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Barts Health
NHS Trust

Barts is one of the largest NHS Trusts in England, running five different hospitals across the City and East London. The group delivers world-class Acute and specialist care, as well as community services, to the local area. The five hospitals, united under the newly created Barts Health umbrella in 2012, include Britain’s oldest, St Bartholomew’s.

The merger left the five sites disparate clinical systems and no centralised networking infrastructure, making it difficult for staff to work across sites. This amplified the existing IT challenges and created barriers to meeting their ambitious goals.

How does one of the UK’s largest NHS Trusts build a modern digital infrastructure and networking foundation across five different hospitals?

 

DOWNLOAD BARTS HEALTH NHS TRUST EBOOK

Autumn 2013
First Contact

Tell us where it hurts

Block was first engaged in 2013 to conduct an independent assessment of the physical environment, the IT infrastructure and maturity of network service across all main sites.

Assessing the environment

17minute

average login times, negatively impacting user experience and staff satisfaction.

24hours

plus to resolve recurring incidents, consuming the majority of the service desk’s time.

11minute

call waiting times for the IT service desk before a resolution could even begin. This was compounded by repeat incidents.

The bigger the Trust, the more complex the challenge.

Block’s initial programme of consultancy work identified potential improvements in a number of key areas:

  • Staff mobility
  • Desktop logon
  • Email
  • Networking reliability and speed
  • Access to clinical systems
  • Active Directory
  • Datacentre performance
  • Service desk
  • Comms room remediation
  • Single points of failure

These improvements were then prioritised as ‘Now’, ‘Soon’ and ‘Should’.

Summer 2014
Project Kick Off

Enhancing the user experience

We began with a single hospital, Whipps Cross, with a focus on improving the user experience. We specifically looked at these work streams:

  • User profiles
  • Active directory
  • Email and exchange
  • Current process
  • Desktop migration
  • Network and server infrastructure status

Whipps Cross Hospital – Get well

The Barts and Block teams came together to look for quick wins, laying the foundation for future transformations and securing early buy-in from all those affected.

The most obvious place to start was the service desk, most of whose time was taken up with repeat issues. We decided to focus on resolving this first, quickly delivering a significant programme of work to demonstrate that once you decide to address a key issue, visible benefits soon follow.

The next step was to install a stable infrastructure, ready for the new technology that would further enhance the user experience.

Here are some examples of what we achieved together:

  • Created and implemented a brand new Service Policy, including monitoring and event management, and monitored adherence;
  • Removed single points of failure within the network, applying best practice and configuring optimal routing;
  • Applied best practice configuration to Microsoft Exchange, migrating appropriate mailboxes;
  • Identified and resolved application compatibility issues, developing a migration process for implementing Windows 7 desktops with minimal user impact.
90
seconds

Average time-to-answer reduced from 11 minutes to 90 seconds – all delivered without additional operators

73
percent

Less calls each month to the service desk

40
seconds

User login wait times of around 17 minutes to just 40 seconds

650
days

Resulting in a saving of 650 days per year

Winter 2016
Future Ready Workplace

Empowering the digital workspace

The desktop transformation journey began in 2016 at Whipps Cross to support 4,000 staff. Following the initial success of this rollout, the programme was expanded to Newham in 2017, Royal London in 2018 and St. Barts Hospital in Summer 2019. The new Workspace solution now supports more than 20,000 staff.

Delivering exceptional value for money

The desktop service has enabled secure, fast, convenient access to patient records and medical information, at the point of care. Staff are now able to work effectively across all of the Trust’s sites, meaning specialist medical skills can be pooled, delivering one of the major goals of Barts’ workforce transformation strategy.

Some clinicians need to logon to different areas up to 40 times per day. The decrease in logon times from several minutes to seconds, combined with the improved system performance, saves thousands of staff hours every day, making for a much more productive workforce.

The IT team now has more visibility into the consumption of applications and resources than ever before, and staff are able to work remotely. The new desktop service will monitor the environment, helping to understand potential performance bottlenecks and forecast the impact of changes such as new applications and Windows 10 before they occur.

Spring 2017
Future Ready Workplace

Enabling virtual MDTs

Barts Cancer Centre has an international reputation for treating both rare and common cancers, serving more than 1.5 million people across north east London and beyond.

Cancer care is provided by multi-disciplinary teams that include consultant medical oncologists, consultant clinical oncologists, consultant surgeons, consultant physicians, pathologists, radiologists and clinical nurse specialists.

Barts knew that technology could play a vital role in ensuring that virtual MDT meetings were as productive, consistent and effective as possible. A new video conferencing and collaboration strategy was co-developed between the Barts Health ICT Department and the Cancer Care Delivery Team.

