Over the past four months, businesses up and down the country have been complaining about how much the COVID-19 coronavirus pandemic and the resulting lockdowns have up-ended their normal business procedures – but if you think that’s a big adjustment, try working for the NHS.

Not only have all the same challenges affected the line-of-business staff that keep NHS trusts moving, they’ve also got to contend with the fact that keeping their clinicians and support staff operating at maximum efficiency is a literal matter of life and death.

While the government’s use of technology to combat the effects of coronavirus has been patchy at best, many NHS trusts have been upgrading and improving their own IT to make sure their staff have the best possible tools to ensure that they can fight the disease in a safe way, while still continuing to treat their non-COVID patients. 

Five years of work in five days

For Bob Beckwith, infrastructure manager of Newcastle NHS Trust, remote working is at the heart of these efforts. Like many organisations, he says, the NHS has had to rapidly adopt the technology in order to minimise the amount of face-to-face contact between members of staff, as well as between clinicians and patients. 

The trust has recently deployed Starleaf’s collaboration and videoconferencing technology throughout its sizable estate, and Beckwith says that the deployment has been a roaring success. 

“We took the approach of giving everybody a Starleaf account – use it or not,” he explains. “In terms of adoption, more people are now using it. As for the rollout, I don’t think we’ll ever be finished. The trust is so large by the time you’ve done one wing, the next wing is ready for a refresh.”

He’s not kidding, either; the Newcastle NHS Trust is one of the largest trusts in the country, with 1,800 beds and around 14,000 members of staff across 40 sites and two major hospitals. It also covers a huge range of specialisations, including cancer treatment, major trauma centres, children’s hospitals and more. Despite the scale, however, the response to the new system has been almost uniformly positive.

“I heard the expression somewhere around five years of work being done in five days, in terms of developing the product, increasing confidence in the use of it,” he says, “and I think that’s very true. There were a lot of people who I would have had a safe bet on never using video until after they retired. Now, they’re absolute converts; they can’t live without it. So this horrible thing happened and it kind of was a blessing in disguise for video conferencing … We couldn’t keep up with demand for headsets and webcams and speakers, but other than that, it was very good.”

Education, education, education

One particular problem that videoconferencing has helped to solve is education. As junior doctors and medical students come into the trust, they need to be trained – a task that is not helped by the fact you can’t have more than a small handful of people together in a room. To get around this, it has used Starleaf to let staff conduct training sessions remotely, with students able to dial in from anywhere.

“They’re just the ones I know of, because the beauty of this is IT doesn’t have to know about everything; if they want to use it for something bizarre and it works, they’re welcome to,” Beckwith explains. “They’ve done all the things you see on the news as well. They’ve had their team meetings, their team-building pub quizzes.

“It’s about keeping people together as a team. So you don’t forget what everyone looks like, I suppose!”

Starleaf wasn’t rolled out as a direct response to the challenges of coronavirus, though. It grew out of an earlier system of Polycom endpoints, which were deployed by the Northern Cancer Network (now known as the North of England Cancer Network) in cancer centres across the region. While somewhat neglected, the idea was judged to have promise, and a programme of upgrades eventually gave way to a root-and-branch replacement of all of its various components with a single provider.

Starleaf was identified as the provider of choice, and there were a number of factors that swayed the decision; security and reliability were high on the list, given the huge amount of extremely sensitive medical data the NHS handles needs to be carefully safeguarded.   

The fact that Starleaf is a British company also helped its case, as did the fact it was already on NHS Digital’s Health and Social Care Network procurement framework, which meant that many elements of the data protection impact assessment (DPIA) that a trust needs to carry out before it deploys a new technology were already addressed. “Because they’re on that they naturally ticked a lot of the boxes,” Beckwith says, “so a lot of the concerns were gone in terms of transmission of the data, storage of the data, where the actual data centres sat.”

“The other one was the licence model. Generally, if something is secure and reliable, it’s expensive, and a lot of the models from other people were per-seat. For an organisation our size with initially quite a low percentage adoption rate, it was just ridiculously expensive. Now, maybe not, because so many people are using it but at the time, it was.”

Freedom isn’t free

Another appealing way in which Starleaf differs from other videoconferencing and collaboration providers is its licensing model. As Beckwith explains, if a product is both secure and reliable, it’s normally expensive; with many of the other solutions considered being priced on a per-seat basis, the cost was prohibitively high.

