Wachter tells ministers: Discard 'unrealistic' 2020 IT target

Professor Robert Wachter’s long awaited review, published today, sets out the stark warning and proposes a new target to achieve a digitally mature NHS by 2023. But it states that even this date would not be achieved without significantly more funding.

The review, Making IT Work, says: “We believe the target of ‘paperless by 2020’ should be discarded as unrealistic. The goal is not paperless – it is improvement facilitated by having information where it is needed and when it is needed.

“Our advisory group was very concerned that an aggressive push to digitise the entire secondary care sector by 2020 was more likely to fail than succeed.

“Regarding timing, we have set 2023 as a reasonable date to have robust clinical information systems in all NHS trusts.”

On central funding the report says: “While the Treasury’s allocation…is generous in light of today’s austerity conditions, we do not believe it is enough to complete the entire job.”

A “rough calculation” is that “slightly more than £3bn, or nearly twice the [£1.8bn allocated for the paperless NHS project]” would be required from government, it says.

It says the estimate is based on an average trust requiring “a minimum of £40m to digitise”, and that half of this would need to be centrally funded. A full economic analysis was beyond the scope of the report.

The 2020 paperless at the point of care target was developed out of NHS England’s Personalised health and Care 2020 strategy, launched in November 2014.

The target has been the focal point for the development of the NHS’s digital strategy since then, but it has long been viewed as largely unrealistic and often described as “aspirational”. Professor Wachter, a prominent academic and physician and currently interim chair of the department of medicine at the University of California, was commissioned to carry out the review by Jeremy Hunt last year.

The health secretary had originally in 2013 announced an “ambition” for a paperless NHS by 2018, but it was pushed back.

Speaking exclusively to HSJ, Professor Wachter said his call for extra funding and a delay in target date were tough asks of government and NHS England, but that Mr Hunt had been “extraordinarily supportive”.

“I can only imagine that it would have been slightly easier politically if we had said ‘we believe the country can get there by 2020 [in the current spending envelope]’. We recognised there would be political issues but our job was to make the recommendations that would be the best for the NHS.

“When we presented [the recommendations] to the secretary of state he pushed back a little bit, wondered if there was any possibility of meeting [the 2020] deadline, but he also made it clear that the deadline was aspirational [rather than a hard stop].”

The report makes ten recommendations:

• Carry out a “thoughtful long-term national engagement strategy”
• Appoint and give appropriate authority to a national chief clinical information officer
• Develop a workforce of trained clinician-informaticists at trusts who are treated as senior managers
• Strengthen and grow the CCIO field and health IT and clinical informatics more generally
• Allocate more national funding
• While some trusts may need time to prepare to go digital, all trusts should be largely digitised by 2023
• Link national funding to a viable local implementation/improvement plan
• Organise local/regional learning networks to support implementation and improvement
• Ensure interoperability as a core characteristic of the NHS digital ecosystem
• A robust independent evaluation of the programme should be supported and acted upon

Professor Wachter said he was delighted his recommendations were already being acted on, pointing to Mr Hunt’s announcement today of funding for a group of “global exemplar trusts”, and NHS England’s move to appoint a national chief clinical information officer.

The recommendations were made to ministers some months ago but publication was delayed by the Purdah period for the EU referendum, then the summer.

NHS England’s recently appointed chief clinical information officer Keith McNeil insisted to HSJ that the 2020 paperless target should not be entirely discarded, and that a significant restructure of the existing digital programme was not required. But he admitted “achieving the whole piece for the whole of the NHS by 2020 is maybe a bridge too far”.

He added: “We should certainly aim to [achieve the 2020 paperless target] but in aiming to do that, we need to be cognisant that we don’t want to be driving at the target too fast. We should do as much as we can as quickly as we can.”

Dr McNeil also agreed with Professor Wachter’s assertion that more money would be needed. He said: “It’s going to be a challenge to achieve it within the [existing] funding envelope. The challenge for us is to show that we can do a lot of good work with the [existing] money and that we can get a return on investment, so that we can, if we need to, go back [to the Treasury] and say ’we do need some more but here’s the return on investment that we can give’.”

Mr Hunt said in a statement: “Bob Wachter’s excellent review made it clear that digitisation is as much about people as it is technology, and that this is a real opportunity to improve patient care for the long term. We want to fast track existing digital excellence, as well as nurture new skills and expertise that we will need to deliver a new breed of digitised services.

“This means on the one hand giving pioneering NHS organisations the financial backing to unleash their full potential, while also making sure that we can build a digitally-confident workforce across the whole NHS.”