Transforming clinical collaboration

If there’s one thing we’ve learned from our own research, it’s that poor, unreliable or non-functioning equipment dramatically impacts how fast effective clinical decisions are reached during a virtual MDT. For care providers to make better and more informed clinical decisions, audio and video quality needs to be at its very best.

To ensure a standard deployment across all four sites, each room was given the same equipment. This supported interoperability, improved speed of adoption and ensured cross-site compatibility. All rooms provided staff with the ability not only to host MDTs, but also present and share information.

  • With more and more cross-location collaboration, bringing associated conveniences for experts, patients and Trusts alike, audio and visual dropouts can be minimised for a more natural interaction.
  • Removing drop-outs keeps inter-site meetings coherent and decision-making fluid. Productivity is maintained, saving time and the costs of both travel and delays.
  • Being able to read on-screen notes clearly and see imagery in high definition means that experts can prescribe the correct treatments with no concerns around misinterpretation or lack of detail.
  • This kind of digital transformation also removes the need for a large volume of printed documents.
  • By applying a single and consistent equipment platform across all collaborative locations, the historical problems of interoperability are avoided.
Spring 2017
The Catalyst

WannaCry ransomware

The global ransomware attack infamously known as WannaCry hit NHS Trusts across the United Kingdom on the 12th of May 2017. As a trusted partner, Block was contacted to support with resolving the situation at Barts.

Emergency measures

The joint approach between Barts and Block ensured that the Trust’s services were back up and running as swiftly as possible.

The experience enhanced the relationship and understanding between both parties, and understandably acted as a catalyst for the future development of Barts’ IT and networking strategy.

The critical nature of the health and care services at Barts required a lightning quick response.

Within 48 hours, a 20-person team led by Block CEO Marc Chang had been deployed on site, operating at Barts for what evolved into a four-week period.

Find out more

Summer 2018
Strategic Investment

Future proofing the architecture

Following the aftermath of WannaCry, Barts developed a digital strategy that highlighted relevant technology investment needs in four key working areas:

  • Cloud and application hosting
  • Network and unified communications
  • Service desk
  • End-user devices, mobility, and virtual platform

Charles Gutteridge

“In order to enable high-quality, digitally driven clinical care as part of the Trust’s digital transformation ambitions, Barts needed to establish a robust underlying infrastructure.”


Charles Gutteridge,

CCIO at Barts Health NHS Trust

Investing in the foundations of a world-class network infrastructure

One of the key goals of the Trust’s digital transformation ambitions was to establish a robust underlying infrastructure, capable of enabling high-quality, digitally-driven clinical care. This would serve as the foundation for both the Trust’s clinical and operational activities.

Establishing a resilient, reliable, scalable and flexible technology infrastructure became the focus of the network and unified communications workstream.

Spring 2019
Future Ready Networks

Delivering the foundation for exceptional care

Supporting digital innovation at the pace and scale that Barts were driving for meant that they needed a health IT network that was more robust, easier to manage and future-proofed. What’s the point of best-in-class clinical applications if the underlying infrastructure impedes their performance?

Future Ready Networks

The mission was to deliver a highly robust, medical grade network architecture that could support the deployment of a wide variety of mission-critical digitised services without compromising the robustness and reliability of the network.

Block’s industry-leading campus networking solution, based on Cisco SDA technology, was developed with clinicians and healthcare technology leaders to deliver the full suite of capabilities for today’s digital hospital.

Our extensive real-world deployment experience within large healthcare environments, coupled with the expertise within the Barts team, meant that we were uniquely positioned to collaborate around the integration of medical devices, applications, security and IoT, and together ensure that the network drives innovation rather than delaying it.

Barts took the opportunity to go further than just a refresh, taking an entirely new approach to the design of the network. It’s all based on a software-defined architecture, allowing them to benefit from:

  • Better visibility and control
    The IT team can centralise control, automate management tasks and use APIs to interface with applications;
  • Reduced security risk everywhere
    The network now acts as a sensor, with security policies enforced dynamically as users and devices move around;
  • Increased efficiency, simplified automation
    New applications and devices can be deployed in minutes; changes can be simply rolled out using best practice templates;
  • New ways of working
    Simple and secure deployment of digital health and care technologies and IoT will allow Barts to continue to innovate and transform care.
Autumn 2019
Extended Service

A truly strategic partnership

Having delivered the underlying network, Block was selected as the partner to deliver the accompanying service transformation.

Block supplemented the Barts team with 7 specialists, based on-site, working together to deliver an ICT service aligned to the Trust’s Forward View. The service harnesses technology to provide staff with secure, stable and reliable tools to improve staff experience and enhance patient care.

