Central and North West London NHS Foundation Trust Cloud case study

Central and North West London NHS Foundation Trust (CNWL) provides a diverse range of community healthcare and in-hospital mental health services across the central and north west London boroughs, as well as neighbouring counties in Surrey and Buckinghamshire. Their circa 8,000 staff work across 112 sites, providing mental health, community and sexual health services.

The trust needed to implement a hosting environment for their data and applications that was performant, highly secure and resilient. It also needed to provide best value for money.

The trust previously used a private cloud hosting platform which presented a number of challenges. It carried a significant excess storage resource which meant it was costly to run. Moreover, due to the nature of the legacy design, any requirements to increase its capacity would need a large upfront capital investment. A move over to the public cloud would therefore mean the trust could scale up and increase their storage capacity, without the need for a large financial outlay. Furthermore, the legacy platform was slow to adapt to the changing digital needs of the trust and an ever-increasing demand for digital services.

By opting for a hybrid cloud strategy, CNWL was able to:

achieve a 15% reduction in operational costs for their application and data estate
make use of a platform which enabled them to scale up services to meet patient and clinician demand
reduce their hosting carbon footprint significantly through the use of carbon net zero hosting environments, thus meeting their sustainability aims

CNWL’s aims for cloud migration

Owen Powell, IT Director and Nigel Tazzyman, Director and Deputy Director of ICT and Head of Commercial at CNWL set out the following aims for the migration

to implement a platform that was futureproof and would enable clinicians to trial and scale up patient-facing healthcare innovations as and when required
to achieve better value for money by lowering operational costs for existing applications with no degradation in performance
to ensure the cloud hosting environment met with the trust’s Sustainable Development Management Plan (which seeks to lower the environmental impact of services across the trust)
complete the migration within an ambitious nine-month timescale
have zero server and storage footprint on the premises

Preparing for a hybrid migration

In preparation for the migration, the trust carried out the following

Conducted a cloud readiness assessment

This enabled the trust to gain an in-depth understanding of their infrastructure state, as well as the capacity and memory requirements of their applications. The assessment also helped to verify whether their applications would still work as effectively in a public cloud environment.

Considered architectural principles

The trust established early on in the planning stages that SaaS applications would be their first choice where possible and opted for public cloud if the applications were unavailable in SaaS. The private cloud environment was only opted for as a final destination where applications were identified as unsuited or unsupported in public cloud. Any applications that they subsequently identified as SaaS ready were then assessed for migration readiness to SaaS with the application vendor.

Engaged with third party suppliers

CNWL worked to engage with their current application and technology suppliersto ensure that their support contracts and commercial arrangements for their applications would still be fulfilled once migrated onto the cloud. The third-party suppliers also helped to validate the correct placement of each application within the hybrid cloud stack and provided vital input into the migration strategy for each application migration runbook.

Carried out a pre-migration review

This pre-migration review and consolidation of their applications meant that CNWL was aware of any hereditary application issues, prior to migration. They also carried out a performance baseline for each application prior to migration to the new platform. This was significant as it prevented the trust from moving legacy data applications to the hybrid cloud environment. Furthermore, capturing pre-migration performance data meant that the trust was able to use the data as evidence to their key internal stakeholders (business intelligence owners) to show that the performance of applications remained at least the same, if not better, post migration.

Richard Alexander, CNWL’s Technical Assurance Lead ensured that the technical architecture aligned with the operating model and would achieve the intended business benefits once migrated. By ensuring all partners, suppliers and third parties involved in the hybrid cloud migration were aligned and fully aware of the trust’s intended outcomes, CNWL was able to ensure everyone was working towards the same goals. This allowed for a level of independence for decision making, ensuring key milestones throughout the migration were met.

Impacts

As a result of their hybrid cloud migration, the trust was able to successfully achieve the following

Realise a 15% reduction in operational savings: The applications migrated to the cloud were not only more cost effective to run but also performed as effectively. Cloud migration also provided the added benefit of enabling a ‘pay as you consume’ based model, meaning minimal upfront investment was required.
Reduce the overall infrastructure footprint: The flexible nature of the public cloud allowed for virtual machine consolidation and rationalisation and in one case reduced 36 virtual machines to 12.
Lower carbon footprint: The efficiency gained through migrating the existing virtual estate onto less physical infrastructure helped the trust to lower the carbon footprint of the hosted estate.
Greater visibility to help meet DSPT requirements: The trust was better able to demonstrate their compliance with the DHSC’s data security and information governance requirements, utilising the management tooling offered in the hybrid cloud environment.
Operational efficiencies: CNWL’s modern hybrid cloud environment enabled processes to be streamlined and allowed for potential automations for provisioning and lifecycle management of application supporting infrastructure.
Greater innovation: A move to hybrid cloud enabled the trust to scale up and utilise their infrastructure accordingly at a low cost. This enabled them to carry out digital innovation trials to be run far more frequently throughout the trust, which benefitted both clinicians and patients.

Learning

Richard Alexander, CNWL’s Technical Assurance Lead, offers the following learning points for any trusts that are considering migrating to the cloud

Start with the right architectural principles: Consider which applications can be delivered as SaaS. Any applications that can’t be delivered in this way would need to go onto a public cloud as the most cost-effective route. Legacy applications generally are best suited to a private cloud platform.
Try and baseline your pre-migration application performance: This helps to ensure the end state of existing applications is good after migration, if not better in terms of performance.
Mandate high quality documentation: Ensure technical teams are mandated to deliver detailed documentation, including design documents, migration runbooks and test plans.
Maintain a quality plan: A good project plan and accompanying team are vital. Ensure milestones are defined and met and ensure RAID logs are kept up to date.
Maintain overall ownership and assurance: Have the final say in everything. The technical and project leads should maintain overall accountability for the project, and they themselves must ensure they are always aligned with the agreed objectives.
Test everything (within reason): A good test plan is vital to the overall success of the project. Maintain an issues log and ensure partners/suppliers are on the hook for meeting the agreed test objectives.
Keep stakeholders engaged: Ensure communications are relevant, targeted and frequent. Some teams will want weekly updates, others a notification when key milestones are met. A tailored communications plan keeps stakeholders ‘in the tent’.
Be pragmatic (sometimes): Not everything goes according to plan, and so ensure teams are empowered to make pragmatic decisions to keep the project progressing.
Get experienced help: If you don’t have the skills to run the project in-house, reach out for assistance! Cloud migration experienced technical leads, project leads, and commercial teams can offer considerable support.

Last edited: 18 October 2022 8:08 am