Project Estonia: a proven model for e-governance in the UK
Compare and contrast these two nations. We have the UK, a country where one in five NHS Trusts is paper-based. This means that records are kept on paper and must be physically transported between hospitals, sometimes by taxi. Recordings are sometimes lost.
When computers are used, performance can be abysmal. A doctor at Kettering Hospital says it takes him 10 minutes to connect to the hospital system. “Sometimes I give up and go to another computer,” she reveals. Globally, only 1 in 10 trusts is fully digitized.
And the police? Northamptonshire Police issue speeding tickets to drivers and require an ink signature. Do it online? No chance. The police confirm that it is possible to send documents by post or by fax. Yes, fax. A primitive array of printers popular in the 1980s.
Now rotate the globe to Estonia. This unicorn tech factory is considered a haven for digital living. The entire government runs on a sleek online interface. A unique identification code gives citizens access to almost all of its public services. The login is the same for everyone. Vote online. Get a prescription. Pay the tax. Form a society. All with one personal number and one PIN code.
Even more incredible, the entire Estonian system is run for around 100 million euros per year, according to 2020 figures from the State Audit Office.
So why is the UK so far behind Estonia?
A big reason is the unique identifier. At birth, Estonians are assigned a lifetime identification number. The national computer system is built around it. The British do not have such a number, but instead use a multiplicity of identifiers: passport number, NHS number, national insurance number, unique tax reference, driving license, etc. It’s chaos.
“We are not related,” observes Deryck Mitchelson, who was chief information officer at NHS National Services Scotland from 2018 to January. “Even in the same department, things are different. In Scotland we have the CHI – the Community Health Index number – which is the same but separate from the NHS in England and Wales. There are three separate NHS numbering systems: one for England, Wales and the Isle of Man; one for Scotland; and one for Northern Ireland. He studied the impact of this fragmentation on government computing. “There are just too many identifiers,” he says. “The data is siled in local systems. In Scotland, each health trust manages its own records. None of them transmit any information, which is why you see big delays. There is no single source of truth.
During the pandemic, Mitchelson had to create an integration layer to share patient information between the Scottish and English NHS systems to monitor patients. “People are asking what sits between 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 UK country, meaning some Britons could not prove their status abroad.
Even current identification 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 for his middle name, preventing the system from recognizing him. The sample was discarded because it could not be registered. “I deliberately tried to disrupt the system,” he says. As a small gesture, he would refuse to print documents, demanding a digital version. “If people don’t take a stand, that won’t change.”
Now back to Estonia. The entire nation runs on X-Road, a national data sharing platform that stores all data in the cloud on compatible systems. The Department of Education maintains school records and the Department of Health records medical data, but all state systems are interoperable. There is a one-size-fits-all policy, so information is never entered twice. Data can flow from one service to another without loss of information. No candidate is older than 13 years. 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 enables rapid creation of applications and services. Almost 100% of the work is carried out by private contractors, usually smaller agencies rather than the large consultancy firms used in the UK.
The Estonian approach is so remarkable that Finland and Iceland now use the X-Road model. Mexico is a recent adopter. Even Japan has signed a digital cooperation agreement with Estonia for mutual aid 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 modernizing IT. But there are no clear signs that the UK wants to learn.
Sion Smith is CTO of OSO, a technology consultancy which works on software design for NHS Wales and the Department for Work and Pensions, says there is no overall direction and no plan in place to imitate Estonia. “I have never heard of Estonia. Never.” Instead, he says, the mindset in the UK is “reactive”, focused on solving immediate problems as they arise. “I don’t blame the civil servants. They lack experience. They lack understanding,” he says. Even single politicians are hard to point fingers. “It’s the system. Politicians don’t stay long enough. There’s a time lag. four years between what is approved and what is done. At that point, the politician has moved on. The result is archaic and dysfunctional systems. “We talk about technological debt when the code is not optimal or usable. The NHS is tech debt on steroids,” he says.
Could the UK take small steps and adopt a unique identification code, like Estonia? Political objections to Orwellian surveillance are a major obstacle. Estonia sidesteps this debate by giving citizens the right to see who is viewing their data. An identification code can thus increase transparency.
“If done correctly, a unique ID gives you much tighter security and controls,” says Mitchelson, who is now chief information security officer at cyber company Check Point. “In the event of fraud, you can immediately deactivate access to other services. This gives more visibility and allows the consumer to manage their data.
So there is a model that the UK can learn from. It’s cheap to run. Secure. Proven. And Estonians are enthusiastic about sharing their knowledge.
As Estonia grows in importance, thanks to a booming GDP per capita and its reputation as e-Estonia – the land of code – its example will prove increasingly difficult to follow. ignore.