The ‘paperless plan’ and the NHS’ digital transformation legacy


Written by Rodolphe Malaguti, Product Strategy and Transformation, Conga

It’s been a decade since Jeremy Hunt, as Health Secretary at the time, set an ambitious goal of a ‘paperless NHS’ by 2018. Initial plans included paperless referrals, electronic health and care records to improve day-to-day services and help meet the challenges of an ageing population. It’s been five years since original target was missed. Whilst some progress has been made and now 90 percent of NHS trusts have electronic patient records, the NHS’ overall digital transformation legacy remains somewhat unclear

A recent report by the British Medical Journal (BMJ) found that most NHS trusts are still reliant on paper notes, despite 88 percent of trusts in England being equipped with electronic patient record (EPR) systems. Similarly, analysis by the Times Health Commission revealed that some hospital trusts have so many paper files accumulated over decades that they have to rent space in off-site storage units. In fact, the NHS has spent more than £1 billion on storing medical records in England over the past five years.

Why has the ‘paperless plan’ been delayed?

Firstly, it starts with how leaders approach transformation in the first place. Too often, project leaders focus on the technology, rather than establishing clear objectives and what they are trying to achieve. Without taking a step back and reviewing their current operational model or data cycle, IT teams won’t be able to identify areas of improvement or where technology would be best suited. For example, there could be issues with a certain trust’s data architecture or how data is shared between different practices or EPR systems. Additionally, perhaps manual processes are leading to inaccurate data or bottlenecks across the operational cycle. 

In this case, introducing an entirely new digital system for the NHS – which is made up of hundreds of trusts and practices, all of which have their own methods and ways of working – is not as easy as it first looked. Health and social care providers often manage patients through multiple systems, chasing down paperwork and juggling various systems of record, none of which communicate well with one another. Therefore, IT or project leaders should have spoken to teams and departments prior to implementation to ensure that the new digital tool is delivered effectively and suits each practice’s or department’s needs. There also needs to be a clear communication plan, explaining how this tool or platform will affect staff’s day-to-day workloads and, most importantly, project leaders need to set a strict timeline for when it will be introduced.

Secondly, there’s been a ‘stop-start’ approach to the NHS’s long term digital goals and transformation programme. There have been multiple delays to the paperless project, with a second deadline extended to 2020, followed by 2023. Leaders have underestimated the size and complexity of this kind of digital transformation programme. 

If IT teams continuously stop-start or pause their digital transformation programmes, it often leads to even more inefficiencies or complications. In this case, if technology is implemented at the wrong time – for example, when processes and data are scattered or systems are not fully integrated or communicating effectively – it leads to further operational complexity. Successive project leaders have to back-track, to try to undo – once they have figured out what it is that they need to undo – the previous team’s work. Naturally, there are temporary setbacks or budget constraints, but approaching digital transformation in this way will only make matters worse and complicate existing operational issues. When implementing a new tool or system for a large organisation like the NHS, it needs to be approached in a phased manner. Ideally, introduced across one department at a time, so project leaders can identify any issues and ensure all data is accounted for and shared easily between teams. 

Furthermore, any organisation that relies upon a blend of legacy systems and technologies may encounter many issues. In fact, data is often poorly managed or misplaced throughout its lifecycle. From a compliance point of view, this could present a significant risk to the institution. Ageing legacy systems are far more susceptible to cyberattacks, system errors and crashes. Equally, the lack of updates or patches will mean that current software will likely no longer be kept up to date with the latest legislation or data regulations. Most importantly, it simply will not integrate well with any new software or systems from other trusts. 


Is a paperless future in sight?

Digital transformation offers many advantages, but that does not mean it is easy to define, plan or execute. There is no ‘one size fits all’ solution, especially for healthcare organisations as large as the NHS. When it comes to tackling issues of the paperless plan, it is important for that project leaders take stock of the situation and works towards establishing a more unified system. With NHS waiting lists reaching an all-time high and NHS trusts having a lack of accessibility to electronic patient record (EPR) systems, this is a top priority for all healthcare providers. To improve the operational efficiency across the NHS, IT teams and project leaders need to establish each practice’s or trust’s digital maturity – where it stands with regards to its own digital transformation journey. By doing so, teams will be able to identify key areas of improvement and deliver its long-term digital plan far more effectively; one healthcare unit at a time.

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