Ambitious vision for Welsh Community Care Information System still a long way from being realised

Wednesday, October 14, 2020 - 1:15pm

Implementation and roll-out is taking much longer and proving more costly than expected.

Despite efforts to accelerate implementation of the Welsh Community Care Information System (WCCIS) across health boards and local authorities, the prospects for full take-up remain uncertain. There are also some important issues that still need to be resolved, including around how the system functions. This is according to a report published today by the Auditor General for Wales.

WCCIS was developed to enable health and social care staff to deliver more efficient and effective services using a shared electronic record. The system has been developed for use across a wide range of services for adults and children and to move away in some cases from paper records. The report acknowledges that the WCCIS programme is complex and ambitious, requiring various organisations to collaborate at a national, regional and local level.

The intention for the system was that all seven health boards and twenty-two local authorities in Wales would implement it through a contract signed in March 2015. As of 31 August 2020, 19 organisations were using WCCIS or had signed deployment orders, with four in active negotiation and six yet to commit. Of the 19 organisations, 13 local authorities and two health boards had gone live. Alongside today’s report a data tool provides further detail on the roll-out position across the 29 organisations.

The report found that there are differences in how organisations are choosing to deploy WCCIS. This is currently limiting opportunities for integrated working and raises other value for money issues. Also, key aspects of the expected functionality have been significantly delayed, although this includes certain enhancements to the original contractual requirements. Following work to establish a clearer timeline, the current estimate is that the remaining updates will be delivered on a phased basis through to the end of 2021. The WCCIS National Programme Team has also needed to address some concerns about system performance.

The costs for implementing and rolling out the system have also been more than expected, and additional investment has been needed to support related service transformation. To date, just over £30 million has been spent or committed to March 2022 by the Welsh Government and NHS Wales Informatics Service (NWIS).  There have been further costs met from health board and local authority budgets. It has not been possible to provide a reliable overall estimate but it is clear that these run into several millions of pounds.

One key element which requires further development is a set of national data standards to ensure organisations input data in a consistent way. This work is at different stages across different service areas. The COVID-19 response has highlighted the importance of this work and showed that this is possible given enough focus. Meanwhile, work is still ongoing to develop a suitable framework for reporting on the benefits of WCCIS implementation.

The report makes a number of recommendations on the overall management of the WCCIS national programme. These include:

  • taking stock of expectations for further roll-out of the system and likely costs.
  • pulling together a clear national picture on feedback from front-line users about the performance and general functionality of the system.
  • considering how relevant lessons can be applied to any successor contracting arrangements and wider public procurement.

The potential benefits of a shared electronic record across health and social care are clear to see; even more so given some of the challenges presented by the COVID-19 pandemic. 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.

Adrian Crompton, Auditor General

Notes to Editors:

  • The data tool which has been published alongside the report can be found here. Appendix 2 provides an overview of roles and responsibilities for WCCIS implementation.
  • There was an initial estimation that all local authorities and health boards could be using the system by the end of 2018, although the timescales were not binding. It was anticipated that the detailed plans would be completed in negotiation with the supplier and participating organisations.
  • WCCIS has the potential to cover the following service areas: social care services for adults, children and families, social care financial services, child and adolescent mental health services, child community services, adult and older mental health and other community services. See the report’s ‘Key Facts’ for more detail.
  • The Auditor General is the independent statutory external auditor of the devolved Welsh public sector. He is responsible for the annual audit of the majority of the public money spent in Wales, including the £20 billion of funds that are voted on annually by the Welsh Parliament. Elements of this funding are passed by the Welsh Government to the NHS in Wales (over £8 billion) and to local government (over £4 billion).
  • The audit independence of the Auditor General is of paramount importance. He is appointed by the Queen, and his audit work is not subject to direction or control by the Welsh Parliament or government. 
  • The Wales Audit Office (WAO) is a corporate body consisting of a nine member statutory Board which employs staff and provides other resources to the Auditor General, who is also the Board’s Chief Executive and Accounting Officer. The Board monitors and advises the Auditor General, regarding the exercise of his functions.
  • Audit Wales is the umbrella name for the Auditor General for Wales and the Wales Audit Office. Audit Wales is a registered trademark, but it is not a legal entity in itself.