Performance report menu
This section provides a summary of our key achievements, as well as those initiatives which require further time and/or planning to execute.
The achievements cover the twelve portfolios identified within our 2022-23 plan, and thus the main body of work undertaken. Those initiatives which were not completed to plan in-year have been re-planned with stakeholders and will appear in our 2023-24 plan.
During our second year as a Special Health Authority, we strengthened partnerships with Welsh Government, health boards, NHS trusts, Health Education and Improvement Wales, NHS Wales Shared Services Partnership, primary care and other organisations, including local authorities to support the NHS Wales response to the COVID-19 pandemic. At the same time, we continued to maintain and develop core national digital infrastructure and systems, and it is this level of collaboration which we take forward into 2022-23. 
We made key achievements across our 12 portfolios, taking on significant new work programmes. At the same time we continued to support NHS Wales colleagues in recovery via the digital services available to support front-line care, and in moving forward national digital transformation plans. Our annual business plan is an ambitious plan which we flex to enable take-on of additional work in-year, and we achieve this by a continuous exercise of reviewing and re-prioritising workload. Of course this means that there will be some initiatives which are slowed or paused within the period. Those initiatives are noted within their relevant sections below, alongside the achievements that we have made.
Our ambition to achieve an open architecture moved forward with a strategy for the development and delivery of Architecture Building Blocks, the underlying components and interactions needed for a digital health and care record This includes the facility for third parties to develop software in some key areas, using our API Management system.
We published the National Data Resource Data Strategy and the Advanced Analytics Strategy to enable increased capability in the transformation of health and care data. We also procured the National Data Platform, which will underpin access to the data required by the Digital Health and Care Record.
The National Audit Tool roadmap was in our plan for 2022-23, and part of the delivery has been achieved in the period, but there is still more to be done in 2023-24.
As the digital organisation for health and care in Wales, we have a system leadership role to protect the national healthcare network, as well as the vast amount of patient information and data that is stored electronically. We work closely with the National Cyber Security Centre and NHS Wales colleagues to ensure digital systems are resilient and secure.
Working with colleagues across DHCW, our Microsoft 365 (M365) team reacted quickly to a cyber-attack which affected an NHS Wales digital supplier. The M365 team worked with our applications teams to deliver a time-critical business continuity solution to support users of the 111/GP Out of Hours service impacted by the cyber-attack on the supplier’s system. Our Business Change team quickly developed training materials and worked closely with stakeholders to ensure that the business continuity solution could be adopted with minimum disruption.
To ensure sustainability we will continue to adopt cloud computing services using a cloud-first approach for both new and existing products and services. 
Working towards our goal of cloud-first, we have made significant progress in to optimise our cloud implementation, and within this we have made savings which will equate to almost half a million pounds per year. In addition to this, our new data centre facility (due to go live in 2024), will release further efficiencies.
To drive creative digital innovation across NHS Wales and support staff in using the M365 platform, we launched the NHS Wales Microsoft 365 Centre of Excellence (CoE).
Hosted within DHCW, the CoE aims to boost successful, sustainable improvement projects across NHS Wales by developing and sharing knowledge and ideas through best practice.
Alongside more familiar tools such as Teams, Word and SharePoint, the CoE supports colleagues to make use of the Microsoft Power Platform, which includes Power Apps, Power BI and Power Automate. It enables staff to build apps, aid data capture, automate processes, and report business information to meet clinical and management requirements.
The NHS Wales e-Library procured a new collection of 400 e-books of medical, educational and career-building reference material, providing even more evidence tools to NHS Wales and social care staff.
Content was selected through collaboration with librarians across NHS Wales along with Welsh Government and provided though EBSCO Information Services and Browns Books - the UK's leading supplier of books and e-Books for schools and libraries.
By the end of 2022-23, more than 35k health professionals across Wales were using the Welsh Clinical Portal. The Welsh Clinical Portal provides access to the patient electronic health record by collating patient information from several sources, supporting clinical workflow and enabling health professionals to make safer, better clinical decisions.
