Three months ago, a doctor at my GP surgery referred me for a blood test, but the form is still gathering dust on my bedside table. Since June, my local hospital has not been able to conduct any routine blood tests following a major Russian cyberattack on their pathology service provider Synnovis, bringing many diagnostic services to a standstill.
This huge ransomware attack will have a significant impact on the patient backlog, given seven London hospitals rely on Synnovis. Hospitals have been forced to prioritise urgent blood tests only, and even revert to archaic pen and paper for delivering results to patients. What’s more, confidential patient data was also allegedly published maliciously on the dark web.
A month after this attack, another IT event took down NHS hospitals again – this time, a global Microsoft outage following a faulty cybersecurity update from the third-party provider CrowdStrike, which stopped GP surgeries from being able to access patient records or refer them on to hospitals for tests or appointments.
These kinds of incidents severely disrupt access to essential healthcare. It’s no secret that the NHS’s creaking digital infrastructure is highly susceptible to both planned attacks and major IT malfunctions, causing distress, frustration and poor outcomes for staff and patients. Not all hospitals have comprehensive digital systems in place. According to a survey conducted by the British Medical Journal, roughly three quarters of NHS trusts in England are still reliant on paper patient notes and drug charts, and 4 per cent said they still use paper notes alone.
Many NHS trusts are also still using archaic technology such as pagers and fax machines. Others have out-of-date CT and MRI scanners, meaning cancer patients, and others needing urgent care, don’t have access to the latest diagnostic technology: roughly half of NHS trusts still have an MRI or CT scanner in operation past the recommended lifespan of ten years.
Successive governments vowed to transform the NHS’s achingly out-of-date digital infrastructure with little success, and ambitious targets to make the NHS “paperless” have been missed. A previous abandoned attempt to create a centralised patient record system cost the taxpayer nearly £10bn, and was dubbed the “biggest IT failure ever seen”.
In the last Budget, the previous government promised a huge digital transformation yet again – the former chancellor 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.
While the new government has yet to commit to a figure of this size, Keir Starmer has made his own declarations around digitisation, mostly through a £171m-per-year Fit for the Future fund, which aims to replace outdated CT and MRI scanners, and introduce new scanners with “state-of-the-art” technology such as AI, which can detect diseases like cancer quicker.
Karin Smyth, a minister for health, spoke to Spotlight prior to the general election when she was still part of the shadow cabinet. She said that Labour’s approach to NHS digital transformation will be focused on “what it means for patients, what it means for staff and what it means for the system”. The Fit for the Future fund is “ring-fenced” for increasing access to scanners to improve diagnosis rates and help bring NHS waiting lists down, she said, but “where places are [already] doing that”, then the money will instead be “targeted and focused on other pools of capital to make the system work better”. This could include digitising patient records, for example, or introducing other new equipment into hospitals.
But healthcare professionals worry that focusing on new technology such as AI is the wrong approach, given the litany of issues facing staff when it comes to even simple IT.
“All the hype about innovations like AI tools for detecting lung cancer won’t matter if we don’t get the basics right,” says Dr Katharine Halliday, the president of the Royal College of Radiologists. “A sophisticated AI tool is useless if patients miss appointments because their invitations arrive too late; image analysis AI tools are pointless if computers take 20 minutes to start each morning.”
Indeed, doctors and nurses routinely complain about inadequate technology making their jobs harder rather than easier. A broad variation in digital proficiency across the country means that interoperability – the ability to send information between different NHS trusts, GP surgeries, hospitals or systems – is lacking.
The doctors’ union, the British Medical Association (BMA), estimates that 13.5 million working hours are lost by doctors in England every year due to inadequate IT systems and equipment. Dr Latifa Patel, the union’s representative body chair, agrees that beyond hardware malfunctions such as computers that constantly freeze or run out of battery, a regular source of frustration is “systems that don’t talk to each other”.
“When you email a friend who has a Microsoft email address from your Gmail account, it never occurs to you that they won’t be able to receive your message because you’re using different providers,” she tells Spotlight. “[In the NHS] files are often saved as PDF attachments or even printed out and physically moved from one place to another, slowing everything down and increasing the likelihood of human error. For doctors, it results in added stress, frustration and wasted time that could be spent actually treating patients.”
Speaking anonymously to Spotlight, hospital staff have said how faulty and out-of-date IT is more of a burden than a help, and slows down their day significantly. One A&E doctor tells me that the IT setup has been different in every hospital they have worked in, with some operating on a single staff login system, and others requiring multiple logins for different purposes, such as recording patient notes, ordering prescriptions or referring for scans and tests. In their current hospital, staff time is wasted trying to find a working computer, calling the IT department multiple times a day because the patient database software has crashed, or struggling to generate blood sample labels because of faulty printers.
