Recommendations & Conclusions
13 items
10
Conclusion
Twenty-Second Report - Digital transfor…
Accepted
The Department, NHSX and NHS Digital told us that the COVID-19 outbreak had shown how quickly and efficiently the NHS can introduce new IT services and adapt to new technologies.15 This view was echoed by NHS Providers, which told us in its written evidence that the pandemic had resulted in …
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The Department, NHSX and NHS Digital told us that the COVID-19 outbreak had shown how quickly and efficiently the NHS can introduce new IT services and adapt to new technologies.15 This view was echoed by NHS Providers, which told us in its written evidence that the pandemic had resulted in many trusts accelerating their digital plans, including by increasing remote consultations and improving the way data is captured and used. The Nuffield Trust also told us that there had been a surge in patients’ uptake of remote health services, including using the NHS app, NHS login and e-prescription services.16 NHS Digital told us that the pandemic was showing that the NHS could be more ambitious than it had been in the NHS Long-Term Plan and get more effective at sharing data across the system. It explained that, as a result, it was more confident in the potential for the digitisation of the system than it had ever been previously.17 Governance and accountability arrangements
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Government response AI summary
The government agrees with the committee's conclusion, recognising the importance of a clear digital strategy. It plans to publish a comprehensive digital strategy and implementation plan for the entire health and social care system by Spring 2021, outlining a clear plan to digitise and connect …
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HM Treasury
11
Conclusion
Twenty-Second Report - Digital transfor…
Accepted
Since 2016, management of the portfolio of national programmes to digitally transform the NHS has been overseen by the Department, NHSE&I and NHS Digital. The National Audit Office reported that these governance arrangements were complex. It found that problems included confusion caused by there being multiple stakeholders, funding held in …
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Since 2016, management of the portfolio of national programmes to digitally transform the NHS has been overseen by the Department, NHSE&I and NHS Digital. The National Audit Office reported that these governance arrangements were complex. It found that problems included confusion caused by there being multiple stakeholders, funding held in multiple budgets across organisations, and unclear lines of commissioning, funding, delivery and accountability. The NAO concluded that these issues contributed to slow delivery and transformation within the NHS. It found that previous attempts to improve these arrangements had been unsuccessful for a variety of reasons, for example, because accountability for managing development costs and for achieving programme benefits were shared across different organisations. The Department set up NHSX in July 2019 to lead digital transformation across the NHS to resolve conflicting priorities and confusions 13 Q48; C&AG’s report para 14 14 Qq 52–53 15 Qq 74 & 78 16 DGT0011 - NHS Providers, para 3; DGT0021 - The Nuffield Trust submission, para 5, 17 Q 31; NHS Long-Term Plan, NHS England, January 2019 Digital transformation in the NHS 11 and take overall responsibility for digital transformation.18
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Government response AI summary
The government agrees with the committee's observation regarding complex governance and states that the new digital strategy (Spring 2021) will outline clear roles and responsibilities for national digital bodies. The Digital Transformation Board has also been established to ensure strategic alignment and accountability.
