Clinical Messaging: Paperless Communications the NHS Needs

Powerful Patients, Paperless Systems, a report sponsored by Jeremy Hunt, was released this week. The report calls for a ‘fully digitised NHS’ and the introduction of a new digital messaging system across the national health service – but would these proposed recommendations improve patient care? And, perhaps more importantly for a cash-strapped service, are they affordable?

The Centre for Policy Studies, chaired by Conservative MP Alan Mak, published this report which proposes ambitious reforms to the NHS. Among other recommendations, it is suggested that technical innovations in messaging and broader healthcare informatics could not only transform care delivery and remove the need for legacy systems, but even lead to significant financial savings that can be reinvested in frontline services.

This report is particularly timely, given recent reports on the growing reliance on consumer messaging (IM) apps. As clinical use of apps such as WhatsApp and Facebook Messenger grows, it is crucial to respond accordingly. A total of 43% of all NHS staff report using consumer IM apps to collaborate with colleagues or patients, clearly demonstrating the demand for the new communication channels. However, there are other considerations that should be taken into account before any sweeping changes are made.

New Targets, New Challenges


This report suggests three key targets the Department of Health and Social Care (DHSC) should aim for, all of which are targeted for completion by 2028.

  1. Ensure that 100% of interactions within the NHS are digitally driven
  2. Build an ecosystem of apps and innovations to improve patient care and control
  3. Invest in R&D and staff technology training with cost savings unlocked by innovation


Whilst these targets represents a shift in thinking regarding app development and patient-orientated innovation, the idea of a ‘digitally driven NHS’ is an evolution of objectives from predecessors and echoes the calls from NHS Digital for a paperless NHS by 2020. In turn, this is a viewpoint that finds its roots in the Five Year Forward View.

The endorsement of developing an app ecosystem and new innovations however is a shift in thinking that should not be overlooked. It is clear that the foundations for this idea are already becoming a reality.

The NHS Digital App Library (currently in Beta) could represent a natural testbed for developing this app ecosystem in a controlled, centralised way. Innovative messaging tools appear to be the immediate priority, due to that fact that the absence of a secure, reliable communication channel is driving NHS staff to use unregulated consumer alternatives. This is also indicative of a failure in existing pager infrastructure as well as a lack of innovation to meet changing demands.

A Tight Focus on IT Development

Overall, 10 recommendations are suggested in this report that aim to guide NHS services toward meeting the key objectives. Several of these critical success factors are directly tied to application development and messaging. In fact, the first four seem designed to help maintain focus on this area:

  1. All NHS patient records to be fully digitised
  2. New digital messaging system for all NHS doctors and nurses
  3. Build a NHS app to provide patients with instant access to medical data & health services
  4. An NHS Kitemark for approved apps


In our own independent research into the topic, we found that 25% of NHS staff reported issues in reaching colleagues over Trust approved communication channels in the past 12 months, amongst a breadth of other concerns. It is therefore unsurprising to see focused priorities on messaging and digitisation.

Clinicians need access to secure, reliable communication channels that are responsive during emergency, high-pressure situations. Considering the present reliance on consumer IM technology and cumbersome paper-based processes, this is simply not the case. Further, NHS leaders are becoming increasingly vocal about inaccuracies in patient records, as an increasing number of treatment decisions are made outside of Trust communication channels with no auditable record of conversations retained.

This is a clear demonstration of frontline clinical demand outpacing innovation, purchasing and deployment.

Because of this, the NHS now faces a situation where an unidentified amount of patient data is stored in Facebook data centres around the globe, unknown to the patient or clinical team around them. And as the recent Cambridge Analytica scandal has shown, it would be ill-advised to assume that this information is completely secure from outside access or interrogation.

Impact on Patients


Because of these data security risks, it is clear that patients will be positively impacted by the implementation of these targets and recommendations.

Past failures have led to an healthy dose of scepticism among the public too. For example, the care.data initiative was designed to create an anonymised national database of patients’ medical records to further research and development. Care.data was supposed to give the public anytime access to their care history and allow researchers to interrogate data freely. Instead the launch was riddled with delays and problems which ultimately failed to win the public’s trust and lost the battle for doctor’s support. These issues eventually led to the project’s termination.

