The dire state of cloud-first strategies in NHS Trusts in 2020

Clouds at the top of Snake Pass, Derbyshire

Why Public Cloud?

There are plenty of articles and arguments available of why moving to the cloud makes sense, along with the Secretary of State for Health and Social Care’s Tech Vision¹ and the the National guidance from NHS Digital². For me, there’s an even simpler driver — my view is that in 10 years time there will be very few people around who are sufficiently skilled to maintain an on-premise data centre at the performance and security levels required with pay demands that are affordable to a normal NHS Trust. Following a similar logic, I also see that there will be very limited private cloud providers, so our approach will be to focus on the public cloud.

Who is doing this in Provider Land?

Given that KGH is an acute provider, this research is focused primarily on the provider side. The focus was on finding Trusts who had a cloud-first strategy in place with similar wholescale ambitions, rather than those who are using piecemeal pieces of Software as a Service (SaaS), or things like Office 365. I was looking for numerous examples of Trusts who had decommissioned whole chunks of their data centres, and if I was lucky, I hoped see some who had moved their Patient Administration System (PAS) into the cloud.

Starting with GDEs is a good move right?

Wrong. A Google search for all Acute GDEs and Fast Followers (that’s 32 Trusts) did not yield any results for a cloud strategy (see notes on the methodology below).

Research Summary Table
  • Alder Hey Children’s Hospital NHS Trust: “Cloud technologies will be reviewed and where appropriate will form part of the overall data centre strategy”
  • Gateshead Health NHS Foundation Trust: “The Trust is assessing the option of utilising cloud based services as part of its options appraisal process for each Informatics programme and project”
  • Milton Keynes University Hospital NHS Foundation Trust: “The Trust has started to invest in cloud based infrastructure and will look to extend this where needed to meet user requirements. This will allow the Trust to make an informed decision as to whether to solutions should be locally or cloud based.”

What about anyone else?

A more general Google search for NHS Trust Cloud Strategy did not yield anything much more helpful:

  • Sherwood Forest NHS Trust: Digital Strategy 2020–2025 only mentions cloud in passing “an anticipated move towards a cloud-first strategy”
  • York Teaching Hospitals: Digital Strategy 2017–2022 “appropriate Cloud alternatives will also be reviewed”
  • Barts Health NHS Trust: Article obviously from a Capgemini Press Release “The three-year agreement will see Capgemini work across all five hospitals in the Trust, rolling out end-to-end cloud services across sites in Central and East London”. But a search on the Barts website reveals nothing in terms of a strategy or policy document.

Conclusions and Final Thoughts

  1. The NHS is terrible at sharing, and that makes me sad. If the purpose of the GDE programme is to exemplify good practice and share it with the rest of the NHS then it is failing at the very basic level of Making Things Open [#9 of the NHS Service Manual Principles] and sharing Digital Strategies. Perhaps it is just the way I formulated the Google search or their individual Trust websites that don’t index the content? I’d love for someone to prove me wrong, but even if this is the case, I’d argue that for £300M, the folks running the GDE Programme ought to make it mandatory for each GDE and Fast follower to have a published Digital Strategy. The next step would be for them to have a published statement, updated every 6 months on progress against the Tech Vision¹. [Just so we have our own house in order — the KGH Digital Roadmap and Health Intelligence Strategy are here under “Our Supporting Strategies”.]
  2. The Tech Vision is one of best examples of a sensible policy document we’ve seen in a long time, but it would appear no Trusts are working towards achieving the cloud-related aspects. Why is that? There’s certainly the challenge of moving spend from lumpy capital to annual revenue subscriptions, but it can’t be simply that? Is it about someone needing to go first? That was the point of the GDEs and Fast Followers, so that hasn’t worked. Hasn’t the risk/benefit calculations swung far enough to cloud yet? Perhaps it is simply a case of needing to address years of under-valued and under-funded infrastructure before moving to the cloud is considered?


¹ NHS Policy Paper: The future of healthcare: our vision for digital, data and technology in health and care


  • Using the Google search in the format [Full Trust name]+”cloud strategy”. If that yielded no results, then searched in the format [Full Trust name]+”digital strategy”, followed by [Full Trust name]+”digital roadmap”
  • Then did a bit of digging round in any sections on the Trust website that were related to digital strategy.
  • Then a look at the overall Trust strategy. I’m very fond of repeating a phrase I heard a while back (which I think is attributable to Bud Caddell) “There’s no such thing as a Digital Strategy, just a strategy in a Digital World”, so if I could find it, I also opened the Trust strategy and searched for Digital and Cloud.



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Andy Callow

Andy Callow

Husband. Dad to 3 smashing lads. Cub Leader. MAMIL. Group CDIO for Northampton and Kettering Hospitals. Ex NHS Digital. Views own. Always learning.