There have been several announcements from NHS England / HSCIC in support of open source solutions for NHS organisations. These announcements have spawned much discussion and debate - on EHI/HSJ/NHSHackday sites and at EHILive - which ranges in style and content from Chicken Licken to Richard Stallman.

In a short series of blogs I’m planning to post I’m going to look at these announcements and the reaction from a few different perspectives. In this post I’m looking at where the direction for such support from NHS England is coming from and what ‘support’ for open source solutions might actually mean.

Direction towards for open source comes from the Cabinet Office and also Department for Business Innovation & Skills as demonstrated here:

“The days of the mega IT contracts are over, we will need you to rethink the way you approach projects, making them smaller, off the shelf and open source where possible.” Francis Maude MP, Minister for the Cabinet Office, 2nd December 2010. (cited, PDF)


“Government Open Source policy is a commitment to ensuring a level playing field for open source and proprietary software.” Francis Maude MP, Minister for the Cabinet Office, Memorandum answering questions submitted by the Public Administration Select Committee (PDF) for the Cabinet Office evidence session on 30th of March 2011.

The goal from BIS is to level the playing field, ensuring that public sector procurements are not unfairly (or anti-competitively) excluding any licensing mode or preferring one business model over another due to a lack of understanding or lack of knowledge of how to procure on the part of the buying organisation. So we can understand NHS-E / HSCIC’s announcements as being fully in line with Cabinet Office policy; good thing for NHS-E / HSCIC … the Cabinet Office appear to have to double stamp any procurement or funding over a fiver these days and being in line with policy goes some way to getting the first of those stamps.

The Cabinet Office published an Open Source Procurement Toolkit back in 2011 the purpose of it is to ensure that there is a level playing field for open source and proprietary software. I’m pretty sure that if P came before O in the alphabet it would read ‘a level playing field for proprietary and open source software’. Intellect have done much supplier engagement work with NHS-E and HSCIC on helping to shape and share government policy around open source - I’ve been to several such events.

None of this is particularly new to HSCIC, or rather, CfH as was then. Starting back in 2009 (!) eHealthOpenSource was a KTP project which served as an ‘engine’ to lift-off an ‘ecosystem’. CfH Data Standards and Products and the Department of Health Informatics Directorate contributed a number of products and services to the eHealthOpenSource community. After initial pump priming, it was envisaged that eHealthOpenSource would evolve into an independent and self-sustaining organisation. This didn’t happen. Mainly due to a rather messy end-of-project transfer phase and also due to the churn of the re-organisation of various health informatics and technology services bodies. There are lots of great resource on the eHos website and its well worth a rummage.

Fast forward from 2009-11 to 2013. The Safer Hospitals, Safer Wards Technology Fund announced in June make specific references to open source, helping to ‘level the playing field’ and educate procuring organisations about such solutions. Complicating the debate was the inclusion of some sort of NHS VistA in the Tech Fund bid. EHI editor Jon Hoeksma posted a long op-ed piece about NHS England’s thoughts of committing millions of pounds to a UK version of a US open source electronic record system. A good number of sessions at EHI Live this year also covered technology strategy, including open source approaches. Where as previously such sessions would have been more on the fringe on the exhibition, in Birmingham earlier this month key-note addresses covered the opportunities and approaches for Trusts in this area.

All the above demonstrates that NHS-E & HSCIC are becoming an educated and informed purchaser of information technology services in line with Cabinet Office policy and are, at the same time, disseminating knowledge to the other public sector organisations it interacts with.

Since the closing of Tech Fund round 1 NHS-E have indicated that up to £20m of the ‘Safer Hospitals, Safer Wards: Technology Fund’ will go towards open source projects - or to put that in perspective for Chicken Licken and Richard Stallman 4% of the Fund. A recently published draft of The Health and Social Care Information Centre strategy for 2013-2015 presented at the centre’s latest board meeting says it will extend its support for NHS organisations and providers using open source technology to increase integration across health and social care. I can understand why too. Over the summer information was published about a skunk-works project to build an NHS Spine replacement using open source and agile methodologies by Leeds-based BJSS. Full PDF here. This National Infrastructure will need support services over its life-cycle and with other aspects of National Infratructure heading in the same direction (HES, CnB, etc) this need becomes more pressing.

From the strategy paper:

  • “Extend our support for local health and care organisations in their use of Open Source software, especially for their Electronic Patient Records;”
    • Translation: We support some license based software procurement models, why not others?
  • “Review the implications of the extended use of Open Source for the HSCIC’s own business model, regarding the ongoing management and development of the national services it manages;”
    • Translation: We’ve rebuilt Spine with open source technologies … how do we support and maintain it?
  • “We work collaboratively with the market so that we can work to support the new requirements, particularly in regard to the use of Open Source software and the development and use of Application Programming Interfaces.”
    • Translation: There must be more developers out there that can build us new features, but how do we procure skilled domain specific services? And all the cool kids have got APIs these days to make it easy to flow data … how do we get these interfaces built to H&SC information systems?

As I wrote in EHI, the real story for health IT from this HSCIC briefing paper is the changes to commercial relationships envisaged (page 21).

“Our future relationship with the market involves:

  • Contracts with smaller financial values, covering shorter duration;
  • Significant reductions in procurement timescales;
  • Increasing use of Government frameworks;
  • New approaches to engaging and driving the market, with particular emphasis on engaging with Small to Medium Enterprises and creating competitive market tensions not only during procurement, but throughout the delivery of a service;
  • Less reliance on multi-national operators acting as prime contractors;
  • Where possible leveraging services from other Government departments.”

From everything I can see from NHS-E and HSCIC they are fully in line with Cabinet Office policy and contemporary service procurement approaches and are levelling the playing field, all the while exploiting the opportunities of each to the benefit of the public purse and UK Tech Plc. Most importantly NHS-E and HSCIC are taking a strong position on educating procuring organisations with the skills and techniques to be an informed an savvy consumer of IT and services in line Treasury and Nicholson economics: Do More With Less.