Recommendations & Conclusions
9 items
2
Recommendation
Twenty-Second Report - Digital transfor…
Not Addressed
The Department’s failure to ensure clear and transparent governance arrangements for digital transformation is putting the successful delivery of the Vision for digital, data and technology at risk. There are many organisations working at both national and local levels to deliver the digital transformation of the NHS. Yet governance arrangements …
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The Department’s failure to ensure clear and transparent governance arrangements for digital transformation is putting the successful delivery of the Vision for digital, data and technology at risk. There are many organisations working at both national and local levels to deliver the digital transformation of the NHS. Yet governance arrangements are complex and confused. The Department, NHSX, NHS Digital and other stakeholders recognise that there is a lack of clarity over the roles of NHSX and NHS Digital and the overlaps in their work. The new Chair of NHS Digital is due to review the approach that has been taken to digital transformation, including the operating models being used across NHS Digital, NHSX and NHSE&I. However, we are concerned that governance arrangements for NHSX have still not been finalised over a year after it was set up. NHSX is not a statutory body and does not prepare financial statements for audit, and so there is little transparency over its spending and activity. It has spent an estimated £11 million on the first phase of the delayed contact-tracing app, and expects to spend another £25 million on the second stage. Given the taxpayers’ money involved, transparency is important to allow Parliament and the public to hold it to account. Recommendation: To improve clarity and transparency, the Department should: • Write to the Committee by spring 2021 clearly setting out the responsibilities for digital transformation of each national organisation, and communicate 6 Digital transformation in the NHS this to local organisations. • Publish an annual report of NHSX’s activity and the spending it controls and/or directs.
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Government response AI summary
The government's response addresses funding decisions for the Towns Fund and Levelling Up Fund, providing details on transparency for those programmes, and does not engage with the specific recommendations regarding digital transformation, NHSX governance, or publishing an annual report for NHSX.
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HM Treasury
3
Recommendation
Twenty-Second Report - Digital transfor…
Not Addressed
Without a proper implementation plan, the Department and NHSX cannot be sure that the £8.1 billion of taxpayers’ money being invested in the digital transformation programme will deliver value for money. The Department’s 2018 Vision for digital, data and technology is not an implementation plan as it does not set …
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Without a proper implementation plan, the Department and NHSX cannot be sure that the £8.1 billion of taxpayers’ money being invested in the digital transformation programme will deliver value for money. The Department’s 2018 Vision for digital, data and technology is not an implementation plan as it does not set out how the NHS will deliver its ambitions in practice. It does not include a timeframe or plan for achieving interoperability, which NHSX acknowledges is an “extremely complex” process and could take “years”. The Department asserts that it will take a “blended” approach to planning, which will take place both nationally and locally by NHS systems and individual organisations. However, the Department has not demonstrated that national and local initiatives will be sufficient to meet the overall ambition. Furthermore, the national organisations have not yet put in place the planned levers and incentives to encourage trusts and other parts of the NHS to take the appropriate action on the ground. This will make it harder to ensure that local organisations are carrying out transformation in a way that is consistent with the national strategy and will benefit patients and staff. Recommendation: NHSX should, as a matter of urgency, publish an implementation plan for meeting its ambitions for transforming digital services. This should: • Clearly set out actions required to transform digital services and how it will assess progress in enabling organisations to interact effectively to improve care. • Include the incentives and levers that improve the application of national standards for interoperability within and between local NHS organisations. • Identify and prioritise those areas where the digitisation of services will add the greatest value to patients and clinicians.
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Government response AI summary
The government response is boilerplate text and does not address the committee's urgent recommendation for NHSX to publish a comprehensive implementation plan for digital services, detailing actions, progress assessment, interoperability incentives, and priority areas for digitisation.
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HM Treasury
4
Recommendation
Twenty-Second Report - Digital transfor…
Not Addressed
To deliver the digital Vision, NHS organisations’ IT systems must be interoperable. Many of the standards required to enable this are not yet in place, and much work is required before benefits, such as digital-image sharing, can be realised. NHSE&I increasingly seeks to plan and coordinate patient care through local …
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To deliver the digital Vision, NHS organisations’ IT systems must be interoperable. Many of the standards required to enable this are not yet in place, and much work is required before benefits, such as digital-image sharing, can be realised. NHSE&I increasingly seeks to plan and coordinate patient care through local partnerships of health and care organisations, making data sharing between organisations essential. Currently, many local organisations rely on legacy systems that are unable to do this, so these systems need to be upgraded. But at May 2020 only three of the 10 sets of standards for achieving interoperability, identified by NHS Digital, were ready and NHSX could not tell us when the others would be ready. Interoperability will also help the NHS to make good use of the cloud which could, for example, benefit patients, radiologists and consultants by facilitating the sharing of digital images. Recommendation: NHSX should urgently bring forward the remaining standards in order to provide clarity for trusts and suppliers, including providing trusts with guidance on the potential use of the cloud to enable digital image sharing. Digital transformation in the NHS 7
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Government response AI summary
The government's response is a non-sequitur, discussing an annual update on a "Fund" and its monitoring, which does not address the committee's recommendation for NHSX to urgently bring forward remaining interoperability standards and provide guidance on cloud use for digital image sharing.
