Smoothwall Primary Care Report

Commissioning and Implementing Web Filtering and Internet Security Solutions

S P E C I A L R E P O R T

Protecting Your Network When Provisioning Free Public Wi-Fi in the NHS

The Digital Future of the NHS

Achieving Innovation in the World of Austerity

Making the Transition to Wi-Fi

Web Filtering – The Key to the Digital Future

Published by Global Business Media

Sponsored by

SPECIAL REPORT: COMMISSIONING AND IMPLEMENTING WEB FILTERING AND INTERNET SECURITY SOLUTIONS


Global Business Media Limited 62 The Street Ashtead Surrey KT21 1AT United Kingdom

Switchboard: +44 (0)1737 850 939 Fax: +44 (0)1737 851 952 Email: [email protected] Website: www.globalbusinessmedia.org

PublisherKevin Bell

Business Development DirectorMarie-Anne Brooks

EditorTom Cropper

Senior Project ManagerSteve Banks

Advertising ExecutivesMichael McCarthyAbigail Coombes

Production ManagerPaul Davies

For further information visit:www.globalbusinessmedia.org

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Contents

Foreword 2Tom Cropper, Editor

Protecting Your Network When Provisioning 3 Free Public Wi-Fi in the NHS Claire Stead, Smoothwall Limited

A Digital Health Service by 2020

The Benefi ts of Providing Free Public Wi-Fi

The Concerns

How to Overcome Them

About Smoothwall

Next Steps

The Digital Future of the NHS 8 Tom Cropper, Editor

The Digital Drive

Free Wi-Fi

Obstacles to Uptake

Moving to the Future

Achieving Innovation in the World of Austerity 10 Jo Roth, Staff Writer

Ambition versus Fund

A Future of Defi cit

A Question of Security

Making the Transition to Wi-Fi 12 James Butler, Staff Writer

Why Install Wi-Fi?

How To Do It

Looking to the Future

Web Filtering – The Key to the Digital Future 14 Tom Cropper, Editor

A Connected Future

Monitoring Use

Tailored Filtering

References 16

Commissioning and Implementing Web Filtering and Internet Security Solutions

S P E C I A L R E P O R T

Protecting Your Network When Provisioning Free Public Wi-Fi in the NHS

The Digital Future of the NHS

Achieving Innovation in the World of Austerity

Making the Transition to Wi-Fi

Web Filtering – The Key to the Digital Future


Sponsored by

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Foreword

WE HAVE become accustomed to Wi-Fi

technology infiltrating every part of our

lives – it’s there in hotels, it’s there when we travel

and it’s there in public spaces, but what about

when we have to go to hospital? Not necessarily.

People staying overnight in hospital still often have

to pay for the privilege of slow internet with limited

connections - but all that is changing.

As part of the drive towards a digital and paperless

future, the government is pushing NHS Trusts

across the country to start offering free Wi-Fi in their

hospitals, GP practices and care centres. These

will be available to the public and staff alike and

can have a huge range of benefi ts. But even so, the

challenge of installing systems which are suitable

for the NHS is considerable.

Our opening article comes from Claire Stead of

Smoothwall who provide specialised filters and

security systems for the public sector – especially

the health service. She describes the need for

change, some of the benefi ts and the key obstacles,

before outlining how their system meets the needs

of NHS managers.

We will then look more closely at the government’s

drive towards its digital utopia. Modernisation is

coming fast and will be used to introduce a host of

new capabilities in all areas of the health journey.

Staff will use smart connected equipment to assist

with diagnosis and treatment, patients will use it to

improve their stay and managers can use it to enhance

performance.

Jo Roth will then look at one of the key obstacles

– cost. In an environment of austerity, how will the

NHS be able to justify additional expenditure on new

technologies? He’ll look at the cost/benefi t analysis all

managers will be making.

James Butler will then focus on how trusts can

achieve a smooth and effective implementation before

we round off the Report by looking at the key trends

hitting internet security and some examples of how it

is transforming healthcare.

Wi-Fi is one of those technologies that has become

so integral to our lives that we truly miss it when it’s

absent. Its introduction provides multiple gains for

medical professionals and patients alike. Getting the

installation right is worth the cost and additional effort.

Tom CropperEditor

Protecting Your Network When Provisioning Free Public Wi-Fi in the NHS Claire Stead, Smoothwall Limited

A Digital Health Service by 2020In 2015, UK Secretary of State for Health, Jeremy Hunt, outlined ambitious plans for all NHS organisations to be fully digital and paperless by 2020. The initiative includes removing a lot of the paper-based administration currently undergone by clinical staff, migrating towards solutions that are easier to manage online such as e-prescriptions. The announcement also included the UK Government calling for NHS organisations to offer a free Wi-Fi service for all patients and visitors, in a bid to improve the use of technology within the health service and help reduce costs.

