DITO did not begin with a grant application. It grew from more than a decade of advocacy, pilots and policy work arguing that public digital infrastructure - and health technology above all - should be open.
The paper that started it
The direct seed was An Open Digital Approach for the NHS, written by Stuart Mackintosh and published in autumn 2018. It was not a think piece: the paper was grounded in real implementation experience and consultancy with the NHS and other public-sector bodies - and it was written to settle an argument. In a debate with NHS Digital, Stuart presented the case that open source was not merely appropriate for public health systems but the optimal delivery mechanism for them. Asked to put that case in writing, he produced the paper.
Following the research behind it, the paper focused on the barriers to open adoption in the public sector - and specifically in the NHS. Many of its points still hold true today, a decade on.
The natural next step was an implementation manual showing how to put the policies, principles and practices into practice. It quickly became clear that a manual could not be written credibly on a small budget - the practices had to be lived through a real clinical development to be documented honestly. So DITO was designed as the full implementation proof-of-concept: a funded, multi-partner project that would exercise every part of the approach on a real application, and write down what actually worked.
The Apperta spark
The second spark was the partnership with the Apperta Foundation. Apperta had previously been the NHS Open Source project - NHS England's open-source programme - before becoming the clinician-led foundation that would serve as DITO's governance partner. That lineage mattered: it meant the project started with a governance body that understood both the NHS and open source, and it provided the custodianship model that DITO would prove in practice.
The groundwork
Around those sparks sat years of groundwork by the eventual partners:
- 2019
- Innovate UK awarded the grant - at £790,000, the largest R&D grant Innovate UK had made to an open-source project at the time of award.
- 2018
- An Open Digital Approach for the NHS published; Innovate UK application submitted.
- 2016
- Engagement with the SLaM Open-eObs pilot - the feasibility work that showed an open eObs application could work on a real ward, and seeded the clinical partnership. This, with the Code4Health support and other projects, preceded and informed the paper.
- Europeans joining forces to promote open source software in healthcare
- 2015
- Support for the NHS Code4Health platform.
- 2011
- Government Technology article on open source - open standards enter the public-sector cost conversation.
- 2010
- Stuart Mackintosh becomes co-secretary, with Basil Cousins, of the OpenForum Europe Public Sector Group (PSG) - working on the open standards policies and supporting Francis Maude's Cabinet Office in using open source to improve government systems.
- 2009
- GDS / Cabinet Office / OFE input into Open Standards policy
- 2005
- OpusVL open-source awareness campaign targeting MPs and politicians.
By 2019 the pieces were in place: a lead partner with twenty years of open source delivery, a governance foundation born inside the NHS, two trusts with real deteriorating-patient need, a university with a simulated ward, and a funder willing to back the open approach at scale. DITO was the project that put them together - and the outputs that outlast it are the result.