Thanks to the ambitious and oft-criticised National Programme for IT (NPfIT), the NHS today relies on a number of large and complex IT systems operated by outsourced suppliers.

Examples include the NHS Spine, a set of national services operated by BT, and Lorenzo, the patient record system that is still mid-way through implementation by CSC.

Monitoring the performance and availability of these systems is essential if NHS staff are to receive the quality of service they require, and it also helps the organisation hold its IT suppliers to account.

IT support staff and technical architects in the various NHS trusts all need visibility into the performance of these systems, but the responsibility for providing that visibility falls to NHS Connecting for Health, the central department charged with ensuring the successful delivery of NPfIT.

NHS Connecting for Health’s original approach was to use ‘synthetic’ transaction monitoring, in which tests are based on simulated user activity, to assess the performance of each system.

According to Rob Shaw, a director at the National Integration Centre and Assurance within the NHS Technology Office, this worked up to a point, but it did not allow it to monitor real-world performance issues that users were suffering at any given time.

“Synthetic transaction monitoring provided a high-level indication that there may be degradation in performance, but it didn’t offer a clear view of who it would affect, and how wide-reaching that impact may be,” he recalls. As a result, that service management system was underused.

NHS Connecting for Health needed a new system that could provide near real-time performance monitoring and independent confirmation of the service levels the suppliers said they were delivering, and which could scale to meet future demand. In the end, it selected user experience monitoring software called Vantage from Compuware, which now forms the basis of what is known as the National Monitoring Service.

A shared view

For the system to work, it was necessary to persuade the external suppliers to install software ‘probes’ in their own data centres. This, Shaw explains, was not easy: “There was a fear that the solution would provide the ammunition for the NHS to consistently challenge suppliers with an unprecedented amount of evidence.”

However, the external suppliers were eventually persuaded, as it would give them access to improved service monitoring functionality and establish a shared view of performance across the NHS.

In early 2009, the project hit its next hurdle. As originally deployed, the Vantage system was complex, inflexible and highly technical, Shaw reports. This threatened adoption of the system, its ability to scale to meet increased demand in future and ultimately the value that NHS Connecting for Health hoped it would deliver.

What was needed was a single, shared view of application health and performance across all the relevant NHS systems in near real time. That would mean that when a performance issue arose, it would be possible to identify where the issue had originated – and therefore whose responsibility it was to resolve.

At this point, senior stakeholders within the NHS were beginning to question the validity of the project. There had been “high investment in technology with little to show for the efforts and expense thus far”, Shaw recalls. “The project had progressed slowly, and with the transition of a major NHS system imminent, the project team were aware of the need to develop content and features quickly that would support the organisation and NHS users through that transition.”

That led the team to adopt Scrum, one of the more popular Agile development methodologies, consisting of two-week iterations and daily stand-up meetings involving representatives of the user community. This, says Shaw, was intended to “reconnect with the users of the service, understand their key priorities, which had moved on significantly since the start of the project, then generate a momentum of delivery that would address these priorities”.

Making sense of it all

The resulting system is known as the ‘Book of Views’. A web-based portal hosted in a BT facility in Leeds, it condenses a range of highly technical data into a graphical view of the current status of all the relevant systems. It allows users to analyse the historical performance of each service, enabling them to predict the likely impact of such events as applications upgrades or software patches. It also offers the option to subscribe to email-based alerts, meaning that incidents can be identified as quickly as possible.

The NMS, complete with the Book of Views, is today used by a variety of organisations across the NHS to monitor all manner of services. Shaw reports that it is particularly well adopted by IT staff monitoring RiO, an application designed to support mental and community healthcare operations that is operated by BT.

“The NMS dashboard provides a red-amber-green status, updated every five minutes, for the performance of the application for each individual NHS trust,” he explains. “That gives users an impression of their own performance compared with neighbouring trusts, and allows them to drill down to see the volume of user sessions, the number of users impacted by errors and the performance of each page of the application at their own trust.

“In the case of Lorenzo, NMS provides a detailed view of end-to-end business process timings, allowing trust users to compare local performance to the national average.”

Shaw points to testimonials from users describing the value of the system. Lee Rucker, head of service management for the NHS’s London programme for IT, has said NMS has made a “huge difference”, for example. “We are able to see issues in near real time, and the service provides the ability to determine accurately both the duration and the scale of impact on end-users. Feedback from trusts has been extremely positive.”

And, despite their initial reservations, suppliers have found NMS to be beneficial too. “NMS has enabled us to effectively manage customer perception regarding system performance, to swiftly identify and resolve application performance issues, proactively identify and prevent application issues and to easily define ownership regarding customer internal issues,” a BT spokesperson has said.

The future of NPfIT and NHS Connecting for Health is not entirely certain. The present government has pledged to cut back public sector IT spending, but how much can be changed at this late stage remains to be seen.

But Shaw believes that the NMS will continue to be used to monitor IT services, “irrespective of what the organisation may look like in future. Having the ability to monitor these systems will continue to benefit any organisation, whether it’s managed locally or centrally.”