Hunt tech adviser calls for ‘new central investment’

Bob Wachter was commissioned by the then health and social care secretary in 2015, and authored the 2016 report Making IT Work, which called on all NHS trusts to achieve the “realistic target” of a good level of digital maturity by 2023.

While Professor Wachter told HSJ this week that there had been “reasonably good” progress, he said it was “not quite what I would have hoped for” seven years on from his report. 

He acknowledged that factors such as the pandemic and the subsequent economic situation slowed progress, but added that he was “a little bit worried” at the state of digital maturity in some areas, including interoperability and reliability of key systems such as electronic patient records.

As reported by HSJ in July, just three integrated care systems of 42 scored higher than a 3 out of 5 on NHS England’s digital maturity score assessment which was introduced to track progress against digital maturity targets.

Later that month, a report from the Infrastructure and Projects Authority – the government body which scrutinises and supports major projects – concluded that the NHSE’s goal of having a working EPR system in every trust by March 2025 was “unachievable” after £700m was cut from the “frontline digitisation” programme.

Speaking on Tuesday following an event hosted by the Health Foundation, Professor Wachter said funding was the “biggest obstacle” to digital transformation in the NHS, and that “we could do amazing things… with another investment”.

Mr Hunt is now chancellor, while the NHS and Department of Health and Social Care is thought to be pressing for more capital investment for technology – as well as estates – ahead of this month’s autumn statement and beyond.

June’s long-term workforce plan said it was predicated on improving staff productivity with “investment in digital infrastructure throughout the NHS, including appropriate training and support, to enable NHS staff to make the most of new technologies”; and on “a sustained increase in capital investment in the ageing NHS estate, including in primary care”.

The original 2016 report included a recommendation that trusts should be subjected to regulatory and financial penalties for failing to meet digital maturity targets. Reflecting on this on Tuesday, however, Professor Wachter said he no longer thought it would be effective.

He said: “Looking at this from an outsider’s point of view, [the NHS] does not feel like a system that’s going to be well motivated by saying to people, whether it’s frontline providers or leaders, ‘we’re going to slap you harder if you don’t do this thing’. I think they’re already feeling like they’re in this incredible bind, where what’s being asked of them they cannot achieve with existing resources.

“It’s going to require an investment. It required an investment to get us to a certain stage with electronic health records. But [we need to] recognise that that was a foundational investment that was very important, but it mainly achieves the goal [that] the data are now digital. We could do amazing things with it with another investment.”

He added that the risk of no further investment from government was that “the status quo is pretty terrible and only gets worse” and that, “if the system is not working now with existing resources, [there’s] no way it’s going to work in the future”.