The National Health Service (NHS) this month completed a major email migration project, moving more than two million NHSmail mailboxes to Microsoft’s Azure cloud as part of the government’s cloud-first approach to the health service.
The migration, which was completed on Feb. 2, stemmed from an agreement struck between NHSX, NHS Digital and Microsoft last June that gave eligible healthcare organisations in England access to Office 365 tools. The deal promised to improve productivity, enhance collaboration, and strengthen cybersecurity across healthcare services, whilst simultaneously guaranteeing significant savings for both individual NHS organisations and the NHS as a whole.
Although the NHS email service had already been refreshed in 2015 and 2016, the just-completed migration is the first to take place since Health Secretary Matt Hancock wrote the Internet First policy – in which he proposed to move services away from potentially costly, complex, and inflexible purpose-built networks and onto the public cloud.
“The NHS is a really complex web of different organisations that sit underneath that NHS banner,” said Chris Parsons, head of collaborations services at NHS digital and whose team were responsible for the migration. "We provide that NHS mail service to just over 22,000 uniquely different organisations that all boast themselves as being within that NHS or wider health and social care community."
He said the migration process took around 18 months in total, with the planning phase beginning in March 2019 and the live migration of more than 2.1 million mailboxes taking place between August 2020 and this month.
Despite the upheaval in the country and extra pressure put on the NHS by the COVID-19 pandemic, Parsons said the migration went smoothly, finishing a month ahead of schedule and with less than 1% of users needing any form of support. He said “planning, getting the pilots right and communication” were key to success, with a random percentage of users being selected each day so the migration could be done in batches.
Around 22,000 accounts were moved to Microsoft’s Exchange Online platform every weekday since August, rising to around 83,000 each weekend. Users were also given a two-week warning of the migration as well as a reminder the day before and a notification of success after the fact.
The partnership with Microsoft also meant that the biggest issue Parsons’ team did encounter, an Office 365-imposed rate limit on the amount of data that can be migrated at any one time, could be dealt with in advance. Microsoft’s product group provided support where devices were still running Office 2010, ironing out compatibility issues between the legacy system and the Office 365 suite.
“It's testament to the planning work we did that most of the things we found were things we expected to find,” Parsons said.
Moving away from legacy technology
The NHS has long been plagued by issues related to legacy technology. The 2017 WannaCry ransomware attack, which infected devices running unpatched versions of Windows XP, affected at least 80 out of 236 NHS trusts, forcing the cancellation of around 20,000 hospital appointments and operations, and prompting five A&E departments to divert patients to other hospitals.
After the attack, the Department for Health and Social Care announced an agreement with Microsoft in April 2018 that oversaw NHS devices upgraded to Windows 10 for free. However, in February 2020, a month after Microsoft stopped patching Windows 7, around 500,000 NHS devices were still running on the outdated operating system.
Despite some of these long-standing issues, the ongoing partnership between Microsoft and the NHS meant NHS staff had Microsoft Teams available to them throughout the pandemic.
Although the pandemic did force Parsons’ team to take stock of the situation in March 2020, there was no plan to delay the migration, as a deadline had already been set for the work to be done by March 2021.
“We weren’t just doing the migration for migrations sake,” Parsons said. “We're doing it to deliver additional capabilities.”
He said his team last week deployed a booking app that allows clinicians to have video consultations with their patients over Microsoft Teams, a tool that wouldn’t have been available to them without the move to Exchange Online.
“There’s all kinds of layers of goodness that have come about because we've done that basic migration in the first place,” he said.
And he argued that the need for the health and social care system to respond to the pandemic meant that some traditional barriers to technology adoption and transformation have been put to one side. That allowed tech teams working in the NHS to deliver digital transformation projects within timeframe nobody would have previously expected.
“If we look today at where we are with our Microsoft Teams usage and adoption, every day on the platform that we're providing, we're seeing about a million messages, a quarter of a million meetings and just under 200,000 calls happening every single day, seven days a week,” Parsons said. Those levels of adoption would never have happened in such a short time without setting aside barriers to allow the healthcare system to move forward.
“We've made some really great advances in the delivery that we've made, we just need to make sure that we capitalise on that and keep the momentum going,” he said.