As a service driven industry, it’s vital that the NHS is able to keep up with expectations from a digitally savvy generation. As Hunt outlines, “everyone using the NHS expects it to be a world leader in digital healthcare and free Wi-Fi is an essential part of making that a reality.” With the proliferation of Wi-Fi and mobile devices in retail and other service driven industries such as travel and leisure, this has now set an expectation amongst the general public

that internet access should be provided as standard. In an independent survey conducted by Smoothwall, research found that only 18% of patients were currently able to access public Wi-Fi in their local health service, with 55% of respondents claiming that they wished they could access Wi-Fi during a visit.

The Benefi ts of Providing Free Public Wi-FiFree public Wi-Fi in the NHS has several benefi ts, including the ability to improve patient rehabilitation and build on the reputation of the health service. 97% of respondents to the survey agreed that having access to Wi-Fi would improve their stay, with social media and email being amongst the highest rated applications that would be desirable to use during a visit to the health service. This shows that keeping in touch with friends, relatives or work has a direct positive correlation with the perception of an improved hospital stay, allowing patients to have more of a home-from-home experience and recover quicker. This also becomes very


2 | WWW.PRIMARYCAREREPORTS.CO.UK

Tom Cropper has produced articles and reports on various aspects of global business over the past 15 years. He has also worked as a copywriter for some of the largest corporations in the world, including ING, KPMG, and Zurich Insurance.

Free Wi-Fi for staff, patients and visitors is an essential tool in the bid to improve the

use of technology in the NHS. But with the potential threat to your network, how do

you ensure you provide safe, secure, web access for everyone?

SPECIAL REPORT: COMMISSIONING AND IMPLEMENTING WEB FILTERING AND INTERNET SECURITY SOLUTIONSSPECIAL REPORT: COMMISSIONING AND IMPLEMENTING WEB FILTERING AND INTERNET SECURITY SOLUTIONS

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NEL CSU provides expert support and advice to help clinical commissioners to deliver improved health services to local populations, and they deliver an extensive range of services from contracting and analytics, to fi nance and communications. Their services cover over 30 Clinical Commissioning Groups (CCGs) across London, Essex, Hertfordshire, Bedford, Luton and East Anglia representing more than seven million CSU people in total. NEL CSU also deliver a range of support services and bespoke solutions to healthcare organisations across England, including Hospital Trusts, GP Practices, Mental Health Trusts, NHS England and Local Authorities.

James Davis, Head of Infrastructure Solutions at NEL CSU, identifi ed that their current web filtering platform would not be sufficient for the scale of the project, due to a lack of fl exibility and the inability to provide a robust reporting engine. The system was not sophisticated enough to meet the demands of being able to report on users’ web browsing habits, which was vital in order to support their customers with safe internet access, whilst also meeting obligations around data compliance and information governance.

NEL CSU decided to utilise Smoothwall’s Secure Web Gateway (SWG) as a platform for delivering controlled, authenticated internet access for all. Smoothwall’s SWG has a number of features which were vital for the roll out, including real-time content analysis, bandwidth management, granular user based permissions, advanced reporting functionality, and anti-malware. The real-time solution has been specifi cally developed to support dynamic segmentation based on the user, device and location and compliance status of the devices

that will allow staff and patients access to the network effi ciently and safely.

Davis explains, “Smoothwall’s multi-domain support, robust reporting engine and sophisticated anti-malware scanning proved to be essential to our organisation’s requirements. Their bespoke solution allowed us to deliver web fi ltering as a service to our customer base, providing us with greater control over web browsing within our organisations. It has also helped to reduce IT staff workload due to the simple reporting functionality that Smoothwall provides and centralised settings that can be managed for all units.”

Smoothwall had worked with NEL CSU to design and deliver a unique web fi ltering cluster that was fl exible to their requirements. The cluster needed to serve a varied environment with multiple Active Directory domains, and multiple authentication options were needed for customer systems, depending on their location and how they connected to the main network.

Bespoke solutions were created for their diverse challenges and the flexibility of the authentication options and proxy setup on the Smoothwall system allowed Smoothwall to fi t into this environment with little work needed from NEL CSU system administrators.

Davis continued, “With implementing any new complex solution there are always ups and downs, but the commitment and tenacity from Smoothwall has been excellent. Our account manager and supporting colleagues were always available, and ensured our solution was implemented, addressed our needs, and tracked all work streams were running smoothly and to deadlines.”

There are several other NHS trusts and CSUs in the UK that are already utilising the powerful

Free public Wi-Fi in

the NHS has several

benefi ts, including the

ability to improve patient

rehabilitation and build

on the reputation of the

health service

meaningful when considering children staying in hospitals for prolonged periods of time, being able to provide them with educational material and internet access for distance learning.

