NHSnet

However many grand scheme created by governments fail to work adequately and this is a case in point. The scheme was started in 1995 and by 2002 it should have been finished. All surgeries were supposed to be linked in by now. However many surgeries have data on patients going back as much as 100 years. All this data has to be typed in by someone. Very little government money has been made available for this task. About 18 months ago the deadlines were extended by a further 5 years, and they could well be extended again as only a few surgeries are pilot in the system at present. How did this happen?

Background

There is some misunderstanding about what NHSnet is and what it's used for. It can be difficult locating information about NHSnet, and what is involved in getting linked. So, the following notes aim to explain how the NHS wide network (NHSnet) came about, where it fits in the NHS IM&T framework, what resources are available and what's involved in getting linked.

Some history is useful in explaining the make-up of the network. As one of the more mature of the regional networks prior to the inception of NHSnet, the development of the Trent regional network is a good case in point. The Trent network came about as a result of a project in the mid 1980's to link its hospitals via a simple network to NHS supplies, which had centralised to a single warehouse site at Alfreton in Derbyshire, to enable a JIT (just-in-time) approach to hospital stocking. The imperative was one of cost reduction by rationalisation of hospital inventories. Later, in Sheffield the Trent network was upgraded into a high speed and resilient network (i.e using multiple routing to eliminate dependency on individual cables). This enabled the centralisation of "District" resources such as a population health register (PHR), with centralised District-based hospital computer systems for the Sheffield Hospitals, and it was used by South Yorkshire Ambulance Service for ambulance booking and scheduling.

In the early 1990's the various regional networks were linked to form an NHS-wide network. This has provided a backbone for national infrastucture projects in the NHS IM&T strategy; services such as interpersonal massaging and electronic data transfer as in the NHS-wide clearing house service for the exchange of minimum data sets (MDS), used in healthcare commissioning. However, the GP-health authority "links" system currently resides outside of the NHSnet environment (see below).

So the picture here is not of a web-based NHSnet infrastructure but largely a network of dumb terminal / terminal-emulation access to main systems, and machine-to-machine communications. Still the network is largely used by NHS Supplies, the Clearing House and the ambulance services.

The concept of the NHSnet as a web-based information platform / NHS Intranet is a very recent one, and is still extremely underdeveloped as such. As an aside, there is some misuse of terminology here. The terms Intranet or extranet are often used incorrectly as a synonym for network. Intranet generally describes a network within an organisation or between related organizational units that incorporates web page based access to data / information. Whereas the term extranet implies an extension of the intranet to include customer and/or supplier organisations, i.e. external to the organisation. An extranet is not simply a collection of intranets.

Recently the NHSnet has been enhanced by the addition of a managed message handling service(MMHS), i.e. e-mail, and internet access through a secure "gateway." BT Syntegra has the NHS contract to provide this. The MMHS uses a store-and-forward X.400 protocol for e-mail which is the open systems standard adopted by the NHS. BT has provided a MMHS service to NHS organizations previously, but outside the NHSnet environment, along with a similar service offered by Racal. The Racal service is based on a KERMIT protocol for e-mail rather than the more modern X.400 approach (but later offered X.400). However, many of the GP practices using a health service MMHS are on the Racal KERMIT system (i.e. most Sheffield practices) and so are neither X.400 nor NHSnet based. But, there is a direct link between the Racal and BT X.400 MMHS's called the P1 link.

The X.400 services has the advantage of operating on a TCP/IP (Internet protocol) platform, and so the NHSnet is able to provide, via a secure gateway, access to internet e-mail (and WWW browsing). This is not available on the Racal KERMIT or X.400 service. At the moment GP registration links, items of service links, and pathology links to health authorities and Trusts go through the Racal MMHS system. As yet, they are not NHSnet based.

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