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Cutting reliance on paper will make patients safer, says NHS England

The NHS will urge health  and social care leaders to end the unnecessary reliance on paper in the treatment of patients and make services safer, more effective and efficient.

The NHS will announce new measures to help the patients, the public and clinicians make more use of technology to improve the health of the nation.

Tim Kelsey, NHS England’s National Director for Patients and Information and chair of the National Information Board, will make the announcement later this week when he addresses 5,000 NHS leaders at the NHS Innovation Expo Conference in Manchester.

He says: “Health and social care services in England must end the unnecessary reliance on paper in the treatment of patients.  It’s key to making services safer, more effective and more efficient.

“Every day, care is held up and patients are kept waiting while an army of people transport and store huge quantities of paper round our healthcare system.

“This approach is past its sell by date.  We need to consign to the dustbin of history the industry in referral letters, the outdated use of fax machines and the trolleys groaning with patients’ notes.

“As well as saving precious resources, technology can dramatically reduce errors. Urgent action is a moral imperative where paper is the currency of clinical practice.”

He adds: “The NHS needs to get over the idea that we’ve had too many false starts and we can’t do information technology.  While bringing our own systems into the digital age, we must do more to help the public and clinicians take advantage of the game-changing opportunities on offer to improve outcomes for patients.”

The NHS is encouraging commissioners and providers to adopt modern, digital working practices by putting in place new levers and incentives and introducing new governance measures for assessing how far healthcare services are supported by effective use of technology.

To maximise the NHS’s chances of achieving its ambition to be paper-free at the point of care by 2020, local health and care organisations are required to begin work now.

By April 2016, clinical commissioning groups (CCGs), working with local authority partners and providers of care, must submit delivery plans for how they will eradicate the use of paper in the treatment of patients across all health and care services in their region by 2020.

These plans will focus local NHS leaders on the task of modernising services and allow CCGs to be held to account for meeting agreed milestones.

To provide clarity on what is expected, guidance has been produced which includes a set of key digital standards that healthcare providers must implement.

For example, from October all discharge summaries for acute or day care patients transferring from hospital to the care of their GP must be completed electronically.

Trials have shown that granting GPs instant access to discharge summaries online reduces the risk of error during ‘patient handover’ as doctors can immediately see what medicines their patients are on and what procedures they have had.  This will help to ensure that a patient’s transition out of hospital is as smooth and safe as possible and enable doctors and nurses to care for them more effectively straight away.

Next year this will be broadened out to include discharge to social care.

From 1 November 2015, clinical commissioning groups and providers will be asked to complete a self-assessment to benchmark their digital services.  The results will form a ‘digital maturity index’, giving a picture of how far the NHS has come on its mission to make effective and meaningful use of technology and highlighting areas for improvement.

NHS Improvement will play a key role in supporting providers to make progress.  Going forward, the ‘digital maturity index’ will become part of the CQC inspection regime.

Last Autumn, the NHS set out a bold vision for the future, outlining what change is needed to bring the NHS into the 21st century and support new and improved models for delivering patient care. In November, the National Information Board in health and care published Personalised Health and Care 2020: a Framework for Action which sets out how more effective use of technology and data will enable that vision.

The NHS is committed to making all patient and care records digital by 2020, meaning that whenever and wherever patients access services those caring for them have all of the relevant information available at their finger-tips – from diagnostic tests and clinical notes to case histories and records of personal preferences.

The evidence for this improving patient safety is clear: Electronic prescribing systems, which support clinicians to ensure the right medicine is provided to the right person in the right quantity, halve medication errors, yet only 14% of NHS hospital trusts currently use these systems.

There is also the potential to save the NHS thousands of pounds on the cost of storing and moving paper around the system.  The estimated annual cost of paper storage is between £500,000 and £1million for each Trust – money which could be spent instead on more doctors and nurses.

The NHS has been on a journey to locate useful and safe digital healthcare services and make them available to patients.

97% of GP practices now offer patients the chance to book appointments, order repeat prescriptions and access their records in summary form online. In the first quarter of this year, more than 3.7 million repeat prescriptions were ordered online and over 3 million people have registered for record access.

More than 96% of people registered with a GP now have a summary care record and more than a third of ambulance services share that patient information in real time with A&E departments and out of hours services meaning clinicians can treat patients more safely based on knowledge of their medication history and especially allergies and other likely adverse reactions to drugs.

To drive forward digital working practices in hospitals and GP practices and increase uptake of online services amongst patients, the NHS is moving forward with its bid to investigate the potential of converting the entire NHS estate into a free Wi-Fi zone.

For doctors and nurses, Wi-Fi is a key enabler of online clinical systems including remote monitoring of patients and electronic prescribing through portable devices, which dramatically reduce errors and increase efficiency.

Patients will have the opportunity to use online tools such as apps to self-monitor their health from their hospital bed.  This is an important factor for people with long term conditions – for example, a fifth of patients with diabetes will have experienced a largely avoidable hypoglycaemic episode whilst in hospital.

Patients will also be able to go online while at their GP practice to book appointments and repeat prescriptions, access their medical record, fill in the friends and family of patient satisfaction and, if necessary, make a complaint.  Where free Wi-Fi access has been already installed, patients report feeling more engaged and empowered as a result.

Mr Kelsey says: “Whether it is patient frustration about not being remembered or professional concern about managing care in the face of unknown risks, the effectiveness and safety of NHS services will be strengthened from being delivered paper-free at the point of care.

“Without fully digitised patient data that can be shared across healthcare settings, the NHS cannot modernise in the way that is required.”

The NHS has been on a journey to locate useful and safe digital healthcare services and make them available to patients.

97% of GP practices now offer patients the chance to book appointments, order repeat prescriptions and access their records in summary form online. In the first quarter of this year, more than 3.7 million repeat prescriptions were ordered online and over 3 million people have registered for record access.

More than 96% of people registered with a GP now have a summary care record and more than a third of ambulance services share that patient information in real time with A&E departments and out of hours services meaning clinicians can treat patients more safely based on knowledge of their medication history and especially allergies and other likely adverse reactions to drugs.

This month the NHS will begin piloting a new endorsement model, that will help patients and doctors, nurses and care staff to sift through the 97,000 health apps that are currently available on the EU market and identify the ones that are most effective in managing long term conditions and increasing wellbeing.

The Mental Health Apps Library, which features online tools, resources and apps with a proven track record of effectiveness in improving mental health outcomes, was launched in March and has increased traffic towards digital provider sites meaning that more people are now receiving the benefits of online mental health services.

Building on this success, diabetes has been selected as one of the areas that will go next.  A 2015 review of diabetes self-management found that technological interventions had positive impacts on diabetes outcomes including improvements in haemoglobin A1C levels, diabetes self-management behaviours, and diabetes self-efficacy. Participants reported that they appreciated the education and personalised feedback they received through this type of treatment.

The potential impact for this is huge: 3.3 million people currently have diabetes with another 5 million at risk of developing it by 2020.  NHS England will work with relevant clinical experts and patients to develop our approach.

Apps will be promoted in other areas including obesity prevention, maternity and early years, smoking cessation and COPD.  There will also be apps to allow patients to book appointments, order repeat prescriptions and access their GP records.

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