What They Admitted Under Oath of Public Accountability

On a grey January morning in 2026, the leadership of Digital Health and Care Wales sat before a Public Accountability Meeting to answer for the organisation's performance. What followed was an extraordinary sequence of admissions — on cost, on delivery, on workforce growth, on the inability to demonstrate that any of it is producing measurable benefit for patients or clinicians in Wales.

This article presents what DHCW's own leaders said, in their own words, under public scrutiny. Every quotation is attributed by name, title, and forum.

1. The morning outage

The meeting began with an unscripted prologue. DHCW's own systems suffered an outage on the morning of the accountability session itself.

Ruth Galzzard, Interim Chair of DHCW, addressed it with what she may have intended as levity:

"Some people have suggested we may have done that deliberately today, so we've had something to discuss with you."

— Ruth Galzzard, Interim Chair, DHCW Public Accountability Meeting, January 2026

The joke landed badly. For an organisation whose core function is to keep NHS Wales digital infrastructure running, an outage on the day it is called to account is not a coincidence worth laughing about. It is a data point. It tells the Welsh public something about the reliability of systems that clinicians and patients depend on every day.

No detailed root-cause analysis of the outage has been published. No indication was given of how many users were affected, which systems were disrupted, or what clinical impact — if any — resulted. The meeting moved on.

2. The ROI admission

The most consequential exchange of the meeting concerned return on investment. DHCW manages a portfolio of digital programmes collectively worth several hundred million pounds of public money. When asked to demonstrate what Wales has received in return, CEO Helen Thomas offered this:

"We don't have an ROI on all of our investments."

— Helen Thomas, CEO, DHCW Public Accountability Meeting, January 2026

This is not an accusation levelled by a critic. It is a statement made by the Chief Executive of the organisation responsible for those investments.

When pressed on the 25% growth in DHCW's workforce — from approximately 960 to approximately 1,200 staff — and what that growth had delivered, Thomas said:

"It would be lovely to sit here and be able to demonstrate the value."

— Helen Thomas, CEO, DHCW Public Accountability Meeting, January 2026

She then offered an analogy that warrants careful consideration:

Measuring the return on digital investment, she argued, was like asking "what are the benefits of having electricity or having water available to run our services?"

The comparison is revealing. Electricity and water are utilities. Their value is not measured by ROI because they are essential infrastructure that simply works. DHCW's programmes, by contrast, are bespoke digital transformation initiatives — each with a defined scope, a budget, a business case, and promised benefits. They are not utilities. They are investments. And the person responsible for those investments has confirmed she cannot demonstrate their value.

3. The NHS Wales App

The NHS Wales App was conceived in 2021-22 as a flagship citizen-facing digital service. By early 2025, it was in beta with approximately 1,000 users at 10 GP practices. By late 2025, DHCW claimed 345,000 registered users.

The accountability meeting revealed what that headline figure conceals.

Nick Wood, Deputy Chief Executive of NHS Wales, did not mince words:

"[The NHS Wales App has] been mired in delay, non-delivery."

— Nick Wood, Deputy Chief Executive, NHS Wales, DHCW Public Accountability Meeting, January 2026

"People are clearly not adopting it, because it's not there for what they want it to be there for."

— Nick Wood, Deputy Chief Executive, NHS Wales, DHCW Public Accountability Meeting, January 2026

When Sam Hall, Director at DHCW, was asked to provide a timeline for when the App would reach critical mass — the point at which it becomes genuinely useful to a meaningful proportion of the Welsh population — the answer was notably absent:

"I think it's really hard to put a time point on when we'll hit that critical mass."

— Sam Hall, Director, DHCW Public Accountability Meeting, January 2026

Jeremy Miles, then Cabinet Secretary for Health and Social Care, responded with visible frustration:

"I'm not getting a great deal of confidence that we know what the critical path is for the app."

— Jeremy Miles, Cabinet Secretary for Health and Social Care, DHCW Public Accountability Meeting, January 2026

Helen Thomas, the CEO, conceded the point:

"I think that's a bit of a gap at the moment."

— Helen Thomas, CEO, DHCW Public Accountability Meeting, January 2026

A gap. In the critical path. For the flagship citizen-facing product. After years of development.

And the figure that was not discussed at adequate length: 653,000 people are currently on NHS Wales waiting lists. They are excluded from the App's data. The people with the most urgent need for visibility into their care — those waiting for treatment — cannot use the App for that purpose. The App's claimed user numbers exist in a context where the most pressing use case remains unserved.

4. The 25% workforce growth

Between its creation in April 2021 and early 2026, DHCW's headcount grew from approximately 960 staff to approximately 1,200. That is a 25% increase in a period during which none of its nine Level 3 programmes have been delivered on time or on budget.

