The NHS e-Referral Service (e-RS) is a flagship NHS system. It is used by over 1,100 NHS organisations and their patients to choose, book and change over 70,000 referral appointment requests every working day.


Handling outpatient hospital appointments, e-RS provides real-time information about available services and clinicians. It has largely replaced paper-based referrals, slashing the time to process a referral by 75 percent and reducing missed appointments by half. The National Audit Office (NAO) estimates that these improvements are saving secondary care providers over £50.5m every year.

When BJSS and NHS Digital originally built e-RS in 2015, to replace the previous Choose and Book system, the service was operated by dedicated storage equipment. This meant that in addition to the equipment used to provide the service, enhanced security was needed too. Spare equipment to automatically take over if something failed, in addition to dedicated data communication and environmental control equipment was also required. While this dedicated structure made e-RS reliable, it made it expensive to maintain and complex to manage.

However, with time, improvements to public Cloud offerings became available. Cloud enables organisations to host their data remotely, rather than maintaining their own computing equipment. NHS Digital was keen to explore the viability of transferring e-RS to the Cloud. It hoped that this would save taxpayer money and also support the NHS’ Internet First policy of providing access to digital systems by other providers such as dentists, optometrists and pharmacies.

BJSS, (which is AWS’ (Amazon Web Services) Public Sector Partner of the Year) with vast experience in delivering large and small technology projects to the NHS, was asked to help NHS Digital achieve these ambitions. This became the NHS’ biggest and most ambitious Cloud migration to date and has resulted in e-RS achieving performance, security and cost-saving improvements.

“There are a wealth of benefits that come from moving large systems like e-RS to the Cloud. Costs are lowered, reducing pressure on the public purse, there is better security and reliability, as well as greater flexibility, performance, scalability and availability, to name a few.”
 

Neil Bennett
Director of Services, NHS Digital

A roadmap towards cost and efficiency savings 

An initial cross-functional team from BJSS and NHS Digital looked at the viability of moving e-RS to the Cloud. BJSS’ Cloud experience was integral in choosing AWS as the Cloud provider for e-RS and then deciding which services would suit it best.

NHS Digital’s Technical Review Group independently assessed these recommendations and gave the project approval to proceed.

This resulted in a joint BJSS and NHS Digital Delivery Team of 28 covering platform engineering, architecture, application development, functional and non-functional test, delivery management, business analysis, database administration, service management and operations.

This team successfully moved e-RS to the Cloud two years later.

They delivered: 

  • The opportunity to realise significant cost savings from moving to a more flexible and resilient storage and management system
  • Improved ability to manage changes in demand and to understand system performance, providing more responsive support for users

Lower cost doesn’t always mean lower quality 

Moving e-RS to the Cloud is a significant milestone for the NHS’ digital transformation journey. While costs will be optimised, its performance has greatly improved. The service uses 21 best of breed AWS Cloud tools and services and has been developed with scalability, availability and durability always in mind.

Medical data and personally identifiable information are highly sensitive. Robust security measures were implemented as part of moving e-RS to the Cloud. Today the service benefits from even greater security with sophisticated and cutting-edge protection and firewalling measures that are repeatedly updated.

While moving e-RS to the Cloud will result in savings for the NHS, it has improved the resilience and quality of the service. Through BJSS’ support, NHS Digital has delivered its first major Cloud migration and has created a system that will make the health service more connected and efficient than ever before.