It has also been found that working professionals are currently likely to hold off going to the doctor at the threat of missing work, with 91% of business people surveyed revealing that they would be more likely to go to the doctor sooner if they knew they could access Wi-Fi and continue to work. There are implications here that could prove that having free Wi-Fi could actually help the health service reduce costs by detecting illnesses earlier and treating patients sooner.

The wider need to implement wireless networking not only for patients but for NHS staff is to be able to work more effi ciently, leading to a reduction in administrative tasks which frees up clinical time by being able to process patients’ data faster, ultimately lowering overall healthcare costs.

The ConcernsWhilst all the above offer a great argument for the provision of free public Wi-Fi to patients and visitors to the healthcare service, the initiative does not come without its risks and potential threats. The initiative has given some offi cials cause for concern over the danger which surrounds opening their networks to external users, with many asking whether to do so could affect security and staff productivity.

The first, most obvious concern would be that, with patients having access to the internet, the network is opened up to malicious threats that, no matter how unintentional, could be downloaded by an unsuspecting patient. Users and providers alike often don’t realise the harm that the web can cause, and with an industry

like healthcare, reputational damage can be huge. Equally, deliberate misuse can be a cause for concern, creating a liability for illegal downloads or other deliberate attempts at damaging your network.

Healthcare professionals also have concerns over the bandwidth allowance and how this may impact business-critical services. Opening up the network to be used by patients and visitors could easily start to impact load times on applications which are vital for clinical and non-clinical staff to perform their roles.

The NHS also has a responsibility to ensure that the principles and duties of safeguarding adults and children are consistently met, ensuring staff are protected whilst also meeting their general duty of care towards their patients. The implications of this are that, whilst the NHS has a duty to provide internet access, they also have obligations to ensure that patients and staff aren’t exposed to damaging or harmful content online. Additionally, with the Information Commissioner’s Offi ce imposing fi nes for any breach of the Data Protection Act, it is more important than ever to be able to identify which devices are connected to a network and be able to monitor and control who can have access to data.

How to Overcome ThemAlthough the concerns referred to above pose potential challenges for the healthcare industry, the use of an intelligent web fi lter such as a solution from Smoothwall can help to overcome these. North East London Commissioning Support Unit (NEL CSU) found out exactly that when they decided to start rolling out free Wi-Fi across their GP surgeries in a drive to be one of the fi rst CSU’s jumping on board with the initiative.



The NHS also has a

responsibility to ensure

that the principles and

duties of safeguarding

adults and children

are consistently met,

ensuring staff are

protected whilst also

meeting their general

duty of care towards

their patients

UK health sector, there has never been a better time to discuss your needs with Smoothwall. To fi nd out how your network can benefi t from secure web control by Smoothwall, request a free trial at smoothwall.com/evaluate or call one of our specialists on 08701 999 500. To fi nd out more information, you can also visit smoothwall.com/markets/healthcare.

Contact

SmoothwallAvalon, 1 Savannah Way, Leeds, LS10 1AB,United Kingdom

Tel: 08701 999 500Email: [email protected]: www.smoothwall.com

web filtering functionality from Smoothwall. With bandwidth management, application control, real time dynamic content analysis, granular reporting and more, there are many reasons why organisations are turning to Smoothwall for help.

About SmoothwallSmoothwall are specialist developers of web filtering and security solutions for the public sector, with experienced industry knowledge and product development in healthcare. Smoothwall currently protect over 100,000 NHS staff split across NHS trusts and CSUs.

Their web fi ltering is favoured by the healthcare sector because of its real-time content aware analysis, audit level reporting and guest Wi-Fi capabilities. With over 120 fi ltering categories that can be used to tailor a user’s web browsing experience, you can ensure harmful content is out of reach.

Smoothwall understand that the UK Health and Social Care sector is constantly facing unique challenges when trying to ensure safe internet access for its clinical and non-clinical staff, patients and visitors. With the Government driving the movement of free Wi-Fi into all UK healthcare organisations, you now need to be able to secure your environments whilst maintaining a satisfactory online experience for users wanting to browse the web freely.

Healthcare networks have a multitude of different users, all requiring internet access for different purposes, therefore Smoothwall’s web fi ltering solutions are designed to provide custom, safe and secure internet access, which has benefi ts for both staff welfare and patient rehabilitation. The service allows you to apply web fi ltering to all staff members with the ability

to add granular categorisation and bandwidth control to ensure that business critical services are always available to those who need them.

The Smoothwall solution can also identify web content in real-time, meaning your patients and staff are protected from the moment they connect. The gateway anti-malware feature protects your network from web-borne malware attacks which could potentially cause medical equipment to fail. Furthermore, the audit level reporting provides you with full visibility of all web activity on your network and allows you to schedule and access reports in real-time, with over 300 templates to choose from.

