NHS N3 Infrastructure: N3 connette il sistema sanitario nazionale britannico

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With over 51,000 connections, N3 connects more than 1.3 million staff and every GP, hospital and clinic in England and Scotland

For almost a decade N3, the secure national broadband network built and managed for the National Health Service (NHS) by BT, has been delivering fast broadband network services that provide healthcare professionals with quick, easy access to information, anywhere, anytime, ensuring that patients get the best possible care whenever and wherever they need it.

N3 underpins many of the services the NHS relies on today. From transmitting medical images and speeding up response times in emergencies, to ensuring the NHS has internet access even in times of unprecedented demand such as during London 2012. And it is environmentally-friendly too. Its sustainability initiatives have reduced NHS carbon emission by more than 50,000 tonnes.

The beauty of N3 is that it allows us to move intelligence and information around the system, which is a critical part of high quality healthcare. That benefits the public, the patient, it benefits the professionals, and it benefits the planet.
-Dr David Pencheon, Director NHS Sustainable Development Unit

Essential infrastructure

N3 provides the infrastructure which underpins key national services the National Health Service (NHS) relies on. Without it 39,000 hospital appointments couldn’t be booked electronically each day; 675,000 prescriptions couldn’t be sent; clinicians wouldn’t be able to view medical images or log on to their computers to access vital patient information, and there would be no email access for NHS staff.

But N3 is much more than just a broadband network. It enables clinicians and healthcare professionals to deliver high-quality, cost effective care against a back drop of ever–increasing demand for healthcare. Offering a range of value-added services such as voice, videoconferencing, fast internet access, and mobility solutions, it is helping create a world where patients receive better, more convenient treatment, diagnosis is faster, emergency services can respond quicker, hospital stays are shorter, and discharges faster.

The scale of the N3 is impressive. With more than 51,000 connections it links every GP, hospital and clinic in England and Scotland. It is one of the largest private broadband networks in Europe, serving more than 1.3 million NHS employees, through 62 points of presence connected by 12,000 miles of fibre – enough to stretch from London to San Francisco and back.

N3 has become as important to the NHS as the road and the rail networks are to our everyday lives and it has saved the NHS an estimated £926 million. Constantly moving with the times and undergoing technological refreshes every two years, it provides the essential technical infrastructure without which the modern NHS couldn’t function properly today.

When BT first began to roll-out N3 in 2004, broadband was still in its relative infancy. There was a national network, NHSnet, but it was based on old, inflexible technology which was significantly more expensive to run. It was slow in comparison and unable to cope with the increasing demands of the many new bandwidth-hungry services that were beginning to emerge.

It was not uncommon for large NHS organisations to be connected by 2mbps links and GPs with just 64kbps, tiny compared with today’s connections which can be anything up to 100mbps.

Value for money

N3 is ground-breaking in many ways. When BT was awarded the contract it was to act as a service provider, known as N3 Service Provider (N3SP). Under this arrangement, BT was to source broadband connections on the open market from a variety of different telecommunications companies and manage these on behalf of the NHS. Each supplier competes on price and quality, so the NHS gets the best value for money.

The challenge in building the network was not insignificant. Not only did the existing 10,000 connections of NHSnet have to be replaced, but an additional 8,000 sites which weren’t on the network also had to be connected by the end of March 2007.

N3SP was quick off the block. 6,000 connections were reached by the end of March 2005 and in November that year it passed 12,000. By the beginning of 2007 the roll-out to 18,000 sites was completed – nearly two months ahead of schedule – enabling NHSnet to be switched off in March that same year. The resulting efficiencies in switching from NHSnet to N3 led to estimated NHS savings of more than £163 million.

But reaching 18,000 connections was far from job done. Every two years N3SP delivers a technology refresh using the latest network technology which is more cost effective and kinder to the environment. This ensures that, in a rapidly evolving market, the NHS is underpinned by a world-class network and can take advantage of the latest innovations to drive efficiencies and cost savings.

Today, N3’s capacity, network coverage, and capabilities make it unrecognisable from the network first launched more than nine years ago. What started as a data network rapidly evolved into a network capable of supporting a number of cost saving, value added services including, voice, data, mobility, video and web-conferencing, and remote access. This has helped to transform the way the NHS works, and introduced new, more cost efficient ways of working.

More than a broadband network

One of the first value-added services to be introduced was N3 Voice, an IP-based voice service which enables the NHS to take advantage of lower call charges to mobiles – as much as 30 per cent – and free calls to other voice equipped NHS organisations.

