The Five-Year Reality Check

On 1 April 2026, Digital Health and Care Wales marked its fifth anniversary as a Special Health Authority. At the dawn of the new organisation, DHCW published an Annual Plan committing it to eleven national portfolios, three flagship programmes, and the role of "trusted delivery partner" for NHS Wales. Five years later, Helen Thomas — who progressed to CEO of DHCW from her role as Interim Director of the disgraced NHS Wales Informatics Service (NWIS) — is still at the helm. The Chair who co-signed that founding Annual Plan with her has gone. The three flagship programmes the plan named — the National Data Resource, Cancer Informatics, and Digital Services for Patients and the Public — are, respectively, not in operational use, still procuring a replacement system, and substantially behind the schedule the February 2020 business plan set.

This is the reality check.

"As the trusted delivery partner we now have the opportunity to build on our strong foundations... Wales is well-placed to put digital at the heart of health and care."
— Helen Thomas (interim CEO) and Bob Hudson (interim Chair), DHCW Annual Plan 2021/22, foreword

That foreword named DHCW as "the trusted delivery partner" of the wider NHS Wales family. It described its foundations as "strong", its team as "talented informatics professionals who have worked tirelessly", and committed the new organisation to "first-class digital health and care services". Every one of those self-descriptions is now testable against a public record that did not exist when the foreword was signed.

On 6 January 2026, Welsh Government's Director-General for Health and Social Care wrote to DHCW that the organisation must focus on changing stakeholder perceptions. On 12 February 2026, the Cabinet Secretary for Health wrote that DHCW "remains some distance from being able to consistently quantify return on investment, articulate realised benefits across Wales or demonstrate the scale of digital investment is matched by measurable improvements for citizens and clinicians." On 8 April 2026, the Welsh Government escalated DHCW to Level 4 — Targeted Intervention — with concerns around delivery, accountability and leadership.

Five years on, the "trusted delivery partner" is at Level 4.

Promises vs Reality — The Scoreboard

Every promise in the left column comes from a document Helen Thomas signed as interim CEO in October 2021. Every entry in the right column comes from a public document released since. The detail behind each row is set out below.

The Promises

The first Annual Plan was published in October 2021. It named four strategic objectives and eleven portfolios. Three programmes were singled out by the CEO and Chair as the priorities that would "continue to drive digital transformation for better outcomes":

1. National Data Resource — "build the enablers of an open, interoperable architecture from which NHS Wales can derive value and insight from the intelligent use of clinical data" (Plan reference 1.03).
2. Cancer Informatics — "Complete the new Cancer Informatics Solution requirements" and "Develop the minimal viable product for Cancer" (Plan references 2232, 2850, 2952). The CANISC replacement.
3. Digital Services for Patients and the Public — Discovery Stage complete by Q2 2021/22; "Minimal Viable product delivery approved for early adopter deployment" by Q4 2021/22 (Plan references 3102, 3104, 3105, 3106). The NHS Wales App.

The plan also committed to "relocating from one of our main data centres — some systems being located in the cloud and some into our new data centre" with deliverables in every quarter of the year (Plan references 3355, 3356, 3357, 3360).

The foreword described DHCW's foundations as "strong". It described its team as "talented informatics professionals who have worked tirelessly". It promised that "Quality is at the heart of all we do".

The plan placed every promise on a numbered grid: every quarter, every deliverable, every milestone with its own reference. The grid is what makes the five-year reality check possible.

The Reality

Promise: National Data Resource

In the IMTP 2025-28 — signed by Simon Jones as Chair and Helen Thomas as CEO — DHCW publishes its own colour-coded partner-alignment matrix showing which NHS Wales bodies are using which DHCW services. The National Data Resource is amber at all seven Health Boards. It is not in operational use anywhere outside NHS Wales Shared Services Partnership.