Future Ready Service

The Trust appointed Block to transition and deliver LAN and Network Management Services in line with the desired vision and objectives of the Trust, including:

  • Network management services – device and network configuration and management
  • Network monitoring – alerting to any faults and allowing for quicker remediation
  • Equipment and software support – including LAN and WLAN, firewalls and UPS
  • Physical environment – including comms room remediation, plus design and installation of structured cabling
  • Introducing standards – to enhance control and develop new capabilities

“It’s a joint partnership in a truly strategic way. It’s not outsourced. It’s not a managed service. It’s a joint service that we provide into the user-base at Barts, based on a really strong relationship. There’s teamwork in place between Block and the Barts organisation, built over many years, that gives us an in-depth knowledge of general healthcare infrastructure and the specifics of Barts.

We are excited to be helping Barts on their journey to establishing a world class ICT service that will enable the Trust to transform clinical service delivery and improve the experience of patients, carers and staff.

Marc Chang,
CEO at Block

Ensuring High Availability

When your core is strong, everything else follows

One of the ICT Objectives defined in the trust’s digital strategy was to improve availability, reliability and resilience across IT.

In pursuit of this goal, we’ve worked with the Barts Health team to deliver a comprehensive overhaul of their wired network. This initiative involved the implementation of a robust Cisco SDA network, ensuring high availability, across their five primary campuses and ten remote sites, with Network Access Control, and extensive macro and micro segmentation implemented trust wide.

Fay Stevenson“Having one network infrastructure throughout the hospital and across sites is a huge benefit. You’re not reinventing the wheel or having to redesign something in every location or with every piece of tech. We now have defined policy that allows us to cater for what we have now, what you had in the past, and what we’ll have in the future, we’re now truly able to grow as we need to, at pace and scale.”

Fay Stevenson,
Deputy Director of Informatics at Barts Health NHS Trust

Simple and Powerful Management

  • Cisco Catalyst Centre (formerly DNA Centre) is a powerful management system that leverages AI to connect, secure, and automate network operations. The solution has been deployed to configure and manage all sites, helping to design, deploy, and manage the networks at pace with features such as auto discovery, zero-touch provisioning, and configuration automation.
  • Mobility is required for 100’s of devices on 100’s of legacy subnets which traditionally required manual service requests. Now Block AutoPort re-configures ports on-demand using the Catalyst Centre API and ensures best practice port configurations are always applied. This also includes ITSM integration which has increased service levels to 24/7 and reduced tickets by 30%.
  • Quality of experience is monitored across the network using Cisco ThousandEyes and Block’s Axiom dashboard. These are the first port of call when performance issues are raised and allow the service teams to quickly ascertain when there are application or network issues.
Spring 2020
A Global Pandemic

The Nightingale Hospital

With the partnership already well established between Barts and Block, both organisations were able to mobilise together in the fight against the virus.

When the mission is critical and the need is now

The centralised strategy and architecture put in place across Barts allowed Block and our sister company Connect-IP to get involved from the off, understanding the requirements of these new Nightingale facilities and able to deliver at speed.

The project balanced the provisioning of largescale IT infrastructure with the requirements and nuances of an NHS digital hospital, that potentially needed to operate 24/7 – all at an unprecedented pace. Supporting Barts in this manner is just another example of the strength in partnership and mutual trust that exists between both parties, allowing us to work closely together for the greater good.

View the infographic

Professor Charles Knight“I think the single greatest achievement of the doctors and nurses there was that ICNARC, which is the National Audit of ITU outcomes, found the Nightingale mortality as exactly the same as the national average – so for the patients that we treated, in a conference centre, with teams assembled from all over the place, in a completely foreign environment, to have achieved an average outcome is an astonishing achievement.”

Professor Charles Knight OBE,
Chief Executive, Barts Health NHS Trust
paying tribute to the Nightingale Hospital

Nightingale London“Block has worked exceptionally hard to help our ICT teams get the critical IT infrastructure up and running at NHS Nightingale London. The sheer will, determination and knowledge of each team member has been outstanding. We fully realise we would not have been able to do this on our own without each of the people you have dedicated to our deployment. We still have a huge amount of work to do, and we will complete all of it with partners like Block by our side. We really appreciate the way our two teams have jointly solved problems and gone the extra distance knowing that patients and clinical staff depend on the systems we build for them.”

Charles Gutteridge,
CCIO,
Barts Health NHS Trust

Further Digitisation

Wireless innovation

Following the wired network refresh the next step was to tackle the wireless network. The wireless network is a critical component of care delivery at Barts Health. It’s not just about giving internet access to PCs and patient devices, wireless devices are currently in use throughout the hospital, for example; PDAs used by nurses at the bedside; tablets used by physicians in the Emergency Department, sending ECG results directly to the patient record; electronic prescribing; imaging carts and blood gas analysers; the list goes on.

“The wireless network is at a point now where we can do an upgrade without taking down the network, so users can carry on working, which at the end of the day equates to improved patient care.