The use of N3 Voice Services continues to grow, reaching 10.5 million calls in 2011/12, a 70 per cent increase on the previous year. Today, more than 150 organisations use N3 Voice every second of every day, reducing the NHS’s telephone bill by £4 million since the service was launched.

North Essex NHS Foundation Trust is one such example. It replaced its outdated voice network with N3’s hosted voice service, making savings of £81,000 a year in running costs.

N3 also ushered in a new era where clinicians are able to access vital patient information at the touch of a button. Today, clinicians have instant access to the one million scans or x-rays that are stored electronically whether it is at a GP surgery or in a hospital environment – a major leap forward in terms of speed and security from the days when images were delivered by couriers.

Across England, the majority of cancer networks, telemedicine and cardiovascular networks are now using N3 to save time on travelling and enable faster diagnosis and treatment. N3 audio and web conferencing is encouraging more collaborative working, enabling teams to talk and share their experiences and work on documents, presentations and other materials such as patients notes or x-rays or scans.

And N3 Mobile Health Worker, which supports a number of mobile devices from laptop and tablet computers to smartphones, is enabling community health professionals to work more flexibly. It provides clinicians with instant access to patient records whether they are in the office, on the move or in a patient’s home, allowing them to spend more time with patients.

Award winning

Another service that has transformed the way clinicians work and improved patient care is N3 Managed Videoconferencing. Previously, videoconferencing services were set up on a local basis, often for use inside a specific Trust which was then responsible for booking and scheduling calls and managing the bandwidth and infrastructure.

With N3 Managed Videoconferencing all that is taken care of, with the necessary infrastructure built into the N3 network. Trusts are able to easily set up videoconferencing calls with each other using an online booking system. Since the service was launched, clinicians and healthcare professionals had, as at the end of April 2013, taken part in 48,700 video meetings, resulting in savings of £11.7 million. Not only that, by reducing unnecessary travel it has saved 2,100 tonnes of carbon omissions. If extended across the whole of the NHS, N3 Videoconferencing has the potential to save up to £100 million a year.

N3 Videoconferencing is also encouraging greater innovation and more efficient ways of working. The West London Cancer Network and Peterborough and Stamford Hospital, among other trusts, are using it to enable multi-disciplinary teams of doctors, nurses and administrative staff from across all the hospitals to discuss individual patients by simultaneously reviewing x-rays from one place and pathology from another.

Recognising N3 Videoconferencing’s contribution, the service has collected two prestigious national awards for innovation, bringing N3’s tally of awards to an impressive nine for quality, innovation, efficiency, and team working and collaboration. This includes winning e-Government awards for an unprecedented three years in succession.

Bringing it all together

The inexorable rise of traffic over the internet meant that it was not long before it was necessary to increase the capacity of the internet gateway – the part of the infrastructure that carries traffic to and from the internet. The gateway, which carries more than 600 terabytes of data each month – equivalent to 600 billion printed A4 pages every 4 seconds – has now been upgraded twice to cope with ever-increasing demand.

Most recently capacity was more than doubled to 5Gbps to provide faster access and new enhanced functionality to prioritise traffic according to clinical and business need. This was really put to the test during the London 2012 Olympic and Paralympic Games when, despite unprecedented demand, the N3 Gateway ensured that the NHS had continuous access to clinical and business critical websites supporting essential front line services.

Trusts connected to N3 can also join together to form Community of Interest Networks (COINs), enabling them to network their services together more efficiently, converge voice, data, and video communications, and create bespoke solutions to meet their needs.

There are now 69 COINs joining up clinical care in sparsely populated areas such as Cornwall, and bringing together specialisms such as The Kent Cardiovascular Network, which uses the N3 to link local facilities with main centres of expertise in London, so patients get faster diagnosis and treatment.

Since COINs were first introduced they have generated savings of £205 million pounds, and connect more than 30 per cent of trusts in England and 40 per cent of trusts in Scotland. With many COINs now being retendered, N3SP is having considerable success in retaining most of the contracts, winning the majority of them. This is in large part due to the technological refreshes the N3 network undergoes.

With the NHS reforms now in effect, and GP-led consortia known as clinical commissioning groups now responsible for a large part of the NHS budget, N3SP is currently upgrading connections to GPs.

