England’s National Health Service (NHS) has completed the largest-ever migration of enterprise email accounts, after moving 2.1 million mailboxes from on-premise servers to Microsoft Exchange Online.

The six-month project involved moving some 22,000 NHSmail accounts into Microsoft’s Azure cloud every day, rising to 83,000 at the weekend.

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It represents the largest mass migration of enterprise email accounts ever handled by Microsoft, as well as a fundamental step in the NHS’s wider ambitions to become a cloud and digital-first health system.

Sarah Wilkinson, CEO of NHS Digital, said: “The migration of NHSmail to Exchange Online has enabled us to provide staff across the NHS with a mail system which is functionally richer, more secure and lower cost.

“We have also deployed a Microsoft Hybrid implementation of Office 365 to the NHSmail platform, which is allowing NHS organizations to provision Office 365 services much faster, integrate with the existing NHSmail identity, and collaborate more easily.”

NHS Digital, the technology delivery arm of the UK’s public health service, began migrating NHSmail accounts to the cloud in August 2020.

Chris Parsons, head of collaboration services at NHS Digital, told TechRepublic the project involved shifting some 2.3 petabytes of data – or around 2.3 million gigabytes – from NHSmail accounts to the cloud, using an “army” of NHS IT administrators as well as teams from NHS Digital, Microsoft and professional services firm Accenture.

“Microsoft tends to deal with big enterprises, but nowhere near as complex as the way that the NHS is structured,” said Parsons.

The NHS is one of the largest employers in the world, sitting behind the US Department of Defence and Walmart – both of which are also Microsoft customers.

Despite this, the NHS – which employes some 1.3m staff, according to the most recent figures – represents the single largest Office 365 tenancy Microsoft has in the enterprise space.

The wildly varying levels of digital maturity within the NHS presented a unique set of challenges for those charged with moving organizations onto the latest software.

“If we were doing this in any other sector or business, you’d probably do your email migration or refresh at the same time as you do some other kind of refresh activity,” Parsons explained.

“We don’t do that – we can’t do that. We provide our service to around about 25,000 unique organizations within England, from your supermassive acute hospitals like Leeds Teaching Hospitals and Sheffield, all the way down to a small care home, that maybe only has one or two NHSmail users.”

Some 16,000 to 17,000 IT administrators work within the NHS, working with local organizations to run, maintain and update services provided by NHS Digital. 

Parsons said that these admins had been working since the start of 2020 up until the migration period in August to ensure NHS IT systems had the technical prerequisites needed to move to Office 365 software .

“The biggest challenge was the difference in technology that organizations had deployed on the ground,” said Parsons. “You would like to hope that everybody was always on the latest versions of software, but that just isn’t the case.”

NHS Digital has been working closely with Microsoft in recent years to help move healthcare staff onto modern software and operating systems.

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In June, the NHS struck a landmark agreement with Microsoft to deploy Microsoft 365 across much of the NHS, which came as the UK health service was battling against the COVID-19 pandemic.

Microsoft Teams was also deployed NHS-wide at the start of the UK COVID outbreak, enabling vital remote communication between healthcare teams battling the virus.

Parsons described the impact Teams had as “a game-changer”.

“What we’ve seen since then is just a massive acceleration in uptake in the use of Teams. The last time we took a snapshot of the data, we had a total of about 134 million chat messages, about 3.5 million meetings and just over 13 million calls using Teams from March last year, up until about two weeks ago,” he said.

“That’s technology that, although it existed, just wasn’t available to the NHS this time last year.”

The move to Office 365 also sets the NHS in a position to take better advantage of new technologies enabled by the cloud, said Parsons. “There’s a whole load of quite advanced digital transformation from automating workflows, all the way out to more edge cases that we’re seeing at the moment – so the use of HoloLens technology to support clinicians on COVID wards and junior clinicians under training.

“We’re now able, in the next couple of months, to support that kind of technology at a massive scale. We can only do that because we’ve shifted our foundation building blocks into the cloud and into Office 365.”

Despite a tightening partnership between NHS Digital and Redmond, Parsons stressed that the organization was not “beholden to Microsoft alone”.

He added: “It’s important that we maintain that strategic relationship with Microsoft, but also with Google, and with Amazon, and with Apple, and with all of the big technology providers to make sure that we’re articulating to them where the priority needs are for the NHS.

“It’s my job and my team’s job to represent that to these organizations so that we can get our requirements prioritized on their roadmaps. We need to make sure that they’re keeping pace with the technology developments that the NHS needs to see delivered.”

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