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NHS digital transformation ‘slow’ and ‘inadequate’, watchdog says

by Awil Mohamoud
15 May 2020

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Progress in the NHS’ digital transformation has been ‘slower than expected’, following years of ‘inadequate’ investment and disjointed strategies, a report by the National Audit Office (NAO) has found. 

These shortcomings have left NHS health and care services to rely on some ‘outdated and ‘inefficient’ IT systems, the watchdog said. 

The report, prepared prior to the coronavirus pandemic, concluded that the £4.7bn Government investment to deliver the transformation between 2016-17 and 2020-21 was ‘not enough’ to ensure overall success. 

NAO head Gareth Davies labelled the NHS’ ‘track record’ on this as ‘poor’, having missed key targets such as creating a ‘paperless NHS’ by 2018. This target has now been redefined to reach a ‘core level of digitisation’ by 2024. 

It is estimated that £8.1bn will be needed between 2019-20 and 2023-24, but the NAO said that it is unclear whether this will be sufficient, or even whether it will be made available. 

The NHS Long-Term Plan features the ambition to roll out digitally enabled care across the NHS to transform services. This includes more online appointment booking, remote consultations, electronic prescriptions and integrated IT systems across NHS organisations for data sharing.

The report also found that continually changing strategies, which have moved between ‘centrally-managed’ and ‘hands-off’ approaches, have left the NHS with a ‘vast array’ of IT systems, many of which are ‘aged’. 

The strategy of introducing a larger pool of IT suppliers into the NHS to ‘increase competition and innovation’ has made it difficult to achieve an integrated system for sharing data, it added. The report pointed to a new NHS Digital plan to introduce 69 suppliers, including seven providers of core GP IT systems, as creating further complexities and reducing cohesion.

GP practices 

Looking at interoperability, the report considered a digital maturity self assessment for GP practices, carried out by NHSE&I. The 2019-20 data showed that most GP practices lacked some key IT infrastructure needed for digital working.

The NHSE&I findings showed that while practices had ‘mature’ systems in place for sharing electronic patient records with other healthcare providers in their area, only 23% could share their systems with social care providers and just 17% could access theirs. 

It also found that 56% of practices were not able to access their clinical systems from patients’ homes using mobile technology and only 13% had completely digitised their legacy paper records.

Last month, an RCGP survey found that half of the GP workforce has been unable to work from home during the coronavirus pandemic due to a lack of VPN software.

Speaking to Management in Practice, one GP recently labelled NHS IT ‘catastrophically terrible’, citing that staff have been using ‘very old equipment’ and software as dated as Windows XP up until last year.

Last two months

Responding to the NAO’s report, NHS Confederation director, Dr Layla McCay, said: ‘This report was written before the pandemic, but is a useful reminder that we have a confused national picture and that we have simply not invested enough into the health and care sector’s digital infrastructure.

‘The last two months has seen a digital revolution in the NHS which has brought in widespread virtual consultations, more electronic prescriptions and sharing records like never before.

‘The universal cry from hospitals, community and mental health services and GP practices is that we must not return to where we were before COVID-19. Instead we must reset the way we think about health and care in the UK, including embracing this digital transformation, and move to where we want to be to improve services for patients.’