The GP Next Generation Access programme will ensure that all surgeries in England are equipped with the latest super-fast broadband technology to help improve access to clinical applications and services and is the second upgrade to GPs’ technology. It will see more than 7,100 GP sites, as well as clinics, ambulance stations and other small sites, upgraded to speeds of up to 20mbps – 40mbps. Since the launch of N3, upgrades to GP connections have saved the NHS £13 million.

Blueprint for PSN

N3 is also playing an important role in the Government’s Public Services Network – an initiative to create a joined-up “network of networks” to substantially reduce the cost of communications services across UK government. In many ways N3 can be seen as a blueprint for the PSN, having already demonstrated the benefits of a multi-vendor interoperable network. A pioneer of PSN, N3 has recently been awarded PSN certification for its Direct Network Service Provider connectivity service, linking it with the wider PSN via the Government Conveyance Network.

Connectivity to the PSN means that N3 can now provide secure, resilient access to the core of the PSN, further enhancing the ability of the 1.3 million users of the N3 network to collaborate and share information with other organisations such as local authorities and social care providers.

As well as innovation, customer satisfaction is central to N3’s ethos. Nick Earl, Chief Executive of N3SP, says: “When you’re dealing with something as close to the heart of the nation as the NHS and those people who work for it, customer satisfaction is the number one priority.

“Despite some challenges in the early days of the contract, N3 has earned an enviable reputation for delivering excellent customer service with customer satisfaction constantly improving over the past five years. We can now boast that we have one of the best customer satisfaction ratings across the whole of the industry.”

N3 has a dedicated 24/7 contact centre and customer relationship management system where users can place orders, track faults, and confirm current services. The contact centre target is for all calls to be answered within 60 seconds. Currently 99.5 per cent of calls are being handled within this timeframe.

The green dividend

The N3 network has also had a significant knock-on effect in helping the NHS – the largest UK public sector climate change contributor – reduce its carbon emissions. Working closely with the NHS Sustainable Development Unit and NHS trusts, N3SP has been looking to find ways of lowering emissions.

As well as videoconferencing, N3’s remote access service, which currently supports more than 20,000 virtual private network tokens in the NHS, is calculated to be saving 150,000 days of commuting a year. If extended to all non-clinical staff this figure could increase to 3.8 million days.

Many of N3 services are inherently environmentally-friendly. Flexible working with N3 Mobile Health Worker can help cut down on unnecessary journeys to and from the office, meaning healthcare professionals can spend more time with patients. Likewise, N3 audio and web-conferencing cuts down on unproductive travel, while N3 On Demand Compute –a data centre service hosted in the cloud – reduces carbon emission because it uses less space and power than conventional data centres.

N3 is also there in times of trouble. With the UK experiencing more severe weather events in recent years, such as heavy snow and flooding, N3 has helped ensure business continuity across the NHS.

For example, Sheffield received a month’s rain in just one day during summer floods in 2012, forcing schools to close, nursing homes to be evacuated and affecting 30,000 homes and 7,000 businesses. As the communities pulled together to recover from the damage, behind the scenes N3’s reliable, secure network helped the NHS to carry on.

With clinical data held safely at a secure data centre and accessed remotely via the N3 network, surgeries avoided the potentially life-threatening situation of cancelled appointments, lost patient records, and unavailable prescriptions. The 13 Sheffield surgeries which suffered damage were able relocate to neighbouring practices, access information remotely, and continue surgery as normal.

And thanks to N3, the Yorkshire Air Ambulance has cut its emergency response time after linking its computers to N3, meaning its helicopter can now be airborne in two minutes compared to the average eight minutes it used to take.

A decade of success

The year 2014 represents a real landmark for N3 as it celebrates a decade of success. Innovative, constantly evolving and with an excellent record in customer satisfaction, N3 continues to deliver world-class networking services.

Nick Earl comments: “N3’s contribution to modern healthcare should not be underestimated. It has been a quiet revolution behind the scenes and made a lasting difference to the NHS. N3 is transforming the way people work, increasing efficiency, saving the NHS money and, most importantly, helping improve patient care.”

Looking forwards, James Hawkins, Director of Programme Delivery at The Health and Social Care Information Centre (HSCIC), observes: “Everyone who has worked on N3 should be incredibly proud of these achievements and the continuing difference we make to the everyday running of the NHS. We are committed to building upon the success of N3 to support the needs of the NHS as it evolves.”

Core Services

  • N3 managed on behalf of the NHS by BT

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