Smoothwall’s guest Wi-Fi authentication and application control ensures that your patients and guests are authenticated and provides safe and secure access to the web, which can even help to support patient rehabilitation, whilst controlling fi lters set against particular mobile apps, by identifying over 100 common application protocols and enabling you to allow or block them. Additionally, bandwidth management gives you the ability to make the most of your bandwidth by limiting by policy and minimising the impact that streaming media and fi le sharing can cause, without having to full block services.

Next StepsWith new standards set out in the HSCN proposition, where anyone working within health and social care can access the information and services they need to do their job, anywhere and at any time without the need for complex and bespoke ICT arrangements, the Smoothwall solution helps to facilitate this alongside the free public Wi-Fi initiative. With bespoke solutions designed specifi cally for the requirements of the

Smoothwall understand

that the UK Health and

Social Care sector is

constantly facing unique

challenges when trying

to ensure safe internet

access for its clinical

and non-clinical staff,

patients and visitors



Attitudes towards Wi-Fi

and digital technology in

general have changed

signifi cantly over the

past few years. Today,

innovation and digital

technology are seen

as being crucial to the

future of the NHS – one

in which the vision of a

truly ‘connected’ hospital

becomes a reality

The Digital Future of the NHS Tom Cropper, Editor

DIGITAL TECHNOLOGY is at the heart of every aspect of public and private

life. We can access it in our home, in public and even while travelling. Even so, there is no guarantee you’ll be able to enjoy the same level of connectivity while in hospital. This is something the NHS is working hard to change, but delivering a health service that truly harnesses the benefi ts of digital technology is a major challenge.

As things stand, roughly a third of NHS trusts offer free Wi-Fi to patients and staff. Figures from the Enterasys Network say 64%1 of NHS Trusts do not offer free Wi-Fi to patients. Instead, patients receive access to limited internet services provided by third parties which can often cost as much as £10 a day. Current access, therefore, is far below patients’ experience in day-to-day life while also being extremely costly.

The Digital Drive The NHS, then, is playing digital catch-up. But that has been something the Heath Secretary, Jeremy Hunt has been keen to change. He has made a high-profi le commitment to transform the NHS to a paperless service by 2020, which will include a substantial increase in the realm of digital and online services.

Martha Lane Fox, who cofounded the website Last Minute.com, produced a report into the digital future of health2. Among her four key recommendations was a suggestion that, by 2017, at least 10% of registered patients at a GP practice should be using a digital service such as online appointment booking, repeat prescriptions and access to medical records. These services are already available to most patients as part of the commitment of the NHS to give all patients access to their medical records by 2018.

Free Wi-FiHowever, one of the more ambitious aspects of the report was the provision of free Wi-Fi access across the entire NHS estate. Both staff

and patients, she said, should have access to free Wi-Fi within the hospital. In this respect she was developing a cause which has also been championed by Tim Kelsey, the Director of Patients and Information for NHS England. Speaking to delegates at an NHS England event in 2015, shortly before the General Election of 2010, he called for the introduction of free Wi-Fi across NHS England’s GP practices, care centres and hospitals3. At the time, he said he was expressing a personal view rather than express policy, but would be lobbying the next administration keenly.

Those efforts appear to be paying off as the NHS is moving forward on the introduction of Wi-Fi. Lane’s report said that the introduction of Wi-Fi would help those patients who felt ‘ostracised’ while in hospital. They would be able to check their social networks, keep in touch with friends and browse the internet during their stay. In the future, they would also be able to use apps and online services which could give them a greater role in the provision of their own care.

Attitudes towards Wi-Fi and digital technology in general have changed signifi cantly over the past few years. Today, innovation and digital technology are seen as being crucial to the future of the NHS – one in which the vision of a truly ‘connected’ hospital becomes a reality. Patients will use technology for entertainment and keeping up with work and communications, while staff can use it to improve the quality of care. Wireless networking is being used to access medical records, real time viewing of X-Rays and MRI scans, oxygen monitoring devices and smart beds among others. These smart beds can be connected to EMR Networks to monitor patient statistics such as movement and weight changes to help staff analyse information and improve patient care.

Obstacles to Uptake If the potential benefi ts appear so clear, it begs the question why has the NHS been so slow to

The NHS wants to harness the power of digital technology, but doing so is far from

straightforward.

move? Part of the reason lies in a mix of caution and fear. A system of open internet access raises predictable concerns about security, especially in a data-rich sector such as healthcare. The NHS contains a huge amount of highly sensitive information – its security is a major concern. Any Wi-Fi connections will create risks as well as opportunities. In implementing a system, NHS Trusts need to be 100% certain about the security of the infrastructure.

The consequences if things go wrong can be severe – both in a reputational sense through bad PR and fi nancially through fi nes. A 2015 investigation by ComputerWorld found that the NHS tops the list of serious data breaches alerted to the UK’s data watchdog . In 2013, for example, NHS Surrey was fi ned £200,000 by data regulators after losing sensitive information involving more than 3,000 patients5.

