Four-fifths of NHS trusts are still using pen and paper for record keeping, according to a new report highlighted by The BMJ, underscoring how far parts of England’s health service remain from fully electronic clinical records more than two decades after ministers first set out digital ambitions.
Paper files remain deeply embedded in NHS workflows
The finding comes amid a wave of fresh reporting on health system pressures, with The BMJ noting that only about a fifth of hospital trusts in England reported using fully electronic clinical record keeping. The issue has become a recurring concern in discussions about patient safety, service coordination and the wider modernisation of the health service.
The scale of paper use matters because clinical records sit at the centre of care delivery. When information is fragmented across paper notes and disconnected systems, staff can face delays in accessing histories, test results and treatment plans, which can complicate decisions in busy services.
Why the digital gap matters for patient care
The persistence of paper records is particularly significant at a time when NHS leaders are trying to reduce bottlenecks, improve continuity and manage growing demand across primary and secondary care. The BMJ’s reporting places the issue within a broader conversation about how the NHS functions day to day, from workflow efficiency to the safe sharing of information between teams.
Digital records are often presented as a foundation for better integration, but the latest figure suggests that implementation remains uneven. The gap between policy ambition and frontline reality is one of the central tensions raised by the story, and it mirrors other recent debates about the pace of change across the NHS.
What the latest reporting says about the scale of the problem
The BMJ’s report states that about a fifth of hospital trusts in England have fully electronic clinical record keeping, leaving the majority still reliant on paper-based processes. That snapshot points to a system where digitisation has progressed, but not yet reached the level many reforms assumed.
The report also frames the issue as part of a longer-term challenge for NHS England, where technology rollouts can be slowed by funding constraints, implementation hurdles and the complexity of changing established clinical routines. For staff working across wards, clinics and administrative teams, those barriers can translate into extra time spent chasing information rather than delivering care.
As the NHS continues to face pressure from demand, workforce strain and service backlogs, the state of clinical record keeping is likely to remain a key indicator of how quickly the health service can modernise. For now, the latest figures suggest that paper is still far from being phased out.
Source reporting from The BMJ can be found here: The BMJ Medical News.
Photo source: AI-generated or edited image
