Introduction
Over time organisations change to meet operational demands and pressures associated with growth and development. The NHS has placed technology at the heart of its strategy since the 1970s and one organisation has uniquely provided an unprecedented level of support, spanning over two decades, for the technological dynamics of what is now the National Program for IT.

Celebrating its 25th year of business, CSA Waverley is considered to be a trusted driving force behind provision of hardware and system migration supporting Connecting for Health and the NHS's most robust system, called NHAIS. The infrastructure provider has delivered over 2000 migrations Nationwide.

The client
Department of Health agency, NHS Connecting for Health, is responsible for implementing new solutions for the National Program for IT (NPfIT) to improve patient care and services whilst maintaining support for myriad legacy systems that exist within the NHS.

NPfIT will connect over 30,000 GPs in England to almost 300 hospitals within 10 years, giving patients access to personal health and care information. This will transform the way the NHS works.

The Primary Care level of NHS IT is underpinned by National Health Application & Infrastructure Services (NHAIS): commonly known as the ‘Exeter' system.

NHAIS is implemented nationally across 89 Primary Care Trusts and Strategic Health Authorities, managing services, patient registration and demographic details for England, Wales and Northern Ireland. The system is responsible for the delivery of mission critical national systems and ensures the maintenance and business continuity of some 40 products and services which underpin several key areas of operation within the NHS.

NHAIS covers many services and delivers a vast array of data-heavy work. Statistics include GP payments that process £8BN a year, 58.5 million managed Patient Registration records, 42,000 GPs linked to NHAIS via 8,500 practices, 6.5 million women per annum called for Breast or Cervical screening, Open Exeter with over 2 BN transactions per year and the National Tracing Service which traces 20M records per month and provides 240,000 updates to the Personal Demographic Service (PDS) on a daily basis.

The NHAIS systems are both data rich and accurate and the combined databases are occasionally used to compare and qualify findings against the National Census.

The challenge - Plotting the development of NHS IT systems
As the NHS has grown so new projects, services and upgrades have extended the critical reach of the NHAIS data backbone on a daily basis. This implies a requirement for expertise in NHS systems and operations, an understanding of the very latest technology on the market appropriate to the bespoke needs of each new project, and above all, an appreciation of hardware and system transfer on a macro scale.

In the late 1970's, a landmark move saw the government hone in on the visionary benefits of computing within the NHS. The newly built Exeter General Hospital was chosen to house the Exeter Community Health Services Computer Unit (ECHSCU) and the Exeter Regional Health Authority was awarded £10M to develop the first Primary Care and Patient Administration System (PAS) that would then be rolled out to every Hospital in the country.

The system became a huge success (and won the 1977 British Computing Award) but was constrained by large main frame infrastructure, which proved costly to run. The ECHSCU Project was therefore abandoned (other than in 32 local hospitals) and focus turned to expanding the ‘Exeter' system to develop systems for the 105 Family Practitioner Committees (FPCs) in England and Wales to deliver applications and information for GPs, Dentists, Pharmacists and Opticians. ECHSCU then became known as the FPC Computer Unit.

At the onset of the project, only 3 FPCs were computerised, running only small internal business applications. Additional focus came when Edwina Currey announced the launch of a nationwide Breast Cancer Screening program that demanded computerisation of all FPCs and training of PC illiterate staff within a year. The task was considered landmark in both scope and scale.

The quickened expansion challenged the FPC Computer Unit and its existing supply chain of DEC PDP11 hardware. Computer Sales Agency Waverley Managing Director, Andy Boyle, provided the resolve.

The solution - success through service
The appointment of CSA Waverley as one of the primary hardware and system migration supplier across the largest NHS infrastructure of its type, spanning 22 years as a strategic partnership founded on the supply of DEC PDP11 processors.

With the role being much broader than simply procurement of hardware, CSA Waverley has provided specialist technical expertise regarding new technologies and service delivery, developing the relationship to become almost an extension of the NHS FPC Computer Unit working on the ‘Exeter' system.

