Public Accounts Committee finds that government and health service have made little progress

Credit: George Hodan/Public domain

A highly critical report from the Public Accounts Committee has found that government and the NHS has made little progress in moving on from “the legacy of [a] track record of failed IT programmes over almost two decades”.

MPs on the committee examined the progress of the digital strategy for the health service set out by the Department of Health and Social Care in 2014 – the cornerstone of which was a pledge to realise the goal of a paperless NHS by 2018.

“It still has not achieved this target, which has now been watered-down and moved back by six years,” PAC said.

The 2014 strategy came several years after the Labour government’s long-term NHS National Programme for IT was mothballed. The scheme, characterised by MPs as “expensive and largely unsuccessful”, set out to introduce a nationwide IT system for patient records. 

The scale of the fallout of NPfIT is such “the public purse was continuing to pay the uncertain, escalating price for failures by the department and its contractors”, according to PAC.

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“DHSC and NHS bodies now risk repeating the mistakes that led to those failures and wasting massive sums of taxpayers’ money,” it added.

MPs picked out four components they believe are needed to successfully deliver NHS digitisation – none of which are yet in place, they said: effective governance; realistic and detailed plans; sufficient investment nationally and locally; and clear accountability.

The committee noted that the response to coronavirus has demonstrated the NHS’s ability to implement new digital platforms and technologies. But it has also increased the scale of the financial challenge.

An investment of £8.1bn is needed to achieve health service digital transformation, MPs estimated, of which £5.1bn will come from national entities and the remaining £3bn from local NHS trusts

“It is unclear where struggling trusts, some of whom have been dipping into their capital budgets to maintain current service provision… will find their contribution,” the committee said.

MPs paid particular attention to the development of the NHS Covid-19 app, which has cost £10.8m to date, according to NHSX, which led the project.

Some £4m of this was spent solely on creating the first, centralised app that was scrapped after testing revealed it worked sporadically on Android devices and hardly at all on iPhones. An additional £6m was invested in development activities that applied to both this app and the version, based on the decentralised system jointly developed by Apple and Google, that launched nationally in late September. Some £800,000 was spent on development processes that related purely to this second version, and £25m will be spent on supporting the use of this app over the coming months.

“But NHSX was not able to say what impact [the app] would have on the successful tracing of people,” MPs said.

‘Realistic targets’
The report made a number of recommendations for DHSC and the NHS, the first of which is that the health department “should set realistic targets for transforming digital services” – including measurable near-term and long-term objectives for both national and local programmes – and publish these by March 2021.

MPs noted that there are a number of different bodies – including NHS Digital, NHSX, and NHS England and Improvement – that are involved in transformation programmes. Given the sums of taxpayer money being spent on programmes such as the contact-tracing app, the committee said that there is a need “to improve clarity and transparency”. 

The department has been asked to write to the committee “by spring 2021 clearly setting out the responsibilities for digital transformation of each national organisation, and communicate this to local organisations”.

PAC has also recommended that NHSX publishes an annual report on its work and how much money it is spending.

The health-service technology body is also urged – “as a matter of urgency” – to publish an implementation plan that clearly sets out work that will done and when, how transformation will be enforced and incentivised, and what it believes are the “areas where the digitisation of services will add the greatest value to patients and clinicians”.

Another urgent priority for NHSX is to finish implementing standards to ensure interoperability of technology systems, so as to “provide clarity for trusts and suppliers”.

This should include “providing trusts with guidance on the potential use of the cloud to enable digital image sharing”.

Meg Hillier, the Labour MP for Hackney South and Shoreditch and the 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.”