England’s NHS is still relying heavily on paper records in a sign that the health service’s long-promised digital transformation remains incomplete, according to a new BMJ report published on 5 August 2026. The findings highlight a striking gap between policy ambition and day-to-day practice across hospitals, where many trusts are still not operating fully electronic clinical records.
A digital gap that refuses to close
The BMJ said only about a fifth of hospital trusts in England, 39 of 184, reported using fully electronic clinical record keeping. That leaves the large majority still dependent on paper-based systems, despite years of pressure to modernise and move away from manual record keeping.
The report frames the issue as more than an administrative inconvenience. It points to the continuing burden on staff working across mixed systems, where digital and paper processes often have to coexist. The result is a health service that is still not fully aligned with the goals set out during the first digitisation push more than two decades ago.
Why the issue matters for patients and staff
Paper records can slow information sharing, complicate coordination and make it harder for clinicians to access a full picture of a patient’s history at the point of care. In a system already under pressure, that can add friction to already busy services and leave staff handling extra work that modern electronic systems are designed to reduce.
The BMJ’s reporting also suggests the problem is not confined to isolated trusts but reflects a broader structural slowdown in how digital tools have been rolled out across the NHS. That matters for patients because fragmented record keeping can undermine continuity of care, especially when people move between services or require urgent treatment.
What the latest BMJ reporting shows
The report appears alongside other recent BMJ health coverage that continues to focus on NHS operations, patient safety and clinical service pressures. Among the most recent headlines were items on GP referrals, emergency department delays and NHS training concerns, underscoring how digital reform remains tied to wider questions about capacity and care delivery. The BMJ news section has continued to track these developments closely.
For now, the latest figures suggest that the NHS still has a long way to go before paper records are consigned to the past. The persistence of manual systems may be familiar, but it is increasingly out of step with the demands placed on modern healthcare, where timely information and reliable data flows are central to safe and efficient treatment.
As health leaders continue to push for modernisation, the latest BMJ findings serve as a reminder that digital reform in the NHS is not just about technology procurement. It is about implementation, workflow change and the ability of frontline services to adopt systems that genuinely replace paper rather than sit beside it. BMJ medical news has reported that this remains one of the system’s most persistent challenges.
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