£207,100 to Hear the Truth — Then They Buried It

In 2024, Digital Health and Care Wales commissioned Atos Healthcare Consulting to conduct an independent review of how its stakeholders perceived the organisation. DHCW paid £207,100 for the work — £200,000 for a "Stakeholder Engagement" contract and £7,100 for a separate "Stakeholder Intelligence" engagement. The resulting report, titled Digital Health and Care Wales: Stakeholder Review 2024, was based on 292 survey responses and 30 semi-structured interviews across NHS Wales, Welsh Government, local authorities, primary care, social care, and other sectors.

The title page of the report is marked "for external use."

It was never published.

The report was obtained by a private citizen through a Freedom of Information request (reference 6195807). What it contains is one of the most comprehensive independent assessments of DHCW's performance and reputation ever produced — and it describes an organisation that the people who depend on it find slow, inconsistent, confused, unresponsive, and closed.

This article presents the findings. Every statistic and every quotation is drawn directly from the Atos report. The report speaks for itself.

Download the full Atos report (PDF, 8.4MB) — the complete Digital Health and Care Wales: Stakeholder Review 2024, as obtained through FOI.

The methodology

Atos used a concurrent mixed methods design: an online survey of 292 respondents conducted alongside 30 semi-structured interviews. Respondents were drawn from across the health and care ecosystem in Wales:

This is not a self-selected online poll. It is a structured, independently administered survey of the professional community that DHCW exists to serve, supplemented by in-depth interviews. The sample is dominated by NHS Wales respondents — the clinicians, managers, and informaticians who interact with DHCW's systems and services daily.

What 292 people said

Nobody knows what DHCW does

Only 17.2% of respondents said they had a thorough understanding of what DHCW does. While 57.2% reported at least a general overview, that means the remaining 42.8% had less than a general understanding of the organisation's function — and 12.4% said they knew nothing at all about what DHCW does.

When the question shifted from what DHCW does to what it aims to achieve, the picture worsened. Only 28.9% said they understood what DHCW aims to achieve as an organisation.

Clinical staff were significantly more likely to be unsure about DHCW's missions — the people whose daily clinical decisions depend on DHCW's systems were the least clear on what the organisation was trying to accomplish.

Almost nobody speaks highly of DHCW

Only 13.3% of respondents spoke highly of the organisation.

When asked to describe DHCW in their own words, the most common descriptors were "Slow," "Inconsistent," and "Confused."

The only positive descriptor that appeared with any frequency was "Collaborative" — a word that sits awkwardly alongside the statistical reality that follows.

Working with DHCW is a struggle

43.2% of respondents found it challenging to work with DHCW.

42.8% felt uninvolved in policy and strategy development — shut out of the decisions that directly affect their services.

50.4% believed DHCW did not understand their work.

Half of the people DHCW serves feel that the organisation does not understand what they do.

38.6% rated DHCW as "not responsive."

Only 28.4% found DHCW's communications "clear."

Impact is uncertain — or negative

When asked about DHCW's overall impact, 44% rated it positively, 19.9% rated it negatively, and — perhaps most tellingly — 25.2% said they did not know. A quarter of DHCW's stakeholders cannot say whether the organisation has any positive impact.

On DHCW's individual missions, Mission 5 had the highest negative impact rating at 34.2% — more than a third of respondents judged it to be having a negative effect.

Many stakeholders have disengaged

58.2% of respondents engage with DHCW monthly or less frequently. Only 41.8% engage weekly or more. For an organisation whose stated purpose is to serve as a collaborative partner across NHS Wales, this level of disengagement is a structural problem, not a scheduling issue.

What they said in interviews

The 30 semi-structured interviews add texture to the statistical findings. These are direct quotations from the Atos report.

On DHCW's identity and coherence:

"They say things that are contradictory to my understanding of them. When I think I've got it, they say something different."

"Every leader has a different take on who they are, and I don't think they have a cohesive vision and clarity on who they are."

On decision-making and transparency:

"Sometimes it feels like decisions might be happening within a closed executive level internally within DHCW and presented as a fait accompli to others."

"DHCW is perceived as a siloed organisation, with decisions occurring independently rather than as a cohesive entity."

On working practices:

"I always come away with the impression that DHCW is working on everything internally."

"There are a few incidents where the corners can feel a little bit scattergun."

These quotations describe an organisation that is confused about its own identity, closed in its decision-making, siloed in its operations, and incoherent in how it presents itself to the people it is supposed to serve.

