Performance report
Performance overview
Digital Health and Care Wales (DHCW) is a special health authority transforming the way that digital health and care services are delivered in NHS Wales.
Key facts 2022-2023
Our year in numbers
34,955
practitioners are using the Digital Health and Care Record to gain the best possible joined-up information on patient care
59,000
endoscopy test results viewed by health care practitioners in the Welsh Clinical Portal: enriching the information available for better, safer care
259,000
Consultations for common ailments across community pharmacies in Wales, releasing time for GPs to deal with more urgent patient needs
17,410
monthly users of the Welsh Nursing Care Record: reducing duplication, increasing patient safety and releasing nurses’ time to care for patients
2.5
results and reports generated following x-rays and other digital imaging across NHS Wales: enabling practitioners to diagnose patients and see their results and reports in the digital patient record.
More than
1.8
pain assessments, and over
394,000
assessments for pressure ulcers completed in the Welsh Nursing Care Record: supporting regular management of patients’ pain during their hospital stay
18,840
users of the Welsh Community Care Information System, sharing patient data and information between health and social care for better outcomes
The number of clinical patient documents stored digitally rose from
39
to over
45
that’s 45 million documents that no longer have to be kept on paper
55,000
Welsh residents have their GP record viewed each month in hospital settings, meaning that their practitioner can make better decisions about their care
5,414
users of the Welsh Laboratory Information Management System to process and manage over
38
pathology tests across laboratories in Wales
103
digital services which underpin front line services and enable health and community practitioners’ to treat and care for citizens in with the right information at their fingertips, regardless of geographic location
9
COVID-19 vaccinations enabled by the Welsh Immunisation System, reducing the effect of the virus across Wales
2,484
users of the Welsh Hospital Pharmacy Stock Control System: electronic management of drugs, to reduce waste and increase safety
220,000
calls to our Service Desk, from simple requests to complex issues, with resolution targets to minimise disruption on the NHS
36,307
users of the Welsh Patient Administration System: digital management of hospital appointments and in-patient stays in an efficient and effective way
Our vision
To provide world leading digital services, empowering people to live healthier lives.
Our purpose
To transform health and care for everyone in Wales.
Who we are and what we do
Digital Health and Care Wales is a Special Health Authority with a critical role in transforming the way that health and care services are delivered in NHS Wales.
Established under statute on 1st April 2021, we are funded primarily by Welsh Government and work closely and in partnership with health boards and trusts, primary care, social care, life sciences, industry and academia.
Our aims are to make it easier for staff to deliver care, to enable better patient outcomes and experiences and to help people manage their own health and care.
Our organisation
As a key member of the NHS Wales family our work has demonstrable impact, as seen through the 103 operational services used daily to support health and care and to deliver the single digital health record.
We work with speed and agility to develop new products, to enhance services, and to react to unforeseen digital requirements, as well as delivering against the longer term needs of digital transformation in NHS Wales.
During the year we concluded the recruitment of our executive team and made some new Independent Member appointments to our Board, whilst continuing to refine our vision, missions and delivery portfolios through our strategic plan, which supports the priorities of the Welsh health and care system.
People are at the heart of what we do, so we were proud to win the British Computer Society’s UK Best Place to Work in IT award for 2022 - an accolade for the organisation and all who work for DHCW.
Judges gave top marks for our commitment to diversity and inclusion as well as skills and career development for staff.
Our hybrid operating model means that the majority of our staff work remotely for most of the week, whilst those who prefer to work from the office can do so.
