A £500 million programme to digitise paper patient records in Wales is already outdated

NWIS is supposed to integrate IT systems across Wales’ health boards using new, innovative solutions to speed up red tape, save money and improve patient treatment.

The Committee found that since the NHS Wales Informatics Service (NWIS) was first envisioned in 2003, other technology products have been launched and improved while medical staff in Wales are still struggling with archaic and fragile IT systems which don’t deliver on their promises.

In 2016 the total cost of developing and rolling out the new systems across all Welsh health boards was estimated at £484 million. But the Committee could find little evidence of where the money would come from and whether it would be additional NHS funding or found within existing resources.

NWIS also spends only 10 per cent of its budget on innovation while allocating considerably more to repairing and maintaining systems long past their sell by date.

The Committee was particularly concerned at the fragility of CaNISC, the system used to track the treatment and wellbeing of cancer patients in Wales. CaNISC is based on software not supported by Microsoft since 2014.

Despite the software effectively being obsolete and at risk of cyber-attacks, a replacement still hasn’t been found.

Cardiff and Vale Health Board reported the system was down for three days during August of this year.

Velindre Cancer Centre reported:

“…one patient did not receive chemotherapy treatment, as blood results were unavailable; there was also a delay in radiotherapy treatment for eight patients.”

In total, systems across NHS Wales failed on average once every nine days in the first six months of 2018. The Committee was given assurances no patients were at risk during the outages. But NWIS’s own serious incident log stated:

“There was an increase risk to patients with GP consultations, creating anxiety for clinicians and patients as a result of the inability to view all patient records, as well as an increase in the delays in patient flows within Outpatients, Emergency Department, Endoscopy, and Theatres. Some patients required repeat diagnostics as a result of the inability to process some pathology samples.”

The Committee was also concerned at the ‘overly positive’ reports of progress from senior managers with the Chief Executive responsible for hosting NWIS describing its ambitions as ‘world leading’.

This is despite projects either running well behind schedule, or in some cases, only on schedule because the schedule had been changed.

“In 2003 the iPhone was yet to be invented and Gmail and Skype were yet to take off,” said Nick Ramsay AM, Chair of the Public Accounts Committee.

“It was in this same year that the Informing Healthcare strategy was launched, with an electronic patient record for in Wales at its heart.

“The other technological innovations of that year have not only been realised, but leapfrogged several times, and yet NHS Wales remains far away from a seamless electronic portal for patient records.

“Our inquiry has raised serious question marks about the competence, capability and capacity across the health system to deliver a digital transformation in Welsh healthcare.

“And yet we discovered a culture of self-censorship and denial amongst those charged with taking the agenda forward – in NWIS itself, as well as its partners in the health boards and the Welsh Government.”

The Committee makes five recommendations in its report, including:

– The Committee was very concerned by the evidence heard on system outages, infrastructure and resilience. Given recent evidence of further outages since we took evidence, we would like further assurance from Welsh Government that they systems are resilient. We recommend the Welsh Government set out a clear timetable for putting the digital infrastructure of NHS Wales on a stable footing.

– In the discussions on the use of Cloud computing and the impact of recent outages, it was deeply concerning that, when many consumer systems appear to have very robust performance and up-time, the NHS in Wales is struggling to run its own data centres with 21 outages in the first 6 months of 2018

– One outage every 9 days. The Committee recommends a review of the senior Leadership capacity in terms of skillset and governance within both NWIS and the wider NHS Digital Team; and,

– NWIS is currently overstretched and improvement requires far more than simply pouring more money into the existing organisation, which is unlikely to achieve significantly different results. We recommend that any additional funding apportioned to NWIS needs to be tied to reorganisation to achieve the improvements that are required.

The report will now be considered by the Welsh Government.