What Atos recommended

The report produced six thematic recommendations, each with specific actions:

1. Foster Collaboration & Partnership
2. Enhance Active Listening & Responsiveness
3. Promote Transparency & Effective Communication
4. Clarity of Roles & Responsibilities
5. Optimise Efficiency & Simplify Processes
6. Advance Interoperability & System Integration

Among the recommended actions: create access routes for stakeholders with business partner support; define and document DHCW's role in relation to other organisations; conduct stakeholder mapping for all programmes and services.

These are not radical proposals. They are the basics of organisational management. The fact that an independent consultancy needed to recommend them — at a cost of £207,100 — tells its own story about the gap between what DHCW claims to be and what it actually is.

What DHCW did with the findings

In March 2025 — months after receiving this report — the Welsh Government escalated DHCW to Level 3 (Enhanced Monitoring), for "serious concerns about the organisation's ability to effectively deliver a number of major programmes." Nine programme areas were placed under formal scrutiny simultaneously.

The escalation happened while DHCW held a report that diagnosed precisely the organisational dysfunction the Welsh Government was intervening to address. There is no evidence that DHCW shared the Atos findings with Welsh Government, the Senedd, or the stakeholders who had participated in the review.

The disconnect between the report's findings and DHCW's internal response is striking. According to an anonymous account received by CareNHS from a person present, the Atos report was presented internally to senior DHCW leadership by the CEO as a success — a cause for self-congratulation rather than reflection. No meaningful consideration was given to why the organisation needed to improve. A report in which only 13.3% of stakeholders spoke highly of DHCW, and in which the most common descriptors were "Slow," "Inconsistent," and "Confused," was repackaged internally as validation. This account, if accurate, describes an organisation that can receive a diagnosis of serious dysfunction and convert it — through the filter of its own leadership — into evidence of achievement.

The Atos report recommended enhanced transparency and communication.

DHCW's response to a recommendation for transparency was to not publish the report containing it.

The report recommended enhanced active listening and responsiveness. At the January 2026 public accountability meeting — more than a year after the report was delivered — CEO Helen Thomas admitted: "We don't have an ROI on all of our investments." The accountability gap the stakeholders described remained unaddressed.

The report recommended clarity of roles and responsibilities. Nine programmes — all under the same leadership — were escalated to Level 3 government intervention simultaneously.

Audit Wales has noted that DHCW had "only begun implementing" the Atos recommendations. The report's six themes addressed precisely the organisational dysfunctions that subsequently manifested in the Level 3 escalation. DHCW received an early warning from its own commissioned review. Whatever implementation was underway, it was not sufficient to prevent the most serious level of government intervention.

The diagnosis the evidence confirms

The Atos findings do not exist in a vacuum. They empirically validate concerns that others have raised through entirely independent channels.

A former Chief Clinical Information Officer at a Welsh Health Board, who held senior clinical digital leadership roles including at national level, has described DHCW's governance as fundamentally compromised. In their account, a Wales Audit Office progress report was "a work of fiction" and the CEO's appointment was "clearly destined" for the eventual appointee — raising, in their assessment, questions about the integrity of the recruitment process.

An anonymous submission from within the NHS described DHCW's leadership as "the most toxic leadership system I've worked in" and reported being bullied into signing service-level agreements.

Another anonymous submission, from an individual with knowledge of a Kainos engagement, reported that contracted work was "fully discarded and restarted by permanent staff" — external expertise procured and then wasted.

A programme manager at a fellow NHS Wales body has called for "greater transparency," "stronger management accountability," and "more effective listening mechanisms" — echoing, almost word for word, three of the six Atos recommendation themes.

The FOI requester who obtained the report described the findings as "a complete car crash for DHCW."

When an independent consultancy, a former senior clinician, frontline NHS staff, external contractors, and a fellow NHS Wales body all reach the same conclusion through different routes, the diagnosis is not in dispute. The question is why an organisation that commissioned an independent assessment confirming these concerns chose not to publish the findings.

This site's Leadership Analysis applies six established academic frameworks — Edmondson's psychological safety, Padilla's toxic triangle, Collins's Level 5 leadership, Deci and Ryan's self-determination theory, Senge's learning organisation, and Morrison and Milliken's organisational silence. The Atos data provides empirical corroboration for every one. An organisation where 50.4% of stakeholders feel their work is not understood is not psychologically safe. An organisation where 42.8% feel shut out of strategy is not a learning organisation. An organisation where only 13.3% speak highly of it — and whose leaders each offer "a different take on who they are" — is not exhibiting Level 5 leadership.

The suppression pattern

The decision not to publish this report is consistent with a documented pattern of information suppression at DHCW.

Zero whistleblowing data published. No annual figure for the number of disclosures received, their categories, or their outcomes. An organisation of approximately 1,200 staff, under Level 3 intervention, publishes nothing whatsoever about whether its whistleblowing processes function.