We are structured into seven directorates:
- Digital Strategy
- Operational Services
- Clinical
- Primary, Community and Mental Health Digital Services
- People and Organisational Development
- Finance and Business Assurance
- Corporate Governance and Communications
Our role is to
Support health and care frontline staff with high-quality modern systems and secure access to information about their patients, available wherever they need it
Deliver new digital solutions  that help clinical staff care for patients, including new digital services for nurses, critical care units, hospital pharmacy, prescribing and medicines management and community care
Use data  to provide insights and improve outcomes, as well as to support how health and care services are delivered and accessed by patients
Help the people of Wales manage their own health and recovery from illness, with access to their own digital health record and apps from any device, making it easier to connect with health and care services
Combat cybercrimesupported by a dedicated cyber resilience unit hosted on behalf of Welsh Government
Use digital and data standards by modernising data storage and adopting a ‘cloud-first’ policy
Protect valuable data assets by modernising data storage and adopting a ‘cloud-first’ policy
Provide the resilient technical infrastructure and platform needed, using the highest standards of security, to enable the delivery of digital and data services for health and care in Wales
Strategic priorities
Enabling Digital Transformation
We provide a platform for digital transformation through data protection, infrastructure and information, and by opening up the NHS Wales architecture to enable faster sharing of data with partners and suppliers, supporting joined-up consistent care.
Delivering high quality technology, data products and services
As technology and the needs of health and care evolve, we are developing and delivering standardised services to Wales’ health and care providers, as well as rapidly providing new services to cope with unforeseen situations, whilst also supporting efficiencies and improvements in care processes.
Expanding the content, availability and functionality of the digital health and care record
Clinical and health care information for citizens in Wales is accessible to their care providers through the digital health and care record, when and where needed, helping to improve treatment quality. Moving forward, more elements of the record will become available directly to citizens.
Driving value and innovation for better outcomes and Value-Based care
The need for accurate data for insights and analytics is more important than ever to improve health and care. A data-driven system that increases value in healthcare through timely information to support decision making and better outcomes.
Being a trusted NHS Wales organisation is key to successful delivery of the DHCW vision and achieving all that is expected of us.
Being the trusted strategic partner and a high performing, inclusive, ambitious organisation supporting our workforce and stakeholders.
Being a trusted NHS Wales organisation is key to successful delivery of the DHCW vision and achieving all that is expected of us.
How we do it
DHCW aims to be an excellent employer and a great place to work.
Developing our people is a key part of our strategic missions. Supporting talent development, compassionate leadership, and continuous development is a golden thread running through everything delivered this year and planned into the future.
We launched our People and Organisational Development (OD) Strategy in October 2022, providing a clear signal of the importance of the current workforce and for attracting and retaining new talent.
Our People and OD Vision:
A great place to work where our people are fully engaged, high performing and embody our values and behaviours.
We will achieve this by joining these six themes to shape our workforce.
During 2022-2023 and we have focused on putting the following building blocks in place to support the organisation in becoming:
- an employer of choice
- a learning organisation - supporting qualifications, understanding skills gaps and investing in continuous development, improvement, and skills acquisition
- recognised for its leadership, talent development and culture
- an organisation whose workforce planning supports decision making, recruitment in the right professions, audit and risk management focus, and key skills gap investments
- an organisation committed to developing supportive new ways of working alongside up-skilling managers to work differently with the hybrid working approach, so as to get the best out of everyone’s efforts and achieve high standards of performance both individually and as a team
- an organisation that invests in diverse engagement, partnership working and a culture of listening and learning
- acknowledged as an organisation which has supportive well-being initiatives for all
New workforce policies and strategies developed during the year have been formulated in true partnership with the trade unions and wider workforce, including external stakeholders and networks.
Our culture, values and behaviours
Being a trusted partner is an essential component for successful delivery of our vision and values and in achieving all that is expected of us.
Our leaders are challenged to be emotionally intelligent, to embrace change and seek out innovation and continuous improvement to deliver the outcomes our stakeholders value and want; inspiring and encouraging their teams to do the same.
Values have a positive impact on our identity both internally and externally and are critical to shaping our culture.
Equality, diversity and inclusion
In March 2023 we launched a new Strategic Equality Plan which incorporates organisational anti-bullying and anti-racism commitments. It underpins the importance of equality, diversity, and inclusion for DHCW and includes a range of new commitments to be delivered over the coming years.