Starleaf, on the other hand – much like the NHS itself – is free at the point of use. Anyone can register for an account, download the client and start holding video meetings for free, and the same applies to corporate accounts.

“Where the costs come in is around virtual meeting rooms,” Beckwith explains; “so basically, use of the bridge, use of the cloud. So as soon as you start using the bridging service, there’s obviously a cost associated with it. And there’s also the hardware cost for the room systems.”

This licensing system made Starleaf much more affordable for the trust than competing systems, but while the deployment has been a success, Beckwith says that it wasn’t without challenges. The biggest initial hurdle, he says, was bandwidth.

“We originally massively oversized the internet link that was set aside for Starleaf, but it was used up. Because of the way Starleaf works, when you max out, it reduces the call quality to try and handle the number of calls going on,” he says. “We found that, overnight almost, people were complaining about poor quality.”

Fortunately, the trust has an MPLS-style network and its provider could increase bandwidth fairly easily and quickly, albeit at an additional cost.

Training users on the new system has also proved to be something that required attention, and while some staff immediately took to it, there are always going to be holdouts who initially resist the deployment of new technology. Indeed, for Beckwith, education is probably his team’s biggest challenge.

“The technology works, we can monitor bandwidth usage and increase that relatively easily. The difficulty we have is showing people how it works,” he explains. “Quite often I’ll have comments of ‘that’s useless, it doesn’t work’. But they might not have a microphone, so they’re saying ‘they can’t hear me’. Well, yes, there are basic things like this. That’s the biggest challenge, definitely.”

While its use has understandably been scaled up dramatically in recent months, remote working isn’t a new experience for the trust, and Beckwith’s team has had processes and procedures in place to support remote workers for some time.

“If someone wants to work remotely, away from the main trust, they need a laptop, so they will be issued with a Windows 10 Trust-build laptop with all the usual policies and things,” he says. “We then use Microsoft Always On VPN to allow them to VPN back into the trust. And then we can then use our internet gateways, et cetera, to control what they’re doing. That seems to work well.” 

The trust’s IT team can also help with other hardware requests, such as a bigger screen, to provide “an office experience in their front room”.

“All we’re asking them to do is connect it to their broadband,” Beckwith says.

Every now and then I fall apart

The trust isn’t stopping with Starleaf; the organisation is currently in the process of migrating from Windows 7 to Windows 10, a project that is expected to be completed before the end of the year, and is also re-starting some of the IT upgrade and modernisation projects that had been paused due to coronavirus. Among these, one of the biggest focuses for Beckwith is the network refresh.

“You can imagine, with a network our size, it’s a big task. We’re replacing all the Wi-Fi, all the edge switches, and eventually the core as well,” he says. “That was put on hold [but] now I’m putting a few teams on it and hoping to get it done within the year. We’ve had a Cisco network ever since we’ve had a network. The wireless was about 10-15 years old, so it’s starting to creak – literally fall apart sometimes! The AP covers keep dropping off.”

The trust is heavily reinvesting in Cisco’s wireless products, Beckwith says, partly because of the popularity and versatility of wireless networking and partly because getting rid of cables is much more sanitary for clinical environments. The trust has been able to test this new networking technology in an interesting environment – one of the new Nightingale hospitals built to prevent hospitals being overwhelmed at the peak of the coronavirus crisis in spring.

“We built Nightingale Northeast and we put the new equipment in there because we had it. It’s a great testbed to see how it worked, and it’s much better,” he says. “The most noticeable [improvement] is the wireless connection speed. I think the company is just moving to 802.11n, which is a big difference if you’re just used to the old A/B/G networks.”

With successfully deployed and fully operational videoconferencing and remote working facilities helping to support Newcastle NHS Trust throughout the COVID-19 crisis, what advice does Beckwith have for those unfortunate organisations that weren’t able to set something up before the outbreak?

“As I said before, there was five years worth of development done in five days, and I think that’s very true – and it would have taken that long to get to this point where we are now,” Beckwith says. “It’s worth mentioning that [videoconferencing] is an overlay service to your network. So if your network’s poor don’t even bother trying. A lot of things are like that, I know, but videoconferencing assumes you’ve got a good network in place.”

“Definitely go for cloud-hosted,” he advises. “Make it as simple and as stripped back as possible – a lot of people just want to send an IM and video call someone. That’s it. There’s a whole load of products out there that’ll do an awful lot more [but] I wouldn’t personally bother with that: Just concentrate on the core stuff and do it now. Because this isn’t going away.”