Such penalties are all the more worrying given the crisis of NHS funding. The health service has suffered from continuous under-investment from successive governments, with little signs of signifi cant improvement in the near future. Cash strapped managers will be wary of the additional expense and risk the introduction of free Wi-Fi would involve. Expenditure would come from installation, running costs, and staff expenses. Risks would come from data breaches and the question of bandwidth use. Making Wi-Fi available to staff and patients also implies a threat to bandwidth capacity. With people using the internet to access social media, browse the web and stream videos, bandwidth bottlenecks become a real concern. Health centres will have to take action to ensure critical functions are not compromised because of a lack of bandwidth capacity.

Moving to the FutureThese are all questions which need to be answered. Wi-Fi is coming to the NHS. The government wants it; clinicians want it and the public expects it. New technologies are coming to market which will facilitate a smooth introduction for all stakeholders. Web fi ltering and security technologies have evolved signifi cantly in recent years and allow organisations to layer the level of access permitted for different stakeholders. They enable hospitals to develop an infrastructure which is secure and is seen to be secure – both of which are crucial in putting patients’ minds at rest.

If the potential benefi ts

appear so clear, it begs

the question why has

the NHS been so slow

to move? Part of the

reason lies in a mix of

caution and fear



The latest Health

Secretary with a vision

is Jeremy Hunt and his

plans are ambitious

– a seven-day health

service and a fully digital,

paperless NHS by 2020

Achieving Innovation in the World of Austerity Jo Roth, Staff Writer

What’s the worst kind of manager? One who demands miracles while not offering the resources to achieve them. That’s the relationship the NHS has had with government for some time now. Successive Heath Secretaries have pushed forward ambitious plans for the modernisation of the service but, at the same time, funding has been far below required levels. Managers are left asking the question - how can we achieve these targets within our funding restraints?

Ambition versus FundThe latest Health Secretary with a vision is Jeremy Hunt and his plans are ambitious – a seven-day health service and a fully digital, paperless NHS by 2020. Both are positive moves, but without new funding the pressure will fall on staff, managers and systems.

The NHS funding crisis is never far from the headlines. In October, a committee of MPs refuted the Government’s claims to be delivering £10bn extra funds for the NHS6. The King’s Fund has warned that the need to control NHS budgets will lead to staff cuts at a time when the call is for more, rather than fewer front line personnel7. Figures from the House of Commons Library reveal that real time funding of GP practices fell by £250 million over the course of the coalition government.

The report, commissioned by the Labour Party, found that real terms funding of GP practices has fallen from £9.185bn in 2009/10 to £8.939 in 2014/15. Real terms spending per head of the population fell from £176 in 2009/10 to £165 in 2014/15. Half a million more people struggled to get a timely GP appointment in 2015 with more than 14 million people waiting for a week or more – or could not get an appointment at all8.

A Future of Defi citAnother report suggested that the NHS faces a £10bn a year defi cit in the future. The study, published by the Chartered Institute of Public Finance and Accountancy warned that the NHS

would be missing its spending targets by £10bn9

each year under the current system. The NHS is projected to be spending just 7% of GDP on healthcare, compared with Germany which will be spending 11%.

The solution, according to this report, would be to tie health spending to the growth of GDP. Others have suggested continued partnerships between the NHS and the private sector. For example, spare capacity in private hospitals could be used to ease the strain on hospital beds; others look to various self-pay options, which could see people paying a form of insurance, while those who are most in need continue to have their interests protected.

However, with all those options, the NHS still needs to improve the effi ciency of its operations, which leads to a third solution - technology. Despite IT sitting at the heart of the business world, the NHS can at times seem surprisingly backward. GP services often are still run with paper based administration systems, which are labour intensive and create significant opportunities for errors.

IT based systems are becoming available such as automated out of hours booking systems, which increase the flexibility for patients and reduce the strain on practice staff; cloud based business management systems enable the automated update of notes which can be shared with different medical departments; while e-booking systems allow patients to book appointments online at a time of their choosing. Wireless access can be immensely benefi cial to both staff and patients, while increasingly sophisticated e-learning tools can aid in the training of doctors and practice staff.

All these systems, though, will need increased use of the internet and faster, more reliable connections. That inevitably costs money through the purchase and installation of new technological solutions, and expanding broadband capabilities to cope with wider access to Wi-Fi among both staff and patients.

Money is tight in the health service, so how can managers afford the cost

of new technology?

If an existing system is perceived to have been functioning effectively, there is a natural tendency to lean on the side of caution. Why use scarce funds to sanction the purchase of uncertain technologies?

This expenditure, however, should be set against the healthcare benefi ts and costs savings. These can be diffi cult to quantify because the benefits often come further down the line. A trust would be making an increased investment now in the hope of securing considerable benefits later. Technologies which improve patient wellbeing, for example, can lead to reduced stress and faster treatment times, which reduces the cost of care per patient. More sophisticated systems reduce the time needed for administration tasks, freeing staff up for more productive duties.