Women make up 41 per cent of our employees, and 55 per cent of our Board of Independent Members and Executive Directors. This is above the UK IT industry average of 23 per cent, of which only five per cent hold leadership positions.
Eight per cent of our workforce is from a black, Asian or minority ethnic community and we aim to increase this number.
Embracing difference and including everyone is a fundamental part of developing our workplace community and that means building and developing teams that are diverse and inclusive, regardless of age, gender, disability, sexual orientation, religion, or ethnicity.
We are dedicated to developing an inclusive and diverse organisational culture and a great working environment, where people feel valued, have the opportunity to develop, be heard, and have a clear understanding of the part they play in achieving our vision and outcomes - contributing to our value whilst delivering an unrivalled user experience - which is why, from April 2023 we will have a new Equality, Diversity and Inclusion (EDI) network, supporting and celebrating everyone within the workforce, providing opportunities for input and employee voice.
Strategic workforce planning
Following the Welsh Government Digital Workforce Review in 2022, we will commence the work required to develop the digital profession across NHS Wales, ensuring we are building a workforce for the future.
This will support clear career pathways, consistent job roles and key investment in training and development, the upskilling and developing cutting-edge digital skills, supporting national transformation programmes from 2023 onwards.
Our partnership with the Wales Institute for Digital Information (WIDI) underpins our collaboration with the university sector. A detailed plan responding to the needs of the 2023 workforce planning cycle is being developed to target and support the digital profession across Wales, and to provide robust pipelines of new talent.
Committed to ‘growing our own’ workforce and supporting future generations, we offer learning and development for all DHCW people at all career life stages.
Our commitment to graduates and apprenticeships will further grow in 2023, with learning taken from the strategic workforce planning cycle used to inform our work with the education sector.
Welsh language
The Welsh Language (Wales) Measure established a legal framework to impose duties on certain organisations to comply with standards. DHCW (as the former NHS Wales Informatics Service) was previously required to comply with these Standards as a hosted body of Velindre University NHS Trust.
This requirement ceased with the inception of DHCW who then, as a Special Health Authority with no standards issued, were required to develop a Welsh Language Scheme under the Welsh Language Act 1993. However, we have continued to work to the Standards as we developed our Welsh Language Scheme.
During 2022/23 we worked with the Welsh Language Commissioner to agree our Welsh Language Scheme which commits us to providing a level of Welsh Language services equivalent to the Welsh Language Standards being adopted by similar public organisations in Wales.
The new Welsh Language Scheme aims to:
- provide greater clarity to the organisation on its duties in relation to the Welsh Language
- provide guidance for Welsh speakers about the services they can expect to receive in Welsh
- ensure the Welsh Language is embedded into service delivery and development
Activities undertaken throughout the organisation to actively promote use of the Welsh Language include:
- Development of a multi-disciplinary team, inclusive of Welsh speakers and representatives of all activities undertaken, to ensure compliance. The team is led by the Board Secretary and Welsh Language Services Manager to ensure Welsh language requirements are considered in all existing and new developments.
- Development and implementation of the DHCW Bilingual Skills Strategy
- Development of the DHCW response to the More Than Just Words Task and Finish Group 5-year plan
- Maintaining a service level agreement with NHS Wales Shared Services Partnership for translation services
- Setting up a service level agreement to provide interpretation at livestreamed board meetings
- Supporting the Welsh Language Commissioner with investigations
- Making Welsh language courses available to all staff (from taster level to advanced residential courses
- Further development of the Welsh language SharePoint page to provide guidance for staff wishing to understand their legislative duties and explore opportunities to learn and improve Welsh language skills
- Engagement with new developments such as the NHS Wales App and Maternity
Going forward we are committed to building on our current provision of Welsh language training and activities to promote the use of Welsh in the workplace.