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HM Treasury
12
Conclusion
Twenty-Second Report - Digital transfor…
Accepted
In May 2020, the new governance arrangements for NHSX had not been finalised.19 We received written evidence from NHS Providers, which told us that national governance and oversight arrangements remained fragmented and ambiguous, with many trust leaders still unsure where responsibilities sat between NHSX, NHS Digital and NHSE&I.20 The Department, …
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In May 2020, the new governance arrangements for NHSX had not been finalised.19 We received written evidence from NHS Providers, which told us that national governance and oversight arrangements remained fragmented and ambiguous, with many trust leaders still unsure where responsibilities sat between NHSX, NHS Digital and NHSE&I.20 The Department, NHSX and NHS Digital admitted that there were still tensions in the governance model, a lack of clarity over the roles of NHSX and NHS Digital, and overlaps in work. NHS Digital told us that it had started working with NHSX to clarify where the boundary between the two organisations should sit, although it said the work has become less of a priority while it dealt with the COVID-19 outbreak. It told us that the new Chair of NHS Digital was due to take their post within the next few months and would review the approach that had been taken to digital transformation, including the operating models being used across NHS Digital, NHSX and NHSE&I.21
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Government response AI summary
The government agrees with the committee's conclusion, recognising the importance of clear governance. It states that the new digital strategy, due in Spring 2021, will set out a clear vision for how national digital bodies will work together and outline their distinct roles and responsibilities. …
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HM Treasury
13
Conclusion
Twenty-Second Report - Digital transfor…
Accepted
NHSX is not a statutory body and does not prepare financial statements for audit. We asked how the Department was tracking the performance of NHSX and ensuring that money was being well used given that NHSX was not audited. The Department explained that NHSX’s funding came from the budgets of …
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NHSX is not a statutory body and does not prepare financial statements for audit. We asked how the Department was tracking the performance of NHSX and ensuring that money was being well used given that NHSX was not audited. The Department explained that NHSX’s funding came from the budgets of the Department and NHSE&I, and would therefore follow the normal funding allocations processes within each of these organisations. The Department accepted that the budgetary arrangements for digital transformation were not straightforward and this was an area it should keep under review. It said that it would be worthwhile to get “the money tidied up” so that there was greater accountability over how NHSX prioritised its spending.22
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Government response AI summary
The government agrees with the committee's findings and commits to addressing them through a new digital strategy (Spring 2021), which will establish baselines, track digital maturity, collect cost/benefit data, and publish a full economic assessment of digital transformation value.
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HM Treasury
15
Conclusion
Twenty-Second Report - Digital transfor…
Accepted
The NHS Long-Term Plan includes some challenging ambitions for digitising the NHS, including the target that all trusts reach a ’core level of digitisation’ by 2024. However, the NAO found that there was no digital implementation plan which set out how digitally enabled care will be rolled out across the …
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The NHS Long-Term Plan includes some challenging ambitions for digitising the NHS, including the target that all trusts reach a ’core level of digitisation’ by 2024. However, the NAO found that there was no digital implementation plan which set out how digitally enabled care will be rolled out across the NHS and its plans were underdeveloped. For example, there was no clear schedule for achieving interoperability, which risks making interoperability harder to achieve in the future.25 We asked NHSX how long it expected it to take to achieve interoperability between systems. NHSX was unable to provide a timeframe for achieving complete interoperability, stating that dealing with the enormous legacy of IT systems was an “extremely complex” process and could take “years”. NHS Digital similarly explained that there was no easy way to migrate legacy systems to modern standards, but acknowledged that there needed to be a clear plan for moving away from each legacy system.26
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Government response AI summary
The government agrees with the committee's conclusion, recognising the importance of a clear digital strategy and implementation plan. It plans to accelerate the completion and publication of a comprehensive digital strategy and implementation plan by Spring 2021, which will set out a clear plan to …
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HM Treasury
16
Conclusion
Twenty-Second Report - Digital transfor…
Accepted