Welsh Clinical Portal provides audited access to all blood tests, radiological imaging, referrals, outpatients letters, allergies and adverse reactions, patient warnings, discharge summaries, the GP summary records and care events. We continue to identify gaps in the electronic health record content and work to collect more patient care information to enhance the completeness of the available digital offering to health care professionals in NHS Wales.
To streamline and reduce unnecessary outpatient appointments in secondary care we introduced GP e-Advice functionality in the Welsh Patient Referral System which enables clinical advice and guidance conversations to take place between GPs and hospital doctors, often removing the need for some patients to attend hospital.
We continue to make user-designed improvements to help modernise Outpatient services – this is a core Welsh Government priority. Outpatient attendances data is now collected in NHS Wales’ Data Hub which is used to store and present key information to decision makers across NHS Wales and Welsh Government.   
We have worked closely with Velindre Cancer Centre (VCC) for some time as part of the modernisation of cancer services. The solution to support service delivery uses the Welsh Clinical Portal and the Welsh Patient Administration System (WelshPAS) to hold critical patient information about the patient’s care and treatment pathway.
The much-anticipated implementation of Digital Health and Care Wales’ WelshPAS in VCC went live in January 2023. WelshPAS holds patient identification details, and records details of patients’ hospital visits, including waiting list management, medical records, inpatient treatment, outpatient appointments and emergency visits.
Implementation of WelshPAS in VCC forms part of DHCW’s wider ‘Cancer Programme,’ established to implement a Cancer Informatics Solution for Wales to replace the current Cancer Network Information System Cymru (Canisc).
Moving VCC onto the national architecture and aligning one of their key operational systems with the rest of Wales brings significant benefits including:
This achievement was the direct result of the commitment, determination and effort from all involved, as well as collaboration and team working across the two organisations. Early feedback has been incredibly positive with users praising the improved access to clinical information that the new system provides.
The solution to support cancer service delivery uses the Welsh Clinical Portal and the Welsh Patient Administration System (WelshPAS) and we have worked in partnership with Velindre Cancer Centre (VCC) and the cancer network as part of the modernisation of cancer services.
DHCW is working with colleagues across NHS Wales to replace the paper documents that nurses currently use with a digital alternative. The award-winning Welsh Nursing Care Record (WNCR), which will complete roll out in 2023, is changing working practices and enabling nurses to spend more time caring for patients.  
Two years of the Welsh Nursing Care Record
The Welsh Nursing Care Record (WNCR) has captured more than 3.9 million inpatient nursing notes in just under two years.
The digital system has transformed the way nurses record, capturing 3.9 million nursing notes in under two years and has more than 13,000 monthly users. It has also seen 3.3 million digital risk assessments completed between April 2021 and February 2023
In terms of risk assessments, more than 1.8 million pain assessments have been completed, with more than 394,000 for skin pressure ulcers and more than 223,000 for falls.
Rather than making notes on paper at a patient’s bedside, nurses are using tablets to capture information and store it securely in the WNCR so that care givers along a patient’s healthcare journey have access to the same, up-to-date information.
Digital Health and Care Wales is working with colleagues across NHS Wales to replace the paper documents that nurses currently use with a digital alternative. This uses standardised nursing language, which improves accuracy and makes it easier to share information between settings.
By going digital, healthcare workers can access essential information to make informed decisions about a patient’s care, no matter where that care is taking place. There is no need to search for paper notes or ask the patient to repeat information they have already given, as the documents can be easily accessed in the WNCR.
An electronic record designed specifically for diabetes patients has been heralded by health professionals working with diabetes patients as “game changing”.
One dietitian has spoken about how the Digital Diabetes Consultation Note (DCN) is saving her time, as she no longer must write back to referring nurses or consultants.
Victoria Oldham, a diabetes specialist dietitian in Cwm Taf Morgannwg Health Board, explained: “I can update the note and know that other relevant health professionals will also have access to it. As well as being more effective because all the information is in one place, it also saves an awful lot of time.”
The note is accessed via the Welsh Clinical Portal and used to record, view and share diabetes patient information.
Dr Gautam Das, a diabetes consultant, has been using the DCN since it was trialled at Prince Charles Hospital in 2019.
He said: “It’s a game changer. It brings about a paradigm shift in the way we manage diabetes and maintain patient records.”