In the evidence pack for the 29 January 2026 Public Accountability Meeting, the Welsh Government's Director of Information acknowledged "some resistance" from GPC Wales to participation in NDR on GDPR Article 5.1 proportionality grounds. Five years on from the plan that promised an "open, interoperable architecture", the General Practitioners' Committee for Wales is refusing to send GMS data through it.

The financial picture, released under FOI/6695830 on 28 April 2026, is no kinder. The original 2019 Programme Business Case for NDR — signed off as Senior Responsible Owner by Dr John Peters on 14 June 2019, before DHCW existed — stated that the programme "will create benefits of at least £195m in the ten years of the programme, far exceeding the expected lifetime costs of £57m (including inflation)." The same business case (Table 9) committed to a six-year payback period on the preferred option: by the end of year six of the programme, cumulative cash-releasing and revenue-generating benefits should have equalled the additional costs. Year six ended in March 2026. As of March 2026, no Welsh Health Board uses NDR in operational service; no quantified benefit has been disclosed; and the Cabinet Secretary's February 2026 letter records that DHCW "remains some distance from being able to consistently quantify return on investment." The payback period has elapsed. Payback has not occurred.

By 2025-26 — year seven of the ten-year programme — DHCW had spent £35.7 million on NDR. That is approximately 63 per cent of the entire ten-year cost envelope spent at the seven-year mark, with three years still to run and the single-year burn rate accelerating: 2025-26 alone is the highest yet, at £8.24 million.

* DHCW's FOI response records that all 2020-21 NDR funding, and approximately six months of 2021-22, was redirected to the Covid-19 pandemic response. The line items still belong to NDR; they did not deliver against NDR scope. Welsh Government confirms NDR funding annually; the FOI response states there is "no confirmed budget envelope until the end of the programme."

Promise: Cancer Informatics

The Annual Plan committed DHCW to delivering CANISC replacement requirements in Q1 2021/22, a minimum viable product in Q2 2021/22, and CANISC Phase 2 interfaces in Q2 2021/22.

In the IMTP 2025-28, DHCW records that "Cancer features built but transition to service in planning" — five years on, the cancer programme has not transitioned to service. The Velindre Cancer Centre is procuring its own electronic patient record locally.

Promise: Digital Services for Patients and the Public — the NHS Wales App

The February 2020 NWIS Business Plan that preceded DHCW committed to NHS Wales App Benefits Realisation in 2023/24. The 2021/22 Annual Plan committed to MVP delivery for early adopter deployment by Q4 2021/22.

The IMTP 2025-28 records "Service transition to DHCW complete 2026/27" — i.e. as of 2026, the App is still not fully transitioned to the organisation that was created to deliver it. Benefits Realisation, promised in 2023/24, has not been demonstrated. The original business plan is six years old; the headline benefits are still in the future.

At the 29 January 2026 Public Accountability Meeting, Nick Wood — Deputy Chief Executive of NHS Wales — addressed the App directly. The Welsh Government's chair of the meeting picked it as one of three items to highlight in the closing summary.

Promise: Quality is at the heart of all we do

In 2024, an external review commissioned by Welsh Government concluded that the deployed Welsh Intensive Care Information System (WICIS) was "not clinically acceptable in its current form". The review was never published. The reviewer was never named. WICIS was paused.

In May 2025, Internal Audit issued limited assurance opinions on DHCW's recruitment processes and on its handling of staff culture concerns.

In January 2026, the Cabinet Secretary for Health wrote that DHCW "remains some distance from being able to consistently quantify return on investment, articulate realised benefits across Wales or demonstrate the scale of digital investment is matched by measurable improvements for citizens and clinicians."

Promise: trusted delivery partner

The verdict on whether DHCW has been a trusted delivery partner has now been written — by the Cabinet Secretary, by the Director-General who chairs NHS Wales, by the 13.3% of stakeholders who spoke highly of DHCW in the £207,100 Atos review it commissioned and then buried, and in the escalation grounds dated 8 April 2026. It is set out below, after the full scale of programme failure it reflects. (For the buried Atos review, see £207,100 to Hear the Truth — Then They Buried It.)

