Digital Transformation in the NHS

Public Accounts Committee Closed Inquiry
Opened: 27 Jul 2020 Closed: 9 Nov 2020 Parliament page
The Department for Health and Social Care (DHSC) has a longstanding ambition to digitally transform the NHS and to enable seamless data sharing (interoperability) between the many organisations that make up the health and care system. DHSC’s previous attempt at instituting a paperless patient record, to enable smooth sharing of … Read more
5 Recommendations
19 Conclusions
1 Report
1 Oral session
1 Event
Activity timeline 3 events
4 Feb
2021
Report published
6 Nov
2020
Report published
17 Sep
2020
Oral evidence
Oral evidence sessions 1 session
17 Sep 2020
View on parliament.uk
Digital transformation in the NHS
David Williams · Daily Mail Matthew Gould CMG MBE · NHSX Sarah Wilkinson · NHS Digital
Title HC No. Published Items Response
Twenty-Second Report - Digital transformation in the NHS HC 680 6 Nov 2020 24 Responded
Recommendations & Conclusions
24 results
2 Recommendation Not Addressed
Twenty-Second Report - Digital tra…
The Department’s failure to ensure clear and transparent governance arrangements for digital transformation is putting...
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 … Read more
Government Response
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.
HM Treasury
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3 Recommendation Not Addressed
Twenty-Second Report - Digital tra…
Without a proper implementation plan, the Department and NHSX cannot be sure that the £8.1...
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 … Read more
Government Response
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.
HM Treasury
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4 Recommendation Not Addressed
Twenty-Second Report - Digital tra…
To deliver the digital Vision, NHS organisations’ IT systems must be interoperable.
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 … Read more
Government Response
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.
HM Treasury
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5 Recommendation Not Addressed
Twenty-Second Report - Digital tra…
We are concerned that patients and local health and care systems could be left behind...
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 … Read more
Government Response
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.
HM Treasury
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6 Recommendation Not Addressed
Twenty-Second Report - Digital tra…
The Department and NHSX lack the information they and local organisations need on which of...
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 … Read more
Government Response
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.
HM Treasury
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1 Conclusion Acknowledged
Twenty-Second Report - Digital tra…
On the basis of a report by the Comptroller and Auditor General, we took evidence...
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care, NHS Digital and NHSX on digital transformation in the NHS.1
Government Response
The government response acknowledges the committee's introductory statement about the basis of its report, reiterating the committee's process.
HM Treasury
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7 Conclusion Not Addressed
Twenty-Second Report - Digital tra…
The NHS has not made the expected progress since its 2014 strategy and missed its...
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’ … Read more
Government Response
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.
HM Treasury
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8 Conclusion Not Addressed
Twenty-Second Report - Digital tra…
NHS England & NHS Improvement (NHSE&I) increasingly seek to plan and coordinate patient care through...
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 … Read more
Government Response
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.
HM Treasury
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9 Conclusion Not Addressed
Twenty-Second Report - Digital tra…
We were particularly interested in one aspect of interoperability, namely the opportunities afforded by the...
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 … Read more
Government Response
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.
HM Treasury
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10 Conclusion Accepted
Twenty-Second Report - Digital tra…
The Department, NHSX and NHS Digital told us that the COVID-19 outbreak had shown how...
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 … Read more
Government Response
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 the NHS and social care.
HM Treasury
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11 Conclusion Accepted
Twenty-Second Report - Digital tra…
Since 2016, management of the portfolio of national programmes to digitally transform the NHS has...
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 … Read more
Government Response
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.
HM Treasury
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12 Conclusion Accepted
Twenty-Second Report - Digital tra…
In May 2020, the new governance arrangements for NHSX had not been finalised.19 We received...
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 … Read more
Government Response
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. The Digital Transformation Board has also already been established to ensure strategic alignment.
HM Treasury
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13 Conclusion Accepted
Twenty-Second Report - Digital tra…
NHSX is not a statutory body and does not prepare financial statements for audit.
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 … Read more
Government Response
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.
HM Treasury
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14 Conclusion
Twenty-Second Report - Digital tra…
NHSX was responsible for the initial development of a new NHS COVID-19 app, before this...
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 … Read more
HM Treasury
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15 Conclusion Accepted
Twenty-Second Report - Digital tra…
The NHS Long-Term Plan includes some challenging ambitions for digitising the NHS, including the target...
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 … Read more
Government Response
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 digitise and connect the NHS and social care.
HM Treasury
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16 Conclusion Accepted
Twenty-Second Report - Digital tra…
In response to our questions about when there would be an implementation plan, NHSX told...
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 … Read more
Government Response
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 a clear plan to digitise and connect the NHS and social care.
HM Treasury
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17 Conclusion Accepted
Twenty-Second Report - Digital tra…
The National Audit Office found that arrangements for ensuring trusts’ technology spending was consistent with...
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 … Read more
Government Response
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.
HM Treasury
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18 Conclusion Accepted
Twenty-Second Report - Digital tra…
Patient records are fragmented across thousands of local organisations that provide patient care, including 227...
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, … Read more
Government Response
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 offering clear career pathways.
HM Treasury
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19 Conclusion Accepted
Twenty-Second Report - Digital tra…
The Global Digital Exemplar (GDE) programme, run by NHSX, aims to create a cadre of...
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 … Read more
Government Response
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, targeting support for trusts most in need, outlining national programmes, and strengthening digital skills through training.
HM Treasury
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20 Conclusion Accepted
Twenty-Second Report - Digital tra…
In our 2018 report on the WannaCry Cyber-attack on the NHS, we found that the...
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 … Read more
Government Response
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 strengthen defences, with a full update promised in Spring 2021.
HM Treasury
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21 Conclusion Acknowledged
Twenty-Second Report - Digital tra…
NHSE&I expects that trusts will need to contribute £3 billion, under matched- funding arrangements, between...
NHSE&I expects that trusts will need to contribute £3 billion, under matched- funding arrangements, between 201920 and 2028–29 to meet its current plans for a digital transformation.42 However, in their written evidence to us NHS Providers, the Royal College of … Read more
Government Response
The government agrees with the conclusion, recognising the importance of understanding the whole-life costs and benefits of digital transformation. The new digital strategy, due in Spring 2021, will set out how to achieve this, and a full economic assessment will be published with the strategy to provide an evidence base for future investment decisions, without directly committing to address the funding shortfall for trusts.
HM Treasury
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22 Conclusion Accepted
Twenty-Second Report - Digital tra…
Of the £8.1 billion estimated to be needed to deliver its digital transformation ambitions, NHSE&I...
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 … Read more
Government Response
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.
HM Treasury
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23 Conclusion Accepted
Twenty-Second Report - Digital tra…
The National Audit Office found that NHSX was unclear about the whole-life costs and benefits...
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 … Read more
Government Response
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 assessment, already commissioned, will also be published with the strategy.
HM Treasury
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24 Conclusion Accepted
Twenty-Second Report - Digital tra…
We noted that having a clear grasp of the costs and benefits of digital transformation...
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 … Read more
Government Response
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.
HM Treasury
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Government Response AI assessment · 23 of 5 classified
Accepted 13
Acknowledged 2
Not Addressed 8
Total 5 recs + 19 conclusions