A London-based doctor working in general internal medicine tells Spotlight that they also struggle with data collection at their hospital due to so much of it being paper-based. Their NHS trust – Barking, Havering and Redbridge University Hospitals – is one of the last in the capital to move away from paper records, and is currently in the process of integrating an electronic patient record (EPR) system. They have to write all notes by hand, before filing them in a folder for each patient. A photo of such a file reveals a behemoth stack of papers, disorganised and chaotic. “On a ward round, I have to lug this huge folder around, whilst writing on pieces of paper, and making sure half the things in there don’t fall out,” they say.
Finding previous important information, such as tests, investigations or medical incidents, is extremely difficult, as you can’t “search” paper records like electronic ones. “It’s impossible to keep track of all this information, because if patients have been there for weeks or months, they accumulate hundreds of pages of notes, which are not easy to look through because of legibility issues amongst other things,” they say.
An enormous amount of time is taken up doing repetitive work, such as handwriting blood-test bottle labels, or filling out forms to request diagnostic scans. “It feels like you’re doing a lot of work, but it shouldn’t be work – it’s created by an inefficient system,” they say. “It’s not ‘doctoring’ or ‘decision-making’.”
A huge postcode lottery exists in terms of digitised patient records, with some NHS trusts miles ahead of others. As part of the £3.4bn allocated by the previous government towards NHS digital transformation, £2bn of this was due to be spent on centralising patient records. The new Chancellor, Rachel Reeves, is set to deliver her first Budget on 30 October, and will hopefully provide more details on NHS capital funding, which includes upgrading IT systems.
Smyth highlighted the importance of focusing on “the basics” to start with. “That functionality at the front end is absolutely key for staff,” she said. “[There is] frustration at not being able to have basic kit working. That might be printers, computers operating on out-of-date software, let alone when we get to use equipment to its full use, and use things like AI for diagnosis.”
This also includes ensuring all patients have access to existing tools such as the NHS app, which the new government has promised to “transform”.
The most digitally advanced NHS trusts are known as “global digital exemplars”, and one of these is Oxford University Hospitals. Matt Harris, the interim chief digital and partnerships officer there, tells Spotlight that the health sector is far behind other industries in terms of digital maturity.
“We talk about digitally advanced hospitals – it is, but it’s not digitally advanced,” he says. “There’s a bit of a difference [compared with] what you see outside of the NHS.”
Oxford University Hospitals introduced a comprehensive electronic patient record system more than a decade ago, which joins up all patient correspondence, records and test results into the NHS app, and is the “fundamental building block” for everything else the hospital does digitally, says Harris. This digital transformation has saved the hospital “hundreds of thousands of pounds” a year, and has improved the hospital’s efficiency and sustainability credentials, due to far less paper-printing.
The hospital also uses simple forms of AI to assist doctors – for example, an automated tool is used for hospital bed management, so that doctors and nurses can check for spare beds across different buildings and wards, eradicating the need for phone calls and emails. The hospital is also looking to integrate image recognition technology into specialisms like radiology, which can be used to detect lung nodules that could indicate cancer, for example.
Jane Dacre is a rheumatologist, former president of the Royal College of Physicians, and chair of the previous Health and Social Care Committee’s expert panel on healthcare policy. In 2020, her panel undertook a review, commissioned by the committee, into NHS digital transformation.
Published last year, the panel’s report found digital transformation to be inadequate, and flagged several issues: a lack of interoperability between NHS organisations; geographical disparities, such as access to the NHS app or use of an electronic record system; and a lack of digital literacy and training among patients and staff.
Due to workforce shortages, new equipment is not being used “to its full potential”, Dacre tells Spotlight, as clinical staff struggle to find time to learn how to use it. “It’s easier to buy shiny new kit than it is to train people to use it effectively,” she says. “The resource to buy new kit is different from the resource [needed] to make it work.”
The NHS also loses out to the private sector due to comparatively poor pay. While the new government recently reached an agreement with the BMA over a pay deal for junior doctors after years of strike action, doctors’ wages are not the only stumbling block to recruitment and retention. Hiring specialist digital staff in the NHS is challenging, and leaves it reliant on more expensive third-party suppliers to deliver transformative projects.
