Senior managers’ lack of knowledge about the clinical and cost benefits of improved IT systems is hindering progress towards the health secretary’s ambition for a paperless NHS, an exclusive HSJ survey suggests.

Ninety one per cent of respondents to HSJ’s inaugural annual technology survey say the NHS leadership community’s lack of IT knowledge could thwart Jeremy Hunt’s 2018 target date for the goal to be achieved. Only 29 per cent of those surveyed think the target is realistic.

A lack of joined up working between different parts of the health and social care system is cited as the biggest single reason the sector could fail to achieve the health secretary’s ambition - but the message about gaps in knowledge is unequivocal.

The feedback from the 419 health and health IT professionals who participated paints a picture of a sector that appreciates the need for improved IT systems - 88 per cent say the paperless target is a “great ambition” − but is stymied by a lack of leadership and skills.

The data was gathered last month from respondents from across the sector, with 28 per cent describing themselves as senior managers, 16 per cent as clinicians, and 7 per cent as board members, with the others coming from private sector, medical and clinical roles.

Seventy-four per cent of respondents say trusts do not have the required market insight or skills to buy the right IT systems, with concerns about procurement skills, the capacity of IT departments and funding being predominently cited.  

One senior IT expert told HSJ it was unsurprising that most respondents felt the 2018 target was threatened by cultural issues but he was surprised by the strength of sentiment shown.

He added that the service was in desperate need of leaders with “clinical understanding, informatics expertise and a profound understanding of NHS leadership” but that he knew of no such person in post at high levels in any NHS organisation.

Given these findings, it was perhaps predictable that NHS England was last month able to allocate only £114m of the Safer Hospitals, Safer Wards technology fund, which has a potential value of £260m.

This is in contrast with other additional funding recently made available to trusts, such as the winter pressure fund for emergency departments, which was allocated in two tranches and taken up in its entirety.

There are logistical reasons why allocating the technology fund has proved more challenging. Capital projects always take longer to get off the ground than revenue expenditure and the technology fund was allocated on a tight deadline.  

£91m worth of projects were returned to bidders who were told to improve value for money and resubmit their bids.

However, there will be another opportunity to gain funding for those trusts which missed out or did not apply, which was largely handed out to projects looking to join up records across different organisations, transfer data from paper to electronic systems or e-prescribing.

The unallocated £55m from the initial fund has been rolled into a second tranche of technology funding, which was initially announced in September and expected to total £240m.  

The failings of the £11bn National Programme for IT illustrate that simply throwing money at the sector’s technology deficit will not solve anything - a message understood by NHS England.

Mike Evans on the NHS’s digital challenge

Among the most telling findings from the first HSJ technology survey is the revelation that 59 per cent of respondents believe Jeremy Hunt’s 2018 target for a paperless NHS is great but unrealistic to achieve.

As well as cultural problems among staff, the three top barriers hindering the achievement of a digital NHS highlighted in the survey are the lack of joined up working between primary, secondary and community care, lack of funding and lack of compatibility and integration between different IT systems

When it comes to implementing large scale IT projects, the main questions each trust should ask itself before making a decision are:

First, do we have the right infrastructure in place that is stable, reliable and quick to allow clinicians and senior trust managers at board level to securely access information?Ssecond, do we have the funding?

Third, what do we want to achieve in return?

It is also important to understand what benefits to efficiency and clinical outcomes an improved IT system can deliver. A staggering 74 per cent of respondents don’t think the NHS leadership community has enough knowledge to make this judgement.

To get the trusts through the paper/electronic transition time, strong leadership is required. This must understand the gap between clinical, technical and commercial complexity involved in driving towards integrated digital care.

We all agree information is a critical asset in healthcare. The way we capture and use information is crucial, not only in GP practices and hospital wards but also in NHS administration. With 82 per cent of respondents supporting paperless meetings as an important part of progressing towards a paperless NHS, surely boards should champion the paperless initiative. If digital change comes from the top and gradually moves towards the other areas, there are more chances to succeed.

Mike Evans is chief executive of BoardPad, a meeting and document collaboration solution from ICSA Boardroom Apps used by more than 40 English NHS organisations

An NHS England spokeswoman told HSJ the organisation accepted that there was “an overall challenge for boards and senior clinicians to understand the level of technical, commercial and programme complexity involved in achieving integrated digital care”. She added: “We are working to address these issues through a package of support for NHS organisations.”

Sponsorship will be offered to 12 senior informatics professionals to join the NHS Leadership Academy’s Nye Bevan executive development programme, the spokeswoman said. “We are on an upward trajectory but realise we have a long way to go,” she added.

There was no definitive message from respondents to the survey about how best to address leaders’ lack of knowledge. Nearly half said mandating extra training for leaders or appointing a chief clinical information officer would be the best action to take.

Only 35 per cent said mandating trusts to put their chief information officer on their board was the right approach.  

Addressing the issue of joining up systems across an fragmented health and social care system is an even greater challenge. Respondents showed enthusiasm for using contractual stipulations to drive interoperability, with 79 per cent saying it should be a contractual obligation to make different systems used by different organisations compatible.

The barriers to a paperless NHS

EXCLUSIVE: Board level culture undermines paperless ambition