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Why is cloud computing in such poor health in the NHS?

Gary Flood Profile picture for user gflood November 16, 2014
Cloud doesn't get mentioned once in the NHS's five year plan. Guest contributor Gary Flood wonders if this indicates rejection or ignorance of the cloud's potential?

Last month, Simon Stevens, appointed at the start of the year as the new Chief Executive of the NHS, released his vision for what the NHS needs to do in the next five years to survive the stresses we are throwing at it - as both users and policymakers.

While a genuinely landmark document in many way - with many interesting things to say about the use of technology in the NHS we shall get back to in the course of this series of health IT features – it is interesting for any of us following public sector ICT that the word ‘cloud’ does not appear once in the 39 page treatise.



Before you ask, the word ‘technology’ appears 12 times. So it’s not as if Stevens and his team at NHS England are ignoring the potential of IT to help the NHS – far from it.

But it is interesting that despite the Cabinet Office’s ‘Cloud First’ mandate, which specifically states that ‘purchases through the cloud should be the first option considered by public sector buyers of IT products and services’ being in place for 18 months or so, the amount of purchases made through the CloudStore (now Digital Marketplace ) by health organisations is still astonishingly low.

We’re not saying there haven’t been any – there have, as this 2012 announcement of one of the first G-Cloud UK contracts demonstrates.

But given that the latest rev of the Marketplace has 1,517 suppliers, 88% of which are SMEs offering 16,000 services, are NHS Trust CCIOs missing out on some real bargains here?

'Some Reticence'

We tried to get specifics on what proportion of G-Cloud sales actually have gone to the NHS, but have so far been unable to get very far.

But we know from the feedback we get from suppliers that there is a definite air of malaise about the G-Cloud and NHS informatics. Thus Steve Rudland, European healthcare solutions manager at Hyland:

There still seems to be some reticence in the healthcare market towards G-Cloud.

Rudland thinks this is both down to what he calls a “lack of joined-up thinking at government level” about health IT, plus the fact that G-Cloud has some stiff competition for hospital IT budget – specifically, the two big programmes of the ‘Safer Hospitals, Safer Wards’ and Nursing Technology Fund, which, as he notes, are supposed to be for capital spend and thus the money

can’t be used to fund G-Cloud projects, which are by their nature revenue budget projects.

Other vendors are not so unconvinced that G-Cloud is not on most NHS IT leaders’ radar. When we asked Harry Metcalfe, MD of public sector Web project firm dxw, for example, the answer was emphatic:

Absolutely [it is of interest to NHS teams]: we have four NHS clients, all off G-Cloud, who have been with us for the last few years.

We've been on G-Cloud since its first iteration and it's been our experience that it is quickly embraced - in the NHS and other sectors - once project teams realise that it's a much less onerous process of getting work done than the traditional route.

It's accepted by procurement teams because it's a framework, and so it's familiar, and project teams get on with it because the long list/shortlist/award process is so straightforward.

Is NHS complexity the real dominant factor

But Metcalfe may have spotted what is actually really ‘wrong’ here – it’s not the Digital Marketplace system that is wonky, but the NHS is in itself a very complex beast:

The NHS can be a tricky sector to work with. In general, our experience has been that people in the NHS very much care about doing digital well but can sometimes be held back by their organisations or stakeholders, which can impact the quality of outcomes.

And even in NHS Arms Length Bodies that do come under Cabinet Office spend controls, adoption of contemporary ways of working - as led by GDS - seems to vary. But we're doing our best to help!

The reality is that the NHS is still recovering from all the ins and outs of the National Programme for IT, is going through massive re-organisational change – and probably just hasn’t stopped firefighting long enough to take the measure of what the G-Cloud could offer.
But we really do hope it does – and soon.

As huge opportunity for the sort of tech-enabled change Stevens says it needs could be missed otherwise, if this way of procuring innovative, useful health IT systems is neglected.


Gary Flood is editor of diginomica affiliate partner,  For more on cloud and the healthcare industry, sign up for Think Cloud for Health, supported by diginomica. For information, click below: 


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