Digital transformation in England’s NHS has moved more slowly than expected due largely to insufficient funding, according to a new report from the National Audit Office (NAO).
It also warns that it is not clear whether the planned funding will be sufficient to get the transformation back on track.
The report, Digital transformation in the NHS, was prepared before the coronavirus outbreak. While the NAO has refrained from commenting on the implications of the pandemic, it will raise speculation that the resultant demands on the health service will make the situation even more difficult.
It says that digital maturity among healthcare trusts has generally improved, with 83% assessing their ability to plan and use digital services as high in 2017, compared with 65% the previous year. But only 54% reported that staff can rely on digital records for information when they need it.
Most of the assessments carried out by NHS England and NHS Improvement (NHSE&I) placed the trusts ‘high’ for readiness and infrastructure, but capability was less mature, with a fifth scoring ‘low’.
In addition, a digital maturity assessment for GP practices showed a mixed picture, with most reporting they did not have some key elements in place. Only 44% were able to access their clinical systems from patients’ homes and just 14% had completely digitised their patient records.
It says there has not been enough investment since the NHS launched the Digital Transformation Portfolio in 2104, with he Government having committed £4.7 billion for 2016-21, and many NHS trusts spending less than the 5% of their total expenditure recommended to support the effort.
The financial outlook in current digital transformation plans is unclear. NHSE&I have estimated that up to £8.1 billion will be needed up to March 2024, with £5.1 billion from national bodies and £3 billion from trusts. But this is based on limited data and the NAO says there is a significant risk that trusts will be unwilling or unable to come up with the money.
In addition, arrangements for managing digital transformation at a national level remain confused, despite the creation of NHSX in the Department for Health and Social Care (DHSC) last year. The organisation does not have a statutory standing, governance arrangements have not been finalised, and plans for rolling out digitally enabled care are short on detail.
The report acknowledges that NHSX intends to publish a comprehensive technology plan during the autumn, but it also points to technical challenges such as improving interoperability, making it easier to share digital information across the health service, and resolving these aims with the increasing number of suppliers.
Even though there are efforts to develop interoperability standards, more suppliers will require more integration of systems, the NAO says.
It sets out a number of recommendations, including that the DHSC and its arm’s length bodies to resolve these challenges and the governance issues that hampered progress, and that they should collect more data to gain a better understanding of the funding required to meet the ambitions.
Others are that the department should:
- maintain a set of lessons for digital transformation;
- include an implementation plan with measurable actions as part of the technology plan;
- develop resources and plans for high risk issues, such as on national requirements for clinical records, data quality and privacy, and to provide bespoke support for trusts;
- continue the use of digital maturity assessments by trusts.
Head of the NAO Gareth Davies (pictured) 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.”
Image from NAO