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HM Treasury
5
Recommendation
Twenty-Second Report - Digital transfor…
Not Addressed
We are concerned that patients and local health and care systems could be left behind if some less digitally-advanced trusts are unable to invest in the technology and skills they need to catch-up. There is wide variation in the digital maturity of trusts, with 13% of trusts assessing their capability …
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We are concerned that patients and local health and care systems could be left behind if some less digitally-advanced trusts are unable to invest in the technology and skills they need to catch-up. There is wide variation in the digital maturity of trusts, with 13% of trusts assessing their capability as ‘high’ and 16% of trusts assessing it as ‘low’ in 2017. It is essential that trusts have the necessary digital skills if they are to improve their digital maturity and make national ambitions a reality, but these skills are in short supply. We are particularly concerned about the lack of skills in cyber-security, as legacy IT systems are especially vulnerable to attack. But despite these shortcomings and the variation between trusts, the Global Digital Exemplar programme has focused on improving the digital maturity of a small number of higher-performing trusts. NHSX’s focus is now moving to helping the less-advanced trusts to catch up. However, we are concerned that trusts may be unable to invest the £3 billion expected of them by the Department under its matched-funding arrangements. Our reports have illustrated the long-standing financial challenges facing many trusts. Recommendation: As part of the implementation plan, NHSX should work with NHS England & Improvement and NHS Digital to develop a more-focused package for those local health and care systems most in need of support for planning, funding and implementation, and with a clear basis for priority action.
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Government response AI summary
The government response is boilerplate text and does not address the committee's recommendation for NHSX to develop a focused support package for less digitally-advanced local health and care systems.
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HM Treasury
6
Recommendation
Twenty-Second Report - Digital transfor…
Not Addressed
The Department and NHSX lack the information they and local organisations need on which of the options for achieving digital transformation in local health and care systems achieves the best value for money. The Department considers that the £8.1 billion being invested in digital transformation will be sufficient to achieve …
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The Department and NHSX lack the information they and local organisations need on which of the options for achieving digital transformation in local health and care systems achieves the best value for money. The Department considers that the £8.1 billion being invested in digital transformation will be sufficient to achieve its ambitions, but its costing estimates are based on very limited data. The capital element of this funding is subject to approval at the next spending review, due in autumn 2020, and there is likely to be financial pressures on the Department as a result of the COVID-19 response. NHSX plans to assess the cost and benefits of different approaches to electronic patient record systems within the next six months. Local organisations will need information on the whole-life cost and benefits, and the conditions on the ground needed for success, so that they can make the best choices about how to invest the limited funding available. Recommendation: NHSX should develop and publish a cost-benefit analysis of the various approaches available to local organisations when implementing their system solutions. It should also use the information to assess the realism of the £3 billion contribution from the NHS trust sector toward the overall budget of £8.1 billion. 8 Digital transformation in the NHS 1 Plans for digitally transforming the NHS
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Government response AI summary
The government response is boilerplate text and does not address the committee's recommendation for NHSX to develop and publish a cost-benefit analysis of system solutions and assess the realism of the £3 billion contribution from NHS trusts.
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HM Treasury
7
Conclusion
Twenty-Second Report - Digital transfor…
Not Addressed
The NHS has not made the expected progress since its 2014 strategy and missed its main target to achieve a ‘paperless’ NHS by 2018.10 The 2018 target has since been redefined in a new target to reach a ‘core level’ of digitisation by 2024. We asked why a watered-down target …
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The NHS has not made the expected progress since its 2014 strategy and missed its main target to achieve a ‘paperless’ NHS by 2018.10 The 2018 target has since been redefined in a new target to reach a ‘core level’ of digitisation by 2024. We asked why a watered-down target had been put in place rather than the previous commitment to ‘paperless’. The Department told us that its ambitions for digital transformation within the NHS were no less ambitious, but that this target was “more realistic”. NHSX told us that it has made “considerable progress” against the new target, but admitted that there was still “a very long way to go”.11
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Government response AI summary
The government's response is only a heading and does not address the committee's observation regarding the lack of progress in digitising the NHS or the reasons for the watered-down targets.
