In his Budget last week, the Chancellor vowed to transform the NHS digitally. Jeremy Hunt pledged £3.4bn towards boosting the health service’s productivity, particularly through “harnessing new technology” such as artificial intelligence (AI) to reduce admin and speed up diagnoses.
This feels like déjà vu – the government has promised this grand transformation before, yet the NHS remains woefully behind on its digital proficiency. Ten years ago, when Hunt was health secretary, he promised to make the NHS paperless by 2018. This target was missed, and Sajid Javid, in his tenure as health secretary, then set a new target of 2025. In July 2023 this was declared unachievable by the government’s Infrastructure and Projects Authority.
Today in 2024, nearly three quarters (71 per cent) of NHS trusts still use paper records to some degree, with patient notes and drug charts being particularly analogue. Four per cent of trusts are completely paper-based, meaning they have no electronic patient-record system.
Technology that is deemed extinct to the rest of society still seems to be embedded into the NHS. If you thought pagers (for those under 30, an ancient form of texting through a little “bleeping” device) had been left in the 1990s, you’d be wrong. There is only one company in the world that still makes pagers, and alarmingly, the NHS is keeping it in business: 10 per cent of its global supply is used by the NHS. Despite (yet another) former health secretary, Matt Hancock, promising that this legacy tech would be phased out by 2021, four in five NHS hospital trusts still use them, costing roughly £32m a year. Fax machines (a prelude to email, if you like) were meant to be phased out by 2020, but many hospitals are still using these relics too.
Doctors and nurses have told me of the infuriating technological hurdles they face, and how these woefully inadequate systems hinder them from being able to do their jobs properly. This includes being unable to log on to a staff computer for 40 minutes; struggling to share patient notes between teams; squinting to read other doctors’ scrawls on blood sample labels because their department doesn’t have a working printer; and sifting through chaotic, bedraggled stacks of patient notes with no semblance of order or organisation.
Of course, this doesn’t just affect staff. As patients, many of us have experienced first-hand the disjointedness of the system: of hospital letters arriving at our door weeks after our appointment; of having to repeat our medical history to every healthcare professional we speak to because our records haven’t been passed on; of being told to access services online, only to find the website is broken, and now we’re at the back of the phone queue again.
The problems facing the NHS’s digital infrastructure are so systemic that it’s going to take more than £3.4bn and a superficial adoration for “innovative” technology to fix it. There’s no doubt that new technology, including AI, will eventually be transformative in the shift from a reactive to a preventative health service. The potential for AI to aid doctors’ decision making in medical imaging, such as X-rays and MRI scans for cancer screening, could significantly speed up detection and diagnosis of disease, saving thousands of lives. Equally, its ability to reduce administrative hurdles for healthcare staff (such as analysing bed capacity in hospitals), assist surgeons via robotics, or help scientists develop new drugs and medicines should not be underestimated.
But we need to go back several steps. Both the Conservatives and Labour have spoken about the need to transform the NHS from a “sickness” service to a health service. But how can doctors prevent people getting ill when they don’t have the necessary information at their disposal? Until the NHS has a foolproof, centralised data resource for patient records, taking a more holistic view of an individual’s health will be impossible.
After years of neglecting capital funding, it’s right that the government should start investing in the NHS’s failing infrastructure. It’s a substantial block to improving productivity, and therefore patient care. The Chancellor has said that the government’s £3.4bn investment will make up for 13 million hours lost by doctors due to outdated IT, and deliver test results faster for 130,000 patients a year thanks to AI-powered MRI and CT scans. While the Health Secretary, Victoria Atkins, has promised to focus on digitising patient records and updating IT systems as part of this plan, we’ve heard this many times before with little delivery – and such an extensive task is going to take more than a few billion.
Indeed, a previous aborted attempt to create a patient record system cost the taxpayer nearly £10bn. To avoid another colossal failure, it’s crucial that the government plan effectively. Politicians need to resist the temptation of shiny, untried new technology and properly commit to the boring stuff: up-to-date computer software, an NHS app that actually works, and digitising every patient record into one centralised system. While it’s not perfect, the creation of www.gov.uk in 2012 shows that it can be done: it replaced nearly 2,000 government websites, saving taxpayers billions while significantly streamlining access to public services. If the government really wants to change the way the NHS operates, it should start with the basics.
