A fifth of England's NHS trusts are mostly paper-based as they grapple with COVID backlog, warn MPs

Recent report on IT-led change must be acted on by NHS leaders to address pandemic fallout


A group of MPs in the UK Parliament have called on NHS leadership to end an approach to health service IT that allows a fifth of NHS trust to remain largely paper-based.

Reporting on efforts to clear the backlog in care caused by the pandemic, the House of Commons Health and Social Care Committee said NHS England, the organisation that manages the health service on behalf of the government with a budget of around £130bn, needs to produce a "roadmap" for its plans to ensure technology helps improve productivity in an organisation severely short of staff.

The select committee urged NHS England to respond to the Wade-Gery report on putting data, digital and tech at the heart of transforming the NHS with its plans "at the earliest opportunity so that we and others are able to scrutinise it ahead of implementation."

That report, authored by former Tesco boss Laura Wade-Gery, concluded that the "separation of responsibilities for digital strategy and infrastructure results in a lack of clarity on target state data and technology architecture. This separation also creates friction for the sharing of data for administrative and planning purposes."

It led to the demise of two organisations leading on health service IT — NHS Digital and NHSX — both now folded into NHS England and Improvement, in a decision announced by health secretary Sajid Javid late last year.

While the committee welcomed the £2.1bn additional investment in NHS technology and data announced in the autumn spending review, it pointed out that Amanda Pritchard, CEO of NHS England, had admitted "about a fifth of trusts in the NHS are still largely paper based."

"This is not acceptable," the report said.

The pandemic is creating an acute need to improve NHS efficiency. Around 5.8 million patients were waiting to start treatment in September 2021, 300,000 have been waiting more than a year and 12,000 more than two years. In July 2021, Javid said the true figure could be as high as 13 million waiting for care once patients who had not yet come forward sought treatment.

But medical staff were battling against inadequate IT provision when trying to serve patients. In his testimony to the Committee, Dr Andrew Goddard of the Royal College of Physicians said that the pandemic had provided "lots of opportunities to transform", but highlighted that IT architecture, in particular, posed challenges for innovation.

"We want to improve practice, but there is the IT. If I lose my job, it is most likely because I am going to throw my computer out of the window, given the amount of time that doctors, nurses and other healthcare professionals waste waiting for IT to work, or for systems to talk to each other so that I know what is happening in my [emergency department]."

The select committee report said: "There is enormous potential for technology to support a transformation in NHS care that will bring benefits for patients and staff alike. However, this potential will not be realised while many providers still struggle with basic IT infrastructure."

The MPs also called for new levels to encourage the adoption of new computer systems in healthcare. It said the independent watchdog the Care Quality Commission should include an assessment of the integration of information technology between primary care, secondary care, and the social care sector in its assessment of NHS Integrated Care Boards — organisations with responsibility for NHS functions and budgets.

NHS watchers will have seen the beginning of this movie before. Dating back to 2003, the National Programme for IT was prompted by observers bemoaning poor IT adoption in the service. At times estimated to cost £12bn, the programme was stopped early in 2011 and "did not deliver key benefits, despite the Department spending an estimated £9.8bn," the public spending watchdog National Audit Office said.

Subsequent efforts fared little better. In a 2020 report, the NAO warned that a lack of systematic learning from past failures meant there remained "significant risks to successful implementation… in all areas" of the government's Digital Transformation Portfolio, launched in 2014. ®

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