Making IT work: harnessing the power of health information technology to improve care in England

Making IT work: harnessing the power of health information technology to improve care in England
(Also known as ‘THE WACHTER REVIEW’)

Executive summary

In order for the National Health Service (NHS) to continue to provide a high level of healthcare at an affordable cost, it simply must modernise and transform.

This transformation will involve enormous changes in culture, structure, governance, workforce, and training.

But none of the changes are likely to be as sweeping, as important, or as challenging as creating a fully digitised NHS.

Impressively, the English GP sector began digitising in the 1980s, and by the mid-2000’s was nearly 100% digital. By contrast, an ambitious programme to digitise secondary care – the National Programme for Information Technology (NPfIT), launched in 2002 – was shut down in 2011 after having mostly failed to achieve its goals. Analyses of NPfITcriticised the programme for being too centralised, for not engaging with trusts and their healthcare professionals, and for trying to accomplish too much too quickly. A consensus has since emerged that the time has come to move forward, and, in 2016, the Treasury allocated £4.2 billion to support the digitisation of the NHS.

In late 2015, the National Advisory Group on Health Information Technology in England was formed to advise the Department of Health and NHS England on its efforts to digitise the secondary care system. Our recommendations fall into 2 broad categories: 10 overall findings and principles, followed by 10 implementation recommendations.

Overall findings and principles

1. Digitise for the correct reasons
2. It is better to get digitisation right than to do it quickly
3. ‘Return on investment’ from digitisation is not just financial
4. When it comes to centralisation, the NHS should learn, but not over-learn, the lessons of NPfIT
5. Interoperability should be built in from the start
6. While privacy is very important, so too is data sharing
7. Health IT Systems must embrace user-centered design
8. Going live with a health IT system is the beginning, not the end
9. A successful digital strategy must be multifaceted, and requires workforce development
10. Health IT entails both technical and adaptive change


1. Carry out a thoughtful long-term national engagement strategy
2. Appoint and give appropriate authority to a national chief clinical information officer
3. Develop a workforce of trained clinician-informaticists at the trusts, and give them appropriate resources and authority
4. Strengthen and grow the CCIO field, others trained in clinical care and informatics, and health IT professionals more generally
5. Allocate the new national funding to help trusts go digital and achieve maximum benefit from digitisation
6. While some trusts may need time to prepare to go digital, all trusts should be largely digitised by 2023
7. Link national funding to a viable local implementation/improvement plan
8. Organise local/regional learning networks to support implementation and improvement
9. Ensure interoperability as a core characteristic of the NHS digital ecosystem – to promote clinical care, innovation, and research
10. A robust independent evaluation of the programme should be supported and acted upon


We believe that the NHS is poised to launch a successful national strategy to digitise the secondary care sector, and to create a digital and interoperable healthcare system. By using national incentives strategically, balancing limited centralisation with an emphasis on local and regional control, building and empowering the appropriate workforce, creating a timeline that stages implementation based on organisational readiness, and learning from past successes and failures as well as from real-time experience, this effort will create the infrastructure and culture to allow the NHS to provide high quality, safe, satisfying, accessible, and affordable healthcare.

The experience of industry after industry has demonstrated that just installing computers without altering the work and workforce does not allow the system and its people to reach this potential; in fact, technology can sometimes get in the way. Getting it right requires a new approach, one that may appear paradoxical yet is ultimately obvious: digitising effectively is not simply about the technology, it is mostly about the people.

To those who wonder whether the NHS can afford an ambitious effort to digitise in today’s environment of austerity and a myriad of ongoing challenges, we believe the answer is clear: the one thing that NHS cannot afford to do is to remain a largely non-digital system. It is time to get on with IT.