And while hospitals that excel in digital transformation might be an example for the latest healthcare innovation, their existence has unfortunately also widened geographic inequalities. The organisations that are best at IT tend to be given more funding than those that need it most, the panel found. Indeed, in 2016, NHS England created a £100m funding pot specifically for the 26 most digitally advanced trusts, so that they could “drive forward better use of technology in health”. A fairer funding approach based on need rather than merit therefore needs to be prioritised.
Given the large discrepancies in digital proficiency between NHS organisations, from hospitals and GP surgeries to acute care, it’s obvious there needs to be a centralised overhaul of patient data. But Harris believes that trying to create a one-size-fits-all approach is unachievable. “I think trying to suggest that we would have one system, one simple patient record, is actually probably a lovely utopian view of what you would want to do,” he says. “But to get GPs to use the same system as acute [care], a community hospital or a mental health hospital – unfortunately, they’re all quite different.”
Instead, he believes there needs to be a “centralised commitment” from third-party tech companies that are procured by the NHS to work together. Due to the competitive nature of procurement, they currently tend to duplicate efforts by doing similar work to one another, which is inefficient for both these companies and the NHS. An example of better interoperability between trusts and providers is OneLondon – an organisation that aims to join up and share healthcare data across the capital.
There is also an argument that the implementation of new technology should be done on a localised level, in consultation with staff and patients. “Making decisions centrally without understanding the actual nuances and the working processes at an acute hospital is dangerous,” says Harris. “Sometimes, [hospitals] buy or create a system then ask for feedback [afterwards], rather than having human-led design early doors.”
Taking a localised approach can help to tailor technology to the needs of specific populations, and ensure physical and digital NHS services within the same region are joined up, said Labour’s Smyth. Doing so can also move more services “out of hospital” and ensure people can receive care at home, she added, for example through “virtual wards”. As a relatively new phenomenon, virtual wards aim to give patients hospital-level care at home, with access to tests, treatments, remote monitoring systems and a clinical team, while freeing up hospital beds. The new government has promised to focus on localising care by moving to a “neighbourhood health service”, where more services are delivered outside of hospitals and by other community practitioners, such as family doctors, district nurses, care workers and mental health specialists.
Alongside installing more robust patient record systems, there is also a need to build trust between the public and NHS staff in digital healthcare services. Major cyberattacks do nothing to reassure individuals that their data is secure and safe. Steve Brine, the former MP and chair of the Health and Social Care Committee, spoke to Spotlight prior to the general election. A concerted effort needs to be made to communicate the “benefits to patients of improved data sharing”, he said, such as for medical research purposes, as well as in promoting the use of existing tools like the NHS app.
The Health Secretary Wes Streeting has made it clear that he believes the private sector has a crucial role to play in delivering essential services to the NHS, and helping to clear the backlog. Labour plans to introduce an “NHS innovation and adoption strategy” in England, which will reform procurement processes, and create better incentives for companies to invest their new products in the NHS.
But for patients to truly benefit, healthcare staff should be more involved in the process, says the BMA’s Patel. There should be more transparency around procurement, and doctors should be empowered to have input into how money for digital transformation is spent. “Ultimately, we are the ones that will use these systems, so we must have confidence not only in performance, but also in safety and security. New tech needs to deliver for patients and for staff, and not just boost profits for commercial companies.”
Industry professionals argue that to avoid wasting public money on fruitless projects, the projected impact of new products and services should be better scrutinised. Companies should have to “test and measure their technologies against reliable data” that shows tangible improvements in patient outcomes and long-term cost savings, says Nick Lansman, CEO at the Health Tech Alliance, a consortium of NHS-procured tech companies.
There is a lot of exciting technology on the horizon for the healthcare sector, from virtual wards and wearable devices that can monitor patients in real time, to the use of robot assistants in surgery and AI in diagnostics. If delivered effectively, they have the capacity to improve patient care, increase staff productivity and working conditions, and save the NHS money. But without robust digital systems in place, their benefits cannot be fully realised.
Only 5 per cent of the Department of Health and Social Care’s budget currently goes towards capital spending, and of this, only around 10 per cent goes towards IT and software. In her pre-Budget statement on 29 July, the Chancellor already made clear the dire state of the country’s public finances, and the need to rethink major infrastructure projects, including the New Hospitals Programme, a Boris Johnson-era plan to build 40 new hospitals. The new government’s first Budget on 30 October will determine what value it will place on NHS digital transformation specifically, and where it will direct its efforts: on the allure of new technology or on the mundane but critical task of upgrading the NHS’s laggard IT infrastructure.
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