Published: 16/01/2003, Volume II3, No. 5838 Page 14 15

Leading the way for the rest of the nation, the Welsh health service is introducing its own broadband network. Jane Dudman reports

Wales is quietly fuming. In November 2002, prime minister Tony Blair promised that every doctor's surgery, hospital, primary care trust and health authority would be broadbandenabled by 2006. This was one of the highlights of an 'e-summit' he attended, yet the Mr Blair and his advisers appear to have overlooked the fact that the Welsh health service will not have to wait anything like as long.

While debate rages in the rest of the UK about the speed at which broadband services are (or are not) being rolled out, the Welsh health service is creating its own high-speed network. Indeed, this is already up and running and will have 100 per cent coverage by September 2003.

Funded by the Welsh Assembly, but supplied and managed by British Telecom, the network is being delivered in three phases: data applications, video and voice.

The first stage of the roll-out was to move data services off the previous network, the digital all-Wales network (Dawn), on to the new network (known officially as the NHS Wales broadband network service, but generally referred to as Dawn2).

As they were connected to Dawn2, many GPs got e-mail services and internet access for the first time.

Eventually many new health services will run over Dawn2, including video conferencing, imaging applications and remote diagnostics.

'We are putting in the enabling mechanism so these things can happen, ' says Peter Stansfield, programme director for the new network at the Welsh Assembly. 'Previously, we have had all our trusts online, but primary care has suffered from not being online. The benefit to GPs with the new capacity is that they are now fully part of the network.' Progress towards this high-speed data, voice and video network for the whole of the Welsh NHS took place in several stages. The first important step was to standardise on Internet Protocol for all forms of networking (see box opposite).

With the roll-out of the Dawn network in 2001, IP became the networking standard. Dawn also provided much greater capacity. As part of the overall telecoms programme, all 15 Welsh trusts have upgraded to the IP standard and have improved their own coverage and capacity.

These developments have been running alongside the Assembly's project to bring broadband services to the whole ofWales. The assembly has earmarked£100m for this initiative, which will provide broadband services to an extra 310,000 Welsh homes and 67,000 businesses. The health service network has also required substantial investment.

In 2002, the Assembly allocated£2.3m for the development of Dawn2, with£2m going towards the redevelopment necessary within trusts and£300,000 on the roll-out of core broadband services.

Two other programmes are also being taken forward as part of the overall drive towards modernisation. The cost of connecting GPs to the new network is being funded from the Welsh information and communications technology foundation programme (which aims to deliver IT infrastructure to Welsh GPs through purchase of new computing systems) with£18m over three years coming half from the Assembly and half from local health groups.

As part of this scheme, surgeries will be able to get substantial discounts on Windows software and desktop hardware. The programme will provide secure communications links from GPs' surgeries directly into the new Dawn2 network.

The other parallel scheme is the development of video conferencing and image applications to run over the network.

Implementing Dawn2 has been complex, mainly because of the leading edge technology involved.

Dawn2 is a virtual private network (VPN), owned and managed by BT.When a trust wants to send an e-mail to another trust, the e-mail is no longer directed straight from one site to another. Instead, the message goes into the BT network 'cloud' and is directed on to the right recipient. This makes the network more robust and resilient.

But it meant the first step towards creating the new network had to be backwards. Data traffic running over the old network had to be peeled off and moved to Dawn2, leaving telephony services running over the old network. So, for an interim period, Wales is running two separate networks for voice and data. This is necessary because the IP standard can support voice services, but it requires a technology called Quality of Service to do so.

This technology prioritises traffic over an IP network so applications that require an immediate network connection, such as voice, get put through before less time-sensitive traffic.

The Quality of Service technology necessary to prioritise network traffic in this way has only just been delivered by BT and will be phased in gradually. As this happens, telephony services will move over to Dawn2.

But the first priority has been to increase capacity for data and video services, by moving these on to the new network as soon as possible. 'Our data was screaming out for more bandwidth, ' says Mr Stansfield. The rise in capacity has been dramatic: the old network provided a top speed of two megabits per second.Dawn2 provides between eight and 34mbps.

Getting to this point has required painstaking negotiation between the Welsh Assembly, the Welsh NHS directorate and the 15 trusts, each of which had to redesign its own wide area network in order to meet the standards agreed for Dawn2 and its IP-VPN technology.

'Boundary issues were the main thing, ' says Mr Stansfield. 'We have had to push through to make sure everyone is using the same architecture and the same standards.' The end result has been a big improvement in network service for the trusts, he adds. 'Their response times in some cases have gone from minutes to instantaneous.'

Deciding to outsource the network to BT, rather than run it in-house, was also a major issue.

'That was initially alien to us, 'Mr Stansfield agrees. 'But we see it as a partnership. Our in-house team in Health Solutions Wales is working very closely at an operational level with BT. The network is managed by BT, but we monitor it closely.'

As part of a single, standardised strategy for information in the Welsh health service, several all-Wales systems are being developed, including a financial system, payroll and procurement.

'The key message is that this infrastructure is a means to an end, ' says Stephen Harries, development director at the Cardiff and Vale trust.

'The real goal is a single electronic health record for every patient, as well as imaging applications and remote telemedicine. To make it all happen, we need the broadband infrastructure.'

GPs in Wales have also welcomed the new network, which should enable them to get access to test results and NHS information more quickly and easily.

Telemedicine is another major area that Dawn2 will support.There are several telemedicine pilot schemes within Wales, including a project in Powys demonstrating how video conferencing can be used to carry out remote diagnoses by linking patients in a local GP's surgery with consultants at hospitals in Aberystwyth, Carmarthen and Wrexham.

'The fact that we will have an integrated data, voice and video network makes it far more efficient, ' says Graham Durant, business manager at BT Health in Wales. 'There is more bandwidth, there will be more applications.This network will deliver improved clinical services.'

Timeline: the dawn of Dawn2

2001: The digital all-Wales network (Dawn) is rolled out.This provides voice and data services over a single network, using the Internet Protocol, to trusts and some GPs, but does not provide 100 per cent connectivity.

July 2002: The new broadband network, colloquially known as Dawn2, is officially launched.

September 2002: The core network service is switched over from Dawn to Dawn2; voice calls continue to run over Dawn.

November 2002: Seventy per cent of Welsh GPs are now connected into Dawn2.

Spring 2003: Technology should be in place to support voice calls over Dawn2, as well as imaging applications and video conferencing.

September 2003: All 600 Welsh GPs will be linked into Dawn2, as well as the 15 trusts.Remote workers will also be catered for.

Jargon buster

Bandwidth is how fast data runs across a network and is measured in bits per second and megabits per second.

A modem that works at 57,600bps has twice the bandwidth of a modem that works at 28,800bps.The amount of bandwidth needed by different applications varies enormously. Large sound files, computer programs and videos take up much more bandwidth than plain text emails, which is why video conferencing applications need large amounts of bandwidth.

Broadband is the term used for networks that can transmit large amounts of information.Definitions vary, but generally broadband is used to describe any network with bandwidth of 2mbps or more.

Internet Protocol is the method, or protocol, by which data is sent from one computer to another on the internet. Each computer has a unique IP address, enabling it to be identified from all other computers on the internet. IP has become widely adopted as a networking standard.

Voiceover IP is a technology that uses IP to run voice services, ie telephony, over a network, instead of across the traditional public switched telephone network.VoIP is cheaper than traditional telephony, but still faces some challenges in terms of quality.