Nine Programmes, Zero Results: The £78 Million NHS Body the Government Cannot Fix

The Welsh Government's own official said it plainly: "If we'd have known that, we'd have never started." He was talking about Digital Health and Care Wales -- the organisation that runs the digital systems behind every hospital, GP surgery, and cancer unit in the country. An organisation spending £78 million a year of public money. An organisation that, after a year under the highest tier of government intervention, cannot demonstrate a single pound of return on investment.

In January 2025 -- six weeks before the Welsh Government would impose that intervention -- DHCW's CEO Helen Thomas spoke at Digital Health Rewired. Her candour was striking:

"Are we ready for the next one? No."

-- Helen Thomas, CEO of DHCW, on pandemic preparedness, Digital Health Rewired, 23 January 2025

She elaborated: "The use of data is imperative to an effective health and care system, yet we've almost snapped back to pre-Covid." On integration: "We have 'non-standard standards'; there have been compromises to make things work in an integrated way over the last two decades." She noted that one in four Welsh people were currently waiting for care.

These are not the words of an executive describing an organisation on the cusp of delivering its strategic objectives. They are the words of someone acknowledging systemic failure -- while remaining in post as the accountable officer presiding over it.

The Timeline: From Escalation to Scrutiny to Stasis

On 11 March 2025, Jeremy Miles MS, Cabinet Secretary for Health and Care, escalated DHCW to Level 3 of the NHS Wales Oversight and Escalation Framework. It was the first time DHCW had ever been escalated. His stated reason was unambiguous:

"I am making this decision because of serious concerns about the organisation's ability to effectively deliver a number of major programmes."

-- Jeremy Miles MS, as reported by Digital Health Net, 14 May 2025

The escalation was not confined to a single failing project. It covered all nine of DHCW's largest programmes simultaneously: the NHS Wales App, the National Data Resource, the Radiology Informatics System, the Laboratory Information Network, GP system migration, electronic prescribing, the Cancer Informatics Programme, enterprise architecture development, and national target architecture design (GOV.WALES -- DHCW Oversight and Escalation Framework, May 2025).

Nine programmes. All nine under the highest level of government intervention. Simultaneously.

In July 2025, a Welsh Government written statement confirmed DHCW remained at Level 3. In December 2025, another confirmed the same -- nine months after escalation, with no improvement sufficient to warrant de-escalation (Written Statement, 15 July 2025; Written Statement, 16 December 2025).

The Scale of Fragmentation

At the January 2026 accountability meeting, Ifan Evans, DHCW's Director of Strategy, revealed: "There are over 1,400 different systems in operation" across NHS Wales. This is the fragmented estate that DHCW was created to rationalise -- and that five years later remains essentially unreformed. The Interim Chair Ruth Glazzard revealed that "around 80% of our resources are committed to those operational services. That's an incredibly high proportion of our resources spent on keeping the lights on." Twenty per cent for the transformation DHCW was specifically created to deliver.

The Nine Programmes

Cancer Informatics

The Cancer Informatics Programme received £6.5 million in 2019 to replace CaNISC, a cancer system running on software unsupported by Microsoft since 2014. By January 2023, the total had exceeded £11 million. The system it was meant to replace had already caused harm: in August 2018, CaNISC went down for three days at Velindre Cancer Centre. A patient waiting for chemotherapy did not receive her treatment. She sat in a waiting room expecting to begin treatment. She was sent home. Eight others experienced delays to radiotherapy. The replacement programme remains under Level 3 intervention. For patients on cancer pathways in Wales -- where only 59 per cent begin treatment within 62 days of suspected cancer, against a 75 per cent target -- these are not abstract delivery delays. They are measured in disease progression.

GP System Migration

In 2018, EMIS -- then the dominant GP system provider -- lost its preferred supplier status. GP practices across Wales were required to migrate to VISION. The current programme reverses this decision entirely: all practices are being migrated back to EMIS between 2024 and 2027. The GP IT contract is worth up to £80 million over five years. The cost of the original forced migration to VISION was never published. The cost of the reverse migration back has never been published. Wales has funded two migrations -- in opposite directions -- within approximately six years, with no published accounting for either. Then, in December 2024, the supplier entered administration. Disruption to practices, cost to the public purse, lost productivity, clinical risk during transitions -- none of it has been quantified.

