The NHS holds more clinical data than ever, yet patient flow remains a daily struggle. Not because digital transformation has failed – but because we digitised decisions while leaving delivery analogue.
That fragmentation does not just slow care; it costs the NHS hundreds of millions in lost productivity.
For most NHS staff, the slowest part of care is no longer the clinical decision – it is everything that happens afterwards. During my years working in intensive care, diagnostic work, documentation and test ordering were completed digitally and efficiently.
But the actions that followed were often manual or fragmented. Securing a bed, locating a porter, finding equipment or coordinating tasks across teams relied on phone calls, paper lists and legwork.
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We digitised recording, not coordination
This highlights a critical gap. We have digitised the recording of care far more successfully than the coordination of care. Patient flow rarely fails within the electronic patient record itself, but in the gaps between systems where digital infrastructure has yet to reach. These spaces are not empty. They are filled with informal practices, personal knowledge and improvised coordination that have evolved to keep care moving under pressure.
National policy increasingly recognises this reality. The government’s 10-Year Health Plan, NHS England’s operational planning guidance, and recent national investment in NHS technology aim to boost productivity and flow. Yet without digitised workflows across the system, these initiatives risk being undermined by manual processes that continue to consume staff time and create inefficiencies.
The measurable cost of coordination gaps
The cost is measurable in ways every trust leader recognises:
- Discharge delays extending length of stay
- Staff time spent locating rather than coordinating
- Administrative burden that pulls clinical staff away from care.
Across a workforce of 1.5 million, even small improvements in workflow efficiency represent significant capacity gains – the equivalent of thousands of additional staff hours daily.
This matters for patient safety as well as efficiency.
When coordination fails – when the porter does not arrive, when equipment cannot be found, when handovers are delayed – clinical risk increases even when the clinical decision was correct.
Why digitisation efforts often falter
Addressing this requires understanding why digitisation efforts often falter.
Operational work spans multiple teams and depends on real-time capacity, constraints and priorities. Digital tools compete not just with legacy systems, but with muscle memory shaped by thousands of micro-optimisations.
A clinical coordinator once told me:
“I would rather use a familiar tool than a better one I do not yet know.”
The technology works. The implementation approach often does not.
What success looks like: Learning from Glasgow
Where trusts have tackled this directly, a clear pattern emerges.
One illustrative example comes from Queen Elizabeth University Hospital in Glasgow, where operational teams were involved in system design from day one, mapping real workflows before any technology decisions were made. Workarounds became design requirements.
The result: 90 per cent of coordination tasks now completed on time, with sustained improvement in patient flow. The same approach succeeds across all operational workflows.
Trusts applying these principles – frontline involvement, workflow mapping, adoption over sophistication – report:
- Reduced discharge delays
- Improved theatre use
- Shorter handover times
- Administrative burden shifting from staff to systems.
The strategic imperative: Digitise delivery, not just decisions
If the last decade of digital investment focused on information, the next must focus on workflow. Boards and integrated care system leaders should treat operational digitisation with the same strategic intent as clinical systems.
Three questions matter:
- Where does our digital infrastructure actually stop?
- What manual coordination do staff maintain because official systems do not match real workflows?
- Who is mapping operational workflows before the next procurement decision?
We have digitised decisions. To unlock the full value of that achievement – for patients, staff and system performance – we must now digitise delivery.