In the realm of internet connectivity, faster connections can improve patient outcomes and increase effi ciency. These will all be taken into account by health trusts, but one area which is still little understood is internet security and it is here that some of the biggest gains can be made.

A Question of Security Data security risk is one of the biggest obstacles to the uptake of faster broadband within the Health Service, and with good reason. The Health Service stores and manages a wealth of highly sensitive patient data and the more technology comes into play the greater the level of perceived risk. This is something which needs to change. Offi cial fi gures have shown the NHS

losing anything up to 2,000 patient records per day10. Fines for data loss can have a damaging impact on already struggling practices. Earlier in the year, the NHS was fi ned £180,000 for the loss of HIV patient data when the Dean Street Sexual Health practice mislaid the details of 800 patients11.

As part of any drive to increase internet connections within the NHS, the service needs to ensure connections are as secure as possible. This means heightened data encryption, fi ltering and fi rewalls. As part of the process of updating systems or switching to wireless many practices fi nd that their existing structures are not up to scratch.

The latest specialised web fi ltering solutions offer a range of features which are critical for NHS operations such as advanced reporting options, multiple access options, bandwidth management, content analysis and much more. They are designed to be easily installed and intuitive to use, minimising the risk of service disruption during any transition. Furthermore, they come with ongoing customer support delivered by experts who understand the needs of the health service.

These needs are changing. Technology is expanding the realm of what’s possible within the NHS and can lead to benefits such as cost reductions and a vastly improved service. However, added complexity also creates more risk. Managers need to understand all the implications of new technology to ensure that their new installations fulfi l their potential and truly cater to the future needs of the NHS.



Any new development

brings the possibility of

organisations making

the change for the sake

of it. If it is to truly be

impactful, there will need

to be a reason and a

clear strategy in place

Making the Transition to Wi-Fi James Butler, Staff Writer

THE GOVERNMENT is pushing hard to roll out Wi-Fi across the NHS. However,

wishing something does not necessarily make it so. To achieve real progress health managers will want to see tangible benefi ts in the technology and understand the best way to make it work.

This can be easier said than done because, while the technology feels commonplace to us in our day-to-day lives, there is little understanding of the issues involved with effective implementation, particularly when it comes to security. Before choosing any system, practice managers must answer two key questions: why and how?

Why Install Wi-Fi?The fi rst question to answer is why a practice is making the transition to Wi-Fi. Any new development brings the possibility of organisations making the change for the sake of it. If it is to truly be impactful, there will need to be a reason and a clear strategy in place.

Bringing Wi-Fi into practices has several potential benefi ts: • Reducing missed attendance: Missed

appointments cost the NHS approximately £300million every year12, and reducing this fi gure represents a key goal for the NHS. We all live busy lives and the pressure of work weighs heavily on our minds. Often people feel they simply cannot afford the time out of the offi ce.

• Keep in touch with Patients: Automatic alert text messages can be sent to individuals to remind them of their appointments. Trials suggests patients will be more likely to attend an appointment if they receive a text stating how much the missed appointment will cost the heath service13. A number of apps make use of chatbot technology which uses artifi cial intelligence to engage with patients in a more intuitive way14. They can remind people about their appointments and also check in on their progress after their treatment.

• Reduce Workload: Installing Wi-Fi in a surgery also brings an added benefit in reducing the impact on the working day of a doctor’s appointments. No longer are patients forced to lose several hours out of their day during which time they are out of contact. They can connect via Wi-Fi to check emails or perform quick tasks. By reducing the impact of an appointment on a work day, surgeries can reduce the number of missed or cancelled appointments.

• Improving patient wellbeing: Isolation represents a major problem for people when they spend a day or more in hospital. They fi nd themselves unable to access social networks, keep up with current affairs or keep in touch with loved ones. With access to Wi-Fi connections, they will be able to do all these things and stream entertainment. Happier patients mean a more pleasant and productive stay and, possibly, a quicker recovery time.

• Staff performance: Access to Wi-Fi can be important for staff when communicating within departments. They can see up-to-date data in real time and receive information about patient health, treatments and histories. In the future, the NHS aims to facilitate the online storage of patient data, which can help medical staff get up to speed with treatment and make better decisions.

Health managers should look at the benefi ts of Wi-Fi and assess how they apply to their own situations. Think about what the technology can do and then decide how it can achieve the key goals of the practice. Then they can get onto the second and more diffi cult question: how?

How To Do It While fewer than 50% of NHS Trusts have installed Wi-Fi as yet, those which have are already seeing a number of benefits. Southend University Hospital15, for example, installed Wi-Fi initially to enable staff access patient medical records from anywhere in the hospital through tablets.

Key factors practices should consider before making the transition to Wi-Fi.

Social service staff would also be able to log in and access records held within a central system from wherever they were.

