Our Decarbonisation action plan for 2023/24 was successfully completed. Our environmental annual trend is positive, with operational emissions reduced by 43% (1,166tCO2e) in Quarters 1 - 3 2023/24, compared to our baseline year of 2019-20. Our full year footprint for 2023-24 will be available by the end of Quarter 1 of 2024-25. We continue to monitor emissions in multiple areas to ensure we are actively reducing CO2 levels.

The NHS Wales Decarbonisation Strategic Delivery Plan shows how NHS Wales can contribute to climate recovery and the Wellbeing of Future Generations (Wales) Act 2015. The act addresses long-term challenges such as poverty, health inequity, and climate change.

As a digital organisation, we have a unique opportunity to help reduce carbon emissions within the larger NHS by developing and enhancing digital solutions. These include tools to enable the digital transfer and storing of information, as well as remote consultation services.

Carbon emissions are a key measure of our environmental impact. Our carbon footprint is calculated as the total greenhouse gas (GHG) emissions produced by our activities and services, expressed as carbon dioxide equivalent.

In 2019/20, DHCW (as its predecessor organisation) measured emissions for the first time. We refer to this year as our baseline. Most of our carbon footprint that year was attributed to gas (18%) and electricity (80%). Our operational emissions during 2019/20 were 2757 MtCO2e (Metric Tons of Carbon Dioxide equivalent).

In our current reporting year (2023/24), figures for Quarter 1 – 3 show operational emissions have continued to decrease, largely due to our estates rationalisation work, as a result of hybrid working. This allowed DHCW to vacate premises at Pontypool and we anticipate further reductions in 2024/25.

The below table features data from quarters 1 – 3 in comparison to our baseline year, which so far show a 43% reduction in operational emissions.

Please see the DHCW Decarbonisation Action Plan for further information.

We follow the TCFD-aligned disclosure application guidance, which is tailored for the UK public sector. We see climate change as a major risk, so we comply with the TCFD's guidelines and disclosures set out in phase 1 regarding:

General principles (including scoping)

Governance recommendation and recommended disclosures (a) and (b); and

Metrics and Targets recommended disclosure (b) – where data is available.

DHCW plans to follow the next phases of TCFD in line with central government’s timeline.

Please use this link to find out more.

As a national NHS organisation, it is vital that DHCW delivers strong and proactive communications to raise the profile of its work and build its role as a trusted strategic partner with a reputation as a system leader for digital health and care services.

In September 2023, following wide engagement across DHCW and with our partners, a new communications strategy was approved by DHCW’s SHA Board.

The strategy identifies a proactive approach to communications with five strategic aims designed to support our staff, build our relationships with stakeholders and establish DHCW’s reputation as a trusted strategic partner. The strategy is supported by a yearly action plan, with most of the first year’s actions already achieved.

In terms of raising our profile, we are building DHCW’s brand identity with the launch and roll-out of new branding across the organisation. We have also been developing case studies of work where we are delivering for partners. There has been continued directorate communications support to gain insight and develop stories about team achievements. This directorate approach has also resulted in communications advice and support being given to teams to support them in their work. We have continued our successful delivery of events, including two Ministerial visits, a Senedd event and continued presence at major industry events such as Rewired and HETT, as well as securing presence at new events.

The communications team has also continued to build on our internal communications to support staff, working with People and Organisational Development to share key information for staff, and building on our internal events programme. Our internal events regularly receive high levels of attendance and are helping to build relationships and information share across the organisation. We also created a new and highly successful ‘Festive Thank Yous’ campaign at Christmas time to provide an opportunity for staff to celebrate the work of their colleagues, and we have hosted regular events where staff can come together, including the first hybrid staff briefing in December.

In terms of our stakeholder communications, joint planning sessions are now being held between the communications and engagement teams to share information about stakeholders and their needs. We have undertaken a series of joint workshops with the engagement team to support DHCW’s programmes with a co-ordinated approach to communications and engagement, based on understanding stakeholders’ needs. Workshops with more teams are planned. The DHCW Engagement and Communications Network is now established and meets regularly. Guest speakers from partner organisations are attending the network to share good practice and information.

