Progress in transforming digital services in the NHS has been slower than expected, according to the National Audit Office (NAO).

It deemed recent investment in digital transformation "inadequate", adding that it is uncertain whether current funding will be sufficient to meet the government’s ambitions.
The NAO did point out that the report was prepared before the Coronavirus pandemic, so recognised that the Department of Health and Social Care and the NHS have unprecedented operational priorities to deal with.

It also accepted that improving digital services in the NHS and implementing new ways of working is a huge challenge, noting that the previous attempt to do this - between 2002 and 2011 - was both expensive and largely unsuccessful.

The Digital Transformation Portfolio was launched to deliver the NHS’s 2014 digital strategy. This strategy and the portfolio are now being updated and a new unit, NHSX, has been set up to lead digital transformation in the NHS.

Changing digital transformation strategies for the NHS have made achieving current objectives more challenging. NHS services rely on a vast array of systems, many of which are now legacy IT. National strategies have moved between centrally-managed and ‘hands-off’ approaches, which has increased the number of legacy systems.

"There has not been enough investment in digital transformation to meet the government’s ambitions," stated the report, adding that the government committed £4.7 billion to deliver the portfolio from 2016-17 to 2020-21.

Current digital transformation plans are based on very limited cost data, and it is uncertain that planned funding will be sufficient, wrote the NAO. NHS England & NHS Improvement (NHSE&I) estimates that up to £8.1 billion will be needed between 2019-20 and 2023-24.

"Arrangements for managing digital transformation at a national level remain confused, despite attempts to clarify them, and national oversight of local bodies is still being developed," stated the report. NHSX was established in July 2019 to lead digital transformation, but governance arrangements have still not been finalised and NHSX does not have a statutory basis.

Digital transformation is essential to the NHS’s Long-Term Plan to improve services and roll out digitally-enabled care, but there is no plan setting out how this will be achieved in clear detail, noted the NAO.

NHSX has stated that it intends to publish a comprehensive technology plan for health and care in the autumn.

The NAO said that NHS trusts’ digital maturity has improved, although significant challenges remain. In 2017, 83 per cent of trusts assessed their ability to plan and use digital services as high, compared with 65 per cent in 2016. However, only 54 per cent of trusts reported that staff can rely on digital records for information they need when they need it.

There are several technical challenges for NHSX to resolve, particularly in terms of enabling digital information to be shared seamlessly across the NHS so that users understand it in the same way.

There has been some progress towards ‘interoperability’ of data, but NHSX does not have a timeframe for achieving it and plans are under-developed. "There could also be a tension between achieving interoperability and the aim to increase the number of technology suppliers to the NHS," wrote the NAO.

It continued that the NHS must work to resolve governance and accountability issues, along with major technical challenges that have hampered progress in improving digital services. It recommended that national governance arrangements should be simplified and strengthened, and digital maturity assessments of local organisations should be used to gather important information.

Gareth Davies, head of the NAO, commented: "The track record for digital transformation in the NHS has been poor, with key targets such as a ‘paperless’ NHS by 2018 not being achieved - local NHS organisations in particular face significant challenges, including outdated IT systems and competing demands on their resources.

"The delivery of healthcare will continue to change, and it needs to be supported by modern, integrated and up-to-date information systems," he added.

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