NHS digital transformation slower than expected

A new report by the National Audit Office has found that recent investment in digital transformation within the NHS has been inadequate.

Improving digital services in the NHS and implementing new ways of working is a huge challenge, and the previous attempt to do this, between 2002 and 2011, was both expensive and largely unsuccessful. Furthermore, changing digital transformation strategies for the NHS and what is deemed ‘legacy IT’ have made achieving current objectives more challenging.

The government’s spending watchdog claims that there has not been enough investment in digital transformation to meet the government's ambitions, citing how, at a local level, NHS trusts’ and Foundation Trusts’ expenditure on IT varies widely and collectively less than two per cent of their expenditure is on technology, compared with a recommended five per cent.

Current digital transformation plans are based on very limited cost data, and it is uncertain that planned funding will be sufficient. NHSE&I estimates that up to £8.1 billion will be needed between 2019-20 and 2023-24: £5.1 billion from national bodies (2019-20 to 2023-24) and £3 billion from trusts (2019-20 to 2029-30, with the majority in the first five years). However, its plans are based on very limited data, it is uncertain that planned funding will be sufficient, and there is a significant risk that trusts will be unwilling or unable to fund the £3 billion.

The report also found that arrangements for managing digital transformation at a national level remain confused, despite attempts to clarify them, and national oversight of local bodies is still being developed. The Department of Health and Social Care set up NHSX in July 2019 to lead digital transformation, but governance arrangements have still not been finalised and NHSX does not have a statutory basis. NHSX intends to publish a comprehensive technology plan for health and care in autumn 2020.

In terms of digital maturity, the NAO found that in 2017, 83 per cent of trusts assessed their ability to plan and use digital services as high, compared with 65 per cent in 2016. However, digital capability (the use of technology to deliver care) remains a major challenge. Only 54 per cent of trusts reported that staff can rely on digital records for information they need when they need it.

Gareth Davies, the head of the NAO, said: “The track record for digital transformation in the NHS has been poor, with key targets such as a ‘paperless’ NHS by 2018 not being achieved. Local NHS organisations in particular face significant challenges, including outdated IT systems and competing demands on their resources.
 
“The delivery of healthcare will continue to change, and it needs to be supported by modern, integrated and up-to-date information systems. To meet this challenge, the Department and its arm’s-length bodies need to develop a better understanding of the investment required, set a clear direction for local organisations, and manage the risks ahead. If they don’t, they are unlikely to meet their ambitions for digital transformation and achieve value for taxpayers.”