A Welsh Government official at the meeting stated plainly:

"That's obviously unsustainable. So, what's the organisation going to do to address that?"

— Welsh Government official, DHCW Public Accountability Meeting, January 2026

The CEO's response:

"Oh, yes."

— Helen Thomas, CEO, DHCW Public Accountability Meeting, January 2026

She agreed it was unsustainable. No plan was presented to reverse it. No headcount reduction target was offered. No link was drawn between the additional 240 staff and any specific programme outcome. The workforce grew by a quarter, the programmes continued to fail, and the CEO agreed, publicly, that this trajectory cannot continue.

5. Late notification

One of the most corrosive failures in any public body is the failure to tell its overseers what is going wrong in time for them to act. DHCW has demonstrated a pattern of informing both its own board and the Welsh Government too late for meaningful intervention.

Ruth Galzzard, as Interim Chair, acknowledged this directly:

"We share your frustration as a board when things don't happen as quickly as possible, or we get informed in what we perceive to be late in the day."

— Ruth Galzzard, Interim Chair, DHCW Public Accountability Meeting, January 2026

This is the Chair of the organisation telling the Welsh Government that the board itself is not told things in time. The implications are serious. If the board does not know, then the Welsh Government does not know. If the Welsh Government does not know, the Senedd does not know. If the Senedd does not know, the people of Wales do not know. Late notification is not an administrative inconvenience. It is a break in the chain of democratic accountability.

In February 2026, the Cabinet Secretary wrote to DHCW with unmistakable clarity:

"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."

— Jeremy Miles, Cabinet Secretary for Health and Social Care, letter to DHCW, February 2026

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

6. The only quantified benefit

Across the entire portfolio — nine programmes, several hundred million pounds of expenditure, five years of DHCW's existence, and over a decade of predecessor activity at NWIS — only one quantified benefit was cited at the accountability meeting.

Clare Smith, Director of Finance at DHCW, described savings generated by the Welsh National Care Record (WNCR):

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

— Clare Smith, Director of Finance, DHCW Public Accountability Meeting, January 2026

The figure was approximately half a million pounds in "equivalent savings." Not cash released. Not budget reduced. Not reinvested elsewhere. Time saved, translated into a monetary figure. Against an expenditure base of several hundred million pounds, the only benefit the organisation could quantify was a non-cash estimate of half a million pounds.

The ratio speaks for itself.

7. The cost of delay

Perhaps the most sobering admission came from a Welsh Government official, who described the compounding cost of programme delays in terms that bordered on an epitaph:

"There is a tipping point where, actually, if we have delays and reprofiling, the benefits reduce... the benefits might be zero by the end. If we'd have known that, we'd have never started."

— Welsh Government official, DHCW Public Accountability Meeting, January 2026

Read that again. A Welsh Government representative stated, in a public forum, that some of these programmes may produce zero benefit. And that had the government known this at the outset, the programmes would never have been commissioned.

This is not a warning about future risk. It is a retrospective verdict. The Welsh Government is contemplating the possibility that hundreds of millions of pounds have been spent on programmes whose benefits have been entirely eroded by delay.

8. Optimism bias

When asked to account for the persistent gap between what DHCW promises and what it delivers, Helen Thomas offered this explanation:

"Some of that will be around optimism in terms of the plans and teams... I think some of that is that we acknowledge we need to do more discovery."

— Helen Thomas, CEO, DHCW Public Accountability Meeting, January 2026

Optimism bias. The same term the Senedd Public Accounts Committee warned DHCW about in July 2023 — over two and a half years earlier. The warning was issued. It was not heeded. The same pattern continued. The same excuse was offered again.

Discovery, in digital delivery methodology, happens at the beginning of a programme. DHCW's CEO is acknowledging the need for more discovery on programmes that have been running for years. This is not a minor process gap. It is an admission that programmes were initiated — and funded — without adequate understanding of what they would require.

The Cabinet Secretary's verdict

In February 2026, following the accountability meeting, the Cabinet Secretary for Health and Social Care wrote to DHCW. The letter has been published. Its conclusion deserves to be quoted in full:

"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."

— Jeremy Miles, Cabinet Secretary for Health and Social Care, letter to DHCW, February 2026

This is not a campaigner's assessment. This is the Welsh Government's own verdict on its own arm's-length body. DHCW cannot quantify its return on investment. It cannot articulate its benefits. It cannot demonstrate that what it spends is matched by what it delivers.

The people who said this were not opponents of DHCW. They were its overseers, its Chair, its CEO, its funders. They said it in public. They said it on the record. And now the people of Wales must decide what to do about it.

All quotations in this article are sourced from the DHCW Public Accountability Meeting held in January 2026, or from the Cabinet Secretary for Health and Social Care's letter to DHCW dated February 2026. Both are public records.