The must-read stories and debate in health policy and leadership.

Plug and play

Despite being faced with an ever-shifting target for a “paperless” or “fully digital” NHS, a significant cohort of trusts have made little or no progress in improving their IT.

In September 2016, the Wachter review found at least half of all hospital trusts were not ready to even try going fully digital, so antiquated (or absent) were their IT systems.

More than two years later, the evidence suggests that, while some digital-savvy trusts have improved further, the long tail of digital laggards has budged very little.

Now, HSJ has revealed NHS England is considering a national electronic patient record to help these trusts catch up.

Deputy chief executive Matthew Swindells said the idea was to provide a no-frills electronic record on the cloud, which trusts could “plug” into, uploading patient data to share with other providers involved in their care. This could “jump start” digitisation for the trusts that are furthest behind, he said.

Such a national solution would be ambitious. Not even under the National Programme for IT was a universal offer of this type attempted (probably because it was not yet technically feasible).

However, such a service would also not be a huge stretch beyond what is already offered by the market. Running electronic patient records on the public cloud is the direction of travel for most of the NHS’ major suppliers, with some already making the shift (see Emis’ plans here).

Mr Swindells said NHS England would have a clearer idea of what a nationally available EPR might look like, or whether it is worth pursuing at all, over the next 12 months.

But what is clear is that further measures will be needed if the long tail of digitally lagging trusts have any hope of catching up.

Tight timeline

Eleven radiology networks are to be set up by NHS England to standardise the quality of care and simplify its national contractual arrangements.

Trusts have been allocated to one of eleven networks. By next month, they must decide between them which of the trusts in their regional patch should hold the overall contract with NHS England.

But concerns have been raised that the timeline to agree this is incredibly tight – in part because the new service specification’s release was delayed – and it is not clear what happens if the trusts cannot agree who should lead them.

For example, in some areas, large and influential trusts are competing for the role of lead provider – University College London Hospitals Foundation Trust, Royal Free London and Barts Health Trust are all included in a single radiotherapy network.

The Royal College of Radiologists told HSJ it was worried the reorganisation will be “impossible” without funding to help set up the networks and buy in the IT infrastructure needed to make the regional partnerships work.

Historically, NHS England specialised commissioning teams have struggled to push change onto acute trusts. It’s likely they’ll meet resistance this time too, especially as the new service specification says that some trusts will have to give up some specialist radiology services to maintain good staffing levels and improve quality across each patch.

Given the complexities and concerns raised around the new networks, it wouldn’t be surprising if they aren’t up and running this April as intended.