Whether the NHS can be fully paperless by 2018 will depend entirely on the motivation and involvement of all stakeholders, says Bill McCluggage

If there’s one thing we can tell from Jeremy Hunt’s “paperless NHS” speech last month, it’s that the national programme for IT casts a long shadow.

‘It’s much more straightforward to design an electronic records system for a single hospital than for the world’s largest health organisation’

The mention of electronic patient records still provokes a negative reaction among some Whitehall commentators. The previous attempt at digitisation hit a wall of unforeseen costs, but technology has moved on. Meanwhile, the need to streamline health service delivery is growing by the day, and digitised health records have a role to play.

The national programme focused on a centralised repository for every piece of NHS data, which was perhaps overambitious. Rather than a mandated central system for patient records, it’s arguably more effective and manageable to require that stakeholders simply have a system in place. This may be shared or facility specific.

Central government can then produce a set of open standards that allow separate systems, both new and legacy, to work together. It’s much more straightforward to design an electronic records system for a single hospital than to build a system spanning the world’s largest health organisation.

An achievable goal

A necessary first step is to define the objectives behind the paperless NHS project. Is it primarily a savings measure to offset the escalating costs of our healthcare system? Is it a modernisation programme aimed at keeping up with patient expectations in a digital world? Is it intended to drive improved outcomes in specific health areas such as orthopaedics, diabetes, COPD and dementia? 

Understanding the rationale defines who leads these programmes at the local level; whether it’s business leaders, IT professionals or clinicians. With budgets constrained, there is no room for uncertain leadership or speculative spending.

Many NHS organisations are not starting from scratch and have digital systems operating beside, or in addition to, legacy infrastructure. A swift, accurate audit will help assess progress and prioritise investment. Once we know where we are, we’ll be able to work out a timeline to a fully paperless NHS − my feeling is that 2018 could be an achievable goal.

‘Many Whitehall IT projects have been successful, low-cost, useful and delivered effectively and quickly’

There’s plenty of best practice that we can learn from: St Helens and Knowsley Hospitals Trust recently moved to a paperless system as part of a five-year plan to upgrade its IT. On a trust-wide basis, therefore, change can clearly happen rapidly, and the expected savings in time and resources, as well as the clinical benefits in terms of rapid access to patient records, are already being realised.

From an infrastructure perspective, Belfast Health and Social Care Trust has demonstrated what can be done across a wide and complex healthcare area. Nationally, Connecting for Health has been an all-but unqualified success in paperless data management. Abroad some health services are far ahead of the NHS. Catalonia’s, for example, is fully paperless.

Digital success stories

Elsewhere in the UK’s public sector, much is being done to digitise paper-based processes. At Revenue and Customs, the Ministry of Justice, the Depart for Transport and the DVLA, the Ministry of Defence and others, lessons are being learnt and experience gained as we enter the age of “digital by default”.

Many Whitehall IT projects have been successful. These are low-cost, useful and have been delivered effectively and quickly. Even the relatively antiquated direct.gov made short work of dealing with the UK’s rather complex vehicle documenting system.

The work of Mike Bracken, the executive director of digital at the Cabinet Office, and the Government Digital Service in bringing its successor to life is admirable: gov.uk has been a step forward in delivering a more citizen-centred portal.

‘Change on this scale does not happen without all stakeholders buying into its benefits’

Back in the health sector, Tim Kelsey’s work within the relatively new NHS Commissioning Board, and his recent support for the Choose and Book project, is also to be lauded.

‘Spend to save’

So what elements will be needed to achieve a paperless NHS? Collaboration will be vital: a regionally diversified approach with strong local leadership. Central guidance will likely be more effective than central leadership.

Whether the NHS can be fully paperless by 2018 will depend entirely upon the motivation and involvement of the end users of the systems. In one of the world’s largest employers, change on this scale does not happen without all stakeholders buying into its benefits. That means doctors, nurses, patients and management.

We would do well to remember that this is a classic example of “spend to save”. Sufficient resources need to be made available to get the infrastructure and processes up and running.

In 2013, the NHS can ill afford waste, so careful planning will be needed if we are to successfully deliver a fully paperless digital health service in five years’ time.

Bill McCluggage is chief technologist, public sector UK and Ireland at EMC, and was previously deputy government chief information officer at the Cabinet Office.