The Backbone Of The NHS: Understanding The NHS Spine And Its Future

The NHS Spine is a major component of the health and social care IT infrastructure in England. The NHS Spine processes 3,200 electronic messages per second, between 28,000 NHS IT systems, across 21,000 care organisations – that’s up to 1.3 billion messages every month. It provides secure access to over 65 million Summary Care Records, over 90 million demographic records and securely sends 750,000 e-referral messages per day and 2 million electronic prescriptions per day, to help the NHS care for thousands of patients.

NHS Spine’s applications are used by 500,000 NHS health professionals a day and counting, enabling doctors to decide quickly on life-saving treatments, GPs to swiftly refer patients for urgent hospital diagnosis, paramedics reach the people in most need of their help, and pharmacists to check prescriptions are correct for vulnerable citizens.

Components of NHS Spine

Spine is a centralised service that allows information to be shared securely through national services including:

• Electronic Prescription Service
• Personal Demographics Service
• Summary Care Record
• e-Referral Service

NHS England develops and maintains Spine, and recent developments include enabling the sharing of child protection information via the Child Protection Information System (CP-IS), and developing ways to allow easier access to demographic data through the Spine Mini Service.

Spine is a technical implementation that is commonly accessed directly by digital services and software, however many users also access Spine through clinical systems or through the Spine portal, and new ways are being developed to help systems suppliers design IT systems for health and care which can integrate with Spine or access important patient information.

The Spine Futures Program

The Spine Futures program has a visionary goal: to provide a secure, adaptable, and sustainable infrastructure for the health and care system in England. The Spine Futures program aims to deliver this vision through the strategic development of the Spine platform for national digital services to be built upon, meeting the evolving needs of staff, patients, and the public.

Objectives of Spine Futures:

• Enable Rapid Response: The program aims to facilitate swift responses to changing health and care demands, ensuring that the Spine remains agile and responsive to emerging challenges.
• Deliver Better User Outcomes: By providing new and improved capabilities based on user needs, including Integrated Care Systems (ICSs) and existing healthcare users, the Spine Futures program seeks to enhance overall user experiences.
• Comply with NHS Architecture Principles: Adherence to NHS architecture principles, such as being Cloud and API first, ensures that the Spine remains aligned with the broader strategic goals of the healthcare ecosystem.
• Foster Ecosystem Innovation: The program strives to create an environment that fosters innovation by providing open services, reducing barriers for third parties, and supporting system-wide standards.
• Rationalise the Cost of Provision: By challenging the existing portfolio of products and understanding the cost implications, the program aims to make informed investment decisions, optimising the cost of providing services.
• Optimise Operations: Real-time operational data and an effective operating model are crucial elements in optimising the operations of the Spine, ensuring efficiency and reliability.

Active engagement with the health and care system is a key aspect of the Spine Futures program. Collaborating with global technology leaders, gathering feedback from healthcare system suppliers, and involving teams in social care and frontline digitisation are essential steps in shaping the future of the Spine.

Moving Spine to the Cloud

One of the significant transformations recently as part of Spine Futures is the migration of the NHS Spine Platform to the cloud. This strategic move was driven by the need to harness modern technologies and open standards, ensuring that the Spine remains adaptable to the current and future needs of patients, staff, and citizens:

• Security: Strengthen the Spine resilience against potential future cyber-attacks and improve recovery time in the event of an attack.
• Reliability: Maintain a high level of reliability and uptime.
• Scalability: Enable the ability to scale infrastructure based on demand, ensuring the system can handle peak loads and reduce costs.
• Sustainability: Utilise scaling infrastructure to reduce the carbon footprint of the service.
• Maintainability: New services can be built using native cloud tooling and serverless architecture, which enables teams to be more responsive to changing user needs

NHS Spine – Looking forward

The roadmap for Spine Futures includes live cutover events for Spine sites, hardware decommissioning, and optimising the cloud service.

The key focus looking forward is on optimising services by making use of native cloud services and reducing dependencies between parts of Spine, to make it easier to upgrade and further reduce running costs and expand internet access for users.