In a report published today, Friday 6 November 2020, the Public Accounts Committee says the Department for 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.
A 'paperless NHS'
It is six years since the Department’s 2014 digital strategy with the 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.
This follows the Department’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 PAC 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 Department and its contractors.
The Committee says DHSC and NHS bodies now 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.
Vision for digital, data and technology
Having failed to meet its paperless target in 2018 DHSC published its “Vision for digital, data and technology” - but two years later it still doesn’t have an implementation plan for how this will be delivered. Current governance and accountability arrangements are both overly complex and insufficiently defined. Local trusts are at varying levels of digital maturity and some are struggling financially.
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.
The Department and NHS bodies also now face major challenges dealing with the current COVID-19 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.
NHSX was responsible for the initial development of a new NHS COVID-19 app, before responsibility transferred to the newly-established NHS Test and Trace. Initially due to be launched in May 2020, it eventually launched on 25 September, four months late. NHSX estimated that the cost of developing the app and supporting it will be £36 million. It estimated the cost of the first stage of developing the app at some £10.8 million: of that, some £4 million was spent on developing the version of the app that it moved away from, £6 million was on development that was necessary for both versions and £0.8 million was on Google and Apple technology that is now being used. It estimated that a further £25 million would be needed for the second app in 2020-21. But NHSX was not able to say what impact it would have on the successful tracing of people.
Chair's comments
Meg Hillier MP, 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.”