- 96% of staff have updated their Welsh language skills on ESR
- 92% of staff have completed a Welsh language awareness course
- Just Over 12% staff speak Welsh at level 2 or above
- New and Vacant Posts. Number of Jobs were categorised as:
- Welsh Language Skills Essential = 6
- Welsh language skills need to be learnt = 0
- Welsh language skills desirable = 470
- Welsh language skills not necessary = 7
- There were no Welsh language complaints during the period 2022-23
Annual planning framework 2022-2023
In November 2021 Welsh Government published its planning framework guidance, reverting back to a three year Integrated Medium Term Plan (IMTP) to replace the annual plan arrangement of the previous year.
The IMTP was approved by our Board, submitted to Welsh Government at the end of March 2022 and accepted and noted by the Minister for Health and Social Services in July 2022. Feedback was provided by Welsh Government as a set of requirements and accountability conditions, described in our Accountability Report.
Organisational risk and governance
Risk management is a key element of corporate governance that strengthens our ability to achieve our objectives.
Our Risk and Board Assurance Framework Strategy sets out the organisational approach to principal risks to strategic objectives, and how the Board will receive assurance on those principal risks.
This strategy is supported by an organisation-wide risk management system which enables and empowers staff to identify, assess, manage and where necessary escalate risks. More details of this can be found in our Annual Governance Statement.
Key risks to our plan
Operating context
Our plan and objectives are underpinned by legal and policy documents. These include:
A Healthier Wales – the Welsh Government long-term plan for Health and Social Care
Digital Strategy for Wales – Welsh Government’s national vision for jointly adopting a digital approach to modernise public services.
Our plan also represents the requirements of wider Ministerial Priorities and the Programme for Government.
The following diagrams explains how DHCW’s Strategic Missions and Portfolios map to Welsh Government’s Ministerial Priorities and Programme for Government:
DHCW missions and portfolios mapped to ministerial priorities and programme for government
DHCW 2022-23 missions and portfolios mapped to ministerial priorities and programme for government
Develop an ‘open platform’ approach to digital innovation, by responding to national standards for how data, software and technologies work together, and how external partners can work with the national digital platform and national data resource.
Develop an Information Governance and Cyber Security framework, standards and mechanisms that prioritise patient and service user safety and confidentiality, and protect data from external and internal threats, resulting in data remaining secure and NHS Wales being trusted to host patient and service user personal information.
Develop and maintain a high-quality national infrastructure, transitioning to the cloud for better availability, reliability, safety, security, speed and agility.
Becoming the trusted strategic partner and a high performing, inclusive, ambitious organisation
Improving and expanding the content, availability and functionality of the Digital Health and Care Record, agnostic of health board and geographical boundaries and supporting evidence based decision making and connectivity using NHS Wales e-library and Microsoft Office 365 suite.
Develop an Information Governance and Cyber Security framework, standards and mechanisms that prioritise patient and service user safety and confidentiality, and protect data from external and internal threats, resulting in data remaining secure and NHS Wales being trusted to host patient and service user personal information.
Expanding the content, availability and functionality of the digital health and care record
Driving value and innovation for better outcomes and value based care
Delivering high quality technology, data products and services
Develop, operate and maintain a set of high-quality national digital services to support Public Health prevention and early intervention Programmes.
Building digital infrastructure across primary and community care by developing, operating and maintaining a set of high-quality national digital services reflecting new models of local care, closer to home.
Develop, operate and maintain a set of high-quality national digital services to enable new models of planned and unscheduled patient care and management.
Develop, operate and maintain a set of high-quality national digital services to enable the modernisation of diagnostics.
Develop, operate and maintain a set of high-quality national digital services to enable modernisation of medicines management.
Delivering research insights and innovation for service improvement.
Driving value from data for better patient outcomes and service planning.