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HM Treasury
8
Conclusion
Twenty-Second Report - Digital transfor…
Not Addressed
NHS England & NHS Improvement (NHSE&I) increasingly seek to plan and coordinate patient care through partnerships of local health and care organisations, known as sustainability and transformation partnerships (STPs) and integrated care systems (ICSs). This makes sharing data between organisations essential to enable electronic patient records to be seen and …
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NHS England & NHS Improvement (NHSE&I) increasingly seek to plan and coordinate patient care through partnerships of local health and care organisations, known as sustainability and transformation partnerships (STPs) and integrated care systems (ICSs). This makes sharing data between organisations essential to enable electronic patient records to be seen and updated by clinicians in different organisations such as GP practices and hospitals. A key part of the Department’s plan is the interoperability of IT systems within the health and social care service, which involves the seamless sharing of data so that electronic patient records can be shared between different organisations. NHSE&I expects that interoperability will release staff time and provide a better patient experience. For example, it is hoped that interoperability will reduce duplication of care, since clinicians will see information (such as test results) recorded by others. To enable interoperability, organisations need to upgrade their legacy systems to meet modern standards. However, in 2017 only 15% of trusts reported being mostly compliant with the standard for clinical terminology (SNOMED CT). NHS Digital asserted that the level of compliance was now much higher: it estimated that over 80% of trusts were now using SNOMED CT in one or more healthcare settings for information recording or reporting.12 6 Committee of Public Accounts, The dismantled National Programme for IT in the NHS, HC 294, Session 2013–14, 15 July 2013. Available at: https://publications.parliament.uk/pa/cm201314/cmselect/cmpubacc/294/294.pdf 7 National Advisory Group on Health Information Technology in England, Making IT Work: Harnessing the Power of Health Information Technology to Improve Care in England, 2016 8 C&AG’s report, para 19 9 Q36 10 C&AG’s report, para 4 11 Qq 41–42 & 44 12 C&AG’s report, para 14 & 1.7; Qq 44- 45; Correspondence from NHS Digital, dated 24 September 2020. 10 Digital transformation in the NHS Nonethel
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Government response AI summary
The government response is boilerplate text and does not address the committee's conclusion regarding the essential role of interoperability in patient care coordination within local health and care systems.
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HM Treasury
9
Conclusion
Twenty-Second Report - Digital transfor…
Not Addressed
We were particularly interested in one aspect of interoperability, namely the opportunities afforded by the cloud and cloud computing. For example, vendor-neutral digital image sharing through the cloud can benefit patients, radiologists and consultants. But suppliers might experience difficulties in providing these services to the NHS. NHSX told us that, …
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We were particularly interested in one aspect of interoperability, namely the opportunities afforded by the cloud and cloud computing. For example, vendor-neutral digital image sharing through the cloud can benefit patients, radiologists and consultants. But suppliers might experience difficulties in providing these services to the NHS. NHSX told us that, to facilitate the use of cloud (for image sharing, and more widely), there were a number of actions that could be, or had been, taken. First, it could ensure that the policy and standards facilitate the use of cloud and image sharing. Second, that NHS Digital had already undertaken work to ensure the connectivity and bandwidth were in place to allow these types images to be shared. Third, care pathways could be designed to make use of digital image sharing to deliver a more efficient service and better outcomes.14
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Government response AI summary
The government response is boilerplate text and does not address the committee's conclusion regarding the opportunities and challenges of cloud computing for interoperability, particularly digital image sharing.
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HM Treasury
14
Conclusion
Twenty-Second Report - Digital transfor…
NHSX was responsible for the initial development of a new NHS COVID-19 app, before this responsibility transferred to the newly-established NHS Test and Trace. The app, which was initially due to be launched in May 2020, alerts people who have had close contact with someone who has tested positive for …
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NHSX was responsible for the initial development of a new NHS COVID-19 app, before this responsibility transferred to the newly-established NHS Test and Trace. The app, which was initially due to be launched in May 2020, alerts people who have had close contact with someone who has tested positive for COVID-19. It was launched on 25 September, after our evidence session and some four months after it was due. We asked NHSX why it had taken so long to launch the app. It told us that while some areas of the project had worked “extremely well”, other parts of the technology had not worked in the way it anticipated. It explained that it started the project before the Google and Apple framework had been announced or developed, and it had changed direction to using this framework very soon after it was announced. It asserted that it had tested “very extensively” to make sure it understood the effects of the app, how it worked and how people would interact with it, and had changed its approach as a result. NHSX estimated that the cost of developing the app and supporting it will be £36 million. It estimated that the cost of the first stage of developing the app was 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 2020–21.23 NHSX was not able to tell us what impact it would have on the successful tracing of people, because that would depend 18 C&AG’s Report, para 11, 2.2–2.3 19 C&AG’s Report, para 11 20 DGT0011 - NHS Providers 21 Qq 56–59 22 C&AG’s Report, para 11; Qq 67 & 69 23 Qq 23, 25 & 29; Department of Health and Social Care announcement, 25 September. Available at: https://www. gov.uk/government/news/nhs-covid-19-app-emails-and-sms-messages 12 Digital transformation in the NHS on many
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HM Treasury