The DCN is available for health professionals for diabetes care including dietetics, podiatry and antenatal in hospitals in Swansea Bay, Cwm Taf Morgannwg and Hywel Dda University Health Boards.
A new digital service that ‘puts healthcare at your fingertips’ will make it easier for the citizens of Wales to interact with health and care. The NHS Wales App went through extensive testing during the year prior to moving into a phase whereby members of the public were invited to join in testing activity in early 2023.
Available on smartphones, tablets and computers, it is a key development in the Digital Services for Patients and the Public Programme, which will help people in Wales to access better healthcare and support health providers to deliver care more efficiently.
As part of the Private Beta testing, over 500 repeat prescriptions were ordered, over 3,400 records viewed and 100 GP appointments booked.
Continued development of the WIS included cross-border UK-wide and overseas vaccination data. These enhancements help to create a more accurate record for people who received their vaccinations outside their residential area, by including a full vaccination history which can be accessed by clinicians where required. A further release of WIS delivered both Welsh Language and two-way texting, meaning people who record Welsh as their preferred language, can receive timely and accurate information in Welsh.
The Welsh Immunisation System (WIS) has administered 8.9 million vaccinations since the beginning of the pandemic and 1.1 million vaccinations during the 2022 winter programme from September to December. Wales is the only part of the UK to have developed a digital vaccine management solution using an existing in-house software team.
The team from DHCW worked with partners, including Welsh Government, Health Boards and Trusts to provide the digital solution for the management, distribution, and reporting of the COVID-19 vaccination programme.
The system uses information on patient demographics, occupation groups and agreed priority levels for receiving the vaccination to schedule appointments for patients. It also tracks vaccine stock, creates appointment slots, sends out appointment letters, and records details about each vaccination for every Covid 19 vaccine administered in Wales.
Hospital prescriptions can now be transferred electronically to the patient’s choice of community pharmacy. This means the pharmacist can easily carry out a Discharge Medicines Review of the patient’s medication following a stay in hospital.
The Welsh Community Care Information System (WCCIS) is a digital service for nurses, mental health teams, social workers and therapists to help them work better together. It enables access to relevant information on care provided and shows where a patient is with their treatment and care plan.
Benefits include quicker hospital discharge, fewer missed appointments, accurate records, safer care, time and cost savings, clinical safety through data sharing, decrease of record duplication, improved service delivery, reduction in unnecessary hospital admissions and improved patient experience.
WCCIS is now live in 19 organisations across Wales, with Aneurin Bevan University Health Board being the latest to join, with over 3,000 users. A pilot with a large cohort of district nursing professionals also began in Betsi Cadwaladr in 2022.
Choose Pharmacy is a secure digital platform to support patient consultation workflow in community pharmacies. It enables the pharmacists to provide free NHS care for minor ailments, a contraception service, an emergency medicines supply, flu vaccinations, discharge medicines reviews and support for independent prescribers.
Pharmacists who are qualified as independent prescribers, can prescribe for any condition within their clinical competence and record that information on the patient’s digital Choose Pharmacy Record. This service provides access to the patient’s Welsh GP Record to support the pharmacist’s clinical decision making. In 2022-23 there were over 259,000 consultations for common ailments across community pharmacies in Wales.
The table below indicates what patients would have done, had they not gone to their community pharmacy for a consultation:
Community pharmacists in Wales are using a bacterial detection service to encourage patients to screen against infections.
Choose Pharmacy’s Sore Throat Test and Treat service (STTT) promotes antimicrobial stewardship by using a stepwise approach of a clinical examination by a pharmacist and, for patients who meet the criteria, an on-the-spot sore throat swab service to screen against bacterial infections.
If bacteria are not detected, the sore throat is probably caused by a virus - meaning antibiotics will not help. Results from the throat swab are provided in minutes, and if a bacterial infection is present and the patient can be helped by antibiotics, they may be supplied by the pharmacist.
Antibiotics are only supplied after the pharmacist discusses benefits and possible harms, including antibiotic resistance.
Results are sent digitally to the patient’s GP via Choose Pharmacy, the digital infrastructure that Digital Health and Care Wales developed to support provision of services in community pharmacies in Wales.
