Background to the report

The NHS’s health and care services are dependent on people, processes and IT systems, and some of these IT systems are outdated and inefficient. The Department of Health & Social Care (the Department) and NHS England & NHS Improvement (NHSE&I) believe that it is essential to implement new ways of working and that improved digital services are central to this. In other words, the NHS will need to undergo a digital transformation.

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However, the previous attempt to achieve this, between 2002 and 2011, was both expensive and largely unsuccessful. Since then the Department, NHSE&I and NHS Digital initiated the Digital Transformation Portfolio (the Portfolio) to deliver their 2014 digital strategy. The Department and NHSE&I are now updating their strategy and the Portfolio, and in July 2019, they set up a new unit, NHSX, to lead digital transformation in the NHS. NHSX intends to use a different approach to digital transformation to that attempted in 2002, though the objectives are similar. In particular, it will allow NHS trusts and foundation trusts more autonomy to develop their overall approach to digital transformation and the IT systems they implement so long as they comply with national standards which are currently being specified.

Content and scope of the report

This report describes the current state of digital services in the NHS and examines the readiness of the NHS to deliver digital transformation, focusing on:

  • strategy and implementation plans, including lessons from past strategies and progress made to date;
  • the governance of digital transformation;
  • financial and human resources; and
  • technical challenges.

Report conclusions

The Department and its arm’s-length bodies have ambitious plans for digital transformation, intended to enable many of the wider service changes set out in the NHS Long-Term Plan. However, the track record for digital transformation in the NHS has been poor, with the previous major national programme being closed early without achieving its objectives. Currently, £4.7 billion of national funding is delivering some national digital services and improving the digital maturity of some NHS trusts. However, the target of a ‘paperless’ NHS by 2018 has not been achieved. NHSE&I now expects the NHS to reach a core level of digitisation by 2024, with important information routinely available to clinicians when and where they need it.

Local NHS organisations face significant challenges in working towards digital transformation. This includes outdated IT systems that do not connect to other systems and competing demands on their resources. The Department and its arm’s-length bodies need to set a clear direction for local organisations and to ensure resources are directed to the right priorities nationally. Doing so will require financial investment, but the government does not have a reliable understanding of how much funding is required. It will also require strong governance and accountability for delivery, which are not yet in place and which are to be led by a new unit, NHSX, which has no statutory footing. National bodies must manage other significant risks including insufficient skills and capability and major technical challenges such as how to embed interoperability between systems in such a complex environment. Unless the Department and its arm’s-length bodies address these issues far more effectively than they have managed previously, then they are unlikely to achieve value for money for the up to £8.1 billion they estimate will be spent on digital transformation between 2019-20 and 2023-24.

"The track record for digital transformation in the NHS has been poor, with key targets such as a ‘paperless’ NHS by 2018 not being achieved. Local NHS organisations in particular face significant challenges, including outdated IT systems and competing demands on their resources.

"The delivery of healthcare will continue to change, and it needs to be supported by modern, integrated and up-to-date information systems. To meet this challenge, the Department and its arm’s-length bodies need to develop a better understanding of the investment required, set a clear direction for local organisations, and manage the risks ahead. If they don’t, they are unlikely to meet their ambitions for digital transformation and achieve value for taxpayers."

Gareth Davies, head of the NAO

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Publication details

Press release

View press release (15 May 2020)

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