The UK government has announced another major overhaul of IT in the NHS. Global Insight considers the crucial lessons that have been learnt when engaging with big tech. 

If all goes to plan, National Health Service (NHS) patients in the UK will be able to access their full medical records via the NHS App as part of a wide-ranging digital revolution. The reform means that patient records will no longer be owned and managed locally by general practitioner (GP) practices, or the hospitals that patients visit. Instead, they’ll be held in a central database accessible by all parts of the NHS, explained the UK Secretary of State for Health and Social Care, Wes Streeting, in October 2024.

The revamped app will also provide patients with the ability to decide where they’re treated in a move intended to reduce waiting lists. As part of the government’s elective reform plan, announced by Streeting in January, GPs will be able to directly refer and book patients in for checks, scans and tests to reduce the chances of people getting stuck between GP referrals and hospital appointments. The government sees the overhaul of the digital capabilities of the NHS as key to reducing waiting times for treatment to 18 weeks for 92 per cent of patients – a goal that the NHS hasn’t met since February 2016.

While the NHS App has been grabbing the headlines, much of its success depends on upgrading often outdated and incompatible back office IT systems. For example, NHS trusts must adopt a digital patient engagement portal (PEP), or else patients and healthcare teams will be unable to send messages, share documents, remotely monitor patients or have information at hand for appointments.

In mid-2024 there were 215 NHS trusts in the UK. But recent analysis has shown that only 84 trusts have implemented PEPs – and, of those, just 26 have integrated it with the NHS App, according to statistics from NHS England. While there are probably many more trusts in the early stages of launching PEPs today, the work needed to make them mature enough to integrate effectively with the app will be extensive.

The elective care plan also said that trusts should use the NHS Federated Data Platform (FDP). This consolidates data from across different parts of the NHS to provide healthcare professionals with a single view of their patients, although most GP data is not included on the platform. The government is aiming for 85 per cent of trusts to be on the FDP by March 2026, and although NHS England has said that the use of the platform isn’t mandatory, it expects organisations ‘to fully consider using NHS FDP as part of their planning to deliver best value for money for taxpayers’.

The contract with the consortium of businesses providing the platform was valued at about £330m over a seven-year period and is expected to deliver the FDP for 240 NHS organisations. Given that only 39 NHS hospital trusts were on the FDP as of the end of June 2024, successfully accelerating this process to meet the March 2026 deadline will be challenging.

Multiple failures

Can it be done? Given the history of the previous attempts by the NHS to achieve such goals, there are strong grounds for scepticism. The Department of Health has been struggling to create a fully integrated electronic care records system since 2002 when it launched the National Programme for IT in the NHS. Just as now, the idea was to rapidly provide every patient with a digital record that could be shared between different parts of the service by 2007. At £11.4bn, it was considered the world’s largest civil IT project.

It turned out, in the words of the National Audit Office (NAO) – the UK’s independent public spending watchdog – to be ‘expensive and largely unsuccessful’. A parliamentary report by the Public Accounts Committee in 2011 concluded that despite spending over £6.4bn by 2011, the Department of Health received very little benefit from its investment and had been forced to abandon its key goal of creating an integrated system for patient records. Two key suppliers, for example, were unable to fully deliver the technologies they had originally been contracted to build. Individual trusts were then left to develop their own data systems, leading to the fragmentation of digital records – now held on outdated software systems – that exists across the NHS today.

Further, according to a 2014 ‘case history’ analysis by University of Cambridge researchers, the top-down imposition of the system created scepticism among healthcare professionals and there were also privacy and confidentiality concerns. Altogether, the project lacked clinical engagement, was hastily implemented and badly procured. It was dismantled in 2011.

In its analysis of the lessons that needed to be learnt, the government-commissioned Wachter report of 2016 said that the aim of digitalisation was to provide ‘better health, better healthcare and lower cost’. Among its overall findings and principles, the report said that health IT should involve adaptative change – ‘substantial and long-lasting engagement’ between those implementing the changes and the individuals making them work – as well as technical change.

As such, a ‘thoughtful long-term national engagement strategy’, aimed at harnessing the help of NHS staff, is needed. That would include creating a governance structure that struck the right balance between centralised control and local engagement, thorough-going IT training for clinicians and the ability of leaders at NHS organisations to take an active part in controlling, monitoring and being accountable for how well investment is spent.

In 2019, the NHS Long Term Plan announced that digitally enabled care would be rolled out to transform how patients are looked after and to achieve the efficiencies that had up until then eluded the service. But again, a 2020 report by the NAO found that there was little substance behind the ambitious targets set out in the plan. ‘There is no digital implementation plan setting out how this will be done in clear detail, including the role of national bodies, and to a realistic schedule’, it said, concluding that few lessons had been learnt from the failures of the National Programme for IT in the NHS. In particular, there was little coordination between national plans and how these were meant to be implemented locally, while a shortage of digital and data skills was identified within the NHS.

The NHS Long Term Plan fizzled out, leaving patient data scattered throughout the organisation in systems that couldn’t communicate with one another.

‘The foothills of digital transformation’

When the UK’s new government came into power in 2024, it immediately commissioned a rapid review of the current state of the NHS, led by Lord Ara Darzi. He concluded that the UK has underspent on capital investment in the service by £37bn. In addition to the money wasted so far on failed patient record systems, the way that the Treasury managed the capital expenditure limits was dysfunctional, he said, leading to trusts using investment money on day-to-day expenditure.

‘The workforce has been rapidly expanded while its capital base has been artificially constrained, since the health service as a whole – as well as individual trusts – lacks the authority to decide how the NHS budget is divided between day-to-day spending on wages and consumables versus capital investment in digital technology, diagnostic scanners, or modern buildings’, he said. ‘It is little wonder, then, that productivity has declined when capital per worker fell year-on-year during the 2010s.’

While there are pockets of IT excellence, he concluded, ‘the NHS remains in the foothills of digital transformation’. And many IT initiatives have brought little benefit while adding to the workload of clinicians. New technologies such as artificial intelligence (AI) are also largely absent from an organisation with the rich and extensive data sets that could provide a revolutionary transformation of patient care.

Despite the catalogue of woes in Lord Darzi’s report, his overriding conclusion is that the service and its technologies are fixable, even if not in the course of a single parliamentary term. He identifies technology as one of the key drivers for change because it can transform the way that patient care is delivered, simplifying processes that are overdependent on data that’s hard to access and share. In fact, surveys have shown that patients aren’t overly concerned about issues of privacy as long as the data is used to improve their outcomes and the productivity of the NHS.

Unlike in 2002, health professionals today are much more supportive of technological change – not least because those trusts that have adopted PEPs and the FDP have seen significant improvements in patient care – and the implementation of these systems is not as top-down as in previous initiatives. The government has also made significant money available. That won’t guarantee success, but it’ll help.

But there’s another, less tangible problem that could yet derail the initiative – too much haste. In one of the multiple assessments of the National Programme for IT in the NHS written in later years, the Saudi academic Taghreed Justinia said that rushing to reap the expected rewards of the project led to unrealistic timetables and poor governance. Pushing too hard for change could have an adverse effect on the success of the new project. As everyone in the NHS knows, a sick patient needs treatment, care and whatever time they need to recover.

Arthur Piper is a freelance journalist. He can be contacted at arthur@sdw.co.uk

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