Health chiefs want to spend nearly £500m putting people’s confidential medical history onto a connected NHS medical system, a new report by Wales’ top financial watchdog has revealed.

WalesOnline reports the Auditor General for Wales detailed the difficulties that were preventing health services scrapping traditional paper health records. It revealed that despite millions having already been spent, the NHS in Wales estimated that it would cost £484m on top of its existing budget to digitise health records. And it warned that “the cost estimates could be optimistic” and there was no clear vision where the money would come from. It also revealed that spending on IT services had been falling significantly since 2010 as the NHS faced cuts and was “some way below recommended levels.”

Health chiefs believe that putting patients records onto computers would stop records becoming lost and make it easier for medics to understand a patient’s history. They say a fully digitised system would reduce mistakes, speed up treatments and make the system run more efficiently.

But report found the project is “inherently challenging” because the NHS is such a complex system. The report states “There is a widespread recognition that progress towards the patient record has been slower than expected. The NHS has never set a formal deadline by which time it expected a full record to be in place. However, there is widespread disappointment across the NHS that the vision has not yet been realised, nearly 14 years after the NHS committed itself to developing an electronic patient record.”

Although slow, the report states there has been some progress in setting up electronic patient records. A Welsh Clinical Portal has been created which makes test results, transfer of care documentation, theatre notes, referral and outpatients’ letters available wherever the patient receives care. Other positive examples in the report included the Wales Clinical Communication Gateway, which allows information to be sent between primary and secondary care staff, and the National Intelligent Integrated Audit Solution which tracks exactly who is accessing patient data.

But the report found that there is still no system for electronic prescribing and will never achieve its goal of a fully electronic system by its original target date of 2021. The report said “There are still informatics systems within NHS bodies that do not communicate with each other or the national systems so the patient data cannot be shared and viewed electronically.”

NHS Wales has estimated that the cost of achieving the vision of a fully electronic patient record system currently stands at £0.5bn, although the Welsh Government and NHS bodies have not yet committed to providing the funding. At present the Welsh NHS spends less than 2% of its funding on ICT.

The report also highlights that there is “widespread frustration” among NHS bodies that the NHS Wales Informatics Service (NWIS), which was set up to deliver technology and digital services in the Welsh NHS, is juggling too many projects and developing new systems without fully implementing existing ones. It found a lack of independent scrutiny of NWIS, that lines of accountability need to be clearer, and that reports on progress and performance have tended to be overly positive and did not paint a balanced picture. And out of thirty current projects currently being implemented by the NWIS only seven are rated as “green” on milestones being achieved, with nine facing “significant delay.”

The report said “NWIS staff also reported some frustration at what they saw as a lack of direction and engagement from health boards, particularly clinicians, in designing and rolling out new systems. These frustrations are, in our view, having a significant negative impact on the relationships between NWIS and NHS bodies.”

Auditor General, Huw Vaughan-Thomas, said “We know that better access to information leads to better outcomes for patients and fewer mistakes by clinicians. Putting the vision of an electronic patient record into practice means all parts of NHS Wales, including Welsh Government, need to take some tough decisions, particularly on funding, priorities and enabling clinicians to have the time and space to lead on this agenda. Unless it addresses the issues identified in my report, the NHS risks further frustration amongst frontline staff and ending up with systems that are already outdated by the time they are completed.”

Vanessa Young, Director of the Welsh NHS Confederation, said the Welsh NHS need high quality informatics systems to support the delivery of health and care services in Wales. She said “The right technology will improve efficiency, enable the significant change required to services, and help people better manage their own health and wellbeing. Creating an electronic record for every patient, that can be accessed by all services across the NHS in Wales must be an absolute priority for the service. To achieve this, the obstacles and challenges highlighted in the Auditor General’s report have to be addressed. Welsh Government must work with the NHS to agree clear actions and an effective delivery plan, and ensure that the funding needed is in place to create an electronic patient record within a realistic timeframe. This will require the integration of existing informatics systems, which is challenging but key to improving our system-wide performance. Work needs to be done to establish common standards across the systems, including social care, to enable effective integration. It is import ant that clinicians and IT specialists have the capacity and skills to collaborate on system design so that technology solutions meet clinical needs, resulting in the best outcomes for patients.”

Chairman of the National Assembly for Wales’ Public Accounts Committee, Nick Ramsay AM, said “This report from the Auditor General paints a mixed picture on progress in rolling out the informatics systems that a modern NHS needs. It is good that the NHS is putting in place many of the building blocks of an electronic patient record. However, it is clear that the NHS needs to do better in the way it prioritises and supports the development of new systems, including through effective leadership and improved governance arrangements. The Public Accounts Committee has already taken an interest in informatics as part of its work on medicines management and hospital catering and will consider the wider issues raised by the Auditor General’s report shortly.”

A Welsh Government spokesman said “We will respond in full to the report in due course. However, we recognise the value of IT in a modern, efficient NHS and as the report recognises we have a clear vision of how we want to make best use of IT and deliver real benefits and improved outcomes for patients. Despite severe pressure on our budget we continue to invest in IT infrastructure for the NHS in Wales.”