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Report into failings of Welsh NHS digital systems is ‘wake-up call’

Unclear accountability, widespread dissatisfaction, outdated systems – and unjustified optimism in NWIS

Louise Prime

Thursday, 08 November 2018

An official inquiry by Welsh Assembly members has raised serious question marks about the competence, capability and capacity of Informatics Systems in NHS Wales (NWIS) to deliver digital transformation – with major systems outages on average every nine days in the first six months of 2018 – and has found, despite this “clear failure to deliver”, a culture of self-censorship and denial among NWIS and its partners in the health boards and the Welsh Government. The “extraordinarily disruptive” data outages should “kickstart a process that improves digital technology in the Welsh NHS”, the Royal College of GPs in Wales has demanded this morning.

The Public Accounts Committee of the National Assembly for Wales said its hearings into NWIS had uncovered a raft of problems. In its report,* published today, it said many of the digital projects are behind schedule, while others appear to be on schedule only because their schedules were revised. It found unclear lines of accountability, widespread dissatisfaction across the NHS at its performance; and it reported that, “in the first six months of this year alone its major systems have gone down 21 times”.

The committee reported that NWIS is primarily focused on running outdated IT systems. Committee chair Nick Ramsay, Welsh Conservative AM for Monmouth, commented in his foreword: “At a time when the potential of digital healthcare is capturing the imagination and improving patient outcomes, just 10% of NWIS activities are focused on innovation.” Yet, he noted, “the Chief Executive responsible for hosting NWIS described its ambitions as world leading”.

Other of the committee’s findings included:

  • Digital transformation requires an open culture, but the culture at NWIS was the antithesis of this. We are particularly concerned at the apparent lack of openness and transparency across the whole system.
  • Witnesses were reluctant to be critical of progress or arrangements on the record. Some written evidence from two parts of the NHS was remarkably similar and the Committee was left with the impression that we were getting a pre-prepared line.
  • Overall, the Committee is deeply concerned about the slow pace of delivery of modern informatics systems across the NHS in Wales and the underlying weaknesses in support and oversight arrangements. … NHS bodies are frustrated with the slow roll-out and problems with systems they have and concerned about confused accountabilities. NWIS is frustrated at the lack of direction from the wider NHS. The greatest frustration is that electronic records lead to better patient care and outcomes but in too many cases, the NHS relies on outdated, paper-based records.

Nick Ramsay pointed out that despite its clear failing to deliver, the auditor general found NWIS to be ‘overly positive’ in its progress reporting. He concluded: “Despite the Welsh Government and NWIS accepting all of the auditor general’s recommendations, we found little reason to be optimistic that things were changing. … this report will be a wake-up call to all those involved in harnessing the power of digital innovation to improve healthcare in Wales.”

RCGP Wales warned that data outages cause huge difficulties for practices and patients, and said the report’s publication should “kickstart a process that improves digital technology in the Welsh NHS, supporting and enabling practices to offer improved services for patients”.

Its joint chair Dr Peter Saul said: “Today, IT systems are as critical to clinicians as stethoscopes and scanners. Data outages can be extraordinarily disruptive for practices and for patients. They affect appointments, prescriptions and the nuts and bolts of a functioning practice and can take hours to recover from. Unfortunately, these data outages are becoming all too common, leaving GPs scrambling to find solutions or workarounds while waiting rooms fill up.

“Embracing safe, reliable and innovative technology will be vital for the future of healthcare, but that will be undermined if the Welsh NHS cannot get its IT right.”

* National Assembly for Wales Public Accounts Committee. Informatics Systems in NHS Wales. November 2018

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