Project Estonia: a proven template for UK e‑governance

Com­pare and con­trast these two nations. We have the UK, a land where one in five NHS Trusts is paper-based. This means records are kept on paper, and must be phys­i­cal­ly trans­port­ed between hos­pi­tals, some­times by taxi. Records are occa­sion­al­ly lost.

When com­put­ers are used, the per­for­mance can be appalling. A medic in Ket­ter­ing hos­pi­tal says it takes her 10 min­utes to log into the hos­pi­tal sys­tem. “Some­times I just give up and go to anoth­er com­put­er,” she reveals. Over­all, only 1 in 10 trusts is com­plete­ly digi­tised.

How about the police? Northamp­ton­shire Police posts speed­ing tick­ets to dri­vers and demands an ink sig­na­ture post­ed back. Do it online? No chance. The police con­firm it is pos­si­ble to send doc­u­ments by post or fax. Yes, fax. A prim­i­tive net­work of print­ers pop­u­lar in the 1980s.

Now swiv­el the globe to Esto­nia. This tech uni­corn fac­to­ry is regard­ed as a par­adise for dig­i­tal liv­ing. The entire gov­ern­ment runs on a slick online inter­face. A sin­gle ID code offers cit­i­zens access to almost all its pub­lic ser­vices. The login is iden­ti­cal for all. Vote online. Get a pre­scrip­tion. Pay tax. Form a com­pa­ny. All with a sin­gle per­son­al num­ber and PIN.

Most incred­i­bly of all, the entire Eston­ian sys­tem is run for around €100 mil­lion a year, accord­ing to 2020 fig­ures from the State Audit Office. 

So why is the UK so far behind Esto­nia?

A big rea­son is the sin­gle iden­ti­fi­er. At birth, Esto­ni­ans are assigned an ID num­ber for life. The nation­al IT sys­tem is built around it. Brits have no such num­ber, but instead use a mul­ti­plic­i­ty of iden­ti­fiers: pass­port num­ber, NHS num­ber, Nation­al Insur­ance num­ber, Unique Tax Ref­er­ence, dri­ving licence and so on. It’s chaos.

“We’re not joined up,” observes Deryck Mitchel­son, who was chief infor­ma­tion offi­cer of NHS Nation­al Ser­vices Scot­land from 2018 until Jan­u­ary. “Even in the same ser­vice, things dif­fer. In Scot­land, we’ve got the CHI – the Com­mu­ni­ty Health Index num­ber – which is the same as but sep­a­rate from the NHS in Eng­land and Wales.” There are three dis­tinct NHS num­ber­ing sys­tems: one for Eng­land, Wales and the Isle of Man; one for Scot­land; and one for North­ern Ire­land. He has stud­ied the impact this frag­men­ta­tion has on gov­ern­ment IT. “There are just too many iden­ti­fiers,” he says. “Data is siloed in local sys­tems. In Scot­land, each health trust man­ages its own records. None of them pass­es on infor­ma­tion, which is why you see big delays. There’s no one source of truth.”

Dur­ing the pan­dem­ic, Mitchel­son need­ed to cre­ate an inte­gra­tion lay­er to share patient infor­ma­tion across the Scot­tish and Eng­lish NHS sys­tems to mon­i­tor patients. “Peo­ple ask what sits between the NHS sys­tems and con­nects them. The answer, real­ly, is noth­ing.” It’s a dis­as­ter. The NHS app failed to show dou­ble vac­ci­na­tions if one was in anoth­er nation of the UK, mean­ing some Brits couldn’t prove their sta­tus when abroad. 

Even the cur­rent ID process­es are poor, being based on names and date of birth. Mitchel­son says he went for a blood test and the nurse for­got to ask his mid­dle name, pre­vent­ing the sys­tem from recog­nis­ing him. The sam­ple was thrown away as it could not be logged. “I delib­er­ate­ly tried to dis­rupt the sys­tem,” he says. As a small ges­ture, he would refuse to print doc­u­ments, demand­ing a dig­i­tal ver­sion. “Unless peo­ple take a stand, it isn’t going to change.”