Thirteen Programmes — Nine Failing, Four Already Dead

Three flagships are not the whole story. The 2021/22 Annual Plan named eleven national portfolios and four strategic objectives. Five years on, the Welsh Government's own escalation framework counts nine of DHCW's largest programmes as failing for delivery reasons. DHCW's own 2024-25 Annual Report identifies four further national programmes that have been closed, paused, or stripped down to design-only.

The Nine — All Under Government Intervention, Simultaneously

When DHCW was placed under Enhanced Monitoring (Level 3) in March 2025, the escalation was not confined to a single failing project. The Welsh Government's published framework named all nine of DHCW's largest programmes at once: Cancer Informatics, GP System Migration, the Laboratory Information Network (LINC/LIMS), the NHS Wales App, the Radiology Informatics System Programme (RISP), the Welsh Community Care Information System (WCCIS / Connecting Care), the National Digital Eye Care Programme (OpenEyes), Electronic Prescribing, and the National Data Resource (NDR).

The detailed evidence for each programme — supplier names, contract values, missed milestones, patient-safety incidents — is set out in Nine Programmes, Zero Results. In summary:

• Cancer Informatics — £11M+ spent replacing a system unsupported since 2014. A 2018 outage caused a chemotherapy patient to be sent home without treatment.
• GP System Migration — £80M contract. Two forced migrations in opposite directions. Supplier entered administration December 2024.
• LINC / LIMS — Started December 2017 with a December 2024 completion target. After seven years: one laboratory partially live, one discipline. February 2026 board declared the programme "no longer feasible" for 2025-26.
• NHS Wales App — "Mired in delay, non-delivery" (Nick Wood, Deputy CEO NHS Wales). 653,000 waiting-list patients excluded.
• RISP — £47–56M, the single largest disclosed contract. Supplier never publicly named.
• WCCIS / Connecting Care — £42M+ over eleven years. Two organisations actively seeking to exit. Audit Wales: ambition "still a long way from being realised."
• OpenEyes — £8.5M. Original target March 2021. Two locations live. Paper and fax everywhere else.
• Electronic Prescribing — 7% of GP practices using it after a year. England completed this rollout over a decade ago.
• NDR — Internal audit found active restrictions on data ingestion. Cannot perform its core function. Target: 2030.

Nine programmes. All escalated for delivery failure. All sustained at escalation for over a year. None de-escalated. As of 8 April 2026, the escalation deepened from Level 3 to Level 4.

The Four — Already Killed, Paused, or Stripped to Design-Only

Alongside the nine escalated programmes, DHCW's own 2024-25 Annual Report records four further national programmes that did not survive intact:

• Digital Maternity Cymru — closed nationally. Welsh Government withdrew central funding and switched to direct Health Board funding. The promise of a national maternity record died with the budget line.
• National Digital Eye Care Programme — paused due to "funding challenges and commercial complexities." The same programme already named as failing under escalation has now formally stopped.
• Welsh Intensive Care Information System (WICIS) — paused pending an independent review commissioned by Welsh Government. The review concluded the deployed system was "not clinically acceptable in its current form." It has never been published. The reviewer has never been named.
• Welsh Nursing Care Record (Paediatrics) — descoped from build to design-only due to funding reduction. The paediatric ward rollout that the IMTP 2025-28 commits to "100% of paediatric wards" was, in the previous year's accounts, abandoned as a build.

Nine programmes under intervention. Four more killed, paused, or nerfed. The Welsh Government's Digital Priorities Investment Fund — £135.2 million ring-fenced over five years for exactly these national programmes (Welsh Government FOI ATISN 26790, 13 April 2026) — funded a portfolio in which every named programme is now either failing, frozen, or dead. (For the financial picture in full, see £600 Million In. £0.5 Million Out.)

