Twenty-Second Report - Digital transformation in the NHS

Select Committee

Public Accounts Committee HC 680 6 November 2020

Report Status Government responded

Conclusions & Recommendations 24 items (5 recs)

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Government Response (AI assessment · 23 of 24 classified)

Accepted 13

Acknowledged 2

Not Addressed 8

Government response

Treasury minutes: Government response to the Committee of Public Accounts on the Twenty-second report from Session 2019-21 · published 4 Feb 2021

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Recommendations & Conclusions

9 results

2 Recommendation Not Addressed

The Department’s failure to ensure clear and transparent governance arrangements for digital transformation is putting...

Recommendation

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 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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3 Recommendation Not Addressed

Without a proper implementation plan, the Department and NHSX cannot be sure that the £8.1...

Recommendation

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 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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4 Recommendation Not Addressed

To deliver the digital Vision, NHS organisations’ IT systems must be interoperable.

Recommendation

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 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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5 Recommendation Not Addressed

We are concerned that patients and local health and care systems could be left behind...

Recommendation

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 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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6 Recommendation Not Addressed

The Department and NHSX lack the information they and local organisations need on which of...

Recommendation

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 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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7 Conclusion Not Addressed

The NHS has not made the expected progress since its 2014 strategy and missed its...

Conclusion

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 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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8 Conclusion Not Addressed

NHS England & NHS Improvement (NHSE&I) increasingly seek to plan and coordinate patient care through...

Conclusion

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 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 Show less

Government Response 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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9 Conclusion Not Addressed

We were particularly interested in one aspect of interoperability, namely the opportunities afforded by the...

Conclusion

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 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.

HM Treasury

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14 Conclusion

NHSX was responsible for the initial development of a new NHS COVID-19 app, before this...

Conclusion

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 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 Show less

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