However, they are also using the system to make signifi cant gains to care quality and patient experience throughout the hospital. A proof of the project trial sees them tagging equipment with Radio-frequency Identifi cation (RFID) tags. This means their location can be displayed online at any time and staff can be notifi ed about when a piece of equipment requires servicing. This has the potential to reduce equipment cost by streamlining servicing and maintaining superior inventory control.

However, to deliver on this experience the NHS needs to install it in the right way. This means addressing the following issues: • Bandwidth: Expanding Wi-Fi for use with

staff and patients will consume a huge amount of bandwidth. Hospitals will need to include bandwidth management measures to ensure critical systems are not compromised due to bottlenecks.

• Access control: Hospitals contain a huge amount of sensitive data and multiple people requiring different levels of access. Web fi lter and security options will need the fl exibility to create varying levels of access to maximise value while maintaining security. Unblocking services must be swift. Hospitals have put strict access protocols in place to maintain security. However, they can waste valuable time and resources processing unblocking requests and staff might fi nd it diffi cult to access

the information they need in a timely manner. Specialist fi ltering systems will be required to swiftly and automatically resolve such issues.

• Staff mobility: The mobility of staff is enhanced by Wi-Fi allowing them to access key functions from anywhere in the hospital. However, such a degree of mobility creates challenges. For example, hospitals must ensure that they are always connected to the hospital Wi-Fi system, and do not inadvertently connect to an alternative network.

Looking to the FutureWi-Fi has a huge amount to offer in the future. However, this added technology creates complications and risk – and in an environment in which funds are tight, that is often enough to discourage implementation. To achieve the government’s goal of total Wi-Fi access across the NHS estate, those barriers need to remove.

Web security and fi ltering technologies will have an important role to play. Specialised services which work around the specific issues NHS networks encounter will be critical to underpinning the entire network. So, when managers start planning their transition to the world of a Wi-Fi, there is one factor they should pay particular close attention to: security. This is an area which is often easy to overlook. There’s a temptation to view web filtering services as offering identical levels of service across the board. However, the unique requirements of the NHS require a level of security, delivered by a team of specialised experts.



The provision of a rapid

4G network enables

nurses to quickly update

medical records while

they are on the move.

Previously, they would

have been forced to

return to their health

centre and input

information to a central

system by hand

Web Filtering – The Key to the Digital FutureTom Cropper, Editor

IN THE 1970s the few people connected to ARCNET – the forerunner of the internet –

used its glaring security weaknesses to play practical jokes on one another. They were harmless and the number of users was so small that most knew one another - but they did point to more serious issues. However, although there were some serious security breaches, little was truly done until computers truly became connected. Today, the internet plays an increasingly important part in our lives, but as every aspect of our world becomes more connected, the security risks increase.

A Connected FutureThe NHS is moving full steam ahead to imbue internet connectivity through every aspect of its operations. Patients can interact with surgeries through online services and mobile apps. NHS trusts are adopting wireless broadband, while key medical instruments are becoming more connected and capable of delivering real-time information about the condition of patients. There is no knowing how far this can go. For example, in the future, nanotechnology could be injected into patients to provide advanced health monitoring and even to manage ongoing conditions. Patients can already wear mobile monitoring devices which can monitor issues such as blood sugar levels, for example. This could be a useful bonus as many diabetics report experiencing problems while in hospital.

Greater connectivity increases the mobility and efficiency of staff. Berkshire NHS Trust, for example, is providing faster connectivity to its nurses through 4G mobile broadband. The Trust employs 4,000 staff and provides services to around 900,000 people within the county. It has more than 100 sites including Prospect Park Hospital, community hospitals and GP Clinics. In addition, much of their work is done in the community with nurses providing health services to people within their own homes. The provision of a rapid 4G

network enables nurses to quickly update medical records while they are on the move. Previously, they would have been forced to return to their health centre and input information to a central system by hand. Not only is this more time consuming, but each additional data entry process increases the potential for error16.

However, one factor could prove crucial to making this work: security. As connectivity grows, so too does exposure to security threats. Cybercrime is increasing and every attempt to combat criminals results in an evolution of attack methods.

Monitoring UseAside from cyber criminals, health centres will need to monitor how the internet is used. Those who have introduced free Wi-Fi into centres have encountered challenges such as the download of illegal materials and restrictions on available bandwidth for essential operations.

Aintree University Hospital, for example, encountered a series of problems when they introduced Wi-Fi access17. Staff took the opportunity to access Wi-Fi for use in social media and other non-essential tasks. As a result, they experienced bandwidth bottleneck issues which compromised some essential devices. Their existing provider did offer the ability to block certain websites but it didn’t provide the level of fi ne control they were looking for. Setting up security protocols was also time consuming and forced management to deal with multiple unblock requests. Software dedicated to blocking social media, therefore, was playing a role in restricting access to information. In an acute hospital, in which access to fast, real time information is crucial, that was a problem which could not continue.