The 2021/22 Annual Plan promised eleven portfolios delivering "first-class digital health and care services". The 2024-25 Annual Report describes thirteen of those promises ending in escalation or closure. The two documents are signed by the same Chief Executive. The balance sheet behind that record: approximately £600 million of public investment since April 2021, £49.1 million paid to external consultants and contractors, headcount expanded by approximately 30 per cent (964 in 2021-22 → 1,257 by February 2025), and an annual budget now approaching £200 million — the highest-funded year in DHCW's history, reached under government escalation for delivery failure. (See £600 Million In. £0.5 Million Out and £757K to £49 Million.)

What Welsh Government, the Senedd and the NHS Director-General Have Now Said

Thirteen failed programmes. Three near-identical infrastructure failures (which follow in the next section). A workforce-savings model named as a financial risk by Audit Wales. The verdict on whether the "trusted delivery partner" of the 2021/22 foreword has discharged its promise is no longer a matter of campaign opinion. It has been written, in the last six months, by the most senior people in Welsh Government and NHS Wales — and by the Senedd opposition leader. Their words follow.

The Cabinet Secretary — 12 February 2026

Cabinet Secretary for Health Jeremy Miles wrote to DHCW's Chair (reference DC/JMHSC/00046/26). The letter is part of the evidence pack for the January 2026 PAM. It states:

"the organisation remains some distance from being able to consistently quantify return on investment, articulate realised benefits across Wales or demonstrate the scale of digital investment is matched by measurable improvements for citizens and clinicians."

"these are positive steps, but they have been a long time in development, and you must shift to this approach immediately."

"WG demands significantly earlier risk notification" — confirming a pattern of late notification.

The Cabinet Secretary's letter, which arrived eight weeks before Level 4 — Targeted Intervention was imposed, was the first time a Welsh Government Cabinet Secretary had written in those terms to a DHCW Chair.

The Director-General — 6 January 2026

Jacqueline Totterdell, who took up the role of Director-General for Health and Social Care and Chief Executive of NHS Wales in September 2025, wrote to DHCW. The letter is reproduced verbatim in the 30 April 2026 Portfolio Delivery Committee papers — submitted by the Board Secretary, approved for publication by Helen Thomas. Its seven bullets:

"Progress made against the escalation milestones — not translating into the level of change, improvement and transparency that WG expected."

"Escalation framework is too transactional."

"Focus needs to be on system leadership, engagement, stakeholder perceptions, programme planning/reporting."

"There is a perception that risks and failure to deliver milestones are not being reported and escalation to WG in a timely and transparent manner."

"DHCW must focus efforts to change stakeholder perceptions, and this will be aided by delivering on your core priorities."

"Needs to be greater scrutiny and objective assurance in relation to programme delivery, risk and engagement."

"As system leaders, you need to look beyond your own organisations and guide the health and care system across Wales in adopting appropriate digital solutions."

Twenty-three days after the letter arrived, Helen Thomas told the same PAM that "we do not run hospital IT, and that distinction matters. It shapes our accountability." That is the framing the Director-General's letter had explicitly rejected.

The escalation — 8 April 2026

DHCW's own 30 April 2026 Portfolio Delivery Committee paper, Section 3.5, records Welsh Government's escalation decision verbatim:

"On the 8 April 2026 Welsh Government confirmed DHCW's escalation status had increased to Level 4 — Targeted Intervention, with concerns around delivery, accountability and leadership."

The phrase "delivery, accountability and leadership" is Welsh Government's grounds, restated in DHCW's own papers. It appears three times in the same paper. It is the first time leadership has been named as a ground for escalation of an NHS Wales body. Accountability and leadership map directly to the Chief Executive and the Chair.

From 9 June 2026, the new Escalation Board chaired by the Director-General will begin to meet. (For the silent escalation itself, see DHCW Now at Level 4.)

