The NHS has spent more than £1 billion on storing medical records in England over the past five years.
Some hospital trusts have so many paper files accumulated over decades that they have to rent space in off-site storage units. Many still have overflowing dusty basement archives, despite the health service’s promise to become “paper-free at the point of care” by 2020.
Analysis of NHS England estates data given to the Times Health Commission shows that hospitals spent more than £234 million on the storage of paper medical records in the year to April 2022. This included about £175 million for on-site storage and more than £59 million for off-site storage.
The total spend on the storage of medical records by hospital trusts since 2017 was £1.19 billion. More than £260 million was paid for off-site storage over this period, including the cost of transporting documents between the storage units and relevant departments.
The cost of remote storage units has increased by almost 20 per cent over the past five years. The NHS is paying for heating, lighting, staff, furniture and stationery, as well as renting space at these facilities.
The analysis by Lord Allan of Hallam, a Liberal Democrat peer and former Meta executive, follows the news that Newcastle Hospitals failed to send out 24,000 letters from senior doctors to patients and their GPs.
This year a patient who had been waiting nine months for a hospital appointment missed her slot because the letter informing her about it did not arrive in time.
Allan said that the storage costs highlighted the need for the health service to modernise its systems. “Electronic medical records, done properly, help everyone in the healthcare system. Clinicians have the data they need for care, managers can plan services more effectively and patients can access their information quickly and securely.
“There are still far too many systems that depend on paper records in the NHS and we all pay the price in terms of hundreds of millions of pounds of handling costs and a less efficient service.”
In 2015 the NHS promised to “end the unnecessary reliance on paper” and “consign to the dustbin of history the industry in referral letters, the outdated use of fax machines and the trolleys groaning with patients’ notes”.
Announcing an ambition to be paper-free by 2020, the health service said that technology was “key to making services safer more effective and more efficient”. However, about 12 per cent of hospitals are still paper-based.
There are some trailblazers that have successfully moved into the 21st century. Milton Keynes University Hospital has transferred all its paper records to a digital system. Patients can book appointments and see test results through an app. Doctors doing their ward rounds dictate notes into their iPhones and the audio is transcribed directly into the patient’s medical record using AI.
The change has liberated hundreds of square feet of space in the basement that was previously taken up by the medical records library. A whole corridor has been converted into a suite of rooms used for staff training and clinical telephone consultations.
Joe Harrison, chief executive of the hospital and NHS England’s digital lead, told the Times Health Commission that every £1 spent on technology had generated between £3.50 and £4 in savings. “When we did the business case in Milton Keynes to move away from paper to sending a text message and emailing patients, we worked on the premise that it was £1 per letter,” he said. Sending a text message or email costs “less than 5p”.
He said there was vast variation across the country, and that some parts of the NHS were still operating with “effectively carrier pigeons and pen and paper”. He added: “Every time you send a letter the organisation also is storing a huge amount of paper. The real estate costs of storing medical records in the health and care system is staggering.”
NHS England is providing £1.9 billion to ensure trusts are providing a core level of services digitally so patients can access them in the way they choose. More than £400 million was allocated to 150 trusts in the last financial year and more than 30 million people have signed up to the NHS app. A spokesman said: “Digital, data and technology underpin so much of our lives; how we socialise, shop and work. But in the NHS, we are yet to harness this enormous potential in the way that other industries have.”
The Times investigates the crisis facing the health and social care system in England. Find out more about The Times Health Commission