In response to our questions about when there would be an implementation plan, NHSX told us that it had intended to produce a digital strategy during the first eight months of this year. It put out for consultation the vision part of its digital strategy in February 2020, which was …
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In response to our questions about when there would be an implementation plan, NHSX told us that it had intended to produce a digital strategy during the first eight months of this year. It put out for consultation the vision part of its digital strategy in February 2020, which was to be followed by six months of consultation and “co- creation” between the national bodies and frontline. The Department explained that the development of the strategy had been delayed as a result of the extra demands that had been placed on organisations as a result of COVID-19, but it was still its intention to undertake this consultation.27 The Department told us that it will take a “blended” approach to planning, which will take place nationally, as well as locally by NHS systems and individual organisations. NHSX added that its digital ambitions would primarily be delivered by the frontline, so their capability, decisions and progress were fundamental to overall success. As such, it considered that it was important that the national bodies helped local systems and organisations by giving them parameters, support and guidance.28
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Government response AI summary
The government agrees with the conclusion, recognising the importance of a clear digital strategy and implementation plan. It plans to accelerate the completion and publication of a comprehensive digital strategy for the entire health and social care system by Spring 2021, which will set out …
Read full response →
HM Treasury
17
Conclusion
Twenty-Second Report - Digital transfor…
Accepted
The National Audit Office found that arrangements for ensuring trusts’ technology spending was consistent with the national strategy were still being developed.29 We asked NHSX what levers it had to influence trusts’ digital investments, and whether there were any circumstances where it would intervene in local systems if they were …
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The National Audit Office found that arrangements for ensuring trusts’ technology spending was consistent with the national strategy were still being developed.29 We asked NHSX what levers it had to influence trusts’ digital investments, and whether there were any circumstances where it would intervene in local systems if they were out of step with national strategies. NHSX told us that it wanted to implement “more nimble” spending controls, covering much more of trusts’ technology spending than the current business case approvals process for large projects. It explained that these controls will be used to ensure that the systems purchased by trusts were consistent with its standards and can speak to each other.30 NHSX told us that it was using procurement frameworks to save money, as well as to ensure that organisations are purchasing from a set of products that it has vetted and which it knows are compliant with the standards. We asked NHS Digital how it would manage the tension between achieving interoperability and increasing the number 24 Q24 & 29 25 C&AG’s Report, paras 10, 15 & 1.15, 26 Qq 50–51, 54 27 Q37 28 Q37 29 C&AG’s Report, para 12 30 Q 71 Digital transformation in the NHS 13 of suppliers in the system via the procurement frameworks. NHS Digital responded that interoperability would be a foundation condition for a vibrant, competitive market for healthcare technology.31 31 Qq 35, 54, 71 14 Digital transformation in the NHS 2 Funding and support to improve the NHS’s digital capabilities Supporting local organisations to improve their digital capabilities
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Government response AI summary
The government agrees with the committee's observation and states that the new digital strategy (Spring 2021) will strengthen national digital spend controls, ensure investments align with national standards, and detail intervention circumstances if local systems deviate.
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HM Treasury
18
Conclusion
Twenty-Second Report - Digital transfor…
Accepted
Patient records are fragmented across thousands of local organisations that provide patient care, including 227 NHS trusts and NHS foundation trusts, around 7,000 GP practices and around 18,500 adult social care providers.32 NHSX acknowledged that to deliver its digital strategy, local organisations would need the necessary skills and capacity, as …
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Patient records are fragmented across thousands of local organisations that provide patient care, including 227 NHS trusts and NHS foundation trusts, around 7,000 GP practices and around 18,500 adult social care providers.32 NHSX acknowledged that to deliver its digital strategy, local organisations would need the necessary skills and capacity, as well as guidance from the centre, to be able to make decisions and progress.33 However, specialist skills in digital are in short supply.34 The National Audit Office found that 13% of trusts self-assessed their capability as ‘high’ and 16% of trusts self-assessed it as ‘low’ in 2017.35 The Department noted that some trusts were more digitally mature than others.36
