Investment in NHS digital transformation inadequate, says National Audit Office

Recent investment in the digital transformation of the NHS has been “inadequate”, according to a report from the National Audit Office (NAO).

Digital transformation involves updating existing IT and other digital services to improve how staff within the NHS are able to work as well as make such systems more secure.

The public spending watchdog’s report, which was prepared before the outbreak of the coronavirus pandemic, said a “better understanding” of the required investment in the NHS was needed to help improve its digital infrastructure.

The report says the NHS has acknowledged that the Government’s current committed £4.7 billion investment between 2016 and 2021 as part of its Digital Transformation Portfolio is not enough to achieve its goals.

It says NHS England and NHS Improvement have estimated that up to £8.1 billion will be needed between 2019-20 and 2023-24 to reach those goals, which also includes £3 billion invested by trusts between 2019-20 and 2028-29.

But the report indicates that these estimates are based on limited data and it is uncertain if even that level of funding would be sufficient, and there is a risk trusts would be unwilling or unable to fund the £3 billion needed from them.

The report acknowledged that improving digital services across the NHS was a complex issue, but more needed to be done.

The NAO report also indicated that spending on IT and technology at NHS and foundation trusts was collectively around 2% of expenditure, compared with a recommended 5%.

“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,” Gareth Davies, head of the NAO, said.

“Local NHS organisations in particular face significant challenges, including outdated IT systems and competing demands on their resources.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 (of Health and Social Care) 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.”

In 2019, NHSX was launched to lead digital transformation and innovation projects in the health service.

However, the report says governance arrangements around the body have still not been finalised, although NHSX is expected to publish a comprehensive technology plan later this year.

MP Meg Hillier, chairwoman of the Public Accounts Committee, warned that the health service’s continued reliance on older IT systems also made it vulnerable to a cyber-attack similar to the WannaCry incident in 2017, which led to widespread disruption across the NHS.

“The Department of Health and Social Care knows what a digital revolution could mean for NHS patients. However, it hasn’t drawn up the detailed plans needed to make one happen,” she said.

“NHS systems were originally supposed to be sharing data seamlessly by 2005.

“Fifteen years later, the NHS hasn’t even established a complete set of standards for trusts and the IT industry to follow.

“The NAO report shows that not enough has been learnt from previous failed IT strategies. Meanwhile, continuing dependence on obsolete systems leaves the NHS open to another WannaCry-style cyber-attack.”