What Is DHCW?
Every GP visit, every prescription, every hospital appointment in Wales depends on one organisation you've probably never heard of. Here's what it does — and why it matters when it fails.
The invisible backbone of the NHS in Wales
Every time you visit your GP, wait for a hospital appointment, receive test results, or get a prescription filled — you depend on digital systems built and maintained by a single organisation: Digital Health and Care Wales (DHCW).
DHCW is a Special Health Authority created by the Welsh Government in April 2021, replacing its predecessor organisation, the NHS Wales Informatics Service (NWIS). It is the sole body responsible for the digital infrastructure of the entire NHS in Wales. There is no alternative provider. There is no competitor. If DHCW's systems fail, the NHS in Wales cannot function.
What DHCW controls
DHCW builds, procures, and maintains every critical digital system that NHS Wales depends on:
The Welsh Patient Administration System (WPAS) — used in every hospital in Wales to manage patient admissions, discharges, appointments, and transfers. Over 52,000 users process 4.5 billion transactions through this system. It has been identified by a Health Board as a factor in at least one patient death.
The Welsh Clinical Communications Gateway (WCCG) — the system that connects GPs to hospitals, enabling referrals, test results, and clinical communications. It runs on technology unsupported for eight years. If it fails, every referral to secondary care stops.
The Enterprise Master Patient Index (eMPI) — the national system that matches patients to their records. A catastrophic outage in this system mixed up patient records across Wales, with patients receiving wrong health communications and others missing invitations to life-saving treatments.
GP systems — DHCW manages the contracts and infrastructure for the software systems used by every GP practice in Wales.
The NHS Wales App — intended to be the national "digital front door" for patients to access their health records, book appointments, and manage their care. After years of development, the Deputy Chief Executive of NHS Wales described it as "mired in delay, non-delivery."
Laboratory information systems, radiology systems, prescribing systems, eye care systems, cancer informatics, and more — the full stack of digital services that clinicians depend on to deliver care safely and efficiently.
How big it is
DHCW employs over 1,100 people — 25% more than when it was created in 2021. Its direct revenue allocation for 2022-23 was approximately £31.4 million, with additional capital funding. But the total public expenditure channelled through or attributed to DHCW across its five-year existence runs into several hundred million pounds when capital programmes, nationally-funded projects, and absorbed health board digital costs are included.
In 2023-24, DHCW's revenue pay costs alone were £66.1 million. CEO Helen Thomas earned between £160,000 and £165,000, rising to over £210,000 with pension contributions.
At least 23 off-payroll workers earn £245 or more per day — likely £500 to £800 per day for senior interims. None is named in any public document.
What it was supposed to do
The Welsh Government created DHCW in April 2021 with an explicit mandate: transform healthcare through digital technology. Its predecessor, NWIS, had been found by the Senedd's Public Accounts Committee in 2018 to have "archaic and fragile IT systems," a culture that was "the antithesis of open," and suffered one data centre outage every nine days. DHCW was meant to be the fresh start.
The Welsh Government backed this fresh start with significant investment, including a £50 million commitment announced in 2019 and successive capital injections for specific programmes.
What actually happened
Four years later, the Welsh Government placed DHCW under Level 3 — the highest tier of intervention — for "serious concerns about the ability to deliver major programmes." Not one programme. Not two. Nine. Every major project DHCW is responsible for is under scrutiny, simultaneously, under the same leadership.
In July 2025, the Royal College of Physicians and RCGP Cymru Wales warned that digital failures were causing patients to "regularly experience delays that lead to worsening health." DHCW itself acknowledged that the current digital environment "ultimately increases the risk of harm to patients."
Thomas admitted in January 2025 that NHS Wales systems were not ready for another pandemic. At a public accountability meeting in January 2026, she admitted she could not demonstrate what return the public had received on its investment: "We don't have an ROI on all of our investments."
As of February 2026, DHCW remains at Level 3. The Cabinet Secretary's follow-up letter confirmed that "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."
Why you should care
DHCW is invisible to most people in Wales — until it fails. But its failures are not abstract. They mean:
- Longer waits — when digital systems don't work, clinicians spend more time on paperwork and less time on patients.
- Lost information — when records don't transfer between systems, patients have to repeat their history, tests are duplicated, and critical information falls through the cracks.
- Delayed treatment — when referral systems run on unsupported technology, referrals take longer and some don't arrive at all.
- Risk of harm — when patient identity systems fail, patients receive the wrong communications, miss screening invitations, and in the worst cases, receive the wrong treatment.
- Wasted money — every pound spent on programmes that fail to deliver is a pound that could have funded nurses, doctors, equipment, or medicines.
The people of Wales fund DHCW through their taxes. They are entitled to know what is being done with their money, by whom, and with what results. That is why this campaign exists.