We have also upskilled the communications team in digital communications and can now produce digital content in-house. We are undertaking improvements to both SharePoint and the website following a review of these channels and an increase in specialist skills within the team. We have delivered training and information to DHCW staff as well as NHS Wales communications leads on best practice for digital communications.

Some key indicators of success in our communications work include:

Record levels of attendance at staff briefings

A waiting list for some of our internal events, including TENTalks

Consistently high levels of engagement across our digital and social channels – which are higher than those we benchmark against

Both the communications and engagement teams are being approached by teams across DHCW to support them in developing their communications and engagement work

High staff engagement in key areas such as opinion surveys

In terms of next steps, we will be focusing efforts on completing the outstanding actions within this year’s plan and developing the action plan for year two of the strategy.

Digital Health and Care Wales uses the following definitions to categorise incidents clinical incidents:

Clinical incident: “Unexpected or unintended incident associated with DHCW products and services that could have or did lead to harm of one or more patients receiving NHS / Social funded care”.

Serious clinical incident: “A clinical incident that prevents or threatens to prevent an organisation’s ability to continue to deliver health or social care services, for example, significant disruption to services due to a failure of an IM&T system, actual or potential loss or damage to property, reputation or the environment”.

We also use the definition of a serious incident, now referred to as a Nationally Reportable Incident, provided by the Nationally Reportable Patient Safety Incident Policy (June 2021): “A patient safety incident which caused or contributed to the unexpected or avoidable death, or severe harm, of one or more patients, staff or members of the public, during NHS funded healthcare.”

During the past year, five clinical incidents were logged. Two of these incidents were escalated to Welsh Government as early warning notifications due to initial assessments indicating the potential for patient harm. No patient harm has been identified in relation to any of the incidents, and there were no requirements to trigger the Duty of Candour.

Our Clinical Informatics Professionals are registered health professionals who play an important role in ensuring the safety, assurance and development of national systems. They draw on their clinical expertise as end-users and engage with national clinical networks.

We have developed our Clinical Informatics and Business Change Strategy 2023-2026. The strategy includes a framework to guide how clinical input and the Business Change team can shape the development and deployment of our products. Including these perspectives will strengthen and maintain high standards of clinical quality within our Product Operating Model and Portfolio Management Office.

The health service in Wales is facing significant challenges and digital is crucial to driving forward the transformation needed to address these challenges.

The digital landscape is evolving rapidly and presents its own challenges: increasing cyber threats, supply chain disruptions, varying availability and affordability of digital resource, and tackling outdated technology.

That is why our plan places a strong focus on how digital and data can help manage the significant pressure on healthcare services and improve patient outcomes. We are committed to working in the open and our Integrated Medium Term Plan (IMTP) sets out our plans, risks and challenges clearly. This transparency supports our commitment to being a trusted strategic partner.

In 2023/24 we refined our missions and portfolios to align more closely to Ministerial Priorities and the IMTP Framework. We developed new and revised portfolios to highlight our commitment to open architecture and standards, as well as infrastructure investment and our increased activity in primary and community care. Throughout the IMTP period of 2023-26, we effectively managed our key pressures and risks and identified upcoming work.

Our annual business plan is an ambitious, comprehensive plan covering our portfolio of change initiatives for the year. To enable DHCW to respond to changing priorities and new requests for additional work in-year, we enact a robust change control process to ensure close management of the plan and our deliverables. While this means some initiatives may be slowed or paused, it enables resources to be focused on the highest priority initiatives which deliver the most benefit to NHS Wales.

We successfully achieved 87% of our IMTP milestones through carefully managing funding, resource constraints and other complexities within the system.

A strong operating model is essential for delivering our vision and strategic objectives. This is underpinned with an effective Performance Management Framework and clear lines of responsibility and accountability at a team and individual level.

DHCW’s operating model is set out in our Standing Orders and Standing Financial Instructions.

