The digital transformation efforts by the NHS prior to the outbreak of the coronavirus have been heavily criticised in a report published today by the National Audit Office (NAO), the independent Parliamentary body responsible for auditing government departments.
The report, which was prepared prior to the coronavirus outbreak, levies a laundry list of criticisms against the NHS’s technology efforts, labelling its digital transformation investment “inadequate” and describing progress as “slower than expected”.
There have also been concerns raised about the amount of outdated IT systems within the NHS, which the NAO notes have increased in number in recent years as a result of a shift from a centrally managed to a “hands-off” approach.
“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,” said Gareth Davies, the head of the NAO.
“Local NHS organisations in particular face significant challenges, including outdated IT systems and competing demands on their resources.”
Poor government funding blamed for weak NHS digital transformation
The report highlighted that inadequate government funding was a key cause of the digital transformation failures within the NHS, with the NAO noting that “there has not been enough investment in digital transformation to meet the government’s ambitions”.
This largely centres around the Digital Transformation Portfolio, which was launched in 2014 to deliver a renewed NHS digital strategy, after previous attempts proved “expensive and largely unsuccessful”.
However, the report notes that the £4.7bn the government committed to support this between 2016 and 2021 was acknowledged by NHS England & NHS Improvement (NHSE&I) to be insufficient. The organisation did hope it would receive further funding to plug the gap, but this does not seem to have emerged.
Now the NHSE&I estimates it will need a total of £8.1bn to cover efforts between 2019-20 and 2023-24, with £3bn coming from NHS trusts. However, not only did the NAO find that these estimates were based on limited data and so may not be accurate, but that the trusts may not be able to cover their share.
Lessons to learn: Publishing amid the coronavirus
The NAO acknowledged that the coronavirus has been an unexpected roadblock in the road to digital transformation facing the NHS, saying that it decided to go ahead and publish the report “because it contains valuable information that will remain relevant and help with digital transformation in the NHS in the longer-term”.
It also notes that there has been some improvement in digital efforts within the NHS, with 83% of trusts scoring their ability to plan and make use of digital services as “high” in 2017 compared to 65% in 2016.
However, there is far more to be done. Only 54% of NHS trusts say their staff can rely on digital records, and sharing such records across the NHS remains limited and inaccessible to patients.
Much of this challenge will be up to NHSX, the unit launched in 2019 to lead digital transformation, although the report also stresses that all those involved should build far greater understanding of how much funding is actually needed to make such goals a reality in the NHS.
“The delivery of healthcare will continue to change, and it needs to be supported by modern, integrated and up-to-date information systems,” said Davies.
“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.”