NHS not in position to reverse failed IT programmes

The Public Accounts Committee has claimed that the Department of Health & Social Care (DHSC) and the NHS have a long way to go to deal with, and move on from, the legacy of their track record of failed IT programmes over almost two decades.

It is six years since the digital strategy which was revealed under a headline target to achieve a ‘paperless NHS’ by 2018: it still has not achieved this target, which has now been watered-down and moved back by six years. Additionally, the department’s vision for digital, data and technology still doesn’t have an implementation plan for how this will be delivered, with the committee reporting that current governance and accountability arrangements are ‘both overly complex and insufficiently defined’.

That announcement followed DHSC’s ‘expensive and largely unsuccessful’ previous attempt, between 2002 and 2011, at introducing modern, integrated IT systems with patient records available electronically throughout England. In 2013, the Public Accounts Committee reported on the ‘extremely disappointing’ level of benefits from that National Programme, and how the public purse was continuing to pay the uncertain, escalating price for failures by the government and its contractors.

The committee now says that DHSC and NHS bodies risk repeating the mistakes that led to those failures and wasting massive sums of taxpayers’ money. It concludes that in 2020, ‘none’ of the components essential to successful delivery of the digital ambition for the NHS - effective governance, realistic and detailed plans, sufficient investment nationally and locally, and clear accountability - are in place.

According to NHSE&I, the NHS will need around £8.1 billion to deliver its digital transformation ambitions, including £5.1 billion from national bodies and £3 billion from trusts. But it is unclear where struggling trusts, some of whom have been dipping into their capital budgets to maintain current service provision, as the Committee reported in July of this year, will find their contribution.

Health bodies also now face major challenges dealing with the current coronavirus pandemic, but the commendable work of staff across the services has shown the potential for organisations to deploy digital solutions and adapt to new technologies. The DHSC and NHS bodies must make best use of this learning in their digital programmes, says the committee.

Meg Hillier, chair of the Public Accounts Committee, 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, still, 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.”

Danny Mortimer, chief executive of the NHS Confederation, said: “Health leaders tell us that the response to the Covid-19 pandemic has seen a digital revolution with the creation of shared care records, a wholescale shift of GP appointments to telephone and online, and the rapid adoption of video-based outpatient and follow-up appointments, alongside continuing to provide face-to-face services where needed.

“Patients and frontline healthcare workers have responded well to these new ways of accessing healthcare but our members need support to take them further, particularly around infrastructure improvements and up to date equipment. In our recent survey, almost three-quarters of NHS leaders said they did not have enough capital funding to upgrade their infrastructure, including IT.

“Health leaders shouldn’t be expected to raid their limited capital budgets to support these developments and we need to see a commitment to greater financial support from the Chancellor’s one-year spending plan with a commitment to a proper longer-term plan for capital investment in all parts of the NHS, not just the repeatedly announced 40 hospitals.”