Industry Voice: ‘Making IT work’ report by Health IT UK: Ten years on and the outlook is better than we might have expected

Former NHS CIO reflects on the past ten years and the positive progress that the NHS has made since the publication of ‘The Wachter Report’ – the National Advisory Group’s independent report on UK health IT in 2016.

Despite the closure of NHS England, a global pandemic, a changing political landscape, continued austerity and underfunding, and even Brexit, the NHS has made some progress on many of the recommendations made in the report—no mean feat, all things considered.

Where digital transformation began

This September marked the ten-year anniversary of the publication of the independent report, Making IT work: harnessing the power of health information technology to improve care in England.

The report on health information technology in England was written by the National Advisory Group, led by Dr Robert Wachter at the request of then Secretary of State for Health Jeremy Hunt. The group was formed to advise the Department of Health and NHS England on its efforts to digitise the secondary care system. Dr Robert Wachter, a hospital physician from California, shot to fame a few years earlier when he published his book ‘The Digital Doctor’. His book examined the mistakes made during the US healthcare system’s digitisation journey and how they contributed to a loss of support among the clinical community. Hunt read the book and invited Dr Wachter to assess the situation in England.

The report stated at the outset: “In order for the National Health Service (NHS) to continue to provide a high level of healthcare at an affordable cost, it simply must modernise and transform. This transformation will involve enormous changes in culture, structure, governance, workforce, and training.” It claimed: “None of the changes are likely to be as sweeping, as important, or as challenging as creating a fully digitised NHS.” Those statements remain as pertinent in 2026 as they were ten years prior.

The report distilled its recommendations for achieving these changes into two categories: ten overall findings and principles, followed by ten implementation recommendations.

It’s not just about the money

Reviewing the report now reveals considerable insight and clarity in its proposals. Whilst funding has always been a critical issue, principle 3 states that the return on investment from digitisation is not purely financial. It says that short-term ROI is more likely to come in the form of improvements in safety and quality than financial gains; cost savings, it claimed, could take ten years or more to realise.

In an organisation as complex as the NHS, the ‘productivity paradox’ applies. A change that appears simple can have a ripple effect, meaning implementation often encounters resistance and practical challenges. A process of ‘adaptive change’ is therefore necessary, allowing people to adapt and adjust the way they work to maximise the value of digital tools. This is rarely a one-step process and can take years to perfect and embed. The productivity paradox of implementing new technology is that its benefits may be clear, but they can take a long time to realise.

Cultural change is central to adoption

This adaptive change, referred to in principle 9, has involved both the digital leaders implementing new technology and the clinicians and frontline staff who use it. Successful deployments have typically involved effective clinical engagement led by clinical digital leaders, focused staff engagement, well-designed training, and a clear realisation of the benefits. Digitalisation is complex, which means ensuring buy-in from all stakeholders at the highest levels. Anyone who has implemented an EPR knows that going live is only the start of the journey; the gains come much further down the track.

The clinical workforce goes digital

The area of clinical leadership in the digital space is where I think the NHS has been particularly successful. From the early days of having to rely on clinical IT enthusiasts and evangelists, with mixed success, we now have clear roles that can take digital transformation programmes forward. I have said many times in recent years that the biggest change I have witnessed in my 35-plus-year career is the rise of the clinical voice in the digital space. Wachter’s book and subsequent report were seminal moments in this journey.

Recommendations 3 and 4 in the report focused on the workforce, proposing trained clinician-informaticians at every Trust, with appropriate resources and authority. It suggested strengthening the CCIO workforce and training more health IT professionals in both clinical care and informatics.

Those of us who read The Wachter Report with optimism should have some pride that we have helped this rise of the clinical voice in the digital space. It is now normal for hospital Trusts to have Chief Clinical Information Officer (CCIO) and Chief Nursing Information Officer (CNIO) roles—positions that were rare or nonexistent a decade or so ago. Where these positions did exist, they were often informal, unstructured, underfunded, and underappreciated. These leaders bridge the gap between frontline doctors, nursing, midwifery, allied health professions, and IT departments. They have now become a fundamental part of the digital delivery infrastructure, supported by national CCIO and CNIO roles that have existed for over a decade.

There is still room for improvement in the training, time, and support needed to deliver at the level required. There is some evidence that these voices have weakened in recent years, which must be addressed. However, it is now the norm for Trusts to have such roles, and clinical informatics is becoming a recognised profession in healthcare. That is a significant achievement and one that has not been replicated in every nation.

Interoperability is the goal

Making interoperability central to the NHS ecosystem was another key principle, supported by recommendations 5 and 6. As the report stated: “To digitise the NHS is to ensure widespread interoperability to exchange digital data – and to enable integrated workflow, service redesign, and clinical decision support.”

The goal was to support seamless care delivery across NHS organisations and ensure that patients can access all parts of their clinical record and, over time, contribute to it. Connected health records could also inform population health management and analytics.

I would argue that much of the progress in this space has happened despite the national agenda and not because of it. That said, there has been success in different regions of the country, driven forcefully by local leaders who understand the complexity of frontline digital architecture and have the formal and informal networks needed to navigate their communities. The numerous successful Shared Care Record programmes across England are a significant achievement, and those involved should be very proud.

As the 10-year plan advances the goal of creating a single patient record that can be accessed by a GP, hospital A&E, or community nurse, national leaders owe a debt of gratitude to the frontline teams whose vision and persistence helped lay the groundwork.

The vendor community has also played an important role. Solutions such as those provided by Imprivata have supported this goal by helping clinicians access patient data quickly across multiple systems. The solutions are designed to streamline workflows and support seamless care, whether a clinician is working in a hospital, theatre, ward, A&E department, or outpatient setting.

Why the benefits of interoperability matter for the patient experience

Principle 7 in the report stated that health IT systems must be designed with input from end users. Poorly designed or implemented systems can create opportunities for errors and result in frustrated healthcare professionals and patients. Surveys by KLAS Research and its Arch Collaborative around the globe, including research across England, reinforce this point.

The successful adoption of Imprivata systems in the UK has been driven by solutions that make everyday tasks faster and easier for clinicians. In 2006, there were just 19,600 Imprivata users in healthcare in the UK and Ireland. Today, there are 1,239,403. The focus has remained on improving productivity and the clinician experience, as well as the patient’s.

A personal review

In my personal review of the report, its principles, and recommendations, I believe there is much to celebrate. The last ten years have seen significant investment, initiatives, and transformational change, resulting in an improved, more efficient NHS, thanks to collective digital programmes and a focus on the key report areas. This progress has been achieved during a time of stretched resources, an unstable political environment, and a global pandemic.

An independent evaluation would, I am sure, result in similar findings and perhaps refine the focus for the next decade. Change is constant, and in a complex organisation like the NHS, successful transformation depends on breaking broad goals into achievable steps that can be implemented and measured. The NHS has achieved a great deal of which it can be proud.