£8bn digitisation strategy for UK's health service doesn't count as a strategy, says spending watchdog

'It does not set out how the NHS will deliver its ambitions in practice'. As for that paperless NHS? Strategy watered down and deadline dates moved

Two years after it began, the NHS digitisation strategy still has no implementation plan and risks repeating the UK health services' legendary IT failures, according to a report by MPs.

The House of Commons' Public Accounts Committee (PAC) said the NHS should urgently publish a detailed plan describing how it aims to meet its ambitions for transforming digital services.

"Without a proper implementation plan, the Department and NHSX cannot be sure that the £8.1 billion of taxpayers' money being invested in the digital transformation programme will deliver value for money," said the PAC in a report titled "Digital transformation in the NHS" [PDF].

The report criticised the Department of Health and Social Care's (DHSC) 2018 "Vision for digital, data and technology strategy" for lacking a time frame or plan for achieving interoperability, which NHSX, the National Health Service's tech body, has acknowledged is an "extremely complex" process that could take "years".

"[It] is not an implementation plan as it does not set out how the NHS will deliver its ambitions in practice," the PAC said.

The Department of Health's "blended" approach to planning, involving national and local NHS systems and organisations, has "not demonstrated that national and local initiatives will be sufficient to meet the overall ambition," the report said.

"Furthermore, the national organisations have not yet put in place the planned levers and incentives to encourage trusts and other parts of the NHS to take the appropriate action on the ground. This will make it harder to ensure that local organisations are carrying out transformation in a way that is consistent with the national strategy and will benefit patients and staff."

The lessons from history spell out the risks in computer-based NHS transformation programmes.

Dating back to 2002, the National Programme for IT was stopped early in 2011 and "did not deliver key benefits, despite the Department spending an estimated £9.8bn on the Programme," according to a 2013 report from the National Audit Office (NAO).

Unless the DHSC and NHS organisations get a grip on their current IT programmes, there is a risk history will repeat itself, MPs said.

"We are far from convinced that the Department and NHS bodies have learned the lessons from previous IT programmes. Without this, they risk repeating the mistakes that led to those programmes failing to deliver," the PAC said in response to an earlier report from the NAO.

"The Department's previous attempt to reform how the NHS uses IT, running between 2002 and 2011, was both expensive and largely unsuccessful. We are therefore alarmed at how little progress has been made against current ambitions. The NHS missed its main target for a 'paperless' NHS by 2018, and this has now been watered down into a new target to reach a 'core level' of digitisation by 2024."

Yet it is still unclear which of the myriad NHS bodies and agencies is actually leading the digital transformation.

NHS England & NHS Improvement was responsible for NHS IT strategy and approves tech projects where capital cost exceeds £15m. Meanwhile, NHS Digital is the main national body responsible for delivering this strategy. But in 2019, the Department of Health launched NHSX to "lead digital transformation in the NHS."

"The Department, NHSX, NHS Digital and other stakeholders recognise that there is a lack of clarity over the roles of NHSX and NHS Digital and the overlaps in their work," the PAC said. "The new Chair of NHS Digital is due to review the approach that has been taken to digital transformation, including the operating models being used across NHS Digital, NHSX and NHSE&I. However, we are concerned that governance arrangements for NHSX have still not been finalised over a year after it was set up."

The committee points out that NHSX is not a statutory body and therefore does not prepare financial statements for audit, which means there is little transparency over its spending and activity.

It said that by spring 2021 the DHSC should start "clearly setting out the responsibilities for digital transformation of each national organisation and communicate its plan digital transformation in the NHS to local organisations." The PAC also said NHSX should publish an annual report, detailing its spending controls.

The DHSC has yet to respond to The Register's request for comment. ®