In early 2020, with hospitals around the UK in danger of becoming overrun, the UK government recognized the need to act. The mantra of “Stay Home, Protect the NHS [National Health Service], Save Lives” was born as public health officials and ministers were laying out the measures they saw as necessary to control the pandemic. The most immediate across-the-board consensus was the need to vastly expand the nation’s COVID-19 testing and contact tracing capacity—to millions per day—and to do it fast.

The ability to then take prompt action to control the spread of the virus on the back of positive results was central to breaking the chain of transmission. The longer the time required to process the results, the greater the potential for virus transmission. IBM delivered a Salesforce platform that enabled the UK Health Security Agency (UKHSA) to rapidly deploy solutions such as the International Arrivals Service, the Managed Quarantine Service (MQS) and a web portal for private test providers. Additionally, IBM® Consulting - Hybrid Cloud Services formed a joint, multidisciplinary team—using the MuleSoft Anypoint Platform—to build a software as a service (SaaS) integration platform that the UKHSA calls the Real-Time Testing Service (RTTS) to process all COVID-19 test results for onward contact tracing.

Looking back at the project, Simon Bolton, Chief Executive of NHS Digital—and former Chief Information Officer of NHS Test & Trace—sees the dramatic increase in test result processing speed as the signature benefit of the project. “The fact that we’ve been able to reduce the processing time of test results from eight hours to minutes, was absolutely essential to suppressing the spread of the virus,” says Bolton. “Today, we’re processing over one million Covid tests per day, as much as 300 per second. It’s this astonishing throughput—made possible by a resilient backbone—that’s the underpinning of everything we’ve accomplished.”

Adam Wheelwright, UKHSA’s current CIO, sounded a similar note on the importance of fast, reliable data transfer. “The criticality of improving the quality and flow of data has been one of the most important challenges of the COVID response. Being able to design, build, deploy and then evolve a production grade, high volume, data interchange solution in any organization can be challenging but successfully doing this during a (hopefully) once in a generation pandemic is truly outstanding and couldn’t have been achieved without world class teamwork and focus on both delivery and outcomes.”

Reduced processing time for COVID-19 test results from 8 hours to

16 minutes

enabling faster contact tracing

Processes COVID-19 tests at a rate of more than

1 million

per day, or as many as 300 per second

Ready to adapt

The pandemic was evolving rapidly across the world and different nations were adopting different response strategies. There was no consistent blueprint response. Infection rates and patterns were shifting, new variants were emerging, and public health officials were gaining a deeper understanding of infection risks.

In early 2021, ministers across a variety of government agencies were actively debating what measures were required at the UK border to control the spread of variants of concern. To Jackie Keane, Digital and Technology Portfolio Director for the Trace Portfolio, the new border rules were exactly the kind of policy changes she and her team needed to be prepared for. So when the border controls were announced, Keane explains, the IBM and Salesforce team weren’t starting from scratch. “With the RTTS and the Salesforce CRM platform already completed, the foundations of the solution were there,” she says. “That put us in a strong position to implement the new International Arrivals Service and MQS very quickly.”

Under the new policy, people arriving at the UK border from abroad had to comply with quarantine and testing rules based on the Covid risk status of their departure country. Travelers from “red list” countries—those deemed to be at high risk for new and emerging strains of coronavirus—would be required to follow a relatively complex testing and quarantine protocol both before and after they entered the country.

For the program to work, the UKHSA needed to guide each passenger sequentially through these steps, from the completion of passenger locator forms to testing instructions and quarantine hotel booking. Because each flow would depend on test results, integration with testing labs was critical.

Woman at end of crosswalk talking on her cell phone

A team of team delivers

In terms of head starts, the solutions the IBM, Salesforce and MuleSoft teams had built weren’t the only pieces in place. They had rapidly and massively scaled their global “teams of teams” to meet an ever-expanding workload, using Continuous Improvement and Continuous Delivery (CI/CD) practices such as KPI monitoring and automated testing, to name just a few. “We had established a very fast, seamless and smooth-running delivery capability,” notes Matt Candy, the IBM Executive Sponsor on the project. “When the MQS and International Arrivals Service project landed, our joint teams were able to gear up to meet the challenge.”

As Deputy Portfolio Director on Keane’s team and delivery leader for the RTTS, Daniel Jeans saw first-hand what seamless co-creation looks like. “Across the entire delivery team there was a ‘leave-your-badges-at-the-door’ mentality. There was shared understanding among every team member that what they were doing could save lives,” says Jeans. “That kind of open, transparent culture really helped promote the continuous improvement—a willingness to try new approaches and learn from mistakes—that a project like this demanded.”

Close-up of male computer programmer coding in office

Continued success under pressure

Within just a few months, roughly 100,000 arrivals were quarantined through the program, and of them, more than 2% tested positive for COVID-19. The fact that the solution prevented those travelers from entering the wider UK population and clearly saved lives wasn’t the only reason the UK Association of Project Managers selected it as the APM Social Project of the Year award for 2021. Nor was it the rapid turnaround.

Perhaps even more, Keane comments, it was the “extraordinary circumstances” under which the solution was built. “The MQS project required a high degree of collaborative working across a particularly complex landscape, and all in the spotlight. I am privileged to have been a part of such a stellar team that worked hard to deliver the outcomes needed against a fast-ticking clock.”

NHS Digital’s Bolton also sees the chemistry of the extended team—united by a common sense of purpose—as a big reason for its ability to accomplish so much in so short a span. “The astounding pace IBM and Salesforce achieved has shown a lot of people what the art of the possible is, just how fast you can deliver if you work together and set your mind to it,” he says. “Each member of this team came to work every day believing that what they were doing made a genuine difference in saving lives. And I believe they did.”

Since the rollout of MQS, the pace of development hasn’t let up. Policy changes large and small have been nearly constant, and the rate of new releases on the Salesforce and MuleSoft platform—at over 100 in nine months—has been rapid to say the least. To keep up with these weekly policy changes, the delivery team applied the Kanban method across the squads, thereby improving its ability to adapt priorities and accelerate delivery on extremely short notice. The full automation of testing has also been a huge factor in driving both speed and quality into delivery processes. Currently, the Test & Trace program can run over 120,000 tests, across all solutions, in less than one hour.

Today these solutions form the strategic bedrock of the UKHSA’s response to the pandemic providing secure, scalable, performant platforms across the UKHSA.

 

Solution components

UKHSA and NHS logo

About UK Health Security Agency (UKHSA)

The UKHSA (link resides outside of ibm.com) is the government department responsible for protecting the UK from the impact of infectious diseases and all other health threats. The UKHSA is an executive agency, sponsored by the Department of Health and Social Care (DHSC) and formed from the predecessor organizations, NHS Test & Trace and Public Health England.

NHS Digital

NHS Digital (link resides outside of ibm.com) is the national provider of information, data and IT systems for commissioners, analysts and clinicians in health and social care in England, particularly those involved with the National Health Service of England. A unit of the Department of Health and Social Care, NHS Data provides digital services for the NHS and social care, including the management of large health informatics programs. NHS Digital is also the national collator of information about health and social care, and publishes over 260 statistical publications each year, including Official Statistics and National Statistics.

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