NAO Report: Digital transformation in the NHS

The UK's National Audit Office have just released their report on digital transformation in the NHS. As many hospitals and GP practices across the NHS use new technology to transition to remote consultations and electronic services, this report outlines some of the key challanges:

The NHS’s health and care services are dependent on people, processes and information technology (IT) systems, and some of these IT systems are outdated and inefficient. The Department of Health & Social Care (the Department) and NHS England & NHS Improvement (NHSE&I) believe that it is essential to implement new ways of working and that improved digital services are central to this. In other words, the NHS will need to undergo a digital transformation. However, the previous attempt to achieve this, between 2002 and 2011, was both expensive and largely unsuccessful. Since then the Department, NHSE&I and NHS Digital (the arm’s-length body that seeks to use information and technology to improve health and care) initiated the Digital Transformation Portfolio (the Portfolio) to deliver their 2014 digital strategy.

The Department and NHSE&I are now updating their strategy and the Portfolio, and in July 2019, they set up a new unit, NHSX, to lead digital transformation in the NHS. NHSX intends to use a different approach to digital transformation to that attempted in 2002, though the objectives are similar. In particular it will allow over 220 NHS trusts and foundation trusts (trusts) more autonomy to develop their overall approach to digital transformation and the IT systems they implement so long as they comply with national standards which are currently being specified.

Digital transformation in the NHS, Report by the Comptroller and Auditor General

The report's key findings are:

Digital services in the NHS:

  • Digital transformation of the NHS is a huge challenge.
  • The NHS has not made the expected progress since 2014, including against a headline target to achieve a ‘paperless’ NHS. 
  • Recent investment in digital transformation has not been sufficient to deliver the national ambitions. 
  • Current plans are based on very limited cost data and it is uncertain that planned funding will be sufficient.
  • The Global Digital Exemplar (GDE) programme is helping a small number of trusts.
  • Trusts’ digital maturity has improved, although significant challenges remain. 

Strategic challenges:

  • Changing national strategies have contributed to a fragmented environment, which makes achieving current ambitions more challenging.
  • Digital transformation is essential to the NHS’s Long-Term Plan to improve services and will need a high-quality implementation plan. 

Uncertainty over accountability and local costs

  • National governance arrangements for digital transformation remain confused, despite attempts to clarify them. 
  • Arrangements for national oversight of digital transformation at a local level are not in place. 
  • NHSX is unclear about the whole-life costs and benefits of the different approaches to digital transformation at a local level. 

Interoperability of IT systems and data

  • Achieving interoperability of data and IT systems is a longstanding aim and essential to current plans for digital transformation, but it will be very challenging to fully achieve. 
  • NHSX does not have a timeframe for achieving interoperability and its plans are under-developed, which risks making interoperability harder to achieve in the future. 
  • There could be a tension between the ambitions to achieve
    interoperability and the aim to increase the number of technology suppliers to the NHS.

Developing workforce skills and public trust

  • Specialist skills are in short supply and national bodies have not finalised plans to improve the workforce’s digital skills. 
  • Maintaining public trust about the use of data is essential to achieving national ambitions. 

Applying the lessons from the previous national programme

  • The previous attempt at digital transformation in health was expensive and largely unsuccessful, but we are not convinced that all the lessons are being applied now.

The recommendations from the report are that the Department of Health should:

  • Maintain a comprehensive set of lessons for digital transformation from NHS and wider government experience.
  • Ensure that the expected technology plan for health and care includes
    an implementation plan with specific objectives and measurable actions that are required. 
  • Collect more data to enable a better understanding of the full cost of delivering digital transformation and prioritise the work programme.
  • Alongside the implementation plan, develop specific resources and plans for high-risk issues.
  • Simplify and strengthen national governance arrangements.
  • Use digital maturity assessments of local organisations to gather additional information. 

Read the full report:


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