NHS doctors warn of safety risks from creaking tech

In the paediatric centre at one of London’s largest hospitals, doctors are confounded each day by a ward computer that is not connected to a printer.

The computer is used for managing the daily list of patients. Doctors can only access and update the list, using one shared account.

So twice a day, two doctors on the ward said one of them has to login to this computer, update the patient list, send the list to themselves via NHS email, and then login to another nearby computer to print it off for the team.

“I am at a top London hospital and yet at times I feel as though we are operating in the stone age,” said one paediatrician on the ward.

Tackling the frustrating delays caused by outdated technology is one of health secretary Wes Streeting and Prime Minister Sir Keir Starmer’s core missions, having vowed to shift the service “from an analogue to a digital NHS”.

The monumental task of moving the world’s largest publicly funded health service into the digital age is not lost on doctors working on the frontline of the NHS.

While many sectors of the economy have been “radically reshaped” by technology in recent years, a landmark report into the state of the health service in England last month concluded that the NHS stood “in the foothills of digital transformation”. 

But doctors and nurses point out that the basic infrastructure needs to be brought up to a minimum standard, given significant regional variations between hospitals, before politicians extol the virtues of cutting-edge tech.

“Some of us just want the printers to work,” noted one NHS hospital doctor.

“The complete flip-a-coin nature of how equipped your hospital is is mind boggling,” they added. “I have worked in hospitals that are at least 12 years behind others.”

A report published in 2022 by the British Medical Association, the UK’s main doctor’s union, estimated that doctors in England lose 13.5mn working hours a year as a consequence of “inadequate IT systems and equipment”.

One reason for the outdated infrastructure is that the country has spent almost £37bn less than its peers — such as Germany, France, Australia — on health assets since the 2010s, according to a government-commissioned study by Lord Ara Darzi last month. 

Meanwhile, research carried out in 2022 by the Health Foundation think-tank found that the UK had spent about 20 per cent less per person on health each year than similar European countries over the past decade.

This has left the health service — the UK’s largest employer — without basic technology in some parts of the system.

Just 20 per cent of NHS organisations, providing health and social care, are “digitally mature”, according to NHS England’s own estimates from 2022.

While 90 per cent of these organisations now have a form of electronic patient record-keeping in place, officials said just 72 per cent of social care providers have digitised their records. 

Yet doctors note that even when digital infrastructure is in place, systems are often siloed, making it difficult to quickly access patient information, or share notes between NHS organisations.

“We are using technology, but it’s not exactly efficient,” said one senior doctor who works in a large hospital. “There’s the risk to patients of us not being able to access information easily,” they added.

“In a clinic, I will have open three EPRs [Electronic Patient Records], at least four web-based apps, and two standalone internal results systems,” they said, by way of an example.

Another noted that some departments use a mixture of EPRs and paper records, which gave rise to “enormous variation in basic infrastructure” within hospitals. It “slows everything down”, they added.  

Streeting has said the government’s 10 year plan for the NHS, which will be published next spring, will include proposals to establish a single patient record that can be shared throughout the system.

In extreme circumstances, clinicians warned of patient safety being put at risk by the variation in IT systems.

Dr Rosie Benneyworth, head of the Health Services Safety Investigations Body, the patient safety watchdog, said she had investigated cases where the “lack of interoperability” between patient record systems and lab result systems has led to blood samples being mislabelled, or patients being misidentified.

“We have seen delayed cancer diagnosis because of systems not speaking to one another,” she said. 

One doctor recalled a situation in which a blood test result had been missed after it had been sent to an outdated system, a mistake that had potentially contributed to the patient’s death.

A second doctor recalled a cancer diagnosis being missed because of a similar IT issue. 

A report published by the Professional Record Standards Body last year noted the “great variation” of systems that can exist even within individual NHS Foundation Trusts.

One trust, it noted, had inpatient, emergency, urgent care and outpatient departments all using separate processes that were not joined up. 

“We have a whole range of paper-based and digital systems, which leads to a huge potential for error,” said Benneyworth. “It can also lead to delays in accessing information at critical points.”

The Department of Health and Social Care said: “Lord Darzi’s report found that infrastructure in the NHS has been neglected.

“Our 10-year health plan will shift the NHS from analogue to digital, equipping the health service with the cutting-edge technology it needs to tackle waiting lists, improve patient experience and speed up diagnosis.”

Professor Harold Thimbleby, a digital health expert from Swansea University, said this represented a huge challenge. “Solving the NHS’s digital problems should be likened to an engineering project on the scale and complexity of reaching the moon.

“You need the rockets, of course, but you also need lots of highly skilled engineers to make them work reliably.”