The solution for Aintree was a system which offered far finer levels of control to ensure smooth and continued access to online content. Developed by Smoothwall, the system enables the setting up of differing policies for multiple user

The internet is set to become increasingly important to the NHS.

However, to safeguard essential systems, the security must be right.

groups. It offers control of content, the ability to offer fast, real time reports on usage, and to quickly manage controls. IT managers now have a highly reliable tool which enables them to switch access protocols at the touch of a button.

In addition, the system offered a smooth installation process which minimised downtime and disruption.

“Downtime is something we’re worried about,” admits Neil Morgan, Information Security Manager at Aintree. “The solution was in place within very tight timescales and the support has been excellent. Smoothwall has a culture of working closely with clients to identify and address individual requirements.”

Tailored Filtering That culture of cooperation is likely to become more important in the future. The market for web fi ltering processes is growing as the scope of threats increase. An analysis of the web fi ltering market predicts it to reach USD$3.1bn by 2020 with growth in some areas reaching more than 20% CAGR18. Within that, growth will become

more specialised with critical systems being tailored for specifi c areas such as education, defence and healthcare.

Solutions are becoming increasingly fl exible in how they manage the control of content. Time based fi ltering, for example, can offer varying policies for different times of the day. Policies can also be designed for different users – ideal in an environment such as health. As we move into the future, solutions will become more fl exible and tailored, placing a greater reliance on those providers who can deliver truly bespoke solutions.

Security and fi ltering services are unlikely to attract any major headlines on their own account but, as so often, major advances are only possible thanks to underlying developments which enable the system to work as designed. Effective security and web fi ltering processes will continue to make the difference between a system which works for everyone and one which creates more problems than it solves. Although it may be a diffi cult topic for many IT managers to focus on, fi ltering could be key to the NHS’s digital future.


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References:

1 What’s Stopping Trusts Rolling out WIFI: http://www.computerweekly.com/feature/What-is-stopping-the-NHS-rolling-out-Wi-Fi-access

2 Lane Fox Calls for Free Wi-Fi: http://www.digitalhealth.net/digital_patient/46978/lane-fox-calls-for-free-nhs-Wi-Fi

3 Kelsey Pushes for Free NHS Wi-Fi: http://www.digitalhealth.net/news/29804/kelsey-pushes-for-free-nhs-Wi-Fi

4 NHS Tops List for Serious Data breeches: http://www.computerworlduk.com/security/nhs-tops-list-for-serious-data-breaches-last-year-3607138/

5 NHS Surrey Fined £200,000: http://www.bbc.co.uk/news/technology-23286231

6 Theresa May’s Claims Not True: https://www.theguardian.com/society/2016/oct/30/theresa-mays-claim-on-health-funding-not-true-say-mps

7 NHS Budget Control Will Require Staff Cuts: http://www.bbc.co.uk/news/health-36760985

8 New Figures Reveal Real Time Funding Cut: http://www.gponline.com/gp-funding-cut-250m-2010-new-fi gures-reveal/article/1391670

9 NHS Faces £10bn a Year Defi cit by 2020: https://www.theguardian.com/politics/2016/may/23/nhs-10bn-a-year-black-hole-2020-cipfa-report

10 2,000 Patient Records are Lost Every Day:

http://www.dailymail.co.uk/news/article-2559876/2-000-NHS-patients-records-lost-day-two-million-data-breaches-logged-start-2011.html

11 NHS Hit with £180,000 Fine: http://www.itpro.co.uk/data-leakage/26497/nhs-hit-with-180000-fi ne-for-hiv-patients-data-breach

12 Lazy Patients Cost the NHS £300 million a year: http://www.dailymail.co.uk/health/article-118237/Lazy-patients-cost-NHS-300m-year.html

13 Patients Less Likely to Miss Appointments If they Are Warned of Costs:

http://www.telegraph.co.uk/news/health/news/11858339/Patients-less-likely-to-miss-NHS-appointments-if-they-warned-of-cost.html

14 Feeling Unwell? Your MD’s Facebook Chatbot Will Find Out What’s Wrong With You:

http://www.huffi ngtonpost.co.uk/entry/feeling-unwell-yourmds-facebook-chat-bot-will-fi nd-out-whats-wrong-with-you_uk_572203fee4b0d6f7bed59b50

15 Southend Case Study: https://www.itservices.bt.com/media/2576/southend-university-hospital-nhs-bt-case-study.pdf

16 Berkshire NHS Trust gets 4G: http://www.computerweekly.com/news/2240212546/Case-study-Berkshire-NHS-adopts-4G-for-home-visits

17 Aintree University Case Study: https://uk.smoothwall.com/resources/aintree-university-nhs-trust/

18 Web Filtering Content Market Trends: http://www.strategyr.com/MarketResearch/Web_Content_Filtering_Market_Trends.asp

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