Quality of services to drive improvements in population health and care
Our contribution to population health and care comes from the digital systems we provide that transform the way health professionals work to care for patients and for people to have greater involvement in the management of their own care. We also support the Value in Health Centre through the collection of relevant data, including outcomes data, which we then combine, analyse and present in a series of condition specific dashboards (such as epilepsy, knee arthroplasty, heart failure, lung cancer). These information products support decision-making in NHS Wales and help to drive improvements in health and care.
All DHCW services are planned according to the wider context of Welsh Government priorities, which take account of trends in health and the expected improvement in patient outcomes. The quality of DHCW’s digital services are monitored through a combination of:
- Service Availability, described later in this report
- Service Management Boards made up of representatives from around NHS Wales, whose role is to ensure that the availability and useability of digital services are meeting their needs
- Health Board and Trust digital leads who monitor the quality of service received in relation to the Service Level Agreements which we hold with each partner NHS Wales organisation
Population needs linked to key NHS themes
The key NHS themes are described below as ministerial priorities and the diagram describes how DHCW’s portfolios map to each priority. Within each of DHCW’s portfolios for 2022-23, there are several initiatives, which fulfil the requirements in transforming the way that NHS Wales delivers health and care through supporting and enabling digital technology.
Governance in Covid-19
As pandemic restrictions eased we returned to business as usual, closing our emergency response structure. However, digital requirements for the vaccination programme continued , and Test Trace Protect contingency services are still in place to support Covid-19, should the need arise; both of these have remained a core part of our delivery for the year.
Wellbeing of Future Generations (Wales) Act 2015
Digital solutions and services contribute to the implementation of the Wellbeing of Future Generations (Wales) Act 2015,which requires public bodies in Wales to think about the long-term impact of their decisions, to work better with people, communities and each other, and to address poverty, health inequalities and climate change.
Our strategic Well-being Objectives
- Globally responsible Embed a sustainable culture to limit the impact on the environment.
- Prosperous Work to strengthen the international recognition of NHS Wales as a Centre of Excellence for digital innovation
- Resilient Improve the health and well-being of the citizens of Wales, helping to sustain a healthy, productive population that contributes to society.
- Healthier Support the sharing of expert knowledge so that the citizens of Wales are better able to access the best possible healthcare when they need it.
- More equal Attract and develop skill and provide opportunities for existing and future generations.
- Cohesive communities Promote a culture of volunteering by creating the conditions for citizens to share their experience and to learn new skills.
- Vibrant culure and thriving welsh language Actively promote the use of the Welsh language.
DHCW will become subject to the Act on 1st April 2024. However, during the year we followed our principles aligned to the Act.
Our role aligns to the digital needs of A Healthier Wales and Welsh Government’s long-term plan for Health and Social Care; the other well-being goals also resonate with our approach and will continue to be developed.
Throughout the year we have reviewed progress against activities for each objective and identified additional activities where necessary.  Some of the key achievements during 2022-23 are: 
We have accelerated the digital transformation of health and care in NHS Wales as the trusted delivery partner for digital health and care services.
We have continued to expand the content, availability and functionality of the Digital Health and Care Record so that care and treatment quality is improved
We have worked with our delivery partners on the plan for Digital Services for Patients and the Public, including the NHS Wales bi-lingual app, which will support the citizens of Wales to take a more active role in their own health and well-being.
We have worked to achieve our Decarbonisation Strategic Delivery Plan roadmap for 2022/23 and gained an understanding of the way in which our digital solutions can contribute to the overall NHS Wales decarbonisation agenda.
We have established a renewed focus in the areas of research and innovation
We have continued to promote and support activities that celebrate diversity and inclusion.
We have continued to promote and support use of the Welsh language and now have an approved Welsh Language Scheme.
We have worked on an all-Wales basis to share best practice and embrace partnership working, including social partnerships.
We have launched a dedicated Microsoft innovation hub for staff.
We have worked with the University of Wales Trinity Saint David (UWTSD) to promote and deliver a culture of embracing change via a new qualification that upskills and empowers staff.