We are particularly concerned at the apparent lack of openness and transparency across the whole system. Digital transformation requires an open culture, but the committee found that the culture at NWIS was the antithesis of this. The auditor general’s report identified a pattern of the organisation being 'overly positive' in reporting its progress. The committee’s evidence gathering found examples of this again and again. 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. 

We also found that witnesses were reluctant to be critical of progress or arrangements on the record. Some written evidence from two parts of the NHS was remarkably similar and the committee was left with the impression that we were getting a pre-prepared line. As a result, the committee could have little confidence in many of the assurances that we were given by NWIS and the Welsh Government. If the problems with NWIS are to be addressed, then an open and honest reflection on the current state of play and the barriers to progress is essential. Indeed, it is quite possible that 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.

We are concerned that neither NWIS nor the Welsh Government are fully ready to openly recognise the scale and depth of the problems. The committee is concerned that this cultural problem may be masking wider and deeper problems, which we did not uncover. We believe a fundamental change in behaviour from NWIS and the wider NHS digital team is required if progress is to be made.

The committee is deeply concerned about the slow pace of delivery of modern informatics systems across the NHS in Wales and the underlying weaknesses in support and oversight arrangements. It's apparent that nobody is happy with the current state of affairs and nobody seems willing to take responsibility for the challenges. NHS bodies are frustrated with the slow roll-out and problems with systems they have, and are concerned about confused accountabilities. NWIS is frustrated at the lack of direction from the wider NHS. However, for us, the greatest frustration is that digital can improve the NHS and it is not being utilised anywhere near enough. A simple example is that electronic records lead to better patient care and outcomes, but in too many cases, the NHS relies on outdated paper-based records. 

The committee found little evidence to show that the need to increase the pace of change had been picked up. The chief executive of NHS Wales’s acceptance of the Wales Audit Office report, which was published in March 2018—and in a letter to this committee, he referred to the 18 months of work undertaken. This suggests that the initial evidence was gathered approximately two years ago in September 2016. Now, the committee recognises that, while the auditor general was undertaking his work, the Welsh Government and the wider NHS were taking steps to begin to address many of the issues. Nonetheless, we remain concerned about the pace and urgency of action, as we saw little evidence of change.

Our report not only endorsed the findings of the Auditor General for Wales and the parliamentary review, but also made five recommendations of our own. We welcome Welsh Government’s acceptance of these recommendations and its commitment to a number of reviews to look at informatics and the development of a national informatics plan. However, we were disappointed that the response, yet again, did not seem to recognise the committee’s deep concerns about the slow pace of delivery of new informatics systems across the NHS in Wales. There still appears to be little recognition of the radical overhaul that is required and the urgency with which this needs to be delivered. We seem to be stuck in a long period of review with little change.

We note that the outcomes of the reviews will lead to change, but this needs to be achieved at pace as informatics in NHS Wales have failed to keep up with modern technology, and every day, staff within the NHS are struggling with systems that simply do not work. It simply is not good enough and the complacent attitudes of those tasked with delivering these systems in NHS Wales need to change. They must be open to the change that is needed and recognise that so far, the approach has not delivered.

The Welsh Government’s reviews and national informatics plan are scheduled for completion within six months, at which time we expect an update of the latest position regarding the plan. We will also wish to seek assurances that the Welsh Government and the wider NHS will act with the necessity needed to put in place the resources and practical changes required to improve informatics in the right timescale. We've invited relevant officials to attend a committee meeting later this year, in July, to provide us with a full progress update and to share with us the outcome of the reviews being undertaken. We sincerely hope that the committee’s report will kick-start the process of improvement and deliver to the people of Wales a modern ICT system to better deliver health services in Wales.