LINC / LIMS (Laboratory Information Network)

The programme started in December 2017 with a target of full deployment by December 2024. That target was missed. The original supplier contract was terminated. The legacy system has been extended to June 2030. After seven years of programme activity, one laboratory is partially live -- PenGU, running microbiology only. DHCW is seeking an additional £1.6 million from the Welsh Government. The legacy system the programme was supposed to replace now has a longer remaining lifespan than the replacement programme has had to date.

NHS Wales App

Nick Wood, Deputy Chief Executive of NHS Wales, described the App at the January 2026 accountability meeting: "mired in delay, non-delivery." He added: "People are clearly not adopting it, because it's not there for what they want it to be there for." Sam Hall, DHCW Director, was asked when it would reach critical mass: "I think it's really hard to put a time point on when we'll hit that critical mass." The Cabinet Secretary responded: "I'm not getting a great deal of confidence that we know what the critical path is for the app." Meanwhile, 653,000 people on NHS Wales waiting lists are excluded from the App's data. The citizens with the greatest need for visibility into their care journey cannot use it for that purpose.

RISP / Radiology

The single largest disclosed contract in DHCW's portfolio: £47.2 million, with potential extensions to £56 million, awarded in November 2023 under a seven-year Master Service Agreement. DHCW's own reporting acknowledges "setbacks encountered due to changes in the supplier's implementation plan." The supplier has never been publicly named despite the scale of the contract. The Welsh public is entitled to know which company holds a contract worth up to £56 million of their money.

WCCIS / Connecting Care

Over £42 million spent on a shared record system for health and social care, launched in 2015 as a 12-year programme. Fifteen organisations are live. Six remain uncommitted. Two are actively seeking to exit. Audit Wales assessed the programme's ambition as "still a long way from being realised." The 2024 rebrand to "Connecting Care" changed the name. It did not change the trajectory.

OpenEyes (Digital Eye Care)

£8.5 million from January 2020. Original delivery target: March 2021. Missed. Revised target: March 2023. Missed. Full rollout now projected for early 2027 -- six years late. In May 2025, the CEO admitted to the Senedd that clinical engagement "could have worked a lot better." Two locations are live. Everywhere else, ophthalmology departments continue using paper records and fax machines.

Electronic Prescribing

The service went live across all seven health boards by October 2024. By January 2025, only 7% of GP practices were using it -- a figure disclosed by Helen Thomas herself. England completed the rollout of its Electronic Prescription Service over a decade ago. Every paper prescription that could have been electronic represents an avoidable inefficiency and a preventable source of error.

NDR (National Data Resource)

DHCW's flagship data platform, built on Google Cloud, intended to create a single national clinical data repository by 2030. An internal audit found that active restrictions had been placed on data ingestion -- the core function of a data platform -- due to perceived conflicts with Welsh Government policy. Budget figures remain undisclosed, but DHCW's 2024 Annual Report noted that "challenges emerged regarding programme funding for 2024-25." The national data platform cannot ingest data, its target is four years away, and its budget is secret.

NTA / Enterprise Architecture

Nine months of Phase 1 activity by two external consultancies -- Channel 3 Consulting and Aire Logic -- produced two reports. The contract value has not been disclosed. No competitive tender notice has been identified on Find a Tender or Contracts Finder, the UK government's official procurement portals. After over two decades in some form, the organisation still does not possess this capability internally.

The Accountability Meeting: "If We'd Known, We'd Never Have Started"

At the public accountability meeting on 29 January 2026, DHCW systems went down on the morning of the session itself. Thomas acknowledged an inability to demonstrate return on investment for the organisation's programmes.

An organisation spending in excess of £78 million of public money per year, unable to demonstrate return on investment to the Welsh Government.

The Director of Finance, Claire Osmundsen-Little, was asked for a single example of quantified financial return. She cited the Welsh Nursing Care Record:

"You will ask me, I know, is that cash on the table? No, it's not. But it is time saved."

The figure was approximately half a million pounds in "equivalent savings." Not cash released. Not budget reduced. Against approaching £200 million in identifiable programme costs, this was the only benefit the organisation could quantify.

Smith went further: "At the moment, we don't have many programmes that are going live that we can really demonstrate that difference that we make."

Thomas disclosed that DHCW's development funding had grown from £13 million to £34 million. When asked whether the resulting 25% workforce expansion -- from approximately 960 to 1,200 staff, against an NHS Wales average of 2.7% -- was sustainable, a Welsh Government official stated bluntly: "That's obviously unsustainable." No headcount reduction plan was presented.

