NHS Wales has a clear vision for the electronic patient record, but more work is needed to deliver it

Wednesday, January 10, 2018 - 2:27pm

Although key elements are being put in place, there have been significant delays and, despite recent developments, there are key weaknesses in the arrangements for delivery

All parts of NHS Wales, including Welsh Government, now face tough decisions on funding and priorities if the vision of an electronic patient record is to be achieved in a reasonable timeframe. These are among the key findings of a report published today, by the Auditor General, which looks at NHS informatics.

The high-level vision for NHS informatics is clear and goes back more than a decade. The NHS is working towards an electronic patient record made up of multiple systems that are able to talk to each other. In developing this vision, NHS Wales learnt lessons from the problems previously experienced by the NHS in England.

Despite the clear vision, the NHS has not clearly prioritised the scarce resources available. There has not been an agreed plan for funding the delivery of the vision nor a clear timeframe. And there has been disagreement within the NHS about the balance between local discretion to develop new systems and the delivery of national systems across all of NHS Wales. Positively, the NHS is now moving towards greater clarity on these areas.

The report also identifies weaknesses in the governance and oversight of NHS Wales Informatics Service (NWIS). The report found that: there is a lack of independent scrutiny of NWIS; lines of accountability need to be clearer; and that reports on progress and performance have tended to be overly positive and did not paint a balanced picture.

There has been some work to strengthen leadership of informatics across the NHS in Wales, with the National Informatics Management Board now setting a clearer direction for the informatics agenda. However, NHS Wales lags behind the private sector in the degree to which informatics is represented at board level. There is also the need to develop local clinical leadership of informatics.

We estimate that the NHS spends less than 2% of its funding on ICT: significantly below the figure of 4% recommended by Sir Derek Wanless in 2003. Historically, health boards have not prioritised spending for informatics and Welsh Government funding to NWIS has fallen in real terms. In 2016, NHS Wales estimated that it would require £484 million on top of existing budgets in order to deliver the vision over a five-year period. This is a tentative figure built up from estimates by individual NHS bodies and NWIS. The Welsh Government recognises that further work is required to test and confirm the assumptions underpinning the estimate. Nevertheless, all parts of the NHS, including Welsh Government, now face some tough decisions on whether and how to provide new funding in order to plan effectively to deliver new and updated systems in a reasonable timeframe.

Delivering multiple new informatics systems across all parts of NHS Wales is inherently complex. Many of the building blocks – such as GP systems, a national radiology system and laboratory systems – of an electronic patient record are in now place or at an advanced stage. However, significant delays to the delivery of new systems have caused widespread frustration and there is still a way to go until it the electronic patient record is fully in place. The report found that there have been issues with functionality of some of the national systems. And a lack of monitoring means it is unclear whether those systems that have been delivered are achieving the expected benefits.

In the context of ongoing work to improve the approach to informatics, the report makes 13 recommendations, covering strategy, leadership, governance, finances, programme management and project management

Auditor General, Huw Vaughan-Thomas, said today: “We know that better access to information leads to better outcomes for patients and fewer mistakes by clinicians. Putting the vision of an electronic patient record into practice means all parts of NHS Wales, including Welsh Government, need to take some tough decisions, particularly on funding, priorities and enabling clinicians to have the time and space to lead on this agenda. Unless it addresses the issues identified in my report, the NHS risks further frustration amongst frontline staff and ending up with systems that are already outdated by the time they are completed.”