DHSC must still learn the lessons of its failed IT programmes

The Department of Health and Social Care (DHSC) and the NHS have a “long way to go” to deal with and move on from the legacy of their track record of failed IT programmes, a key government committee has said.  

The House of Commons Public Accounts Committee (PAC) says it is “far from convinced” the DHSC and NHS organisations have learnt from the mistakes dating back to the National Programme for IT but also much more recent.

“The Department and NHS bodies still have a long way to go to deal with the proliferation of legacy IT systems across the health and care system and move on from their track record of failed IT programmes,” the report summary adds.

There is also a reference to the Covid-19 pandemic, with the PAC says DHSC and NHS organisations “face major challenges” in dealing with the virus.

The report adds: “We commend the work of staff across these organisations.

“This [the pandemic] has also shown the potential for organisations to deploy digital solutions and adapt to new technologies.”

Real costs of the NHS Covid-19 app

Costs of the NHS Covid-19 app were also examined by the committee with hints there could be a second app in development.

“NHSX estimated that the cost of developing the app and supporting it will be £36 million,” the report says.

“It estimated the cost of the first stage of developing the app at some £10.8 million: of that, some £4 million was spent on developing the version of the app that it moved away from, £6 million was on development that was necessary for both versions and £0.8 million was on Google and Apple technology that is now being used.

“It estimated that a further £25 million would be needed for the second app in 2020-21. But NHSX was not able to say what impact it would have on the successful tracing of people.”

Recommendations for NHSX

NHSX, the body responsible for technology innovation across the NHS, is also mentioned in a number of recommendations.

Most notably there is a recommendation of the publication of an “annual report of NHSX’s activity and the spending it controls and/or directs”. Furthermore, the tech unit is asked to publish an implementation plan for meeting its ambitions for transforming digital services with PAC saying it is a “matter of urgency”.

The PAC also says that in order for digital transformation to be delivered across the NHS, “IT systems must be interoperable”, with NHSX asked to “urgently bring forward the remaining standards in order to provide clarity for trusts and suppliers”. This includes “guidance on the potential use of the cloud to enable digital image sharing”.

Trashing the targets?

Another conclusion is that the government and the NHS has made “insufficient progress against national ambitions” with a recommendation stating that DHSC should “set realistic targets” for digital transformation as well as “sustaining the gains made during the Covid-19 pandemic”.

The recommendation adds that this should be published by March 2021.

“This should include a mix of longer-term and intermediate targets for tracking progress for both nationally-led programmes and those delivered at local health and care system level,” it adds.

Not repeating the same failures

Meg Hillier MP, chair of the Public Accounts Committee, said: “After 18 years of failed attempts to digitally transform the NHS you would hope that the one success that could be claimed was the learning and change to ensure those failures are not repeated. Incredibly, still, none of the components essential to successful delivery of the digital ambition for the NHS are in place, and instead the Government presses on with expensive and unproven strategies and contracts that cost the taxpayer millions but don’t deliver.

“The response to the pandemic demonstrates it is possible to reset and adopt new digital solutions and technologies. But there needs to be a clear strategy that works with local trusts and acknowledges the financial pressures they are under.”

The PAC report follows one carried out by the National Audit Office in May 2020, which said local NHS organisations are facing “significant challenges” when it comes to working towards digital transformation. The NAO report also set out a number of recommendations which included using digital maturity assessments of local organisations to gather additional information.