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. That decade produced an argument, the argument produced a paper, and the paper produced the project.
A decade of groundwork
The story starts well before the NHS. From 2005 OpusVL was campaigning to put open source in front of MPs and policymakers, and by 2010 Stuart Mackintosh was co-secretary, with Basil Cousins, of the OpenForum Europe Public Sector Group - working on the open standards policies and supporting Francis Maude's Cabinet Office in using open source to improve government systems. By 2011, open standards had entered the public-sector cost conversation.
The health strand followed. Support for the NHS Code4Health platform came in 2015, and in 2016 the 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. The same year, European organisations were joining forces to promote open source in healthcare. The experience was accumulating; what it lacked was a written case.
The argument and the paper
That case was forced into existence by an argument. In a debate with NHS Digital, Stuart presented the position 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 An Open Digital Approach for the NHS, published in autumn 2018.
It was not a think piece: the paper was grounded in the implementation experience and public-sector consultancy of the preceding decade - SLaM, Code4Health and the policy work all fed it. Following the research behind it, it 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.
From paper to project
The natural next step was an implementation manual showing how to put the paper's 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. Within weeks of the paper, the application went to Innovate UK's Digital health technology catalyst.
One partnership made the project's governance credible from day one: 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. The human connection came through David Jobling: part of the NHS open-source programme and a key driver of the Apperta story, David met with Stuart as the project took shape, and has been a significant partner throughout the journey - today supporting the Digital Health Commons Forum. That lineage mattered: the project started with a custodian that understood both the NHS and open source, and it provided the custodianship model that DITO would prove in practice.
In 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.
The timeline
- 2019
- Innovate UK grant awarded; DITO begins.
- 2018
- An Open Digital Approach for the NHS published; Innovate UK application submitted.
- 2016
- SLaM Open-eObs pilot engagement; European open-source healthcare coalition forms.
- 2015
- Support for the NHS Code4Health platform.
- 2011
- Open standards enter the public-sector cost conversation.
- 2010
- Co-secretaryship of the OpenForum Europe Public Sector Group; Cabinet Office open standards work.
- 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.