Govroam, the NHS, and WiFi

2013-11-21 15.06.52-2
Submitted on behalf of Marcus Baw

Hi, I’m Marcus Baw and I’m a locum (freelance) GP and Emergency Physician in the North West of England. I’m also a health tech specialist, and a programmer. Being a locum means I work in a number of different NHS settings, which makes for very varied day-to-day work. It means I get to experience a wide range of NHS organisations and see how they vary in terms of their (lack of) provision of WiFi for staff.

Me, the NHS and WiFi
WiFi in the NHS has become a bit of a soap-box subject for me, as the advent of the Internet has seen almost all of the current and reliable information resources migrate from books and journals to online websites and webapps, which is great for learning and staying up-to-date – except when you’re deprived of an Internet connection!

If we want our NHS clinicians to make good, well-informed decisions in a timely fashion, it’s vital that all NHS environments provide their staff with access to these online resources. It’s simply indefensible to deny them this access.

It has to be WiFi. 3G/4G ain’t gonna cut it.
Quite often, I find myself working somewhere without access to the WiFi (it’s worth noting here that there is always WiFi present, it’s just that in many hospitals clinicians aren’t deemed important enough to have access). I can sometimes get by, sort of, with mobile data. But many clinical environments – for example modern steel-framed PFI hospitals – have poor or absent mobile signal within them (meaning mobile 3G/4G data won’t work reliably) so without access to WiFi, clinicians are cut off from vital online resources for best practice.

It’s not even about accessing electronic patient records via WiFi
Right now, I know of nowhere in the NHS that has a sufficiently advanced system to enable a clinician to access the patient record through their own mobile device through WiFi (just to pre-empt those comments saying ‘I can dial in on my Thinkpad’ – no, VNCing in on a laptop doesn’t count, it’s slow, it’s clunky, it’s death by abysmal User Experience).

So the WiFi requirement is not actually about accessing patient records through our devices, it’s purely about access to essential information resources.

Why would we send our NHS clinicians to do battle with disease and ill health, without giving them access to the vital weapon of current, evidence-based, peer-reviewed knowledge?

So what resources are we trying to access? Aren’t we supposed to be working?

These days, we’re seeing medical students being educated via Skype and recording their progress in ePortfolios like Moodle – We’re teaching new procedures to junior doctors using YouTube, which gives them an important first overview of a procedure, making them much better prepared for the formal 1-to-1 hands-on instruction that follows – We’re sharing knowledge about management of common and rare diseases more than ever before, creating free online reference texts like and online medical calculators like – our internationally-respected British National Formulary is online and searchable. We can access professional guidelines from the General Medical Council and advice from our medical defence organisations. Patient information leaflets about any condition can be searched for and supplied to the patient in seconds – We can get hold of any journal paper from the history of medicine in a few clicks – And for everything else, there’s always Google.

WiFi backstory
Back in 2013 I did a very simple online survey to find out what the status of access to WiFi is across the whole NHS, and the headline figure was that around 20% of respondents had access to free WiFi in their place of NHS work. Disappointing.

The good news is that since 2013, my subsequent surveys have shown an encouraging trend towards increasing provision of WiFi to NHS front-line staff. Last time I did the survey (2015) about 50% of respondents reported they had access to free WiFi. NHS Digital now has an official NHS WiFi Programme, tasked with bringing free WiFi to the whole NHS, for patients and staff.

However, there’s a flaw. Federated roaming WiFi isn’t in those plans.

Whilst having access to WiFi in one’s home organisation is definitely a step forward, represents some progress, what we really need is Roaming WiFi. We need this in order to make possible new ways of working and new models of care delivery, where clinicians and other staff are able to roam throughout the NHS in an always-connected state.

It has to be Roaming. Single-organisation WiFi ain’t gonna cut it.

Imagine an NHS in which clinicians can roam to neighbouring NHS organisation to see specialist patients, and can remain connected to their familiar systems throughout. GPs would be able to attend a case conference at the local authority’s social care offices, and still access the patient’s record. And that’s just the tip of the iceberg. As more and more public sector organisations joined Govroam, we would see transformation of the way professionals could interoperate across the public sector instead of the current organisationally-siloed working. The benefits of fluid cross-organisational collaboration between Police, Fire, Ambulance, Social Care, Local Government, Central Government, Hospices, GPs, Walk-in Centres, Hospitals, Libraries, and others will lead to innovation that is as yet unimaginable.

When I first heard about govroam as proposed in the UK by Jisc, I thought: ‘That’s exactly what we need in the NHS’. The eduroam model, which has been proven to a) work, b) be cheap, and c) scale internationally, seems to be ideal.

The NHS (and the UK public sector in general) has an appalling record for procurement of technology. It tends to be able to pull off the impressive epic multiple fail of paying all the R&D costs of an untested vendor-specific platform, swallowing rocketing implementation costs, suing the supplier and losing, and still ending up not owning any of the IP, when it’s delivered it’s brand new legacy tech.

So I’m very wary when I hear of ‘public-commercial partnerships’ and new shiny tech, and would be much more comforted by the thought of an Eduroam-influenced platform with it’s reliable, tested technology, oIpen source radius server options, and simple, non-proprietary architecture.

For the record, despite agreeing to guest-blog for Jisc, I’m not a closed-minded govroam fanboi: I’m completely open to other suggestions for how federated roaming WiFi could work. And as long as it does work, at a cost that public sector can afford, then I’m ambivalent about how it’s delivered, whether this be public or commercial. Right now though, I think I would need to hear some extremely powerful arguments against govroam for it not to be a natural choice.

OK – so what do I do about this?

* If you’re someone with responsibility for NHS IT, then ask your clinical colleagues what they need from an NHS WiFi service. In particular, what benefits would be had from access to roaming WiFi. How would this change their practice? Make sure what your organisation is providing will meet these needs.

* If you’re a clinician, you could talk publicly about your clinical connectivity needs (blogs, presentations, Twitter), point out where they are not being met by the current levels of provision, and talk about how roaming WiFi would make the care you deliver easier to provide, and of higher quality.

* If you support the idea of GovRoam then tell people about it – the more people that know that roaming WiFi across all of Health and Care is not only technically possible, but is a real and present offering, the better.

* If you are a senior NHS Digital executive working in Domain A – then you might need to rethink your WiFi programme. Sorry.

Jisc welcomes the opportunity to solicit the personal views of various stakeholders in roaming connectivity use cases and provision, and specifically invited Marcus to contribute his take in this case. However, we would note that Jisc is involved in ongoing profitable discussions with NHS Digital and colleagues around the subject of WiFi roaming, and therefore don’t share his perspective that this aspect of connectivity provision is not addressed in their plans. We would be happy to offer a chance to respond to Marcus’ view to a representative of the NHS team(s) involved – mark.o’

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