Features: May 15th, 2015

As the dust settles on the general election and attention begins to turn to how the newly-elected Conservative majority government will implement the policies detailed in its manifesto, Tony Pickering looks at the NHS and the seemingly growing challenges around its paperless mission.

A recent Freedom of Information (FoI) request revealed that with only three years remaining until the deadline for a paperless NHS, two-thirds of medical professionals still rely on pen and paper for recording information. While targets are in place to ensure this is not the case in 2018, there are significant steps the NHS must take in order to achieve this feat – and these should start long before new technology is even talked about.

The NHS faces a number of challenges on its journey towards a digital future. Firstly, the sheer volume of information and physical documentation it maintains on a daily basis requires an audit as to exactly what will be kept and what will be lost during the changeover. However, it’s not as simple as just managing complex documentation. These papers are all stored in different formats – from different sizes and types of forms, to x-rays and even infamous doctors’ handwriting. All of these will require a significant transformation as we move into the digital era.

The key to achieving success with implementing digital solutions to improve overall process is to start with a tiered approach. This should address the most time-intensive and least efficient processes within the system – building a foundation to start from, rather than trying to solve everything in a top-down approach.

The abandoned flagship NHS patient record system – which has so far cost the taxpayer nearly £10bn, with the final bill for what would have been the world’s largest civilian computer system likely to be several hundreds of millions of pounds higher – is a costly example of why top-down IT implementation across the NHS simply doesn’t work.

MPs on the public accounts committee said final costs are expected to increase beyond the existing £9.8bn because new regional IT systems for the NHS, introduced to replace the National Programme for IT, are also being poorly managed and are riven with their own contractual wrangles.

So how can the new government improve process across the NHS?

Consider goals

The NHS must consider its major objectives set by the government – whether its mortality rates, reducing A&E waiting times or cutting down waiting lists – and examine the processes that support those areas and whether any of those could be improved; or disposed of entirely.

Map processes

Before even thinking about the technology that could support these improvements, decision-makers need to take a step back and map out each entire process from start to finish, how it interacts with other processes and finally where improvements can be made. Because of the formation of the NHS, this is often a difficult task, as responsibilities lie in different jurisdictions – both geographically in terms of patients and culturally as trusts often act independently from each other.

Don’t accept the status quo

Across Britain, we’re far too accepting of the ‘because we’ve always done it that way’ model and we’re often reticent to change. Accepting that change often requires an initial investment – and it will take time for the benefits to be felt – is often something we struggle with when trying to secure buy-in from other members of the team. Yet, leaders must be disruptive and question how things are done – and why they’re done in that way – to achieve real change across the board.

However, this goes beyond just processes and behaviours. When seeking to reduce the paper-reliance across NHS, leaders must provide clear and easily comprehendible advice as to what documents must exist going forward, which ones are needlessly duplicated and how these processes can be streamlined. Inefficient document management is a huge time-waster and can be eradicated
with the right support.

Prioritise bottom-up change

By addressing issues from the bottom-up, trusts iron-out complications at their source, honing in on the exact problems and meeting them head on. For example, hand hygiene is widely acknowledged to be the single most important activity for reducing the spread of disease, yet evidence suggests that many health care professionals do not decontaminate their hands as often as they need to or use the correct technique, which means that areas of the hands can be missed. By taking the time to address this specific area, mortality rates can be significantly reduced across the board – ensuring hospitals are safer and healthier places for patients.

Make use of legacy purchases

Senior team leaders are always keen to talk about the money they’ve spent in the past – even bemoaning the investments they’ve wasted on previous processes – and are often less likely to talk about future spending. Yet, with the right partners, trusts can make the most of their previous investments – leveraging previous purchases and enhancing the technology so it’s more intuitive and easier to use. This can then be championed as cost-saving initiatives in the future.

Simplicity is key

This is the critical point throughout every digital investment – in fact, every investment as a whole. Doctors, nurses, other hospital staff and even patients will use this equipment, so it’s vital that it’s simple and accessible to all.

Digitisation is about replacing those bad processes with new, improved and easy-to-incorporate methods. After all, employees and patients won’t take to new measures if they’re overly complex or long-winded. By helping staff to reduce their time on process-heavy tasks, they can then focus on patient care and support – reducing the gulf between internal operations and advancement.

Measurement matters

It is critical that NHS trusts can tell the story of how the modifications they have made have resulted in positive change for staff and patients alike. After all, making improvements is critical to the welfare of patients and mapping how that has resulted in improved care will promote the trust as a leader within its field.


The NHS must adopt a bottom-up review if it is to improve efficiencies through digitisation. While national flagship programmes are an attractive proposition for any new government wanting to make its mark, leaders must beware of the significant money that has already been wasted on these types of policies in the past.

Each NHS trust is a different entity – with different processes, different targets and at different stages of development in terms of their digital strategy. A one-size-sits-all approach simply won’t result in the positive change this new government is seeking. By facing up to process issues affecting those on the front-line, the NHS can reduce its overall spend and hit more of its targets in the long-term. Addressing micro issues leads to macro change. Perhaps an unfancied policy, but certainly an effective one.

Tony Pickering is Head of Enterprise Solutions Group at Ricoh.