The Importance of a Proactive Cloud Service Provider in the Public Sector

Clare Chambers, Head of Information Management and Technology (IM&T) at East of England Ambulance Service (NHS Trust) joined Version 1 for an interesting discussion on our recent Microsoft Azure Cloud Migration collaboration (refactoring SQL to Azure with overall project go-live taking place in April 2021), and the importance of selecting a proactive Cloud Service Provider in the Public Sector.

The NHS East of England Ambulance Service provides 24*7*365 accident and emergency services to those in need of emergency medical treatment and transport in – Bedfordshire, Hertfordshire, Essex, Norfolk, Suffolk, and Cambridgeshire. This organisation also provides non-emergency patient transport services for patients needing non-emergency transport to and from hospitals, treatment centres, and other similar facilities and who can’t travel unaided because of their medical condition or frailty. In 2018/19 the Trust received more than one million emergency calls and treated 64,157 people through its Emergency Clinical Advice and Triage Centre.

Hi Clare, can you tell us about what you have been working on in the last 12 months?

Clare: The story starts with our Cloud-First Strategy. So when we have to do a system upgrade, as we do at various points, we can ask ourselves whether we should put it in the Cloud.

That’s what happened with our project with Version 1. We had to do a system upgrade because our onsite infrastructure was starting to fail. And this relates to scheduling and rostering tasks, which is critical to an ambulance service.

We struggled with knowledge to be honest. This doesn’t mean that our team didn’t know what they were doing — but that this is fairly new tech to us, and the NHS. We were the first ambulance service to put this particular application into Azure. This meant it was the first time the software developers were putting it into the Cloud as well.

So, Version 1 had the expertise required to support you with this challenge?

Clare: Like many NHS (and non-NHS organisations), we have five million things happening at any one time. We struggled with focus and pace. So we needed a partner that wasn’t going to sit back and wait for us to tell them what to do. We needed someone who would say “Come on, this needs to be done now — we’ve done this — we think this is the answer’.”

What have you learned that you would pass on to others?

Clare: It’s so important to choose the right partner. It’s important to accept that you are never going to know everything. So it’s not a slight on your team, or their knowledge to partner with a company to support you. You can fall into the trap of assuming software suppliers have the latest knowledge. And they don’t always. So it turned out in this case, we wanted to do some things they hadn’t even thought about.

Were there any unexpected experiences as part of this project?

Clare: Often it’s about more generic lessons than the technical or process level. We’ve never worked with a partner, even those recommended by vendors, who have actually pushed us along like this. Previous suppliers always sat back and waited for us to be ready.

I was surprised that 3-4 weeks after the engagement, my Head of IT came on the call and reported that the infrastructure was in place. I had to ask him to repeat himself! And that’s because they had been pushed by Version 1 to make progress. That was really refreshing and I learned how important the right partner can be. I had never come across a partner that added such pace to a project before.

How do you know how far ahead of the curve to aim? How do you pace that?

Clare: I’ve always taken the stance we should never be first. We are an ambulance service, we are here to treat patients. It would be lovely to fly to the moon but we need to be safe, secure and stable. To be frank, I didn’t know we were going to be first(!). It was only when the application provider rang me and asked “Why are you doing this?” that I thought about it and decided — ultimately it’s an SQL database, there’s nothing particularly complicated here.

That said, the Azure platform has been out there for many years now. The rest of the world is quite happy to use it (outside of Public Sector) and it’s proven in other areas. The risk element was the software itself — the application sitting in the Cloud environment.

If it had been our control room, I’d have been more risk-averse, but it was the right risk to take.

What are the signs for you that it’s time to embark on a new tech project?

Clare: Some of it relates to Microsoft’s own lifecycle. Servers are becoming end of life.

Previously in the NHS, teams were sometimes accepting of end of life software and would just say “It’s working, we’ll leave it.” But then (the ransom software) WannaCry changed that in the NHS and Public Sector forever. We are obliged to be running patched infrastructure so we don’t have security loopholes or gaps. We have to think more imaginatively about how and when we do things.

If we had some kind of security incident because we hadn’t upgraded a server, so it wasn’t patched — that would just be indefensible after WannaCry.

It’s also an opportunity for us because cybersecurity was such an unsexy phrase a few years ago. Since WannaCry, our board is much more aware. So if we say we need to replace infrastructure to be secure, they are much more supportive.

How else has the world changed around you in your career?

Clare: I think the whole Cloud element was a buzzword for years. Then, maybe 5-6 years ago in the NHS, everyone was very anti-Cloud. “Why would we do this? It’s patient info, it’s identifiable.” And the Cloud providers have done a good job of showing the NHS and Public Sector that it is secure. You don’t need tin sitting in your computer rooms. You can have Cloud-hosted apps and services.

I think the next one will be AI. Outside of the Public Sector, it’s huge, it’s coming into the NHS. And I think using NHS data, with the right governance and controls, will eventually help us predict health outcomes or ambulance needs.

What slows progress down the most? How do you manage and mitigate this?

Clare: This is no different to other Public Sector organisations, but our biggest challenge is having the resources. Not even funding really (although that’s clearly important because it’s publicly funded.)

But the real challenge is having the right resource in the right place to achieve what we need. That’s why we rely on partners so much. We couldn’t afford some of the engineers at companies like Version 1. They have brains the size of planets, and quite rightly, we couldn’t afford them. Better they work in third parties and spread their knowledge across the world.

Our challenge realistically is around having the right resource in the right place to do what we want. We have so much we want to do, so many projects we want to work on, so many “nice to do” things. But we have to focus on the basics. Like getting infrastructure into the Cloud, which is fairly run of the mill now.

What other advice would you give to our readers?

Clare: It may sound really basic, but it’s so true that there’s no such thing as a silly question, for example if you’re in a meeting around the technical implementation of a system. This is especially true with third-party suppliers, they have heard all of these questions before. You have to be certain when using public money, you need to be absolutely sure what you are doing is for the right reasons, not technology for technology’s sake.

You need to have a partner you can trust, and you need to know that they are doing the right thing for you.

When I or the team ask a question to Version 1, we get an answer we know we can believe.

It’s so important to choose the right partner. It’s important to accept that you are never going to know everything. So it’s not a slight on your team, or their knowledge to partner with a company to support you. You can fall into the trap of assuming software suppliers have the latest knowledge. And they don’t always. So it turned out in this case, we wanted to do some things they hadn’t even thought about.

Thank you to Clare Chambers, Head of Information Management and Technology (IM&T) at East of England Ambulance Service (NHS Trust) for taking part in this Q & A with Version 1.