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Welsh NHS IT programme is ‘outdated’ and could put patients at risk, report finds

Welsh Public Accounts Committee is concerned the country’s outdated NHS IT systems are putting patients at risk, and found the culture at NHS Wales Informatics Service is the ‘antithesis of open’

NHS Wales Informatics Service’s (NWIS) programme to introduce electronic patient records and drive IT uptake across the country needs a reboot as it fails to deliver on its promises, and its outdated IT could put patients at risk, according to the Welsh National Assembly’s Public Accounts Committee (PAC).

The committee’s inquiry into the NWIS programme, which aims to develop and roll out new IT systems across all Welsh health boards, found little evidence that it’s working. Instead, it found “archaic and fragile IT systems which don’t deliver on their promises” and a big culture problem.

Instead of spending time and money on innovation, NWIS spends more on repairing and maintaining old systems, the PAC report said.

Culture problems

The PAC also echoed a report by the Auditor General this year, which found NWIS to be “overly positive” when reporting its progress, despite clear issues.

“The committee’s evidence gathering found examples of this again and again,” the PAC report said. “Troublingly, this mindset seems to be consistent with that of the health boards, and the Welsh government teams working alongside NWIS, as the committee found a collective reluctance to openly discuss the true state of progress.”

“Digital transformation requires an open culture, but the committee found that the culture at NWIS was the antithesis of this.”

The Welsh PAC found reluctance among staff to be critical on the record, and felt that during its inquiries it was “getting a pre-prepared line”.

“If the problems with NHS informatics are to be addressed, an open and honest reflection on the current state of play and the barriers to progress is essential,” the report said.

“Indeed, it is quite possible this culture has prevented the committee from hearing a comprehensive range of issues and problems – in short, we remain unsure of the scale of the issues.”

The Welsh PAC added it is concerned the cultural issue “may be masking wider and deeper problems” which it has yet to uncover.

Outdated IT and infrastructure

One of the issues that did come to light during the inquiry was a key problem with the country’s cancer system, CaNISC. The system, which is used to track the treatment and wellbeing of Welsh cancer patients, is based on software that hasn’t been supported by Microsoft since 2014.

A replacement system has yet to be found as the project to replace it has only just reached business case stage. Witnesses also told the committee that the system is a cyber security risk.

At the Velindre Cancer Centre, part of Cardiff and Vale Health Board, the system went down for three days in August 2018, which led to one patient not receiving chemotherapy treatment.

The report also found that IT systems downtime has been a regular occurrence across the country, with the country’s datacentres seeing outages on average every nine days in the first six months of the year.

“There have been 21 outages of national systems between January and July 2018,” the report said.

“We struggle to understand how NWIS finds itself in this position where it has not made appropriate plans for suitable maintenance of its infrastructure.

“It is symptomatic of a wider concern that the committee has during this work – as we begin scrutinising one area, we find that other, equally serious questions arise elsewhere. As a consequence, we are anxious our scrutiny has merely scratched the surface of NWIS’s problems.”

Read more about NHS IT in Wales

Commenting on the findings, Peter Saul, joint chair at the Royal College of General Practitioners (RCGP) Wales said the findings about the weaknesses in NHS IT were “alarming”.

“Quite clearly, this report raises some alarming findings about the weaknesses of IT in the Welsh NHS, findings which may look familiar to those working in it.

“Today, IT systems are as critical to clinicians as stethoscopes and scanners. Data outages can be extraordinarily disruptive for practices and for patients. They affect appointments, prescriptions and the nuts and bolts of a functioning practice, and can take hours to recover from.

“Unfortunately, these data outages are becoming all too common, leaving GPs scrambling to find solutions or workarounds while waiting rooms fill up,” he said.

Informing Healthcare strategy

NWIS, which is responsible for IT across NHS Wales, was envisioned in 2003, when the country’s Informing Healthcare strategy was launched, aiming to introduce joined-up electronic patient records.

However, they have yet to materialise, and the PAC said it is concerned that by the time NWIS succeeds in its plans, the new IT systems, replacing the already obsolete ones, will also be will be completely outdated.

PAC chair Nick Ramsay, said that when the plan was first launched in 2003, the iPhone hadn’t been invented yet, and Gmail and Skype “were yet to take off”, showing how long ago it was.

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

“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.”

NWIS said it is working with the Welsh government on a response to the PAC review.

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