• 1980's exclusively supplied and maintained hardware for all 105 FPCs
• 1992 won European tender to facilitate move to Unix
• 1999 won further NHS Supplies tender
• 2007 awarded CfH Hardware Framework Agreement (Partnering Probrand)
• 2008 awarded CfH ASCC Framework Agreement

The above timeline indicates that CSA Waverley consistently illustrates excellence, value for money and wins tenders ongoing.

Waverley currently supplies a wide range of hardware solutions, as well as support and maintenance for all Health Authorities and PCTs in England and Wales who run the NHAIS application. In addition, it continues to support, maintain and supply some 450 in-house servers based at core offices at Leeds and Exeter, hosting a variety of ICT, test, development and ‘live' NHS systems.

Waverley also supplies, supports and maintains many other system based solutions to the wider NHS. This means Waverley's credentials are second to none, with unprecedented support and maintenance of an overall total of some 700 NHS systems nation-wide.

The results
Geoff Castle, Service Delivery Manager - National Services, explains: "Waverley has become pivotal in helping us to shape the future program regarding NHAIS and its growth.

"A landmark saw the company propose and then technically lead us through a pioneering system transfer from DEC PDP11s running DSM to a UNIX environment some years ago. Waverley assisted with the facilitation of the transfer of systems and data with our in-house operatives.

"The company has assisted with numerous projects within the NHS. The team's technical expertise, capacity and capability to do the job ensured an agile and personal approach that empathises with the challenges we face in the healthcare sector.

"These credentials coupled with process driven project management enable Waverley to manage an average of 100 migrations or upgrades a year with outstanding accuracy and delivery. This ensures cost effective, timely and consistent delivery to help us meet our objectives of regional and national ICT strategies.

"Waverley is synonymous with our progress as each job specification is met with a creative and optimum solution that delivers on or under budget. Appropriate new hardware, technical solutions and system configuration post-migration is key, ensuring we can reduce downtime and system loss to its absolute minimum.

"The company provides reassurance in handling all site visits and technical surveys, development of an implementation program that co-ordinates with our team for data migration and supply of people on the ground armed with test equipment, advice and technical information.

"This includes readying our network to install software, which has saved us significantly in time and money. It has also maintained business continuity, scheduling down time without impact on provision of service or GP contract management.

"The company's attention to detail is seeing 100% service delivery. That means no negative impact on the business. We are now seeing this attention to service delivery applied to the virtualisation arena."

"Waverley also operates a forward thinking mentality with transfer of any maintenance support across hardware, saving us warranty costs and future issues.

This also applies to ensuring the Operating System software stack and hardware are kept in line with manufacturer standards for easier long term support and optimum business continuity.

"With fully rounded yet specialist end-to-end service, Waverley has set the protocol for delivery and expectation in the NHS. No challenge is too great and the team knows as much about the systems as we do.

Castle also reflects on challenges relating to the last organisational move, when the NHS Information Authority was absorbed into the NPfIT: "Waverley managed a critical move of Sun based hardware from Birmingham to Leeds over a weekend. This demanded configuration of a particularly demanding infrastructure, including decommission, physical hardware move and re-commission. The result saw 100% operability at ‘go-live' on the Monday morning."

CSA Waverley has also helped Wales to centralise the application, rationalising five sites to two on the back of its ongoing Exeter work, saving space, power and cooling capacity. The move will deliver improved infrastructure costs and future proof application flexibility. It is freeing up capacity for testing and refining of fail over services also.

Castle continues: "This future proofing approach is undoubtedly maximising our operations and saving us costly mistakes as major organisational developments continue.

"Waverley is now continuing to assist our drive towards the use of blade servers, rationalisation of our server estate, virtualisation and Disaster Recovery. The recommendation to switch to blades will see us significantly reduce our CO2 impact and server footprint ahead of government recommendations, whilst improving speed of service delivery to key workers.

"New projects are frequently launched and with Waverley's immense NHS business knowledge its hardware and technical input are extremely important. This expertise is currently being applied to new projects, including the Family Nurse Partnership, the Abdominal Aortic Aneurism service and the National Service Desk, amongst others.

"The NHAIS system has remained at the core of the NHS IT strategy, the underlying hardware has had to evolve numerous times during this period, each change necessitating proof of concept, system and data migration, porting of the application and so on. The application's stability is testament to Waverley's commitment to the system and the NHS."

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