Promises of a paperless NHS may have been a bold move from Jeremy Hunt, but an approach in Surrey could still save hundreds of millions if scaled up across the health service. England-wide adoption needs full backing from the new Conservative government if real money is to be saved and better care delivered, writes Geoff Broome, director at Apira.
A recipe to save hundreds of millions in the NHS that no government can ignore
Pre-election promises made very little reference to continuing Jeremy Hunt’s plans for a paperless NHS, some might say with little surprise. Many doubted the realistic nature of the fully digital ambition from the moment it was first set out at the beginning of 2013.
But before voters reached the ballot box in May this year, a collaboration of trusts in the South of England went through rigorous negotiations that, backed by Department of Health cash, has placed them on track for a paperless system which will save significant sums; millions of pounds every year.
Scaled up to all 156 acute Trusts in England, the same approach could save the NHS £1.5bn over the next 10 years. A paperless NHS might not have featured in the Conservative manifesto, but it was in the Five Year Forward View and this is something the newly elected government cannot afford to miss.
Moving to paperless when others have failed
The idea of an expensive and large transformational project to pursue a fully paperless hospital has been seen as a major challenge by many trusts. Some success was seen with the Royal Free in London, for example, but very few have delivered this at the enterprise-wide scale necessary.
One exception was a collective of three trusts that came together under the Southern Acute Programme, a Health and Social Care Information Centre sponsored initiative that actually provided government money to completely fund supplier costs for the first four years of the delivery programme.
Ashford and St. Peter’s Hospitals NHS Foundation Trust, Frimley Park Hospital NHS Foundation Trust and Heatherwood and Wexham Park NHS Hospital Trust, the latter two of which have since merged to create Frimley Health NHS Foundation Trust, took advantage of the money on offer, each receiving £3.5m from the Department of Health. They came together under the programme to procure their own electronic document management system (EDM), with the aim of becoming paperless.
The result is that the trusts are now on track to achieve net present value savings of nearly £30m over the next 10 years by moving to digital records for their 1.25 million patients and allowing their 10,000 staff mobile access to patient information. Trust-wide deployment is expected in 18 months and near zero paper within four years. These estimates are very conservative and were built using the Department of Health’s own business case models, with full account taken of retained risks for the NHS, trust-side execution costs and the time value of money.
Huge benefits – more than just money, this is about better care
The millions of pounds that will be saved as a result of the paperless shift is just one major benefit. Put bluntly, space is worth a lot of money in the South East of England. That might not sound like a very patient focussed benefit, but by the end of the digitisation, combined with other savings, each trust will be saving £137,000 per month in cash that can be redirected into frontline care.
There are also more obvious benefits for patients. Too often junior doctors and nurses spend hours of their time filing paper and searching for physical documents.
Time to care savings as a result of digitisation and instant access to information, will mean that doctors and nurses can stop doing the admin and start spending more time looking after patients. As far as value is concerned here, the three trusts combined will save nearly £5m per annum when fully realised in time to care benefits for junior doctors and nurses.
Staff will be able to access records on mobile devices, rather than dusty and potentially infected folders. Patient safety will be improved by reduced risk of information being misplaced or misfiled, or lack of timely access to vital information. Records will be shared instantaneously across teams and organisational boundaries, allowing crucial information to follow the patient. By dovetailing this with new mobile technologies, clinical decisions and preparation will be easier and more assured and staff will be less stressed due to easier access. Data will be better harnessed and analysed in a digital form, to improve the planning of services for patients. The patient experience will also improve due to noticeably better co-ordination of care and enhanced decision making. All of this cannot be done on paper.
So, why isn’t the NHS doing this already and what must be done to help it succeed?
Moving to a paperless system is no small task. But though nothing is guaranteed when it comes to healthcare IT, the approach taken by the EDM collaborative has set them up to succeed. There are lessons that must be applied going forward.
The government must take some responsibility and central funding to enable this technology take-up is important to sweeten the deal if cash strapped trusts are to be able to pay for technology and still invest in the internal resource needed to drive through the complex change management required. The problem for trusts is the inevitable J-curve with the initial investment seen as a show-stopper. If the government can help with smoothing the supplier costs in the early years many more will have an appetite for the challenge.
The business case for government cash injection stands up too. In taking forward the EDM collaborative procurement, full business plans were scrutinised by the Department of Health and the Cabinet Office. So the government has already checked the numbers.
Money alone though isn’t enough. Getting contracts in place to actually make sure that suppliers deliver for what they get paid to do is no easy task. But with the right negotiation this is possible and also necessary to ensure taxpayers get value for money. This may sound like an obvious point but high profile failings to deliver were seen on a large scale in the National Programme for IT in the NHS, and it is still not unknown for trusts to pay for software only for it to sit on a server unused. Tight commercial arrangements are needed to make this work so that we only pay suppliers when they deliver the outcomes required. Suppliers must be keyed into trust goals and get paid only when the trust has a working solution tailored to its needs. This isn’t about pinning the supplier to the wall so that they walk away, but the NHS does need well negotiated agreements that hold their commercial partners to account. There needs to be a clear commercial proposition that balances the risk on both sides.
Finally, this must be done at scale. This is about enterprise-wide digitisation. Yes, there need to be early adopters within the trust, but benefits will not be realised at the department level. Trusts must go for scale for the investment proposition to count. It must be done across the whole trust or not at all.
It has been proven that this can work. Success has now been seen within the NHS, where paperless is set to deliver financial and clinical benefits. The future is not in paper records if we want to keep trusts solvent and improve patient safety and care. Now is the time to replicate early success and the government must provide the backing hospitals need. This is a challenge but is achievable, it can enable the NHS to regain lost confidence in its ability to adopt technology to achieve step change efficiencies that can be reinvested in patient care and safety. Ministers must now follow through and help hospitals meet the challenge that Jeremy Hunt first threw down in 2013.
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