The Download: Watchdog’s warning to NHS tech sector

Amid the widespread adulation around the NHS’ rapid increase in use of technology during the pandemic, the government’s spending watchdog last month sounded alarm bells.

In a report published on 12 May, the National Audit Office set out its verdict on the prospects of a complete digital transformation in the NHS – covid-19 aside.

The report was published during the pandemic because “digital transformation will increase in importance as a result of the crisis”, according to NAO boss Gareth Davies.

Its findings were not flattering and emphasised the challenge ahead for the baby-faced NHSX, which has already got considerable flak over the delayed test and trace app – its most high-profile project.

“Confused” governance

Three of the NAO’s main conclusions gently stated the obvious: That the NHS had not made the expected progress since 2014, that investment in digital transformation had not been big enough and that there is uncertainty over planned funding levels being sufficient for the task.

These are all problems for which governments, national NHS leaders and local organisations should take some blame.

But further findings by the NAO about governance and transformation costs raise uncomfortable questions for NHS tech chiefs – current and former.

For example, the NAO said national governance arrangements for digital transformation “remain confused”. The creation of NHSX was supposed to simplify this, but – as the NAO points out – the unit has no statutory basis currently.

NHSX is also hampered by the lack of arrangements for “national oversight of digital transformation at a local level”. This is not a new problem.

Another difficulty which NHSX must take responsibility for is the fact the unit does not have comparable cost information for the different ways in which NHS trusts can get electronic patient record systems, which are essential to achieving true digital transformation.

Neither does the unit know the hidden costs incurred by IT legacy systems, the NAO found. Answering these questions is, of course, extremely complex and takes time, but should be a priority for NHSX.

Bear in mind, the NAO analysis pre-dates X’s “credibility” issue, “conflict of interest” warning and £11.8m app U-turn.

NPfIT 2.0?

On interoperability, the NAO gets its boxing gloves out.

It notes that interoperability of NHS systems has been recognised as important by governments since 1998, but efforts to deliver this have actually made life harder – according to tech chiefs interviewed by the NAO.

The watchdog also claims achieving interoperability may be harder if more tech suppliers gain access to the NHS market, as Matt Hancock has signalled.

According to the report, NHSX wants organisations to build “data layers” within their systems to support access and exchanges though detail on this programme appears scarce. The NAO also points to similar attempts in other parts of government which have been “expensive and problematic”.

The watchdog’s knock-out blow comes with the explicit warning that lessons have not been learned from the £9.8bn National Programme for IT, which has become somewhat synonymous for costly public sector programme delivery failure. These lessons include unrealistic expectations, a lack of funding to implement plans, and leadership changes and skills shortages.

All in all, the NAO report presents a daunting to-do list – much of which lands at NHSX’s doormat. Even without the distraction of a global pandemic it is a monumental challenge, and one which will need a fully staffed and smoothly-run organisation to tackle. NHSX – which turns one year old next week – is not yet either.

Finally, health tech leaders have been unfortunate that clarity on tech funding – which the NAO calls for in its report – has been affected by the delay to the comprehensive spending review for reasons far beyond the control of the NHS. A new settlement cannot come fast enough.

Asked for NHSX’s say on all this, a spokesman for the entity said: ”The NHS has made steady progress in digital transformation, including impressive recent uptake of digital solutions during the coronavirus pandemic, and the formation of NHSX just under a year ago is helping to drive the agenda.

“Looking to the future, we will be working with government to ensure sensible investment decisions are made so we can deliver on the digital ambitions set out in the NHS long term plan and the health secretary’s tech vision.”

App update

Despite being described as “crucial” by Matt Hancock in April, a “key part” of covid-19 surveillance by Boris Johnson four days later, and “ready for roll-out in the coming weeks” by the government in May – this month it emerged the covid-19 tracking app will not be launched until winter.

Test and trace’s dependence on the app has been played down since Dido Harding took over the programme’s reins, and there are not many examples globally of apps having a big impact on controlling the spread of the virus.

If it ever sees the light of day the app looks set to play a minor role in test and trace.

There are doubtless some useful lessons learned for NHSX, but the biggest lesson should be reserved for the government: Don’t overpromise.