Now back to Esto­nia. The entire nation runs on X‑Road, a nation­al data-shar­ing plat­form that stores all data on the cloud on com­pat­i­ble sys­tems. The depart­ment of edu­ca­tion main­tains school records and the depart­ment of health logs med­ical data, but all state sys­tems are inter­op­er­a­ble. There is a once-only pol­i­cy, so infor­ma­tion is nev­er input twice. Data can flow from one ser­vice to anoth­er with no infor­ma­tion loss. No appli­ca­tion is more than 13 years old. Any­thing old­er is rebuilt. This means, for exam­ple, that ambu­lance dri­vers can view patient infor­ma­tion on an e‑ambulance app. Doc­tors and para­medics can see blood type, aller­gies, treat­ments or preg­nan­cy at a glance. 

The X‑Road back­bone allows apps and ser­vices to be built at speed. Almost 100% of the work is under­tak­en by pri­vate con­trac­tors, usu­al­ly small­er agen­cies rather than the big-name con­sul­tan­cies used in the UK. 

The Eston­ian approach is so out­stand­ing that Fin­land and Ice­land are now using the X‑Road mod­el. Mex­i­co is a recent adopter. Even Japan has signed a dig­i­tal coop­er­a­tion agree­ment with Esto­nia for mutu­al assis­tance and learn­ing. 

Could the UK fol­low? The struc­ture is there. The UK is a mem­ber of the Dig­i­tal Nations group, a col­lec­tion of nine nations that includes New Zealand, Den­mark, Israel and Esto­nia, with a com­mon goal of mod­ernising IT. But there’s no obvi­ous sign that the UK desires to learn. 

Sion Smith is CTO of OSO, a tech con­sul­tan­cy which works on soft­ware design for the likes of NHS Wales and the Depart­ment for Work and Pen­sions, says there is no over­all direc­tion, and no plan in place to emu­late Esto­nia. “I’ve nev­er heard Esto­nia men­tioned. Nev­er.” Instead, he says, the mind­set in the UK is “reac­tive”, focused on fix­ing imme­di­ate prob­lems as they occur. “I don’t blame civ­il ser­vants. They lack expe­ri­ence. They lack under­stand­ing,” he says. Even lone politi­cians are hard to point the fin­ger at. “It’s the sys­tem. Politi­cians don’t stay around long enough. There’s a four-year lag between what gets approved and what gets done. By that time the politi­cian has moved on.” The result is archa­ic, dys­func­tion­al sys­tems. “We talk about tech debt when code is not opti­mal or usable. The NHS is tech debt on steroids,” he says.

Could the UK take baby steps and adopt a sin­gle ID code, like Esto­nia? Polit­i­cal objec­tions of Orwellian sur­veil­lance are a major obsta­cle. Esto­nia evades this debate by giv­ing cit­i­zens the right to see who views their data. An ID code can thus increase trans­paren­cy.

“If it’s done prop­er­ly, a sin­gle ID gives you much tighter secu­ri­ty and con­trols,” says Mitchel­son, who is now chief infor­ma­tion secu­ri­ty offi­cer of cyber firm Check Point. “If there is a fraud, you can imme­di­ate­ly switch off access to oth­er ser­vices. It gives more vis­i­bil­i­ty and allows the con­sumer to man­age their data.”

So, a mod­el exists for the UK to learn from. It’s cheap to run. Secure. Proven. And Esto­ni­ans are enthu­si­as­tic about shar­ing their knowl­edge.

As Esto­nia ris­es in promi­nence, thanks to a soar­ing GDP per capi­ta and a rep­u­ta­tion as e‑Estonia – the land of code – its exam­ple will prove ever hard­er to ignore.