In Powerful Patients, Paperless Systems there are calls for the introduction of similar, regionalised data hubs to help achieve similar goals. Alan Mak argues that ‘researchers with access to anonymised NHS patient data can explore in unprecedented detail whether certain people are more vulnerable to conditions’. The potential impact of these insights cannot be understated. Given the impact that big data has had on multiple global industries there is no reason why a similar shift in available information and data analysis cannot revolutionise care delivery and help save lives.

Of course, there will always be those who argue against the sharing of their medical data, often for understandable reasons. Many patients would prefer to remain confidential rather than sharing sensitive data relating to their care, conditions and treatment. As such, every patient should have the ability to opt-out of including their data in these proposed regional data hubs. Lessons on how to do this can be effectively can be learnt from the organ donor registry approach in Wales, which has proved extremely popular.

In this system, populations are automatically enrolled onto the organ donor register by default, and only removed at an individuals request. This has been well received by the public and NHS staff alike, with support increasing across the region by up to 20% since its launch. A significant 85% of healthcare professionals now support the policy. With the launch of the national data opt-out programme from NHS Digital we can see the foundations of how this approach can be facilitated if regionalised data hubs are realised.

This opt-out approach to data inclusion will allow those who wish to withdraw their data the ability to do so, whilst ensuring maximum participation. This will give researchers the best possible chance to improve patient outcomes across the country, whilst inspiring innovation and combatting the fear of past failures.

The Cost Conundrum


In order to fully digitise patient records and deploy a national messaging system for healthcare staff, there will be course be a capital cost. To recoup these expenses it is vital that the NHS sees new efficiencies emerge along with a tangible return on their investment. The ability to automate processes is one of the three key objectives proposed in this report and presents a real opportunity where savings can be made.

Currently, clinicians are faced with several cumbersome processes throughout a patients’ care delivery. For instance, when arranging referrals and follow up appointments it is not unusual to involve several internal stakeholders during the process. By automating the referral process and providing better digital resources to care delivery teams, clinicians can independently manage their workload and quickly arrange follow up appointments with patients in their care. As displayed below there is huge potential to simplify this process.

In 2018, up to £200 million will be spent on printing outpatient appointment letters alone. If this could be reduced by even 20%, it is easy to see how the NHS will reap the financial rewards of smaller operating overheads.

There could even be potential to extend communications to outside of the NHS. Direct messaging between carer and patient could transform outpatient services, community care and social care, as well as enabling instant communications. This could lead to a reduction in missed appointments, simple adjustments to care schedules and reactive treatment delivery for those who need it if their condition deteriorates. Combined, all of these benefits will lead to a significantly streamlined, efficient and cost-effective service.

The Impact of Powerful Patients, Paperless Systems


The Powerful Patients, Paperless Systems report is a welcome endorsement of the potential advances new clinical technologies can bring to the NHS. To realise the ambitious nature of this report, bold actions must be taken to adopt, implement and achieve its objectives.

The delivery of patient care must remain central in every consideration. All NHS teams and the suppliers working in partnership with them have a duty to continually deliver the best possible patient service, and the innovative changes proposed throughout this paper will allow new digital messaging and patient record solutions to flourish and better support frontline carers.

Whilst careful considerations must be made on how patient data is securely stored and managed on any new NHS messaging technology, the current problem of consumer IM technology infiltrating care practices cannot be ignored or understated. Any staff regularly using applications such as WhatsApp are actively putting patient data at risk and breaching patient confidentiality at scale.

Patient care and data security will undoubtedly improve as a result of implementing a centralised messaging platform which is controlled, managed and audited in-house. Comparatively, the NHS currently finds itself in a situation where staff are relying on an ageing suite of pager technology combined with uncontrolled third-party systems that are utilised without knowledge or approval on a daily basis.

Regardless of the capital cost associated with establishing a new communication network, the cost of doing nothing is unacceptable.

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