• NHS England looking at a nationally available electronic record for digitally immature trusts
  • Deputy CEO says digital focus needs to shift to less advanced trusts
  • NHS will not be fully paperless by 2024, he says

NHS England is considering funding a nationally-available electronic patient record system, to help dozens of trusts still heavily reliant on paper to catch up.

Speaking to HSJ, NHS England deputy chief executive Matthew Swindells said the proposal was for a national cloud-based IT system that trusts could plug into remotely and use as a basic electronic record.

The system would be aimed at trusts that still mostly run on paper or where clinicians work remotely or over many sites, such as ambulance and community providers.

“That is something we will be looking at in the next year or so. Is there a good economic basis to have a system that anybody that has nothing can just plug into? Either as a long-term future if we enhance it or as a step forward before moving into another solution,” he said.

The system would likely be a simplified version of existing electronic patient records used in the NHS or a new system, he said.

Under the NHS long-term plan, the service has committed to getting all trusts to a “core level” of digitisation by 2024.

In the past two years, central digital funding has mostly gone to more digitally advanced trusts, through the global digital exemplar programme, but Mr Swindells said the focus needed to shift to those trusts that needed a “jump start”.

“The plan is very clear that if at the end of the programme, we have two-thirds of the hospitals that are world class and a third of the hospitals that are nowhere, we wouldn’t have succeeded. We have to get everybody to a baseline in all settings.”

He also played down the significance of the 2024 target in the long-term plan and said it did not mean all trusts would be paperless by that date.

Instead, they would be expected to record basic patient information electronically in real time, such as bed occupancy, treatment, diagnosis, medication and test results and be able to share that information easily.

“Some of our organisations are already there, some of them are quite a long way behind.”

It would likely be a decade before all trusts were fully digital and using more advanced technology such as predictive algorithms or RFID tracking of patient movements, he said.

“The ambition of a truly digital health system I see in a 10-year view. The first five years doesn’t get us to all of it but it gets everybody to safer and better compared to where we are at the moment.”

In late 2016, Bob Wachter’s review of NHS IT found that at least half of all hospital trusts had poorly developed IT and suggested 2023 as a target for a fully paperless NHS.

A survey in late 2017, known as the digital maturity assessment, was meant to track the progress of individual trusts towards this goal. NHS England has refused to make those assessments public but documents obtained by HSJ in August suggest progress has been slow for the least advanced trusts.

Currently, about £600m has already been allocated to fund provider digitisation through to 2020-21, money secured originally from Treasury in 2016. Mr Swindells said clarity on whether additional digital funding, particularly capital, would be made available in the next two years would have to await the spending review but played down the likelihood of a boost in the next two years.

He said: “I don’t think the problem is going to be how fast we can get the money. I think the problem is going to be how fast can we redesign the way we deliver services.”

Revealed: New central IT system could 'jump start' backward trusts