16 - 17th June 2016
etc.venues St Paul's, London, UK

How an agile approach in healthcare saved £21m in the first year

Mat Barrow Infinity Works

Session type: Case Study
Session duration: 45 minutes

Slides from session

The slides used for this session are available to download from here.

About this Case Study

What started as a value for money exercise to inform a major procurement evolved into the successful replacement of the essential infrastructure and messaging service for a national health service and has become an exemplar of the benefits that agile at scale can deliver.

This was a very challenging environment, working with an organisation that was experienced in supplier/contract management and assurance of waterfall projects, but extremely risk averse. They'd historically objected to any suggestion of in-house development, open source technologies and agile delivery.

We took some unconventional approaches, like:

  • using an upside-down test pyramid (lots of integration tests, little unit tests) for the automation tests to reflect the risk profile
  • opting for a simplified technology stack rather than best-of-breed components for long-term ease of maintenance at the cost of short-term developer productivity
  • delivering the minimum viable product (MVP) after 3 years of development as a big-bang release in recognition that the MVP was actually a full-service replacement

The service was transitioned to live with zero downtime for read access to most of the services and minimal downtime (hours) for write access. Since go-live, we have used blue/green and canary deployment methods to deploy hundreds of releases whilst maintaining 99.999% service availability targets. This has allowed us to adapt to change and deliver additional benefits to patients and users that previously have been prohibitively expensive.

Key points of the service:

  • more than a million registered users at more than 20,000 organisations
  • approximately 100 million demographic and clinical summary records and approaching 500 million prescriptions
  • zero data loss, zero downtime and very high availability targets, also quickly horizontally scalable to adapt to emergency load (eg a flu pandemic)
  • written primarily in Python, uses Riak, Redis, RabbitMQ, NginX and deployed using Puppet, Hiera and Cobbler
  • fully automated deployment and test
  • deployed to commodity hardware (concern about patient data security limited cloud based options in 2012)

About the Speaker

Matthew is an established and highly versatile IT leader with a proven record of delivering large-scale agile programmes in high-risk, high-pressure environments. For the past 5 years, he's been working on organisational transformation in the English National Health Service. He has also been a driving force in the adoption of agile at scale across multiple national and local services.

Matthew is now a director and Head of London for Infinity Works, a fast-growing agile consultancy group specialising in project and software delivery, business process improvement and team development.