the lancet as a gimmick which failed to address the causes of in-hospital infections, by the firms doing the work as an attempt to avoid paying for regular better cleaning, and by nhs managers as ineffective. it also attracted criticism because only a quarter of the £60m funding for the scheme went to hospitals, and because a number of hospitals missed the completion target, and as of june 2008 one in four nhs trusts was not meeting the government's standards on hygiene. prescribing its advice to primary care on prescribing drugs such as proton pump inhibitors has been criticised as wasteful. medical training the dh has attracted criticism for its handling of the outcome of modernising medical careers, in particular in the changes it made to the specialist training of doctors and the medical training application service (mtas). these changes left "29,193 junior doctors from the uk and overseas... chasing 15,600 posts..." and resulted in accusations that the dh had broken the law by refusing to reveal scores to candidates. ultimately there was a judicial review and a boycott of the system by senior doctors across the country. mtas was eventually scrapped and patricia hewitt, the then secretary of state for health, resigned following accusations that she had lied to the house of commons over the system. even after the abolition of mtas, anger among the medical profession continued, with the british medical association commenting of the dh response that "not only is this response too late, it does not go far enough". the official government inquiry into mmc recommended that the responsibility for medical training be removed from the dh. recurrent nhs reorganisation successive dh ministerial teams have been criticised for repeated reorganisations of the nhs in england, where primary care commissioning responsibility, in particular, has been allocated to four different sets of organisations in the last ten years: pcgs, small area primary care trusts (pcts) (e.g. covering a rural local authority district or part of a city), larger-area pcts (e.g. covering a whole county), pct clusters (e.g. quarter of london or south of tyne and wear) and the currently unspecified clinical commissioning groups. the tendency to introduce each reorganisation before its predecessor has had time to settle down and generate improved performance has attracted censure amongst healthcare professions in the uk and beyond, including reference to the ironic concept of 'redisorganization'. andrew lansley's promise before the 2010 general election not to impose top-down reorganisation, followed by the instigation from ministerial level of one of the most fundamental nhs reorganisations yet envisaged, has generated especially widespread opprobrium, although some commentators have also suggested that this is to some extent completing the job started under the blair administration. the nhs as of 1 april 2013 is no longer situated within the dh, as nhs england also went 'live' at the same time. therefore, the dh has a further scrutiny role of nhs services and commissioning. information technology in recent years the department of health and the nhs have come under considerable scrutiny for its use of it. since being elected to power in 1997 the labour government had sought to modernise the nhs through the introduction of it. although the policy is correct in aim, many claim its execution is lacking. in september 2008 a new leadership team was established, cio for health, christine connelly, and director of programme and system delivery martin bellamy. previous cio richard granger was believed to have been the most highly paid civil servant in the uk and was a controversial figure. connelly left the dh for a position in the cabinet office in june 2009 and was replaced by tim donohoe and carol clarke. connelly's role was to "deliver the department's overall information strategy and integrating leadership across the nhs", according to the dh's website. that strategy, known as the national programme for it, is intended to do nothing less than revolutionise nhs information workflow and is costed at about £12.7bn. the success or otherwise of connelly's reign will be based on her promise to end delays of electronic medical records. she has said that if there is not clear progress by november 2009, a new plan could be hatched. on the eve of the departure of fujitsu as an outsourcing partner, connelly said in april 2009 that she would open up sourcing to competition at "acute" sites in the south of england and offer toolkits by march 2010 to allow more local configuration of systems. in january 2009, mps criticised dh for its confidentiality agreement with key supplier csc and in march the department was admonished by the information commissioner for its records management. in may 2011, prime minister david cameron announced that he was considering scrapping the project. in 2022 sajid javid launched the plan for digital health and social care, which includes “regulatory levers” will be used to: “signal that digitisation is a priority, identify the non-negotiable standards of digital capability, explain how we will monitor and support compliance”. integrated care systems will be required to put in place a joined-up health and social care record by march 2025 in which all clinical teams will have access to a complete view of a person’s record that they can contribute to. in 2022 86% of trusts had “some form of electronic patient record” but only 45% of social care providers used a digital social care record, and 23% of care home staff cannot access the internet consistently. the nhs app is to be a “digital front door” for patients, with increasing functionality to be added and remote consultations with gps are to be encouraged. £25 million is to be provided in 2022/23 to support the rapid digitisation of social care, including adopting digital social care records. 2010–11 staffing cuts in response to government spending reduction targets following the 2008-9 international financial crisis and subsequent recession, dh in common with several other government departments resorted to large-scale staffing reductions. in order to minimise redundancy costs, the predominant impact was upon dh staff not employed through a traditional civil service 'headcount' contract, with a resultant emphasised effect upon more recent or innovative work-streams dependent upon seconded or externally hosted staff. this has attracted criticism from several of the professional and patient communities of interest concerned, for instance as regards the impact upon improving access to psychological therapies (iapt) and the withdrawal of the practical assistance available to the nhs and local authorities via the national support teams. devolution most health policy in scotland, wales and northern ireland is devolved to the department's counterparts: the scottish government health and wellbeing directorate the welsh government the department of health, northern ireland executive the comparability factor (the proportion of spending in this area which is devolved) was 99.5% for all three countries for 2021/22. a number of health issues are, however, wholly or partly reserved to westminster: scotland regulation of the health professions xenotransplantation embryology, surrogacy and human genetics human fertilisation medicines, medical supplies and poisons northern ireland xenotransplantation surrogacy human fertilisation and embryology human genetics in northern ireland, abortion law is a criminal justice matter and is devolved. wales regulation of the health professions abortion xenotransplantation embryology, surrogacy and human genetics medicines, medical supplies and poisons