The Performance Management Framework outlines how performance is managed through a hierarchy of directorates, departments and groups, overseen by DHCW’s Management Board, and assured by the DHCW Board.

Performance is centred on three main areas:

Plans which articulate requirements and expected outcomes

Resources to deliver the plans and achieve the outcomes

Outcomes of achieved plans, and how they relate to the development of the individual, team, department or organisation

DHCW understands the need to embrace risks to achieve our strategic objectives and delivering value to stakeholders. Each risk is carefully considered using a methodical approach to ensure control is maintained. Our Board ensures that our exposure to risks remains within acceptable limits, with regular reviews for adjustments as circumstances evolve. Any deviations from our risk tolerance undergo a governance process to ensure transparency and effective management. Some risks may be accepted beyond our usual limits if they are deemed unlikely, offer significant potential rewards, are deemed too costly to mitigate compared to potential impacts, have a limited exposure window, or require external parties to mitigate.

1. None

   Hungry

   Risk with rating 25 of above are escalated for consideration to report to the Board
2. Development of Services

   Open

   Risk with rating 20 of above are escalated for consideration to report to the Board
3. Corporate Social Responsibility

   Moderate

   Risk with rating 15 of above are escalated for consideration to report to the Board
4. Financial, Reputational Safety and Wellbeing, Service Delivery Reputational, Information - Access and Sharing

   Cautious

   Risk with rating 12 of above are escalated for consideration to report to the Board
5. Compliance, Information - Storing and Maintaining, Citizen Safety

   Adverse

   Risk with rating 9 of above are escalated for consideration to report to the Board

In our IMTP 2023/26, we identified our main areas of risk as:

Cyber Protecting against cyber-attacks is critical to ensure the availability and safety of our digital solutions. This year we procured the National Security Information and Event Management (SIEM) system for NHS Wales and invested in other areas to protect NHS Wales from cyber security threats.

Suppliers We are reliant on supplier capacity to support our key systems. We need to be confident that delivery timescales are not at risk, and suppliers remain focused on an NHS Wales roadmap and requirements.

Digital Inflation Increased costs from digital service suppliers could impact our ability to balance finances.

Sustainable Funding There are key funding risks including the requirement of additional funding in year 1 and sustainable funding for future years to support evolving service models and growth. These could impact on delivery of new systems and the continuity of our operational services. Additionally, uncertainties about future income from service level agreements with other NHS organisations add complexity, including the transition of major programmes from Welsh Government digital priority investments into business as usual. This year, we completed an initial assessment of service and product costs and their accompanying funding. We are working closely with the Welsh Government on the future funding model state.

Resourcing There is a risk of not filling vacancies in a timely manner. Some digital skills are in short supply and posts are difficult to fill. We set up a Strategic Resourcing Group which enables monitoring of resource requirements at an organisational level to minimise resourcing risks.

Legacy issues There is still legacy infrastructure which needs upgrading across the estate. Any focus away from this means new systems could sit on sub-optimal infrastructure which could delay rollout and have a reputational impact due to instability. This year, we migrated to a new data centre, recruited 5 of 6 staff to the Cloud team and developed a Cloud economic case. We also implemented a Cloud PC solution, commenced cloud migration assessment scans and continued to reduce legacy infrastructure.

Complex Interdependencies Integrating digital systems in health and social care is extremely complex. This can result in unexpected delays which may be difficult to mitigate, for example, when systems are provided by third parties. This year we published our API roadmap and delivered 6 priority APIs.

Although the DHCW Special Health Authority is not covered by the Putting Things Right (PTR) Regulations, we follow the recommended response and guidance set out under PTR Regulations. We take our responsibilities and accountabilities seriously and aim to ensure that our responses to concerns raised are cohesive, measured and timely.

We have robust monitoring metrics and systems in place. This allows us to promptly alert our board to emerging issues and provide assurances. We also maintain a dedicated learning group to ensure proactive measures are in place to address any deviations from our expected standards.