You can read these reports on our website. This article draws out some key themes from our work. It also sets out challenges now facing the Welsh Government and NHS Wales.

Digital transformation in the NHS

Digital transformation means using technology, data, and new ways of working to change and improve health services.

But it takes more than technology to deliver digital change well. NHS bodies also need a clear digital plan, skilled staff, strong leadership, effective governance, secure systems and sustainable funding.

Digital change is a priority for NHS Wales. The Welsh Government's 2023 Digital and data strategy for health and social care sets the national direction. It aims to modernise health and care services through improved digital services, stronger use of data, and better information sharing. It also promotes a ‘Once for Wales’ approach, where shared platforms and common ways of working are used where they add value.

Questions for the Welsh Government and NHS Wales

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?

Our findings

Digital ambition is clear, but delivery needs to be better

NHS bodies have clear digital ambitions that broadly align with the national strategy. But 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.

And 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.

Board support for digital change was clear in the NHS bodies we reviewed. NHS bodies are also helping boards build their digital skills. But the digital landscape is moving on quickly, and it is easy for boards to fall behind. So, NHS bodies will need to keep investing in board development to make sure members have the skills, knowledge and confidence needed to oversee and challenge digital work.

Digital change must not leave people behind

People must be at the heart of digital change. Effective digital change depends on whether people can access, understand, and benefit from new services and ways of working. If digital change makes services easier for some to use but harder for others, it could widen inequalities rather than improve care for everyone.

All NHS bodies recognise the importance of digital inclusion. But some are further ahead than others, with dedicated digital inclusion leads and plans. We also found examples of digital projects that actively considered digital inclusion, in areas such as mental health and maternity services. In future, NHS bodies will need better ways of showing that their digital change projects are improving access for those most at risk of exclusion.

The balance between spending on day to day demands and digital change is an issue

The full picture of NHS spending on digital change is hard to identify. NHS bodies record digital spending in different ways, and the available figures do not capture all digital activity. For example, they exclude some staff time and programme costs outside core digital teams. 

Across 2023-24 and 2024-25, 11 of the 12 NHS bodies reported spending a combined average of around £216 million 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 eleven NHS bodies went on keeping existing digital services and systems running rather than investing in digital change (see Exhibit 1).

Exhibit 1: combined average annual reported expenditure on digital services and systems across 11 NHS Wales bodies (excluding DHCW), 2023-24 and 2024-25

Source: Audit Wales

Note: Figures are as reported by the 11 NHS bodies and exclude DHCW. NHS bodies record digital spending in different ways, and the figures do not capture all digital activity. They might also include contributions to national programmes led by DHCW.

DHCW spent an average of around £191 million 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 £191 million, DHCW recharged NHS bodies around £66 million a year for national products and services. Some of those recharges might also be counted in the spending reported by the other NHS bodies. So, the two figures should not be added together to give a total for NHS Wales. We have not tried to work out a single overall figure as part of our work.

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.

National programmes can support change, but have not been moving quickly enough

National digital programmes help NHS bodies make better use of technology. There is wide support for the ‘Once for Wales’ approach. NHS bodies report benefits from shared systems, common platforms, and regional collaboration. But the approach is not always applied consistently, especially when NHS bodies want to move more quickly or develop their own responses to local needs and priorities.

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.

NHS bodies need to keep pace with cyber risks and AI

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.
 

Workforce skills and capacity are falling short

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.

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.

What’s happening next

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. And we have indicated plans for some further work on national systems.

We also conduct an annual programme of audit work at DHCW. We have recently reported on DHCW's approach to planning, prioritising, and delivering the actions set out in its 2025-26 and 2026-27 remit letters from the Welsh Government.

All this comes at a time when the Welsh Government is looking to improve the delivery of digital transformation across NHS Wales. This includes refreshing the Digital and Data Strategy for Health and Care. We understand that work NHS Wales Chief Executives have commissioned on a framework for digital services will be part of what informs the strategy refresh.

The Welsh Government is also taking action in response to concerns about the delivery of national programmes led by DHCW.