The work that we’ve done on the network has definitely given the nurses and the doctors and the people working on the wards a much more stable network and more reliable platform for them to work. This improved wireless means we can now look at implementing Bluetooth location tracking across the hospital.”

Ian Lyon,
ICT Network and Security Manager at Barts Health NHS Trust

A Critical Component for Care

As so much relies on the wireless network Block always strives to be agile, working within the constraints of a 24/7/365 hospital environment, yet deploying at pace and scale. Here are just two examples of deployment scenarios that we supported throughout the wireless refresh:

  • Royal London Hospital – Wireless phones were in use across the site, so to minimise disruption Wi-Fi needed to be rolled out quickly. Block had a team of five engineers support the Barts team, and in less than a week completed the rollout across three tower buildings and 17 floors.
  • Whipps Cross Hospital – The trust had an ambitious target deadline to implement an electronic Prescribing and Medicines Administration (ePMA) system, Block adapted our project plan to prioritise the wireless deployment in 34 wards to enable access for the required go-live date.
Enabling Secure Access

Connectivity across sites

Following a successful trial in the pathology department, Barts has invested in strategic WAN connectivity, using Cisco SD-WAN technology to provide greater options, flexibility, and security for connectivity between sites and to the cloud. In some cases, the Trust has had to quickly set up new locations, like the Covid-19 vaccination centres. SD-WAN made this fast, easy, and secure.

Simplifying Network Management with SD-WAN

As the world rapidly adopts a cloud-first strategy, the IT landscape has changed. Enabling secure access to applications wherever users are is a priority. While delivering speed and agility, the multi cloud environment creates challenges such as an expanded attack surface and less control over the user experience. Cisco SD-WAN helps you address these issues by simplifying network management. With a single WAN fabric, all policies and configurations can be centrally managed. As a cloud native WAN overlay, Cisco SD-WAN ensures application performance and adapts to changing conditions, whilst providing full-stack multilayer security capabilities for both on-premises and in the cloud.

¹ SD-WAN and SASE: The new landscape of networking, Cisco, 2023

² Five SD-WAN stats every IT decision-maker needs to read, Virgin Media Business, 2023

37
percent

of enterprise architects consider WAN complexity their top challenge.¹

50
percent

(minimum) reduction in network hardware.²

95
percent

of enterprises are using or expect to use SD-WAN within 24 months.¹

Segmenting the Network

Protecting users, reducing risk and building resilience

Keeping data safe is paramount, and that doesn’t come from one bit of technology, it comes from several stacks of technology working together. The key is understanding how these technologies can work together to protect the users and the environment, whilst allowing care teams to deliver patient care without hindrance.

“Our vision for the health and social care sector is for it to be resilient to cyber attacks, minimising the impact on patients and making them safer and better cared for. Cyber threats are always present and constantly evolving, so digital health and care organisations must remain prepared and ready to respond. Cyber must always be managed as a risk and a unified and collaborative approach is key to improving cyber security across the health and social care sector.”

Mike Fell,
Executive Director of National Cyber Operations at NHS England

Segmenting the network

Securing an environment is a constant challenge, the threat landscape is constantly evolving, and unfortunately, healthcare organisations find themselves targeted by threat actors every day. Block has been supporting the trust on the security journey in the following ways:

  • Network Access Control (NAC) – Using Cisco ISE to ensure all devices connecting to the network are subject to certificate-based authentication.
  • Posture Checking – After authentication, managed devices are subject to a posture check using Cisco AnyConnect to check for the correct OS and anti-virus updates.
  • Micro-Segmentation – Authenticated and compliant devices such as medical devices, PC’s, printers and Access Points are then given a Security Group Tag (SGT) according to central TrustSec policy.
The Impact

Measurable results

Block and Barts have worked closely together to implement multiple service enhancements, whilst proactively removing significant risk from the legacy network estate.

Fay Stevenson“Barts is already seeing a host of positive changes from working together with Block on our Trust-wide digital transformation. You can feel it on the ground, in patient feedback and staff morale, but for me the best thing is it’s all measurable via the network dashboard, where the whole team can see at a glance the upgrades in stability, reliability and security across the board.”

Fay Stevenson,
Deputy Director of Informatics at Barts Health NHS Trust

Faster time to value

The key goal of the network refresh was for Barts to be able to roll out new applications and systems faster and more securely. The overall aim was enhanced support for the clinical departments by simplifying the management and operational aspects of such a large network.

64%
decrease

64% decrease in cost per IT deployment through Cisco DNA Centre automation

100%
resolution

100% resolution of P1 and P2 incidents covering all high priority and critical incidents, evidence of a highly responsive managed service

80%
decrease

80% decrease in manpower days for rollout of a major new service or system affecting > 500 users or devices

100%
availability

100% availability of network access, measured over one month for the access layer, up from 97.5% when the project began

The journey continues...