Zero disciplinary data published. No information on proceedings initiated, categories, outcomes, or the seniority of individuals involved.

Zero leavers analysis published. No data on departures by grade, department, or reason. No published exit interview themes.

CareNHS website blocked across NHS Wales and inside Welsh Government. A website containing only publicly sourced accountability material — Senedd proceedings, Audit Wales reports, Welsh Government letters — blocked as though it were a threat.

FOI requests initially blocked on a technicality. In March 2026, DHCW initially refused FOI requests filed by this campaign — not on substance, but citing the use of a campaign name rather than an individual's. CareNHS is an Unincorporated Association with full legal standing to make FOI requests. After challenge, DHCW accepted the requests, which are now in processing — but the initial refusal delayed them by weeks.

The Atos report was marked "for external use" on its title page. It was not published. This non-publication joins a documented pattern: block the website, refuse the FOIs, publish nothing voluntarily, and when you commission an independent review that tells you the truth, do not share the findings with the stakeholders who provided them.

Full documentation of this pattern is available on What They Don't Publish.

The irony

While this report sat unpublished inside DHCW, this campaign was filing its own Freedom of Information requests asking many of the same questions: How does DHCW spend public money? What do stakeholders think of its services? What are the outcomes of its programmes?

DHCW initially refused every one of those requests — on a technicality, without assessing a single question on its merits. The requests were accepted only after challenge, and are now in processing weeks later than they should have been.

Throughout this period, DHCW held a £207,100 independent assessment that addresses, in considerable detail, many of the same accountability questions. The organisation that delayed engaging with the public's transparency requests had already paid to find out the answers — and was sitting on the results.

What this means for the incoming Senedd

Wales goes to the polls in 2026. The next Senedd will inherit responsibility for an organisation that:

• Paid £207,100 for an independent review and did not publish the findings. The report was marked for external use. It was never externally released. It was obtained only through FOI.

• Was told by 292 of its own stakeholders that it is slow, inconsistent, confused, unresponsive, and closed. Only 13.3% spoke highly of it. 50.4% said it does not understand their work.

• Received six specific, actionable recommendations and had, per Audit Wales, "only begun implementing" them before being escalated to Level 3 government intervention.

• Publishes no whistleblowing data, no disciplinary data, and no leavers analysis. The mechanisms that should detect internal problems produce zero public information.

• Blocks a public accountability website from its own network and refuses FOI requests on procedural technicalities.

• Spends in excess of £78 million per year while its CEO admits she "cannot demonstrate a return on investment."

The Atos report is not an opinion piece. It is a structured, independently administered survey of the people DHCW exists to serve, combined with in-depth qualitative interviews, conducted by a professional consultancy at a cost of over two hundred thousand pounds. Its findings are clear. Its recommendations are specific. And its non-publication — despite being marked for external use — tells the incoming Senedd everything it needs to know about DHCW's commitment to the transparency and accountability that public service demands.

The 292 people who gave their time to this review were not told that the findings would remain internal. The title page said "for external use." The next government will need to decide what it means when a public body pays for the truth, receives it, and keeps it to itself.

Right of Reply: CareNHS welcomes a response from DHCW to the matters raised in this article. No response has been received to date. Contact: carenhs@carenhs.org

Source note

The Atos report (Digital Health and Care Wales: Stakeholder Review 2024, Atos Healthcare Consulting) was obtained through Freedom of Information request reference 6195807 filed by a private citizen. DHCW contract values (£200,000 for "Stakeholder Engagement" and £7,100 for "Stakeholder Intelligence") are from public procurement records. All statistics and quotations cited in this article are drawn directly from the report. The Level 3 escalation is documented in the Welsh Government's Written Statement of March 2025. The CEO's ROI admission is from the DHCW Public Accountability Meeting of 29 January 2026. Submissions from identified and anonymous contributors are held by CareNHS. Source identities are protected.

What you can do

This evidence exists because someone filed a Freedom of Information request. You can help make sure the findings lead to change:

• Write to your MS — ask what they will do about an organisation that does not publish independent reviews it commissions
• Share this page — the more people who see this evidence, the harder it is to suppress
• Submit what you know — if you have evidence of waste, misconduct, or the suppression of concerns
• Support the FOI campaign — the FOI that obtained this report is proof the process works

Related pages:

• What They Don't Publish — the full architecture of unaccountability, including website blocking and FOI refusal
• Six Freedom of Information Requests. One Identical Refusal. — DHCW's response to transparency requests
• The Scale of Failure — nine programmes, all under Level 3 intervention
• Leadership Analysis — why the same leadership keeps failing