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Government response AI summary
The government agrees with the conclusion, recognising the critical importance of digital skills. The new digital strategy, due in Spring 2021, will set out a clear plan to address the digital skills gap by strengthening existing staff, attracting new talent, building a diverse workforce, and …
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HM Treasury
19
Conclusion
Twenty-Second Report - Digital transfor…
Accepted
The Global Digital Exemplar (GDE) programme, run by NHSX, aims to create a cadre of high-performing trusts which other trusts can follow (in particular partner trusts, known as ’fast followers’). Despite the variation between the digital maturity of trusts, the National Audit Office found that the GDE programme had focused …
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The Global Digital Exemplar (GDE) programme, run by NHSX, aims to create a cadre of high-performing trusts which other trusts can follow (in particular partner trusts, known as ’fast followers’). Despite the variation between the digital maturity of trusts, the National Audit Office found that the GDE programme had focused on improving the digital maturity of a small number of higher-performing trusts. In 2016–17, the programme committed to providing £385 million of funding between 26 relatively digitally-mature trusts to enable them to become world leaders (with smaller shares going to the fast followers).37 NHSX told us that it had moved from supporting the most digitally-mature trusts to helping the less-advanced trusts to catch up. It told us that it was also reducing the paperwork required for applications for funding, to make the process more manageable and make it easier for trusts that may not have the skills and capacity required to submit a top-quality business case. It explained that it also planned to increase its spending on training the digital workforce, from £3.5 million in 2019–20 to an estimated £9 million in 2020–21 and expected to increase this further in future. Its initial focus will be on training chief executives, boards and leadership teams, and it will next turn its focus to chief information officers and chief clinical information officers.38
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Government response AI summary
The government agrees with the conclusion, recognising the need for a comprehensive support offer for all trusts to achieve a core level of digitisation by 2024. The new digital strategy, due in Spring 2021, will set out how to achieve this by introducing clear baselines, …
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HM Treasury
20
Conclusion
Twenty-Second Report - Digital transfor…
Accepted
In our 2018 report on the WannaCry Cyber-attack on the NHS, we found that the Department and its arm’s-length bodies were unprepared for the relatively unsophisticated WannaCry attack and had a lot of work to do to improve cyber-security for when, and not if, there was another attack.39 We asked …
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In our 2018 report on the WannaCry Cyber-attack on the NHS, we found that the Department and its arm’s-length bodies were unprepared for the relatively unsophisticated WannaCry attack and had a lot of work to do to improve cyber-security for when, and not if, there was another attack.39 We asked how the NHS was ensuring that it had the skills it needed to manage the risks of future cyberattacks, NHS Digital acknowledged that there remained a “significant cyber risk” associated with legacy IT systems, which were especially vulnerable to cyber-attack.40 It admitted that the NHS “desperately need skills” in cyber security. It told us that it was using questionnaires to assess trusts’ exposure to cyber-security risks and was focusing its efforts on trusts at the bottom end of the 32 C&AG’s Report, para 1.4, Figure 2 33 Q37 34 C&AG’s Report, para 17 35 C&AG’s Report, para 8, Figure 4. 36 Q41 37 C&AG’s Report, para 7 38 Qq 73, 81–82 39 House of Commons Committee of Public Accounts, Cyber-attack on the NHS, HC 787, Session 2005–06, 18 April
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Government response AI summary
The government agrees with the conclusion, detailing NHS Digital's ongoing commitment and existing efforts to improve cyber security across the health and care system, including the Data Security Centre and various national services. They acknowledge the enduring risk and state NHS Digital will continue to …
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HM Treasury
22
Conclusion
Twenty-Second Report - Digital transfor…
Accepted
Of the £8.1 billion estimated to be needed to deliver its digital transformation ambitions, NHSE&I expects that £5.1 billion will be funded by national bodies. This includes £2.2 billion of revenue funding, which covers day-to-day activities, and £2.9 billion of capital funding, which covers investments in new buildings or equipment.47 …
