Business > Efficiency

'Mind the ambition gap' between NHS trusts

David Bicknell Published 24 January 2014

In this opinion piece, BCS Health's Justin Whatling and Luke Readman warn that in the pursuit of 'paperless' some trusts are naively seeking a minimalist strategy and creating an ambition gap to what is really needed


Almost a year ago, the Government and NHS England set out a radical timetable for a technology revolution in the NHS. They declared that hospitals must have electronic patient records (EPRs) by 2014, as a stepping stone towards a fully paperless NHS by 2018. One year on, the NHS is still absorbing the scale of the challenge. The centre has set clear deadlines, but left it to individual hospital trusts to decide how to meet them. The result is a growing gulf between the technology leaders and those without a credible path to paperless. The risk is a two-tier NHS, with reluctant adopters meeting a minimum standard but failing to unlock the true benefits of digitisation.

The logic of the Government's strategy rests in the legacy of the National Programme for IT. Although it delivered the foundation required for a paperless NHS, it was perceived as overly-prescriptive and inflexible to local needs. In response, the pendulum has swung in the other direction. Trusts are left to define what 'paperless' means, and how they can make it a reality in their hospitals. This has significant implications for how the NHS embraces technology.

Firstly, it risks widening the technology gap between trusts. For instance, Barts Health, the largest NHS Trust in the country, has already committed to the paperless agenda and has two 'paperlite' A&E departments (a trend which is continuing throughout all clinical services) and has pioneered a Health Information Exchange that links hospital and GP data. The trust has announced its preferred supplier of technology services for the period beyond 2015, when the current National Programme contracts expire. In contrast, some trusts are only beginning to consider their approach and haven't started the lengthy process of appointing suppliers. Time is tight and the different level of momentum is beginning to show.

Tight timescales and tight budgets also risk encouraging a lowest common denominator definition of 'paperless'. The least ambitious trusts could simply seek to digitise paper-based processes, using electronic document management and portal tools. Whilst this would eradicate paper, it would merely store data, rather than create structured and coded data to use in the improvement of care. Clinicians would be left without decision support technology that can prompt real-time interventions that save lives. Eradicating paper is an administrative process. Applying it to frontline care is a medical one. It is vital the NHS is ambitious in targeting the latter.

Attempts to address these issues risk highlighting the problem. In May the Health Secretary, Jeremy Hunt, launched the £260 million Safer Hospitals, Safer Wards Technology Fund, designed to stimulate the adoption of technology. This was supported by an additional £250m in September. In theory, this should have helped close the technology gap by persuading the reluctant adopters to invest. In reality, the emphasis on small projects, deliverable on tight timescales gave the market a tactical nudge rather than a strategic shift. For trusts with a clear 2018 plan it was a catalyst to frontload planned activity. The risk is that others used it to accumulate fragmented technology that may reduce paper, but won't deliver the higher-order benefits possible.

The NHS also needs to be ambitious in how it connects siloed data. NHS England and the Health and Social Care Information Centre have also taken the first steps. The project that extracts and links GP data is a welcome step in the right direction, but as the project extends to hospital data it will be limited by the current rate of digitisation and won't be supported by those implementing portals and document management as bridging strategies. Better local plans and central support are required for hospital data to deliver the research dividend possible. The NHS has a unique opportunity to analyse and apply health data from an entire population. But it is crucial that data is structured in a way that supports, rather than restricts, world-leading research.

One year into the paperless challenge, the Government and NHS England are right to be ambitious. Applied correctly, information and data can help deliver better, safer and more affordable care. The leading trusts have grasped this. For them, becoming paperless will be a byproduct of improving care. The challenge is to prevent an 'ambition gap' emerging between trusts, with trusts naively seeking shortcuts to eradicate paper without truly understanding the reasons for doing it. That would mean settling for second best, when the NHS needs to be ambitious about what can be achieved. We have a unique opportunity to transform the NHS for the better. It is crucial we use the next four years to do it.

Justin Whatling, Chair BCS Health, and Luke Readman, Vice Chair Strategy & Policy BCS Health

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