Slow roll out and a lack of direction is hindering the development of digital health services in Wales

Patients and front line staff are not benefitting from the latest advances in healthcare data and digital technology, because of a lack of clear planning and strategy by the body responsible for developing these tools – Digital Health and Care Wales (DHCW).

Senedd Committees discovered evidence of trepidation among health boards and local authorities about the take up of new services developed by DHCW.

They are also concerned about expenditure on projects to date.

During their joint scrutiny of DHCW, the Senedd’s Health and Social Care Committee and Public Accounts and Public Administration Committee received little assurance about delivery expectations for some of DHCW’s major projects, including the Welsh Community Care Information System (WCCIS), the patient-facing NHS Wales App and integration of services with social care.

Welsh Community Care Information System (WCCIS)

WCCIS has been developed as a single system and a shared electronic record for use across a wide range of adult and children’s services. The intention was that all 22 local authorities and seven health boards in Wales would implement it.

DHCW claim that the system is “live in 19 out of 29 organisations”. But, during the Committee’s scrutiny, it became apparent that there are different degrees of rollout and progress among the organisations that have decided to use WCCIS. Due to connectivity or integration issues, some health boards have no intention of using it, whilst in Cwm Taf Morgannwg UHB, for example, it is only expected to be rolled out only in mental health services initially.

The Committees are also concerned about where responsibility lies for leading on this flagship system, noting that the Chief Executive of Powys Teaching Health Board was one of two Senior Responsible Officers for the programme and they have recently taken on the role of interim Chief Executive of Betsi Cadwaladr UHB.

It is not clear either what WCCIS will deliver with the planned £12m additional spend in the next three years and whether the work completed so far represent value for money.

Lack of cooperation with health boards and local authorities could jeopardise the whole programme, warns Russell George MS, Chair of the Health and Social Care Committee. He says:

“We understand the complexity and scale of the programme, but during our scrutiny of DHCW we were not assured about several issues central to the roll out of WCCIS. These include the lack of a concise but detailed project plan and the lack of clarity about who is responsible for take up of the system. “It’s also clear that there is a reluctance among health board and local authorities to commit fully to the take up of the WCCIS. This could jeopardise the success of the whole project with consequences for services, clinicians and patients. “As part of continuous scrutiny, we are asking Welsh Government and DHCW for six monthly updates on these issues, not least clarity around their intentions for the £12m assigned to the WCCIS project over the coming the years.”

Realistic assessment of achievements, against work still to be done

The Committees were pleased to receive evidence about DHCW’s successes to date – including the continued roll-out of the Welsh Nursing Care Record, services to support the response to the COVID-19 outbreak and enhancements to the Welsh Clinical Portal.

However, in their short report, the Committees warn against over optimism and urge a greater focus on more realistic expectations and evaluation of overall progress.

Mark Isherwood MS, Chair of the Senedd’s Public Accounts and Public Administration Committee says:

“DHCW is still a new organisation. Considerable work has been done to put in place new structures, and we commend the progress that has been made so far. “However, we want to see DHCW be transparent about the challenges and the risks involved in delivering its remit. We applaud ambition and positivity, but we caution against over-optimism and a focus on celebrating successes at the expense of realistically assessing both what needs to be achieved and how the work agenda needs to be prioritised.”

A short report, published jointly by the Senedd Health and Social Care Committee and Public Accounts and Public Administration Committee, contains 16 recommendations for Welsh Government and DHCW.

It includes the Committee’s evaluations of DHCW transition from NWIS, progress and challenges to date and concerns about WCCIS, the NHS Wales App, integration with social care services, cybersecurity and workforce challenges.