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Of the £8.1 billion estimated to be needed to deliver its digital transformation ambitions, NHSE&I expects that £5.1 billion will be funded by national bodies. This includes £2.2 billion of revenue funding, which covers day-to-day activities, and £2.9 billion of capital funding, which covers investments in new buildings or equipment.47 The National Audit Office found that NHSE&I’s costing estimates for the £8.1 billion were based on very limited cost data, using information from just 14 trusts. We asked whether the Department was confident that the £8.1 billion would be enough to achieve its ambitions, particularly given problems of under-investment in the past. The Department told us that it was confident that the £8.1 billion would be enough to achieve its ambitions and make good progress, but recognised that investment in digital capability would be an “enduring 41 Qq 33 & qq83–85 42 C&AG’s Report, para 6 43 DGT0011 - NHS Providers submission, para 5; DGT0007 - The Royal College of Midwives submission, para 25; DGT0014 - NHS Confederation submission, para 6 44 House of Commons Committee of Public Accounts, NHS capital expenditure and financial management, HC344, Session 2019–21, 8 July 2020. Available at: https://committees.parliament.uk/publications/1779/documents/17455/ default/. 45 Q89 46 Q79; House of Commons Committee of Public Accounts, NHS capital expenditure and financial management, HC344, Session 2019–21, 8 July 2020. 47 C&AG’s Report, para 6 16 Digital transformation in the NHS feature” of the NHS. The Department explained that the £2.9 billion of capital funding will be subject to approval at the next spending review, due in autumn 2020. We asked the Department whether the COVID-19 outbreak would put extra financial pressures on the Department’s spending. In response, it told us that that “generally speaking” the Treasury had been meeting additional costs that have resulted from the pandemic and it was not expecting any additional financial pressures
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Government response AI summary
The government agrees with the implied need for clear cost/benefit understanding, stating its new digital strategy, due Spring 2021, will detail how robust cost data will be collected, and will include a commissioned economic assessment of digital transformation.
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HM Treasury
23
Conclusion
Twenty-Second Report - Digital transfor…
Accepted
The National Audit Office found that NHSX was unclear about the whole-life costs and benefits of the different approaches to digital transformation at a local level.50 For example, NHSX expected trusts to take one of three approaches to replacing their electronic patient records: • an enterprise-wide commercial system, which can …
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The National Audit Office found that NHSX was unclear about the whole-life costs and benefits of the different approaches to digital transformation at a local level.50 For example, NHSX expected trusts to take one of three approaches to replacing their electronic patient records: • an enterprise-wide commercial system, which can have high upfront costs; • a “best of breed” approach, integrating different systems, which can have higher running costs; and • in-house systems built by the NHS. NHSX acknowledged that the NHS cannot afford to implement the enterprise-wide system in every trust. A 2019 survey of 186 IT leaders across the sector found slightly more trusts were developing an enterprise-wide approach compared with best of breed (at a ratio of 33:26)
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Government response AI summary
The government agrees with the conclusion, recognising the importance of understanding whole-life costs and benefits. The new digital strategy, due in Spring 2021, will detail how to achieve this through baselines, tracking digital maturity, collecting cost/benefit data, and providing tools and guidance. A full economic …
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HM Treasury
24
Conclusion
Twenty-Second Report - Digital transfor…
Accepted
We noted that having a clear grasp of the costs and benefits of digital transformation will be essential to ensuring trusts are on board. We therefore asked what NHSX was doing to address this and help trusts see the long-term potential savings from its plans.51 NHSX recognised that engaging with …
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We noted that having a clear grasp of the costs and benefits of digital transformation will be essential to ensuring trusts are on board. We therefore asked what NHSX was doing to address this and help trusts see the long-term potential savings from its plans.51 NHSX recognised that engaging with those on the front line would be essential to the success or failure of its initiatives.52 It told us that it intended to complete an initial assessment of the costs and benefits of the different approaches to implementing electronic patient record systems within the next six months.53 However, the NHS also lacks cost and performance information on the true cost of legacy services. The NAO report highlighted that such information is vital for investment decisions on replacement IT systems and for producing a robust business case for such a change.54 48 Qq 76 -78 49 See footnote 49. 50 C&AG’s Report para 6, 13, 3.5, 51 Qq 86, 88 52 Q 88 53 Q87 54 C&AG’s Report, para 1.3 Digital transformation in the NHS 17
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Government response AI summary
The government agrees with the importance of understanding costs and benefits, committing to a new digital strategy by Spring 2021 that will detail how robust data will be collected and include a full economic assessment to drive future investment.
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HM Treasury