging to meet ever-changing demands and requirements based on the virus and the impact on the country.
Over the last three years, healthcare, like other sectors, has also seen a sudden shift to remote working; from researchers and bio-scientists, to even some frontline health roles.
And IT departments have had to rapidly enable this transition and support remote access to services that previously were provisioned only to departmental offices.
This shift has compelled departmental IT teams to ramp up security measures, especially considering the sensitive nature of the medical data on hand.
At the same time however, the pandemic put significant strain on government budgets, with IT departments having to tackle their increasing backlogs of change and new service requests, while maintaining existing services, without having the resources to hire new staff or upskill existing employees.
Clearly, getting the right data to the right people in a timely manner was complicated by the combination of legacy systems, changing working patterns and budgetary pressures.
Initial approaches to capturing and distributing data, such as the COVID-19 dashboard, proved extremely beneficial - albeit expensive.
So, the challenge became how to maintain the value of the approach while undertaking the process at a cost that was sustainable.
The COVID-19 pandemic highlighted the importance of data for delivering responsive health services
Finding a solution
To help solve these issues, UKHSA selected Capacitas to introduce DevSecOps into its delivery teams.
The main feature of this methodology is to accelerate the delivery of application development while simultaneously improving the quality of output.
It is a modern solution for IT teams that are under increasing pressure from stakeholders to release more services, applications, and code without exposing the organisation to new security vulnerabilities.
The idea is that by unifying the development and operations practices with security, the removal of internal silos eliminates the roadblocks to streamlined delivery
The idea is that by unifying the development and operations practices with security, the removal of internal silos also eliminates the roadblocks to streamlined delivery.
Through applying DevSecOps practices, UKHSA set out to solve this problem by starting with best practices around cloud technology.
And it was able to quickly identify and eliminate design inefficiencies in the data platforms, delivering a set of optimisations to slash the cost of delivering data.
By making better use of the native elasticity of the cloud, the dashboard began to scale automatically when demand was present, and scale back down once the wave had passed.
And, beyond this, embedding DevSecOps practices into UKHSA meant introducing reporting that monitored four crucial metrics related to delivery speed and efficiency. These metrics – deployment frequency, lead time for change, time to recover, and change failure rate – became a pillar that empowered teams to identify strengths and areas for improvement in real time and with accuracy.
Examining the results
The impact of introducing DevSecOps is universally recognised, and it was no different for UKHSA.
The team was able to pinpoint bottlenecks and eradicate root causes – boosting delivery speed by 60% and reducing production incidents by 89%.
Also, through pushing accountability and ownership directly into the engineering teams, UKHSA has saved over £1m, simultaneously improving delivery throughput.
Notably, cloud expenditure was slashed at the same time, resulting in £4m in overall savings.
At a time when budgets are strapped across national healthcare departments, this is a huge win for the cause of data driven healthcare.
A legacy of better service provisioning
Outside of a pandemic, both healthcare organisations and the general public stand to benefit from healthcare data being made available at scale.
Data dashboards on health threats, local disease outbreaks, and the winter flu season could help better guide future policy decisions and provide confidence to the public.
At a time when budgets are strapped across national healthcare departments, this is a huge win for the cause of data driven healthcare
The NHS, struggling with long A&E waiting times and delayed appointments, could benefit from their own dashboards to help guide stakeholder decisions.
Thanks to the use of DevSecOps practices, and by formalising the approach to building open data resources, UKHSA has the skills to build new data services making the right use of the cost efficiency and flexibility of the cloud.
And this new set of skills unlocks the development of applications that can help deal with the next emergency by delivering better insights through enhanced data transparency, thereby enabling better decisions to be taken to secure our health.
