Welsh shared electronic record project is far from realising ambition, says auditor
Welsh Community Care Information System roll-out, originally due in 2018, is taking longer and costing more than expected, and the prospect of a full take-up among local organisations is still uncertain
Audit Wales has raised concerns around the roll-out of the Welsh Community Care Information System (WCCIS), highlighting issues around functionality, costs and timelines.
The aim is for the single shared electronic record system to be used by all 22 local authorities in Wales, as well as the country’s seven health boards.
But a report by the Welsh auditor has found that despite efforts to accelerate the process, the prospects for full take-up and benefits realisation “remain uncertain”.
“Some important issues around the functionality of the system, data standards and benefits reporting are still to be fully resolved,” the report said.
The Welsh government signed the contract with supplier CareWorks for WCCIS in March 2015, and the original aim was for the system to be live in all councils and health boards by the end of 2018.
“The initial March 2015 full business case estimated that successful implementation for the whole of Wales could take up to four years to achieve,” said the report. “Estimated dates, that were also reflected in the contractual documents, suggested that all 29 organisations could be using the system by December 2018.
“Of these, 11 organisations were identified for potential go-live in 2015-16 and nine in 2016-17. These timescales were not binding. It was anticipated that the detailed development and implementation plans would be completed in negotiation with the supplier and participating organisations.”
However, as of 31 August 2020, only 13 of the 22 local authorities and two of the seven health boards had gone live with the system.
The auditor’s report added: “However, ‘live’ can mean different things. Differences in how organisations are choosing to deploy WCCIS currently limit opportunities for integrated working and raise other value-for-money issues.”
It added that even where the system is live, “it is not yet being used to its full potential”.
“This, in turn, raises questions about the overall value for money of the expenditure to date,” the report said. “Some organisations’ service charge costs are slightly lower than the costs they were incurring using previous systems. Nevertheless, the contractual framework means that all are essentially paying service charges for functionality that they are not currently using, albeit to different degrees.”
When Wales awarded the contract in December 2014, CareWorks, which had predominantly provided social care systems, intended to use two subcontractors, including one supplier, Advanced, which would provide the health board functionality. However, between the contract award and the signing, CareWorks changed its mind and no longer involved Advanced.
“We have been unable to confirm whether those responsible for the contracting process considered the impact of this change on CareWorks’ ability to deliver the required health functionality, some of which remains outstanding,” said the auditor’s report.
According to Advanced, it withdrew because it felt the system requirements could not be delivered within the timeframe and cost that had been proposed. However, in late 2019, Advanced bought CareWorks.
The original contract timescale was for eight years from March 2015 for the master services agreement, which set out the overarching terms and conditions under which local organisations would implement the system.
But the report said: “It has been clear to the national programme team since implementation in Bridgend County Borough Council in 2016 that the system lacked some of the contractually agreed functionality. A November 2017 Gateway review found that the national programme team and CareWorks had different views about whether the issues identified were part of, or enhancements to, the original contractual requirements.
“In mid-2018, the national programme team began work to identify a definitive list of the functionality that remained outstanding.”
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In March 2019, the team identified that 157 of the 1,500 items set out in the requirements had not been delivered, and that the supplier’s service desk was not operating properly, the system was not supporting performance reporting as expected, and updates to fix longstanding problems that live organisations were experiencing were failing testing.
The report said the national programme team issued CareWorks with a contractual non-conformance notice and sought to remedy the situation. “After a further six months of dialogue, in November 2019 the national programme team and CareWorks agreed a timeline, or roadmap, for delivering the outstanding and enhanced functionality over four updates through to September 2020,” it added.
So far, Wales has spent or committed just over £30m on the system, but the auditor warned that further capital costs are possible.
Partly because of the Covid-19 pandemic, the go-live of the first of four planned updates to the system was delayed until mid-July, which again impacted the timeline for further updates, including enhanced mobile functionality.
“However, the continuing impact of the pandemic put the plan to complete all four updates by January 2021 at significant risk of delay,” said the report. “The current estimate is that the updates will be delivered on a phased basis through to the end of 2021.
“In addition, arrangements have needed to be confirmed for longer-term operational support for the system platform. It has been known since 2018 that WCCIS is based on a version of a Microsoft platform that will not be supported after July 2021.”
Auditor general Adrian Crompton said the potential benefits of a shared electronic record across health ans social care “are clear to see – even more so given some of the challenges presented by the Covid-19 pandemic”.
He added: “However, the Welsh government’s ambitious vision for WCCIS is still a long way from being realised. It now needs to work with the various organisations involved to take stock of expectations for the remainder of the contract term and the resources and wider commitment needed to support progress.”
The auditor called on the Welsh government, the programme team, health boards, local authorities and the supplier to work together to produce an updated business case that takes into account costs and sets out expectations for further roll-outs, as well as to make sure organisations have the capacity needed to support implementation and can prioritise against a “clearly agreed plan”.