In 2022-23 there were over 28,000 STTT consultations across community pharmacies in Wales.
WelshPAS is the primary source of administrative data for patients in secondary care. It holds patient identification details and records details of patients’ hospital visits, including waiting list management, medical records, inpatient treatment, outpatient appointments and emergency visits.
The much-anticipated migration of data from Betsi Cadwaladr University Health Board (west) Patient Information Management System into the central instance of WelshPAS successfully went live in May 2022, with an additional 2,800 users, now totalling over 6,800 users across the single instance.  This forms part of a phased programme of work to consolidate the three separate patient management systems in Betsi Cadwaladr into a single instance of WelshPAS across the health board – this is the largest implementation of a Patient Administration System in Wales since 2013.
The development of a single instance of WelshPAS in BCUHB will streamline the care process and enable up-to-date and accurate information to be available to clinical and clerical colleagues for service delivery across the health board.
The 2022-23 plan included other initiatives in the Planned and Unscheduled Care portfolio, but some of these, including roll-out of the Emergency Department system, integration of Eye Care into the national architecture, and the Intensive Care system, were subject to delays. These are now part of the 2023-24 plan.
Digital Maternity Cymru was pleased to recently announce Ministerial approval and £7m of funding for a five-year work programme that will digitally transform maternity services for women and clinicians in Wales.
Health Boards currently use a combination of different digital and paper systems, however several recent reviews of maternity services in Wales and the UK have called for the creation of a unified digital system.
The new maternity system will be underpinned by a standardised clinical framework incorporating data, care pathways and women’s information. It will integrate with the core Welsh NHS digital infrastructure and form part of the single clinical record for Wales.
Digital Health and Care Wales (DHCW) will procure and implement this new digital maternity system. It will allow healthcare professionals across every health board in Wales to share vital information more quickly, supporting safe, effective and consistent maternity services wherever women choose to access care.
Women will also have digital access to their personal maternity record, where they can contribute details important to them and receive relevant health advice and reminders. They will only need to share their key information once
DHCW has taken on leadership of NHS Wales’ two key new diagnostics programmes, the Laboratory Information Network Cymru (LINC) and the Radiology Informatics System Procurement (RISP), which will modernise the digitisation of diagnostics reporting. These programmes transferred to DHCW on 1st January 2023.
Transfer of the programmes and staff was an important step in aligning major new digital systems with NHS Wales national healthcare technology and data services, delivered and operated by DHCW.
The new arrangements will enable DHCW to better manage the implementation of these programmes as core business.
Endoscopy results from Swansea Bay University Health Board and Powys Teaching Health Board are now available in the Welsh Clinical Portal ensuring vital endoscopy information is available across organisational and geographical boundaries. The integration of the Powys endoscopy system data was the first time a cloud-based clinical system has integrated with our results repository. Endoscopy data is also available for Cwm Taf Morgannwg and Hywel Dda University Health Boards.
Clinicians treating a patient who has had an endoscopy test in these Health Boards, can now see the result in WCP regardless of their NHS Wales organisation. This gives the clinician more clinical information to inform decisions and potentially reduces the number of duplicated tests. A total of twelve hospitals are now reporting endoscopy results across Wales, with over 59,000 endoscopy results viewed in WCP by health care practitioners, across Wales Health Board boundaries during the financial year. 
The Digital Medicines Transformation portfolio is delivering a fully digital prescribing approach in all care settings in Wales. The portfolio brings together four programmes to make the prescribing, dispensing and administration of medicines everywhere in Wales easier, safer, more efficient and effective.
Following an independent review into electronic prescribing in Wales, Eluned Morgan MS, Minister for Health and Social Services set out her ambition for a comprehensive digital medicines plan for Wales:
The Digital Medicines Transformation Portfolio coordinates four areas of work.
Electronic signing and transfer of prescriptions from GPs and non-medical prescribers to the community pharmacy or appliance dispenser of a person’s choice.
The programme engaged with key stakeholders including GP suppliers and Community Pharmacy system suppliers’ in August 2022 to review requirements with a proof of concept in summer 2023.