The Accountability Gap: £100 Million and Zero Consequences

On 12 February 2026, Jeremy Miles MS wrote to DHCW's Interim Chair:

"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."

On risk management: "My clear expectation is DHCW must alert Welsh Government significantly earlier when risks threaten delivery, avoiding the pattern of late notification that undermines system confidence."

The phrase "pattern of late notification" confirms this is not a one-off failing. It is systemic.

Throughout this entire period, Helen Thomas has remained in post as the Accountable Officer. Her total remuneration of up to £215,000 including pension contributions has been paid throughout a period in which every major programme under her leadership has failed to deliver on time, the Welsh Government has imposed its highest intervention tier, and the only quantified benefit the organisation can cite is £0.5 million in non-cash time savings. No DHCW director has faced any publicly visible consequence for the failure of any programme at any point. The Director of Finance won "Finance Leader of the Year" at a London ceremony in June 2022 (DHCW news release). Four years later, she could not demonstrate a single pound of financial return from the organisation's programme portfolio.

The contrast with other NHS Wales bodies is instructive. When Betsi Cadwaladr University Health Board was placed into special measures in 2015, the consequences were swift and visible: the Chief Executive departed within months; the Chair was replaced; board members were removed; an independent review was commissioned by the Welsh Government; and the health board was eventually placed under direct ministerial oversight. The intervention lasted years, but at every stage there were visible consequences for the leadership that presided over the failure. By contrast, DHCW's Level 3 escalation -- covering all nine major programmes, sustained for over a year, with the Welsh Government's own official contemplating "zero" benefit -- has produced no equivalent consequence. The same CEO remains in post. The same directors oversee the same programmes. No independent review has been commissioned. No board member has been replaced.

The Nolan Principles demand accountability. The governance framework promises it. What remains missing is the connection between the two: a visible line from failure, through scrutiny, to consequence.

Seven Years, the Same Problems

In November 2018, the Welsh Public Accounts Committee published a report into NWIS -- the organisation reconstituted as DHCW in April 2021. The Committee found "archaic and fragile IT systems which don't deliver on their promises." There were 21 outages of national systems in seven months -- one every nine days.

Most significantly, the committee described the culture at NWIS as "the antithesis of open." It found a "reluctance among staff to be critical on the record" and warned this "may be masking wider and deeper problems."

2018: "The culture at NWIS was the antithesis of open." Seven years later, all nine of its successor's major programmes are under the highest level of government intervention.

DHCW was established in 2021 to represent a fresh start. Its CEO was appointed from within the existing leadership. Five years on, the Welsh Government's own escalation decision suggests the institutional problems identified in 2018 were not resolved by the 2021 reorganisation. They were inherited.

Questions for the Senedd

Peter Fox MS, Chair of the Health and Social Care Committee, and Mark Isherwood MS, Chair of the Public Accounts Committee, have direct oversight of DHCW's performance. We ask them to put these questions to the Cabinet Secretary:

1. Does the Cabinet Secretary retain confidence in DHCW's CEO given that no return on investment can be demonstrated for any programme, after over a year under Level 3 intervention?

2. Will the Welsh Government publish the total lifecycle cost of each of the nine escalated programmes?

3. What is the de-escalation plan and what milestones must be met before Level 3 is lifted?

Nine programmes. Over a year under the highest level of government intervention. A CEO who acknowledges the scale of the challenge but remains in post. A governance framework that identifies the failure but enforces no consequence. The Welsh Government's own official contemplated the possibility that the programmes may deliver nothing at all. The question is not what went wrong. It is what will be done about it -- and when.

The 2.6 billion annual transactions, the 42,000 clinicians accessing records, the one in four Welsh people waiting for care -- these are not statistics. They are people whose treatment depends on systems the Welsh Government itself has judged to be failing.

All sources cited in this article are publicly available. A full research document with URLs and source classifications is maintained by carenhs.org and available on request.

Right of Reply: DHCW was contacted for comment on 27 March 2026. No response was received by the time of publication.

carenhs.org is an independent public accountability campaign focused on NHS Wales digital infrastructure. We welcome corrections and responses from DHCW, the Welsh Government, and any individual named in this article. Contact: info@carenhs.org