NHS Wales ‘struggling with digital transformation’

Martin Shipton

NHS bodies in Wales are struggling to turn hundreds of millions of pounds of spending on digital technology into meaningful change, according to Audit Wales.

A briefing paper, to be presented to members of the Senedd’s Public Accounts and Public Administration Committee on September 28, states: “We found that most NHS bodies have clear digital ambitions but can struggle to convert them into meaningful change.

“There are examples of successful digital innovation, but funding pressures, ageing systems, and workforce gaps are holding progress back. At the same time, NHS bodies remain reliant on wider national programmes being delivered in an effective and timely way.

“NHS bodies also need to manage growing cyber risks. And they need to make good but safe use of new technologies, such as Artificial Intelligence (AI). They must also make sure digital change does not leave anyone behind.

“Such issues are not unique to the NHS, but they are especially important given the scale of NHS spending and how widely NHS services impact people across Wales.

“Our work raises important questions for the Welsh Government and NHS bodies, if they are to turn their digital ambitions into reality:

How will NHS Wales build and maintain the systems, workforce capability, and funding required to achieve its digital ambitions?

How will NHS bodies show that digital investment is making a difference for patients, staff, and services?

How can NHS bodies make sure digital change does not leave some people behind?

How will NHS bodies oversee digital risks and emerging technologies effectively?

How can accountability for national digital programmes be made clearer between the Welsh Government, Digital Health and Care Wales (DHCW), and NHS bodies? And how could delivery be improved?”

Digital ambitions

Audit Wales found that while NHS bodies have clear digital ambitions that broadly align with the national strategy, most have not translated these ambitions into clear, costed delivery plans with defined actions, responsibilities and success measures.

Also, not all NHS bodies have assessed their digital maturity. As a result, some do not have a clear understanding of their starting point or the full scale of change needed to achieve their goals.

Without clear delivery plans and a strong approach to measuring benefits, digital ambition might not lead to better services or value for money.

Boards of NHS bodies might also struggle to track progress, costs and risks. This might make it harder for them to know whether digital investment is delivering the intended change.

The paper says the balance between spending on day-to-day demands and digital change is an issue.

Across 2023–24 and 2024–25, 11 of the 12 NHS bodies reported spending a combined average of around £216m a year on their own digital technology and services.

This included the seven health boards, three NHS trusts and Health Education and Improvement Wales.

Most of the spending reported by the 11 NHS bodies went on keeping existing digital services and systems running rather than investing in digital change.

DHCW spent an average of around £191m a year over the same period. But its figure is not directly comparable with the other NHS bodies.

DHCW’s main role is delivering digital systems, digital infrastructure and data services for NHS Wales. For other NHS bodies, digital is only one part of a much larger budget.

Within that £191m, DHCW recharged NHS bodies around £66m a year for national products and services.

Financial pressures

The paper states: “Wider financial pressures make up-front investment in digital change even harder. Digital services and projects compete with other demands on spending.

“In what can be a ‘catch-22’ situation, many NHS bodies still rely on ageing systems that are costly to support and difficult to connect to newer technology. This makes it harder to share information between services and slows the introduction of new digital tools.

“Although some funding has been made available specifically for digital investment, it is not enough to meet the demand across NHS Wales. Also, capital funding to replace old technology and introduce new systems is often short term. This makes it difficult for NHS bodies to plan and deliver long-term projects.

“Delivering national programmes needs national and local NHS bodies to work together effectively. But this does not always happen in practice. Some NHS bodies feel they are not always involved early enough in programme planning to make sure local pressures and needs are fully understood by everyone involved.

“Some also pointed to the impact of delays. These mean they have to keep older systems in place for longer, increasing costs and risks.

“But successful delivery depends on more than national programmes being delivered on time. Local NHS bodies also need enough staff, skills, processes and capacity to put them into practice.

“Cyber security remains a major risk because cyber-attacks can disrupt services, expose information, and affect patient care. Older technology, cyber-security workforce and training gaps, and changing threats, also add to the risk.

“Boards discuss cyber risks regularly. Some NHS bodies have also completed self-assessments against national cyber-security standards. But progress addressing the gaps these assessments identify has been slow and keeps the risk high.

“AI offers significant opportunities for NHS Wales. NHS bodies are exploring how it could support daily work, improve services, and make better use of resources. But they are still developing their approaches to using AI safely, ethically, and consistently.

“Without getting this right, bodies may struggle to balance benefits with risks to patient safety, data protection, and public trust.

“NHS bodies do not generally know enough about the digital skills of their staff. We found that take-up of a national self-assessment tool is very low. Across NHS Wales, only around 2% of staff have completed it.

“NHS bodies told us that they do not widely promote the tool because it is optional. They also questioned its value because it focuses mainly on basic IT and digital confidence, rather than the wider skills needed for digital change. Some NHS bodies have achieved higher uptake of locally developed tools to assess digital skills and identify training needs.

Recruit

“NHS bodies also struggle to recruit and retain specialist staff in areas such as cyber security, data analysis, and digital project delivery. This is especially true where the private sector can offer more attractive roles.

“Many NHS bodies also have limited capacity to provide training and develop specialist skills. Although a small number have started to build long-term digital workforce plans, most rely on short-term initiatives.

“Small digital teams can also mean key work depends on one person. This reduces resilience and leaves less capacity for improvement and innovation alongside day-to-day work.

“The Senedd’s Public Accounts and Public Administration Committee is scoping an inquiry into NHS digital. We will be supporting any inquiry and briefing the committee on findings from our recent work. We will also be tracking NHS bodies’ responses to our recommendations.”

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