Implementing e-prescribing and medicines administration (ePMA) across all of NHS Wales’ hospitals. Sending outpatient prescriptions to the person’s pharmacy of choice. A multivendor framework for e-prescribing in secondary care (ePMA) has been established by DHCW on behalf of NHS Wales health boards and Velindre University NHS Trust.
Using the NHS Wales App to share and collect medicines information, order repeat prescriptions and nominate a person’s pharmacy of choice.
Building a single shared record of medicines for every patient in Wales so that all the information is in one place.
These work streams will modernise and digitise medicines management, reducing environmental waste, cost and time whilst increasing accuracy for patients and NHS staff throughout Wales. The shared medicines record design has been re-scheduled into the 2023-24 plan.
DHCW’s Board has approved a Research and Innovation strategy that builds collaboration with partner organisations across Wales in the areas of improvement, innovation and research in health and social care.
Research and innovation can increase the effectiveness and efficiency of healthcare and can support healthcare organisations and services to provide better care for people.
National Data Dashboards, developed with the NHS Wales Value in Health programme, combine and visualise a wide range of information relating to patient clinical outcomes, secondary care activity, case mix variables, mortality, and socio-economic factors, for many different clinical areas.
These innovative dashboards are being used by clinical teams, special interest groups, clinical networks, support functions and other stakeholders to inform better decision making.
Working in partnership with Powys County Council we brought health and social care data together in a ‘proof of concept’ data hub to apply visualisations which underpin the data requirements for A Healthier Wales. 
Electronic Test Requesting (ETR) usage data:
A dashboard that contains the secondary care usage data for blood science and microbiology Electronic Test Requesting (ETR) – this enables health boards to monitor the use of ETR, compared to paper test requesting, and the results are available at hospital and ward level, replacing the manual methods previously used, saving time and providing better visibility of the data.
A Result Notification dashboard is being piloted by Betsi Cadwaladr University Health Board. When the results of pathology or radiology tests are authorised, the relevant consultant is notified that the result has been authorised and that it needs to be signed off in the Welsh Clinical Portal.  The new dashboard summarises the test results from the last 30 days and enables drilldown into individual records. A key benefit of the dashboard is that it enables consultants to view and sign off their patients’ test results more quickly, improving patient care and reducing the risk of potential harm from delayed review of the patient test results.
GP Data Activity Quality Improvement Project introducing analysis of GP activity:
A data extraction is enabling appointment data to be available in the Primary Care Information Portal (PCIP) for use by GP practices. It enables GPs to start their Quality Improvement (QI) process of standardisation and improved data quality.
The mapped appointment data has been analysed with visualisations and is being made available within the PCIP at the Practice, Cluster and Health Board level. This activity has supported the delivery of the Quality Assurance and Improvement Framework (QAIF) and the contractual requirements for Access Standards, and this is the first time in Wales that this type of analysis has been made available.
A monthly data flow from the National Joint Registry, contains data on patients treated in Wales, and on Welsh residents treated in English hospitals. Views can be created to feed back to health boards and linked to data within the Knee and Hip Arthroplasty dashboards.
Phase Two of the Knee Arthroplasty Dashboard has been released to include data on Patient Reported Outcomes and further exploration into the outcomes of knee arthroplasty.
Quality is at the heart of what we do, in how we carry out our business, in the systems we produce and in the data we provide. Integral to this is a quality approach in the development of products, systems, and services, demonstrated through the adoption of internationally recognised and trusted standards.
We have presented our quality strategy and plan and have invested in iPassport to support the document management process. DHCW is now preparing for the introduction of new regulation in relation to medical devices.
Members of the public are entitled to request information from public authorities. This includes information about themselves (Subject Access Requests) or information held by public authorities (Freedom of Information Act and Environmental Information Regulations requests).
DHCW is required to respond to any requests in line with the requirements of the legislation, including responding within statutory timeframes.
From April 2022 to March 2023, DHCW received 51 requests under the Freedom of Information Act 2000.
98% of Freedom of Information Act requests were responded to within the statutory timeframes. One request was responded to outside of the statutory timeframe.
DHCW also received seven Subject Access Requests and three requests from police and other agencies, which were all responded to within this time period.