What the Senedd has said

Darren Millar MS, now the Welsh Conservative leader in the Senedd, has used the phrase "rotten regime" in Plenary to describe the pattern at DHCW. He has also said: "every time someone raises concerns they end up out of a job". The Cabinet Secretary's ROI-letter, Totterdell's seven bullets, and the Level 4 escalation grounds make this charge harder, not easier, to contest.

The 7 May 2026 Senedd election removed Jeremy Miles from Cabinet. Plaid Cymru won 43 seats; Reform UK 34; Welsh Labour collapsed to 9. The new First Minister is Rhun ap Iorwerth. The Cabinet Secretary's verdict, the Director-General's letter and the Level 4 escalation now sit on the desk of a new Cabinet that did not author them and has no political stake in defending them.

Three Years. Three Infrastructure Failures. The Same CEO.

The Annual Plan committed DHCW to "relocating from one of our main data centres — some systems being located in the cloud and some into our new data centre". The migration was supposed to deliver "state of the art infrastructure" during 2021/22.

By the third year of major infrastructure failures, the state-of-the-art ambition had been replaced by an organisation explaining, twice, why its own data centre had stopped working.

2024 — Data Centre 1, cooling failover failure

At the DHCW board meeting of 30 November 2023, the Executive Director of Operations had assured the board that data centre failover worked "in seconds". By the July 2024 board, that assurance had been contradicted by events.

A false alarm on the fire detection system at Data Centre 1 triggered a chain reaction of cooling failures. The failover mechanism that "should have kicked in effectively didn't". 32 services were down for approximately six hours. Three SLA breaches were recorded. The board asked no questions of the executive directly responsible.

2025 — Data Centre 1, cooling failover failure (again)

On 11 June 2025, Data Centre 1 suffered the same failure mode. False fire alarm. Cooling chain reaction. Failover did not work.

At the board on 31 July 2025, the Executive Director of Operations told the board:

"As you say, this should be a never event, but you know, in, it's hard to say how often they happen in my experience. They do happen unfortunately... We have, we did have another incident like this last year, which we've you know, which we obviously worked to resolve as well."

Helen Thomas told the board:

"Let's not kind of kid ourselves though, this should really be a never event in terms of the level of data centres that we commission. So there is that — there's a lot of work for us to do with the data centre providers to ensure that they can, you know, give us reassurance so this is a never event and it will never happen again."

Never event is the strongest term available in healthcare governance — something so serious it should be designed out of existence. The published Copilot-assisted minutes erased it. Helen Thomas's challenge was replaced with "The Board expressed appreciation for the transparency of the presentation and the incident response." Sam Lloyd's admission that the same failure had occurred the previous year was removed entirely. (See How They Falsify the Public Record for the 107 instances of this pattern.)

Two near-identical data centre failures, twelve months apart. The CEO's word for it — never event — was deleted from the public record.

2026 — Two major outages, four months apart

On the morning of the 29 January 2026 Public Accountability Meeting, an NHS Wales network outage took services offline for approximately one hour. The opening Chair, Penny Glazzard, mentioned it from the platform: "It also means getting the lights back on when they go off, as they did this morning, where we had a period of outage for the NHS of an hour." No further detail was given on cause, scope or affected systems.

On 25 March 2026, a Public Sector Broadband Aggregation (PSBA) outage — the network DHCW shares with the rest of NHS Wales — took internet down for all NHS Wales organisations from approximately 5pm to 1:20am. Office 365, EPMA, RISP and radiology systems were all affected. Business continuity arrangements were on the brink of activation. The 26 March 2026 board meeting opened the morning after.

PSBA is contracted by Welsh Government rather than DHCW. The contracting line is not the operational line. From the perspective of the clinician who could not access the patient record on the night of 25 March, or the patient whose imaging could not be retrieved, the question is not who signed the contract. It is who is responsible for the resilience of the national digital estate.

