Wales Is a Decade Behind England — And That's DHCW's Best Programme

Of all the programmes under Level 3 intervention at Digital Health and Care Wales, the Electronic Prescription Service (EPS) is the one with real users, measurable adoption, and visible progress. It is, by any reasonable assessment, DHCW's best programme.

England completed the same programme over a decade ago.

That single fact frames the scale of failure across DHCW's entire portfolio. When your strongest programme is a decade behind a direct comparator delivering the same service to the same kind of health system, the question is no longer whether the organisation is underperforming. The question is by how much.

EPS in Wales: The Numbers

Electronic prescribing went live across all seven Welsh health boards by October 2024. That milestone, presented by DHCW as a significant achievement, meant only that the system was technically available — not that it was being used.

In January 2025, the CEO appeared before the Senedd's Health and Social Care Committee and revealed that just 7% of GP practices were using electronic prescriptions. By May 2025, adoption had reached approximately 50% of community pharmacies and 15-20% of GP practices. Full rollout is targeted for November 2026.

These are not contested figures. They were provided by DHCW's own leadership to the Senedd.

EPS in England: Settled Infrastructure

England's Electronic Prescription Service has been operational for over a decade. It is not a flagship programme or a point of pride. It is settled infrastructure — part of the background fabric of primary care, as unremarkable as email. Hundreds of millions of prescriptions are processed electronically each year. The technology works. The adoption is universal. The debate has moved on to what comes next.

Wales is not attempting to leapfrog England with a more advanced system. It is implementing the same basic capability — electronic transmission of prescriptions from GP to pharmacy — that England delivered years ago. The gap is not one of ambition. It is one of execution.

DHCW's Best Programme Is a Decade Behind

This point bears emphasis. EPS is not one of DHCW's struggling programmes. It is the success story. It is the programme that leadership points to when asked what they have delivered.

If the organisation's strongest achievement is a decade-behind implementation of established technology, what does that tell us about the rest of the portfolio? The answer is in the public record.

OpenEyes (ophthalmology system): Seven years in development, two deadlines missed, £8.5 million spent. Still not delivering the functionality originally specified.

LINC/LIMS (laboratory information management): Eight years, one laboratory partially live, the original supplier contract terminated. A programme that should underpin diagnostic services across Wales, mired in repeated failure.

WCCIS/Connecting Care (social care integration): Eleven years, over £42 million spent, and organisations are actively trying to leave the platform. A programme so troubled that its own users are seeking alternatives.

NHS Wales App: Described in official assessments as "mired in delay, non-delivery." While England's NHS App has millions of active users managing appointments, prescriptions, and health records, Wales has a product that barely functions.

National Data Resource (NDR): Target date of 2030. The organisation responsible for Wales's health data infrastructure cannot currently access its own data in a timely or integrated fashion.

Every one of these programmes is under Level 3 intervention — the Welsh Government's highest escalation level, reserved for systemic delivery failures requiring external oversight.

What England and Scotland Have Built

The comparison is not limited to EPS. Across the full range of digital health capabilities, Wales has fallen behind both England and Scotland.

England has delivered the NHS App with millions of active users, a functioning electronic prescription service that is part of everyday primary care, and FHIR-based integration standards that allow different health systems to share data. These are not aspirational targets. They are operational systems serving patients today.

Scotland has built a national digital platform, with GP IT systems delivering modern functionality and integrated health records accessible across the care system. Scotland's population is comparable to Wales's, which removes the excuse that scale makes delivery easier for larger nations.

Wales has legacy systems, decade-behind adoption rates, no functioning patient-facing app, and no return-on-investment measurement for any programme. The gap is not narrowing. Under current leadership, it is widening.

The Patient Impact

Digital prescribing is not an administrative convenience. It is a patient safety intervention.

Electronic prescriptions reduce transcription errors — the mistakes that occur when handwritten prescriptions are misread by pharmacists. They speed dispensing, reducing wait times for patients who are often elderly or unwell. They enable better medication management, allowing GPs and pharmacists to see a patient's full prescription history and identify dangerous interactions. They support repeat prescriptions without requiring patients to visit their GP surgery in person.

These are not theoretical benefits. They are documented, evidence-based improvements to patient care that have been demonstrated across every health system that has adopted electronic prescribing.

Welsh patients do not have reliable access to these benefits because DHCW could not deliver the system. At 7% GP adoption in January 2025 — more than a decade after England achieved universal coverage — the vast majority of Welsh patients were still relying on paper prescriptions. Every month of continued delay is a month in which avoidable errors occur, patients wait longer than necessary, and medication management is less safe than it should be.

The Cost of Delay

There is a temptation to treat DHCW's failures as embarrassing but ultimately recoverable. Given enough time and money, the argument goes, the programmes will eventually deliver.

This misunderstands the nature of the problem. Technology does not stand still. While DHCW spends years delivering capabilities that other nations completed long ago, those nations are moving forward. The gap is not static. It is compounding.

Every year of delay makes the eventual modernisation more expensive, because the systems being implemented are closer to obsolescence by the time they go live. It makes modernisation more disruptive, because staff and patients have adapted to workarounds that become harder to change over time. And it makes modernisation more difficult, because the technical debt — the accumulated cost of deferred maintenance and outdated architecture — grows with each passing year.

The cost is not just money, though the money is significant. Across the programmes listed above, DHCW has spent well in excess of £100 million with minimal demonstrable return. The deeper cost is in health outcomes — in the patients who receive care supported by inferior digital tools, in the clinicians who waste time on manual processes that should have been automated years ago, and in the health system that cannot use its own data to improve the care it provides.

Wales's patients deserve digital health services that match the best available. Under DHCW's current leadership, they are getting services that trail a decade behind. That gap is not closing. It is the direct, measurable consequence of institutional failure — and it is paid for in health outcomes, not just money.