The NHS and Department for Health and Social Care (DHSC) have still not learned lessons from previous IT programmes and risk repeating old mistakes, according to members of Parliament.
A Public Accounts Committee (PAC) report on digital transformation in the NHS said that although it’s been six years since the government announced its plans to deliver a “paperless NHS”, a target originally set for 2018, the NHS is a long way from realising its goals.
“We are far from convinced that the department and NHS bodies have learned the lessons from previous IT programmes. Without this, they risk repeating the mistakes that led to those programmes failing to deliver and taxpayers’ money being wasted,” the report said.
“Successful delivery of the digital ambition for the NHS will require effective governance, realistic and detailed plans, sufficient investment nationally and locally, and clear accountability. It is six years since its 2014 digital strategy with the headline target to achieve a ‘paperless NHS’, and none of these vital components to make digitally enabled care mainstream across the NHS are in place.”
In 2018, health secretary Matt Hancock launched his technology vision for the NHS, which included several proposals on how the NHS will become the “most advanced health and care system in the world” through modern technology architecture, a focus on user needs, privacy and security, interoperability and inclusion.
In 2019, Hancock launched NHSX, an organisation responsible for policy, implementation and change in digital, data and technology across the health service in England.
However, the PAC report said that the DHSC still has no implementation plan for how this will be delivered, and that governance and accountability arrangements “are both overly complex and insufficiently funded”.
“NHSX told us that it had intended to produce a digital strategy during the first eight months of this year. It put out for consultation the vision part of its digital strategy in February 2020, which was to be followed by six months of consultation and ‘co-creation’ between the national bodies and frontline,” said the report.
“The department explained that the development of the strategy had been delayed as a result of the extra demands that had been placed on organisations as a result of Covid-19, but it was still its intention to undertake this consultation.”
The PAC said NHSX should “as a matter of urgency” publish an implementation plan for meeting its ambitions, which should set out actions to transform digital services and identity and prioritise areas where digitisation of services “will add the greatest value to patients and clinicians”.
Poor track record and interoperability issues
The NHS has a chequered track record of IT transformation programmes, including the disastrous £12bn National Programme for IT in the NHS, and the PAC said that, due to the history, it is “therefore alarmed at how little progress has been made against current ambitions”.
“The NHS missed its main target for a ‘paperless’ NHS by 2018, and this has now been watered down into a new target to reach a ’core level’ of digitisation by 2024,” it said.
PAC chair Meg Hillier said: “After 18 years of failed attempts to digitally transform the NHS, you would hope that the one success that could be claimed was the learning and change to ensure those failures are not repeated.
“Incredibly, none of the components essential to successful delivery of the digital ambition for the NHS are in place, and instead the government presses on with expensive and unproven strategies and contracts that cost the taxpayer millions but don’t deliver.
“The response to the pandemic demonstrates it is possible to reset and adopt new digital solutions and technologies. But there needs to be a clear strategy that works with local trusts and acknowledges the financial pressures they are under,” she said.
The PAC report said that NHSX is aware there is a long way to go to achieve the new target.
“Despite being recognised as essential to managing patient care, there has also been a lack of progress on interoperability (seamless sharing of data),” the report added.
“Only three out of the 10 standards for interoperability so far identified by NHS Digital were ready by May 2020, and the national bodies are unable to tell us how many are now ready.”
The MPs called on NHSX to urgently “bring forward the remaining standards to provide clarity for trusts and suppliers”, as well as for DHSC to set realistic targets for transforming digital services and sustain the “gains made during the Covid-19 pandemic”, which led to an increase in the use of digital services.
NHSX governance clarity
There is also a lack of clarity over the roles of NHSX and NHS Digital, as they often overlap, leading to confusion. Despite being set up in February 2019, NHSX still has no finalised governance arrangements, and because it is not a statutory body, and does not have to prepare financial statements for audit, there is little transparency over its spending.
“[NHSX] has spent an estimated £11m on the first phase of the delayed contact-tracing app, and expects to spend another £25m on the second stage. Given the taxpayers’ money involved, transparency is important to allow Parliament and the public to hold it to account,” the report said.
NHSX’s funding comes from the budgets of DHSC and NHS England and NHS Improvement, but the department told PAC that it “accepted that the budgetary arrangements for digital transformation were not straightforward and this was an area it should keep under review”.
“It said that it would be worthwhile to get ‘the money tidied up’ so that there was greater accountability over how NHSX prioritised its spending,” the report said, as it called for the DHSC to publish an annual report of NHSX’s activity and spending.