Three years. Three major infrastructure failures. The 2024 and 2025 incidents at the same data centre, with the same root cause, twelve months apart. The 2026 incident at the national network layer, taking out every NHS Wales organisation simultaneously. The same Chief Executive throughout. The same explanation throughout: lessons learned, resilience improved, this won't happen again.

The data centre relocation that the 2021/22 Annual Plan promised would deliver "state of the art infrastructure" is the same infrastructure that has failed in two successive summers, twelve months apart, and has been silent on what changed between them.

The Pattern, Five Years On

The Annual Plan foreword described the 964 people then working at DHCW as a "dedicated team of talented informatics professionals who have worked tirelessly to deliver in very difficult times." By February 2025 the workforce had grown to 1,257.

The Workforce Success Profile published by Health Education and Improvement Wales — a 45-indicator framework which DHCW has cited as its workforce standard — sets out what compassionate, capable digital leadership in NHS Wales is supposed to look like. CareNHS has mapped the lived experience of named members of DHCW's senior workforce against those 45 indicators. The mapping is not flattering. (See Best Place to Work(-Related Stress), Speak Up and Get Sacked, and Two Whistleblowers.)

Audit Wales's 2025 Structured Assessment, quoted in the same January 2026 PAM evidence pack, named the financial pattern that has held since the founding plan: DHCW's "reliance, in part, on short-term funding and savings from job vacancies continue to present some financial risks." It was the first formal external naming of the vacancy-as-savings pattern that has run for five years — a pattern that, by the July 2025 staff survey, had pushed reported burnout at DHCW to approximately 69 per cent (65 per cent at the July 2024 survey, increased by 3.9 percentage points over the following year). The 3.9 per cent increase was stripped from the published board minutes.

What's Now on the Desk of the New Cabinet

The new Welsh Government inherits, in a single folder:

• A Cabinet Secretary's letter from the predecessor government stating that DHCW cannot demonstrate value for money.
• A Director-General's seven-bullet rebuke that DHCW's risks and failures are not being reported transparently.
• A Level 4 — Targeted Intervention escalation citing "delivery, accountability and leadership" for the first time on these grounds.
• An external review concluding a deployed clinical system was "not clinically acceptable in its current form" — never published.
• Audit Wales's first formal external naming of vacancy-as-savings.
• Limited-assurance Internal Audit findings on recruitment and on staff culture.
• Three consecutive years of major infrastructure failures.
• The same Chief Executive in post throughout.

The five-year reality check has already been written — by Welsh Government, by Audit Wales, by the NHS Wales Chief Executive, and by the Cabinet Secretary who is no longer in post — but above all by the DHCW leaders who consistently demonstrated nothing but staggering incompetence. The new government's first decision is whether to continue trusting leaders who — like Helen Thomas, leading digital in NHS Wales since 2017 — delivered nothing but failure.

CareNHS invites a response from Helen Thomas (Chief Executive, DHCW), the DHCW Chair, the Welsh Government and the Cabinet Secretary for Health to the matters raised in this article. If received, we will publish any response in full.

This article is based on the DHCW Annual Plan 2021/22 released under FOI/2901781 (October 2021); the DHCW IMTP 2025-28 and February 2020 NWIS NHS Wales App business plan released under FOI/6523156 (January 2026); the 30 April 2026 DHCW Portfolio Delivery Committee papers (Item 5.1); the 29 January 2026 Public Accountability Meeting evidence pack and transcript; the Cabinet Secretary's letter of 12 February 2026 (DC/JMHSC/00046/26); the Welsh Government NHS Wales Escalation and Intervention Arrangements page; and CareNHS's systematic analysis of 37 DHCW board meeting transcripts from April 2021 to March 2026.

Related: The Augean Stables | DHCW Now at Level 4 | £600 Million In. £0.5 Million Out | How They Falsify the Public Record | Best Place to Work(-Related Stress) | Nine Programmes, Zero Results